title: Late development of mitral regurgitation after left ventricular reconstruction surgery.
abstract: OBJECTIVE
  Late presence of mitral regurgitation (MR) after the Dor procedure (left ventricular (LV) reconstruction associated with coronary artery bypass grafting) for postinfarction patients carries a poor prognosis. The aim of this study was to review our experience with the Dor procedure and to analyze the correlation of surgical results with late MR.
  
  
  METHODS
  The study group comprised 19 patients with previous anterior transmural myocardial infarction (MI). Ten patients were classified as New York Heart Association (NYHA) functional class III or IV at surgery. MR was moderate in 2 patients and mild in 15 patients.
  
  
  RESULTS
  Myocardial revascularization was performed in all patients, with a mean of 3.7+/-1.2 grafts. Mitral valve was repaired in 6 patients. Four patients with mild MR underwent posterior annuloplasty, and 2 with moderate MR underwent rigid annular remodeling. Early postoperative NYHA functional class improved from 2.7+/-0.9 to 1.3+/-0.5; however, MR deteriorated to moderate in 5 patients with worsening NYHA functional class 3 months after surgery. Although the valve was not repaired during surgery in 4 patients with preoperative mild MR, 1 patient with moderate MR underwent annuloplasty with a rigid ring. All patients with late MR underwent more than 30-mL/m2 reduction of end-diastolic volume index at surgery. Cumulative 4-year survival including hospital deaths was 89.5%.
  
  
  CONCLUSIONS
  To prevent the risk of late MR, a more than 30-mL/m2 reduction of end-diastolic volume index should be avoided and mitral valve repair should be performed even if preoperative functional MR is only mild.
authors: Second Department of Surgery, Kagoshima University, Kagoshima, Japan.
authors: Goichi
authors: G
authors: Yotsumoto
authors: Ryuzo
authors: R
authors: Sakata
authors: Takayuki
authors: T
authors: Ueno
authors: Yoshifumi
authors: Y
authors: Iguro
authors: Tamahiro
authors: T
authors: Kinjo
authors: Akira
authors: A
authors: Kobayashi
authors: Kazuhisa
authors: K
authors: Matsumoto
authors: Chuwa
authors: C
authors: Tei
authors: Yutaka
authors: Y
authors: Otsuji
authors: Yasuhiro
authors: Y
authors: Tanaka
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology*; D009203:Myocardial Infarction / Q000601:surgery*; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000601:surgery*