Abstract
ObjectiveTo evaluate the changes of the mitral valve geometrics and the degrees of moderate mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS).MethodsA retrospective analysis study of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiography (TTE) was performed in 49 patients diagnosed with pure AS combined with moderate MR, who underwent AVR from January 2013 to December 2017. TEE was used to evaluate the direct geometric changes of the mechanical effects on mitral annulus after AVR. TTE was used to evaluate the changes of MR after operation. All patients underwent TTE during the midterm follow-up. The mean follow-up time was 40.21 months.ResultsAll of the 49 patients had moderate MR. Anterolateral-posteromedial diameter, anterior-posterior diameter, and mitral annular area were significantly reduced after AVR, while no significant changes were found in the intraoperative left ventricular loading conditions before and after AVR. The degree of mitral valve regurgitation, left ventricular size, left atrial size, left ventricular end-diastolic volume, and left ventricular to aortic pressure gradient were significantly reduced before discharge, and midterm follow-up showed good results.ConclusionThis study supports the belief that aortic outflow tract obstruction and an actual mechanical compression of the anterior mitral annulus after AVR would cause reduction in MR. Ventricular remodeling would also cause reduction in MR with time going on. Patients with AS, especially young patients with moderate MR, were most likely to benefit from AVR in early time.
Highlights
Left ventricular (LV) remodeling and increased afterload caused by aortic outflow tract obstruction might lead to mitral regurgitation (MR)[1]
Our study aimed to examine the direct influence and following changes on mitral valve after aortic valve replacement (AVR) in young patients based on a single-center experience
This study suggested that the reduction in intraventricular pressure after AVR seemed to be the most important mechanism related to decreased MR
Summary
Left ventricular (LV) remodeling and increased afterload caused by aortic outflow tract obstruction might lead to mitral regurgitation (MR)[1]. It is a functional MR, commonly coexisting with aortic stenosis (AS). Additional mitral valve intervention during AVR had been long debated, especially for functional MR[1,2,3,4]. Some studies with small patient cohort and short-term follow-up results had been reported on this topic[3,4], but the results remained controversial. Our study aimed to examine the direct influence and following changes on mitral valve after AVR in young patients based on a single-center experience
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