title: Stress echocardiographic assessment of mitral valve function repaired using rough-zone trimming.
abstract: BACKGROUND
  We invented novel mitral valve repair technique; rough-zone trimming procedure (RZT) for anterior mitral valve prolapse. Prolapse site was resected in obtuse triangle shape and sutured edges to creates deep coaptation and improves regurgitation. Though it is simple and reproducible technique, functional mitral stenosis is a risk. Valve function and hemodynamics were investigated using dobutamine stress echocardiography (DSE) in patients after mitral valve repair using RZT.
  
  
  METHODS
  Patients underwent RZT for the anterior mitral valve (AML, n = 10), quadrangular resection (QR) of the posterior mitral valve (PML; n = 4), RZT + QR of bileaflet valves (bileaflet; n = 4) and healthy individuals (control; n = 10) and were assessed by DSE (doses up to 20 μg/Kg/min). Echocardiographic data including mitral valve area (MVA), mitral valve mean pressure gradient (MVmeanPG), and systolic pulmonary artery pressure (sPAP) were measured at rest and at peak stress.
  
  
  RESULTS
  Rest/stress MVA (cm(2)), MVmeanPG (mmHg) and sPAP (mmHg) were 2.8 ± 0.4 and 3.4 ± 0.3, 3.3 ± 1.1 and 7.4 ± 4.1, and 25.7 ± 4.7and 49.1 ± 4.1, respectively, in the AML group. Dobutamine stress increased all parameters but not to pathological levels. The results were similar to those of the other groups after mitral valve repair, whereas MVA was larger and MVmeanPG was lower in the control than in the AML group.
  
  
  CONCLUSIONS
  Valve repair using RZT does not pathologically obstruct the mitral valve, either at baseline or during dobutamine stress, and does not affect valve hemodynamics and reserve.
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. yanasey@sapmed.ac.jp.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Yanase
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. notakagi@sapmed.ac.jp.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takagi
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. yamahiro@sapmed.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. t-watanabe@sapmed.ac.jp.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. mayuko@sapmed.ac.jp.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Uehara
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. aad72150@sapmed.ac.jp.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Tachibana
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. medusay@sapmed.ac.jp.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Miyaki
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. t.ito@sapmed.ac.jp.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.affiliation: Departmetnt of Cardiovascular Surgery, Sapporo Medical University of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. higami@sapmed.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016022:Case-Control Studies; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D004280:Dobutamine