Changes in left ventricular function and dimension after surgical ventricular restoration with or without concomitant mitral valve procedure.
BACKGROUND
An association of mitral regurgitation (MR) with ischemic cardiomyopathy (I-CMP) increases the risk of heart failure and its surgical management remains controversial.


RESULTS
Between July 2001 and June 2006, a total of 49 patients with I-CMP underwent surgical ventricular restoration (SVR) and coronary revascularization with or without concomitant mitral annuloplasty (MAP). The mean age was 59.8 years, and all patients had New York Heart Association (NYHA) class III or IV heart failure (mean left ventricular ejection fraction (LVEF) = 24.8%). Nineteen patients had MR >grade 3 (MR group). SVR and coronary artery bypass grafting were performed in all patients, and concomitant MAP was performed in the MR group. Echocardiography was performed preoperatively, postoperatively, and at mean of 19 months after operation. Preoperative left ventricular (LV) end-diastolic and end-systolic dimensions, left atrial volume index, and MR grade were statistically significantly increased in the MR group. On the early postoperative echocardiogram, mean LVEF was significantly improved, with reduction of LV dimensions, in both groups; however, at follow up, these parameters were more significantly improved in the MR group, but unchanged in non-MR group, reaching almost the same levels as the non-MR group.


CONCLUSIONS
In patients with I-CMP, MR increases early and late mortality; however, after SVR and concomitant MAP, LV function seems to continuously improve with more significant reduction in the LV dimensions than in the non-MR group.
Lee
Sak
S
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seol 120-752, Republic of Korea.
Chang
Byung-Chul
BC
Youn
Young-Nam
YN
Kwak
Young-Lan
YL
Yoo
Kyung-Jong
KJ
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*