Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease.
BACKGROUND
Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up.


RESULTS
Twenty patients selected for the study (12 men and 8 women, mean age 60 +/- 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 +/- 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed.


CONCLUSIONS
Basal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods.
Minardi
Giovanni
G
Division of Cardiology, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy. giovanni.minardi@libero.it
Manzara
Carla
C
Pulignano
Giovanni
G
Luzi
Giampaolo
G
Maselli
Daniele
D
Casali
Giovanni
G
Musumeci
Francesco
F
D000368:Aged; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery*; D011379:Prognosis; D013577:Syndrome; D016896:Treatment Outcome; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004280:Dobutamine