title: Restrictive Mitral Annuloplasty Does Not Limit Exercise Capacity.
abstract: BACKGROUND
  Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis.
  
  
  METHODS
  Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured.
  
  
  RESULTS
  At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 mmHg) maximal. On exertion, they increased to 6.8 mmHg (interquartile range, 5.4 to 8.8 mmHg) (p = 0.001) and 19.7 mmHg (interquartile range, 12.8 to 23.3 mmHg) (p = 0.001), respectively. Maximal VO2 was 18.2 mL/kg/min (interquartile range, 16.3 to 21.5 mL/kg/min), VE/VCO2 slope was 31.1 (interquartile range, 26 to 34). Epinephrine level was 0.024 ng/mL (interquartile range, 0.0098 to 0.043 ng/mL), norepinephrine was 0.61 ng/mL (interquartile range, 0.41 to 0.95 ng/mL), and NT-proBNP was 303 pg/mL (interquartile range, 155 to 553 pg/mL). Maximal VO2 negatively correlated with resting norepinephrine level (r = -0.50, p = 0.003). VE/VCO2 slope positively correlated with NT-proBNP (r = 0.36, p = 0.004) and epinephrine (r = 0.36, p = 0.04) levels and with LV volumes (r = 0.51, p = 0.006) and was negatively correlated with LVEF (r = -0.52, p = 0.004). Neither maximal VO2 nor VE/VCO2 slope correlated with the highest mean (r = 0.24, p = 0.2, and r = -0.20, p = 0.3, respectively) and maximal (r = 0.13, p = 0.5, r = -0.20, p = 0.3, respectively) mitral gradients on exertion.
  
  
  CONCLUSIONS
  Restrictive mitral annuloplasty for secondary mitral regurgitation does result in a degree of mitral stenosis; however, primary heart disease seems more important for patient's exercise performance than the mitral stenosis resulting from using an undersized ring.
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. Electronic address: mdeja@sum.edu.pl.
authors.forename: Marek A
authors.initials: MA
authors.lastname: Deja
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Żak
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: 2nd Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pysz
authors.affiliation: 3rd Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Gaszewska-Żurek
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Turski
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Janusiewicz
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.affiliation: Department of Pathophysiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Chudek
mesh_terms: D000368:Aged; D004837:Epinephrine / Q000097:blood; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D010446:Peptide Fragments / Q000097:blood
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine; D004837:Epinephrine