title: Does stringent restrictive annuloplasty for functional mitral regurgitation cause functional mitral stenosis and pulmonary hypertension?
abstract: BACKGROUND
  It remains controversial whether restrictive mitral annuloplasty (RMA) for functional mitral regurgitation (MR) can induce functional mitral stenosis (MS) that may cause postoperative residual pulmonary hypertension (PH).
  
  
  RESULTS
  One hundred eight patients with left ventricular (LV) dysfunction and severe MR underwent RMA with stringent downsizing of the mitral annulus. Systolic pulmonary artery pressure (PAP) and mitral valve performance variables were determined by Doppler echocardiography prospectively and 1 month after RMA. Fifty-eight patients underwent postoperative hemodynamic measurements. Postoperative echocardiography showed a mean pressure half-time of 92 ± 14 ms, a transmitral mean gradient of 2.9 ± 1.1 mm Hg, and a mitral valve effective orifice area of 2.4 ± 0.4 cm(2), consistent with functional MS. Doppler-derived systolic PAP was 32 ± 8 mm Hg, which correlated weakly with the transmitral mean gradient (ρ=0.23, P=0.02). Postoperative cardiac catheterization also showed significant improvements in LV volume and systolic function, pulmonary capillary wedge pressure, cardiac index, and systolic PAP; the latter was associated with LV end-diastolic pressure [standardized partial regression coefficient (SPRC)=0.51], pulmonary vascular resistance (SPRC=0.47), cardiac index (SPRC=0.37), and transmitral pressure gradient (SPRC=0.20). In a multivariate Cox proportional hazard model, postoperative PH (systolic PAP >40 mm Hg), but not mitral valve performance variables, was strongly associated with adverse cardiac events.
  
  
  CONCLUSIONS
  RMA for functional MR resulted in varying degrees of functional MS. However, our data were more consistent with the residual PH being caused by LV dysfunction and pulmonary vascular disease than by the functional MS. The residual PH, not functional MS, was the major predictor of post-RMA adverse cardiac events.
authors.affiliation: Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kainuma
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Funatsu
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondoh
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shudo
authors.forename: Takafumi
authors.initials: T
authors.lastname: Masai
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fujita
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications; D018487:Ventricular Dysfunction, Left / Q000150:complications