Cardiac dimensions and motion shortly after mitral valve surgery.

Abstract

We studied 71 adult patients echocardiographically both before and 2-16 days (mean 8 days) after mitral valve surgery to systematically evaluate the early postoperative changes in cardiac dimensions and motion. The patients were divided into 4 groups: group I with predominant mitral stenosis (MS) (26 patients), group II with predominant mitral insufficiency (MI) (12 patients), group III with MS + MI (16 patients) and group IV with combined mitral and aortic valvular disease (17 patients). After operation the left atrial dimension at endsystole decreased (mean +/- standard deviation, 56 +/- 12 mm vs 46 +/- 11 mm, p less than 0.001), but did not completely normalize in the majority of patients. The left ventricular dimension at enddiastole decreased in group II from 67 +/- 12 mm to 54 +/- 5 mm (p less than 0.01) and in group IV from 59 +/- 13 mm to 54 +/- 13 mm (p less than 0.01), but increased in group I from 43 +/- 8 mm to 46 +/- 9 mm (p less than 0.05). Mitral EF slope increased from 15 +/- 11 mm/sec to 52 +/- 20 mm/sec (p less than 0.001) after commissurotomy, and decreased from 136 +/- 61 mm/sec to 66 +/- 30 mm/sec (p less than 0.05) after annuloplasty. However, the postoperative means were subnormal in these subgroups. Paradoxical or hypokinetic septal motion occurred in 5/71 (7%) before and 50/71 (70%) after operation. We conclude that: 1) partial normalization of cardiac dimensions and subnormal mitral EF slopes shortly after mitral valve surgery suggest a residual pressure gradient across the mitral valve as well as partial irreversibility of the heart after longstanding mechanical overloading, and 2) postoperative abnormal septal motion, which may be caused by pericardiotomy, can occur after any type of open heart surgery.