Efficacy of mitral valve replacement for patients with mitral regurgitation and a dilated left ventricle.
Mitral regurgitation is a significant complication of end-stage cardiomyopathy, and its existence predicts poor survival. In general, it is thought that mitral valve replacement (MVR) alone is ineffective; however, there are few detailed reports of the clinical course of patients who have undergone MVR. Five patients with mitral regurgitation whose preoperative left ventricular end-systolic volume index was more than 100 ml/m2 were studied. Although their prognosis late after MVR became poor, none of them died within 30 days of the operation. Postoperative cardiac catheterization was performed 6.3+/-1.1 months after surgery; the end-diastolic volume had reduced (before: 193+/-26 ml/m2; after: 166+/-34 ml/m2, p<0.05), but the end-systolic volume had not (before: 110+/-7 ml/m2; after: 112+/-32 ml/m2). The end-systolic wall stress was substantially elevated preoperatively (238+/-29 kdyne/cm2) and tended to increase after surgery (295+/-96 kdyne/cm2). All the patients were able to return to work at some stage postoperatively (their New York Heart Association functional class improved to I or II), but 3 of the 5 patients died suddenly of heart failure at 3.3+/-1.6 years after surgery and the New York Heart Association functional class of the others worsened to III again. Mitral valve surgery, including MVR, can manage severe end-stage heart disease with mitral regurgitation.
Hirata
N
N
First Department of Surgery, Osaka University Medical School, Japan.
Sakai
K
K
Sawa
Y
Y
Ohtake
S
S
Naka
Y
Y
Matsuda
H
H
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006350:Heart Valve Prosthesis; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology