Preoperative advanced left ventricular remodeling predisposes to recurrence of ischemic mitral regurgitation with less reverse remodeling.
OBJECTIVE
The recurrence of ischemic mitral regurgitation (IMR) after mitral annuloplasty is a major determinant of patient survival. The study aim was to investigate, retrospectively, the characteristics of patients with postoperative recurrence of IMR.


METHODS
Twenty patients who had no regurgitation immediately after mitral annuloplasty, were allocated to either recurrence (n = 8) or non-recurrence (n = 12) groups. Recurrence was defined as any interval upgrade of regurgitation. The patients' preoperative profiles and parameters of preoperative, immediate postoperative and intermediate postoperative echocardiography were compared.


RESULTS
Patients with recurrence were more frequently dyspneic and had a significantly higher cardiothoracic ratio (p = 0.041) on radiologic examination. The preoperative left ventricular end-diastolic and end-systolic dimensions (p = 0.018 and 0.021), and left ventricular end-diastolic and end-systolic volumes (p = 0.038 and 0.041), and left ventricular wall motion score (p = 0.0002) were significantly greater in the recurrence group. These differences in left ventricular volume persisted at the immediate and intermediate postoperative stages. Reverse remodeling occurred at a ca. 50% lower rate in the recurrence group, and was associated with significantly smaller preoperative left ventricular dimension and volume. At intermediate follow up, the left ventricular ejection fraction was improved and significantly greater in the non-recurrence group (p = 0.024), but remained unchanged in the recurrence group.


CONCLUSIONS
Advanced left ventricular remodeling and dilatation before surgery predispose to a recurrence of mitral regurgitation and a lesser incidence of reverse remodeling. Mitral annuloplasty alone may have a limited role in preventing the recurrence of regurgitation in the case of advanced IMR, without functional recovery.
Ueno
Tetsuya
T
Department of Thoracic and Cardiovascular Surgery, KagoshimaUniversity Graduate School of Medical and Dental Sciences, Kagoshima City, Japan. tueno@m.kufm.kagoshima-u.ac.jp
Sakata
Ryuzo
R
Iguro
Yoshifumi
Y
Yamamoto
Hiroyuki
H
Ueno
Masahiro
M
Ueno
Takayuki
T
Matsumoto
Kazuhisa
K
D000368:Aged; D002306:Cardiac Volume / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*