title: Effect of mitral valve repair versus replacement on left ventricular rotational deformation: a study with speckle tracking echocardiography.
abstract: OBJECTIVE
  Radial and longitudinal movements of the heart do not fully reflect cardiac hemodynamics and physiology. Twist deformation of the heart is essential for adequate cardiac filling and stroke volume. The study aim was to examine the effects of mitral valve replacement or repair on left ventricular rotational parameters, evaluated by speckle tracking echocardiography, in patients with severe mitral regurgitation (MR).
  
  
  METHODS
  A total of 51 patients (22 males, 29 females; mean age 45.7 +/- 13.5 years) with severe MR, sinus rhythm and left ventricular ejection fraction (LVEF) > 50% was included in the study. Mitral valve repair was performed in 29 patients (group A), and mitral valve replacement in 22 patients (group B). Rotational parameters (basal rotation, apical rotation, twist and untwist), LVEF and left ventricular diameters and volumes were compared before and after surgery. The postoperative percentage change in twist was calculated as follows: (preoperative twist - postoperative twist)/preoperative twist x 100.
  
  
  RESULTS
  Rotational parameters of basal rotation were significantly decreased in both groups (group A: -5.6 +/- 3.1 degrees versus -4.0 +/- 3.0 degrees; p = 0.035; group B: -6.7 +/- 3.0 degrees versus -3.4 +/- 2.6 degrees; p < 0.001). However, apical rotation (group A: 11.4 +/- 6.6 degrees versus 9.7 +/- 8.3 degrees; p = 0.4; group B: 10.9 +/- 5 degrees versus 7.2 +/- 6.8 degrees; p = 0.009), twist (group A: 16.9 +/- 8.4 degrees versus 13.4 +/- 8.4 degrees; p = 0.1); group B: 17.1 +/- 5.7 degrees versus 10.1 +/- 8.7 degrees; p < 0.001) and untwist (group A: -109.2 +/- 57.8 degrees versus -104.6 +/- 56.0 degrees; p = 0.69; group B: -120.4 +/- 47.8 degrees versus -79.2 +/- 39.5 degrees; p = 0.002) were decreased significantly in the replacement group, but the decreases were not statistically significant in the repair group. The change in twist was observed to be significantly higher in the replacement group compared to the repair group (43.2 +/- 34.7% versus 9.4 +/- 54.1%; p = 0009; overall twist change 24 +/- 49.3%). To identify independent predictors of change in twist, a multivariate regression analysis was performed, whereby the left ventricular end-diastolic volume and type of operation were identified as independent predictors of change in twist.
  
  
  CONCLUSIONS
  Compared to mitral valve replacement, mitral valve repair results in better rotational deformation parameters. Maintaining the mitral apparatus and enabling valvular-ventricular interaction contributes to a preservation of left ventricular twist and untwist. However, the prognostic and clinical impact of preserved rotational deformation parameters need to be determined.
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey. oz_candan@hotmail.com
authors.forename: Ozkan
authors.initials: O
authors.lastname: Candan
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Ozdemir
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Soe Moe
authors.initials: SM
authors.lastname: Aung
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Ruken Bengi
authors.initials: RB
authors.lastname: Bakal
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Cetin
authors.initials: C
authors.lastname: Gecmen
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Suzan Hatipoglu
authors.initials: SH
authors.lastname: Akpinar
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Dogan
authors.initials: D
authors.lastname: Cem
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Omaygene
authors.initials: O
authors.lastname: Onur
authors.affiliation: Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey.
authors.forename: Cihangir
authors.initials: C
authors.lastname: Kaymaz
mesh_terms: D000328:Adult; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D015203:Reproducibility of Results; D016896:Treatment Outcome; D016277:Ventricular Function, Left