Hemodynamic and energetic aspects of the left ventricle in patients with mitral regurgitation before and after mitral valve surgery.
BACKGROUND
The role of intracardiac blood flow behavior within the context of manifestation and interventional success in patients with mitral regurgitation is unknown to date. The present study aims to assess left ventricular blood flow behavior characterized by kinetic energy (KE) in patients with mitral regurgitation before and after mitral valve surgery.


METHODS
Patients with mitral regurgitation (mean age 56 ± 9 years) and the necessity for mitral valve repair (n = 6) or biological valve replacement (n = 4) received cardiac magnetic resonance before and after surgery and were compared with a group of healthy volunteers (n = 7; mean age 27 ± 7 years). Volumetric data and KE of the left ventricle were obtained for all subjects. KE normalized and nonnormalized to volume was calculated from four-dimensional flow magnetic resonance imaging. Mean KE and KE peaks (systolic, early-diastolic and late diastolic), and end-systolic phase duration were considered.


RESULTS
End-diastolic, end-systolic and stroke volume were significantly higher in patients with mitral regurgitation than in healthy volunteers (P = 0.00, 0.01, and 0.00, respectively) and decreased significantly after surgery (P = 0.00, 0.01, and 0.00, respectively). A significant postoperative decrease of mean KE, systolic and early-diastolic KE peaks was observed (P = 0.01, 0.02, and 0.01, respectively). Late-diastolic KE peak remained high in postoperative patients (P = 0.58).


CONCLUSIONS
Intracardiac blood flow as characterized by measurements of KE is altered in patients with mitral regurgitation. Physiological flow conditions appear to not fully be restored with mitral valve surgery.
German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
Nadya
N
Al-Wakeel
German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
Joao Filipe
JF
Fernandes
German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.
Aref
A
Amiri
German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.
Henryk
H
Siniawski
German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
Leonid
L
Goubergrits
German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
Felix
F
Berger
German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
Titus
T
Kuehne
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D004735:Energy Transfer; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control*
4D flow magnetic resonance imaging; intracardiac blood flow; kinetic energy; mitral regurgitation