title: Anterior chordal transection impairs not only regional left ventricular function but also regional right ventricular function in mitral regurgitation.
abstract: BACKGROUND
  Preservation of annuloventricular continuity through the chordae tendinae aims to maintain left ventricular (LV) function and thus improve postoperative prognosis. This study was designed to prospectively investigate the effect of anterior chordal transection on global and regional LV and right ventricular (RV) function in mitral regurgitation (MR).
  
  
  RESULTS
  Sixty-five patients with severe MR underwent radionuclide angiography before and after either mitral valve (MV) repair (42 patients) or replacement with anterior chordal transection (23 patients). LV and RV ejection fractions (EF) were determined at rest. Both ventricles were divided into 9 regions to analyze regional EF and the effect of anteromedial translation related to surgery. After surgery there was a significant decrease in LVEF (P=0.038) and an increase in RVEF (P=0.036). However, LVEF did not change after MV repair (63.8+/-9.9% to 62.6+/-10.3%), whereas RVEF improved (40.7+/-10.1% to 44.5+/-8.1%, P=0.027). In contrast, LVEF decreased after MV replacement (61.7+/-10.1% to 57.2+/-9.9%, P=0.03), and RVEF was unchanged (40.9+/-10.9% to 41.3+/-9.1%). LVEF 4 and 5, in the area of anterior papillary muscle insertion, were impaired after MV replacement compared with MV repair (region 4, 77.6+/-16.7% versus 87.7+/-10.8%, P=0.005, and region 5, 73.9+/-19.3% versus 89.9+/-13.1%, P<0.001). Moreover, anterior chordal transection led to a significant impairment in the apicoseptal region of the RV (RVEF 4, 50.3+/-15.6% versus 59.3+/-13.8%, P=0.02).
  
  
  CONCLUSIONS
  Anterior chordal transection during MV replacement for MR impairs not only regional LV function but also regional RV function.
authors.affiliation: Service d'Explorations Fonctionnelles Cardio-vasculaires, Services de Chirurgie Cardio-vasculaire, Hôpital Cardiologique, Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: D
authors.initials: D
authors.lastname: Grandmougin
authors.forename: C
authors.initials: C
authors.lastname: Foucher
authors.forename: E P
authors.initials: EP
authors.lastname: McFadden
authors.forename: P
authors.initials: P
authors.lastname: de Groote
authors.forename: A
authors.initials: A
authors.lastname: Prat
authors.forename: H
authors.initials: H
authors.lastname: Warembourg
authors.forename: G
authors.initials: G
authors.lastname: Deklunder
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002815:Chordae Tendineae / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011875:Radionuclide Angiography; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology