title: Influence of left ventricular function on development of systolic anterior motion after mitral valve repair.
abstract: OBJECTIVE
  A hyperkinetic heart has been suggested as a risk factor for systolic anterior motion (SAM) after mitral valve repair, but the influence of preoperative left ventricular (LV) function on the development of SAM has not been elucidated.
  
  
  METHODS
  Transthoracic echocardiographic data were retrospectively reviewed in 441 patients who underwent mitral valve repair for degenerative mitral regurgitation. Comparisons were made between patients with and without SAM (SAM cases vs noncases).
  
  
  RESULTS
  The incidence of SAM was 6.1% (27/441). There were no differences in preoperative characteristics and operative procedures between the 2 groups except the prevalence of Barlow disease. The SAM cases exhibited a higher preoperative ejection fraction (EF) (SAM cases, 70.0% ± 7.1%; noncases, 65.1% ± 6.9%; P < .01) and smaller preoperative systolic LV end-systolic dimension (LVDs) (32.0 ± 5.4 mm vs 35.4 ± 5.7 mm; P = .02) than the noncases. The incidence of SAM was significantly associated with greater preoperative EF (P < .01 for trend) and reduced LVDs (P < .01 for trend). SAM did not occur in patients with an impaired (EF < 60%) or enlarged (LVDs > 45 mm) LV. The incidence of SAM was highest among patients with a small hyperkinetic heart.
  
  
  CONCLUSIONS
  The study indicates that the development of SAM after mitral valve repair is associated with preoperative LV function. A small hyperkinetic heart is considered a risk factor for SAM and should be treated with caution.
authors.affiliation: Department of Cardiovascular Surgery, Teikyo University Hospital, Tokyo, Japan. s-manabe@fb3.so-net.ne.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Manabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kasegawa
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left