title: Ventricular performance following valve replacement for chronic mitral regurgitation: importance of chordal preservation.
abstract: OBJECTIVE
  To assess immediate and late changes in left ventricular performance after mitral valve replacement (MVR) for mitral regurgitation with or without preservation of chordae tendineae.
  
  
  METHODS
  a prospective, one year follow-up, study.
  
  
  METHODS
  university cardiosurgical hospital.
  
  
  METHODS
  Fourteen patients with symptomatic chronic mitral regurgitation were divided into Group A (n = 7), which underwent MVR with chordal preservation, and Group B (n = 7) which underwent MVR with chordal transection.
  
  
  METHODS
  Transesophageal echocardiography, obtained simultaneously with radial artery and pulmonary capillary wedge pressures over a range of loading conditions, was used to estimate left ventricular elastance (Eps), calculated as the slope of peak systolic pressure/end-systolic volume relation, and preload recruitable stroke work (PRSW). Measurements were taken intraoperatively before and after cardiopulmonary bypass, 6 hours later and 10 days later. Transthoracic echocardiography follow-up data were obtained after 3 months and one year.
  
  
  RESULTS
  Eps significantly decreased immediately after MVR (p = 0.018), with no difference among 2 groups. Eps gradually increased to preoperative levels 10 days after surgery. PRSW also significantly decreased after MVR (p = 0.01). The decrease was significantly larger in Group B (p = 0.038). During follow-up, Group A showed a significantly better ejection fraction (p = 0.008), and a smaller end-systolic volume index (p = 0.01) and left ventricular mass index (p = 0.04), than Group B.
  
  
  CONCLUSIONS
  These data support the hypothesis that chordal preservation during MVR has beneficial effects on left ventricular performance.
authors.affiliation: Institute of Cardiovascular Diseases, Dedinje, Belgrade, Yugoslavia.
authors.forename: Z
authors.initials: Z
authors.lastname: Popovic
authors.forename: I
authors.initials: I
authors.lastname: Barac
authors.forename: M
authors.initials: M
authors.lastname: Jovic
authors.forename: G
authors.initials: G
authors.lastname: Panic
authors.forename: M
authors.initials: M
authors.lastname: Miric
authors.forename: M
authors.initials: M
authors.lastname: Bojic
mesh_terms: D000328:Adult; D002815:Chordae Tendineae; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D016277:Ventricular Function, Left