Left ventricular torsional dynamics immediately after mitral valve replacement.
BACKGROUND
Cardiac operations and cardiopulmonary bypass are associated with a host of unphysiological consequences that have widespread systemic effects. Since previous investigations in human cardiac transplant recipients had demonstrated that left ventricular (LV) torsional deformation was a sensitive method to detect subclinical LV dysfunction during acute rejection, we studied LV systolic torsion and diastolic recoil preoperatively and postoperatively in a canine model using myocardial marker techniques.


RESULTS
Seven dogs underwent placement of LV subepicardial myocardial markers and creation of mitral regurgitation. Three months later, the animals underwent high-speed, biplane videofluoroscopic analysis for determination of LV systolic function and regional LV systolic torsional deformation and diastolic recoil. The animals then underwent chordal-sparing mitral valve replacement and were restudied 1 to 2 hours postoperatively. One to 2 hours after the cardiac operation, regional maximal systolic torsional deformation decreased significantly in all three LV regions on the lateral LV wall, as well as in the apical and apical-equatorial regions on the anterior wall. During early systole, minimal regional systolic torsion increased significantly in all regions on the lateral wall, as well as in the apical level of the posterior wall. Heterogeneous decreases in torsional deformation were also seen during the early diastolic filling period.


CONCLUSIONS
Regional systolic torsional deformation and diastolic recoil are markedly perturbed early after a cardiac operation and its associated manipulations. Such changes, however, may potentially serve as sensitive tools to assess the impact of different techniques of intraoperative management, including newer methods of myocardial protection.
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305-5247.
A
A
DeAnda
M R
MR
Moon
K L
KL
Yun
G T
GT
Daughters
N B
NB
Ingels
D C
DC
Miller
D000818:Animals; D004285:Dogs; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery; D009200:Myocardial Contraction / Q000502:physiology*; D011184:Postoperative Period; D014102:Torsion Abnormality; D016277:Ventricular Function, Left / Q000502:physiology*