Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair.
OBJECTIVE
This study sought to determine whether echocardiography before mitral valve repair (MVR) for mitral regurgitation (MR) was predictive of postoperative left ventricular (LV) dysfunction and useful for deciding the optimal timing of repair.


BACKGROUND
Some reports have shown that the preoperative echocardiographic data of left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVDs) were good predictors of postoperative LV dysfunction. However, few reports were based on long-term follow-up data of large numbers of patients who underwent MVR in the last decade.


METHODS
A total of 274 patients with moderate or severe MR underwent MVR between October 1, 1991, and September 30, 2000. Among them, 171 patients who had both an operation for isolated MR due to degenerative pathology and a postoperative echocardiogram were studied. Postoperative echocardiograms were performed 3.9 +/- 2.4 years after the operation. The LVEF decreased from 66 +/- 10% before surgery to 63 +/- 11% after surgery (p < 0.0001). On univariate analysis, preoperative LVEF and LVDs correlated with postoperative LVEF (r = 0.41 and r = -0.39, respectively). Overall, postoperative LV dysfunction (defined as LVEF <50%) was not frequent (12%). However, the incidence of postoperative LV dysfunction was high in patients with preoperative LVEF <55% (38%) or LVDs > or =40 mm (23%).


CONCLUSIONS
In patients with MR, the echocardiographic data of LVEF and LVDs were good predictors of postoperative LV dysfunction. When a decrease in LVEF or an increase in LVDs is detected, MVR should be considered to preserve postoperative LV function.
Matsumura
Takayoshi
T
Department of Cardiology, Sakakibara Heart Institute, Yoyogi, Tokyo, Japan.
Ohtaki
Eiji
E
Tanaka
Kaoru
K
Misu
Kazuhiko
K
Tobaru
Tetsuya
T
Asano
Ryuta
R
Nagayama
Masatoshi
M
Kitahara
Koichi
K
Umemura
Jun
J
Sumiyoshi
Tetsuya
T
Kasegawa
Hitoshi
H
Hosoda
Saichi
S
D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*