Abstract
BackgroundSurgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up.Methods and ResultsTwenty patients selected for the study (12 men and 8 women, mean age 60 ± 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 ± 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed.ConclusionBasal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods.
Highlights
Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease
Prolapse of posterior leaflet associated or not with ruptured chordae was responsible for mitral regurgitation (MR) in all patients
With the technique we describe, mitral annular dynamics have been preserved as demonstrated by the mild, but not significant, increase in diastolic and significant decrease in systolic diameters and by the increase of annular area and annular area index
Summary
Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Over the last 30 years many surgical techniques have been developed to correct mitral regurgitation (MR) in degenerative valve disease, to prevent the occurrence of left ventricular outflow tract obstruction (LVOTO) and to ameliorate the function and durability of the repaired (page number not for citation purposes). Persists over the long-term stability of correction of MR due to extensive myxomatous degeneration of both leaflets [18,19,20,21,22,23,24] and over the hemodynamics of the repaired valve under stress conditions. Dobutamine itself can produce a transient LVOTO, not necessarily related to surgical technique[29]
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