Ventricular Function Before and After Surgery for Isolated and Combined Regurgitation in the Young

Abstract

Chronic mitral and aortic regurgitation (MR and AR) are associated with progressive contractile dysfunction. In the young, the risk of left ventricle (LV) dysfunction after operation for isolated and combined AR and MR is poorly defined. We aimed to compare LV mechanics in children and young adults with isolated and combined AR and MR, and identify risk factors for LV dysfunction after valve surgery. Echocardiograms from children and young adults undergoing surgery for isolated severe AR (group I, n= 14), MR (group II, n= 21), or combined AR and MR (group III, n= 13), before and up to 18 months after surgery were compared with a normal population (n= 89). Normalized measures of LV geometry and mechanics were expressed as z scores. Before surgery all groups had LV dilatation, while groups I and III had afterload elevation and LV dysfunction. After operation LV dysfunction was more common in group III than in groups I and II (11 [84.5%] vs 5 [35.7%] vs 12 [57.1%], p= 0.04). The preoperative end-systolic volume z score predicted LV dysfunction after surgery in group I and II patients (p= 0.047, area under the curve = 0.75) but not in group III, where moderate LV dysfunction was related to the preoperative stress velocity index (-2.6 with vs -1.1 without, p= 0.04). Left ventricular mechanics in combined AR and MR closely resemble those of AR. End-systolic volume predicts postoperative LV dysfunction in patients with isolated valve regurgitation, while those with combined disease were at high risk of postoperative LV dysfunction.