Association between residual mitral regurgitation and left ventricular outflow obstruction after carpentier ring mitral annuloplasty

Abstract

In 1971, Carpentier et al 1 reported the use of a new technique for mitral valve repair using an annuloplasty ring. Although this technique avoids some complications of prosthetic valves, spatial changes in the mitral apparatus after this operation may result in systolic anterior motion of the mitral valve which may cause left ventricular (LV) outflow obstruction similar to that seen in hypertrophic cardiomyopathy. 2,3 In a series of 439 patients, systolic anterior motion was seen in 6.4% of patients after Carpentier ring repair, and LV outflow obstruction was present in 2.3%. 4 Although outflow obstruction may be treated successfully medically, 4 it may also be a cause of immediate (intraoperative) failure of the technique. 5 We have previously reported a relation between mitral regurgitation (MR) and LV outflow obstruction in 2 groups. In those who have undergone aortic valve replacement for aortic stenosis, the relief of outflow obstruction after aortic valve replacement was associated with a significant reduction in the degree of MR. 6 In the second group, those with hypertrophic cardiomyopathy, the degree of MR was directly associated with the severity of outflow obstruction. 7 The current study evaluates the possible mechanisms of LV outflow obstruction after Carpentier ring mitral annuloplasty, and investigates the relation, if any, of MR to the presence of LV outflow obstruction.