title: Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: implications for interpretation of perioperative echocardiography.
abstract: 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.
authors.affiliation: Department of Cardiology, Quebec Heart Institute, Laval Hospital, Sainte-Foy, Quebec. mario.senechal@crhl.ulaval.ca
authors.forename: Mario
authors.initials: M
authors.lastname: Sénéchal
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Jean G
authors.initials: JG
authors.lastname: Dumesnil
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Eric
authors.initials: E
authors.lastname: Charbonneau
authors.forename: Michelle
authors.initials: M
authors.lastname: Dubois
mesh_terms: 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