title: Mitral Valve Stenosis after Open Repair Surgery for Non-rheumatic Mitral Valve Regurgitation: A Review.
abstract: Mitral stenosis (MS) after mitral valve (MV) repair is a slowly progressive condition, usually detected many years after the index MV surgery. It is defined as a mean transmitral pressure gradient (TMPG) >5 mmHg or a mitral valve area (MVA) <1.5 cm(2). Pannus formation around the mitral annulus or extending to the mitral leaflets is suggested as the main mechanism for developing delayed MS after MV repair. On the other hand, early stenosis is thought to be a direct result of an undersized annuloplasty ring. Furthermore, in MS following ischemic mitral regurgitation (MR) repair, subvalvular tethering is the hypothesized pathophysiology. MS after MV repair has an incidence of 9-54%. Several factors have been associated with a higher risk for developing MS after MV repair, including the use of flexible Duran annuloplasty rings versus rigid Carpentier-Edwards rings, complete annuloplasty rings versus partial bands, small versus large anterior leaflet opening angle, and anterior leaflet tip opening length. Intraoperative echocardiography can measure the anterior leaflet opening angle, the anterior leaflet tip opening dimension, the MVA and the mean TMPG, and may help identify patients at risk for developing MS after MV repair.
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shabsigh
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Cassidy
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Byron R
authors.initials: BR
authors.lastname: Rosero-Britton
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Michael Andrew
authors.initials: MA
authors.lastname: Durda
authors.affiliation: Cardiothoracic Anesthesiology Division, Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Essandoh
keywords: annuloplasty; functional mitral stenosis; iatrogenic mitral stenosis; intraoperative echocardiography; mitral valve repair surgery