title: Time-related changes in left ventricular function after double valve replacement for combined aortic and mitral regurgitation in a young rheumatic population. Predictors of postoperative left ventricular performance and role of chordal preservation.
abstract: BACKGROUND
  The long-term effects of double valve replacement on left ventricular function in patients with combined severe rheumatic aortic and mitral regurgitation have not been reported previously. Furthermore, the importance of chordal preservation in this group of patients is unknown.
  
  
  RESULTS
  Serial clinical and echocardiographic evaluations were performed prospectively in 44 patients who underwent double valve replacement for combined aortic and mitral regurgitation. Chordae to the posterior mitral leaflet were preserved in 27 patients. Mean follow-up was 40 +/- 19 months. Left ventricular end-diastolic diameter decreased significantly 3 months after surgery (from 66 +/- 10 to 52 +/- 11 mm; P < .001) without a substantial change in end-systolic diameter, resulting in a significant decline in ejection fraction (from 60 +/- 9% to 48 +/- 15%; P < .001). At 1 year, a significant reduction in end-systolic dimension was observed without a concomitant decline in end-diastolic diameter, thus normalizing the ejection fraction (55 +/- 12%; P = .17 versus baseline). No further changes were seen at latest follow-up. Multivariate regression analysis identified baseline end-systolic diameter and ejection fraction as independent predictors of postoperative systolic performance. Chordal preservation did not emerge as a univariate or multivariate predictor.
  
  
  CONCLUSIONS
  After an initial postoperative decline in ejection fraction, normalization in left ventricular systolic function may be expected 1 year after double valve replacement for combined rheumatic mitral and aortic regurgitation. End-systolic diameter and ejection fraction are the only independent predictors of postoperative left ventricular performance.
authors.affiliation: Department of Cardiology, Baragwanath Hospital, Johannesburg, South Africa. psareli@iafrica.com
authors.forename: D
authors.initials: D
authors.lastname: Skudicky
authors.forename: M R
authors.initials: MR
authors.lastname: Essop
authors.forename: P
authors.initials: P
authors.lastname: Sareli
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011336:Probability; D012216:Rheumatic Diseases; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left