Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: implications for interpretation of perioperative echocardiography.
BACKGROUND
Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty (MVA) and is associated with a poor prognosis. It was hypothesized that the anterior displacement of the posterior aspect of the annulus caused by annuloplasty could induce a change in the direction of MR jet.


METHODS
The echocardiograms of 21 patients who underwent restrictive MVA for ischemic MR and who had detectable postoperative MR were analyzed before and early after surgery to evaluate the direction of MR jet.


RESULTS
The MR jet direction was posterior in 15 patients (72%) and central or anterior in six patients (28%) before the operation, compared with four patients (20%) and 17 patients (80%), respectively, after MVA (P<0.001). Overall, the jet direction was modified in 16 of 21 patients (76%) following MVA. Among the subset of 11 patients with clinically significant persistent MR (vena contracta width greater than 3 mm), the MR jet direction changed in nine patients (82%) compared with their preoperative evaluation. Importantly, the initial clinical interpretation, based on a subjective evaluation, had classified MR severity as nonsignificant in six of 11 patients (55%), likely due to the eccentricity of the jet and its change in direction.


CONCLUSIONS
The direction of the persistent MR jet early after annuloplasty is often different from that of preoperative MR jet and may lead to significant misinterpretation of the postoperative echocardiogram.
Sénéchal
Mario
M
Department of Cardiology, Quebec Heart Institute, Laval Hospital, Sainte-Foy, Quebec. mario.senechal@crhl.ulaval.ca
Magne
Julien
J
Pibarot
Philippe
P
Dumesnil
Jean G
JG
Dagenais
François
F
Charbonneau
Eric
E
Dubois
Michelle
M
D000368:Aged; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left