Long-term echocardiographic changes in left ventricular size and function following surgery for severe mitral regurgitation
Puneet Ghayal, Ali Haider, Wilbert S. Aronow, Ythan Goldberg, Richard Bello, Mario J. Garcia, Daniel M. Spevack
Med Sci Monit 2012; 18(4): CR209-214
Available online: 2012-04-01
Background: Chronic mitral regurgitation (MR) results in a state of chronic left ventricular (LV) volume overload, resulting in compensatory dilatation. Mitral valve (MV) surgery for regurgitation reduces LV preload but increases LV afterload. Few data are available documenting subsequent changes in LV size and function over time following MV surgery for severe regurgitation in unselected populations.
Material/Methods: Pre- and postoperative echocardiograms (n=454) acquired from 108 consecutive patients with chronic MR who underwent MV surgery were analyzed.
Results: LV diastolic diameter was 4 mm smaller on postoperative compared to preoperative exams, whereas LV fractional shortening (FS) was unchanged. Linear regression analysis showed no change in LV diastolic diameter over time postoperatively, whereas LV FS increased over time following surgery. Improvement in LV FS occurred at an average rate of 1.6% per year (95% CI, 0.2–2.9). Subgroups were small, but the same secular trends were generally noted in groups with or without coronary artery bypass graft surgery (CABGS) and in those with or without mitral leaflet disease.
Conclusions: Following MV surgery for MR, LV diastolic diameter reduces by 2 mm at the time of surgery, but then remains stable over time. Improvement in LV function over time postoperatively was only seen in those without concomitant CABGS, possibly related to less baseline myocardial scarring in this group.
Keywords: Mitral Valve Insufficiency - ultrasonography, Mitral Valve - ultrasonography, Linear Models, Heart Ventricles - ultrasonography, Echocardiography, Diastole - physiology, Coronary Artery Bypass, Multivariate Analysis, Organ Size, Time Factors