1048-140 Accuracy of presurgical assessment of myxomatous mitral valve pathology using real-time three-dimensional echocardiography

Lissa Sugeng, Yan Katsnelson, Lynn Weinert, R.Parker Ward, Kirk T Spencer, Jeanne M DeCara, Victor Mor-Avi, Valluvan Jeevanandam, Roberto M Lang
2004 Journal of the American College of Cardiology  
Valvular Heart Disease patients with no PPM versus 46±8 mmHg and 68% in patients with PPM (p<0.001). Conclusions: PPM is associated with persisting PA hypertension after MVR. The clinical implications of these results are important given that PPM is frequent in patients undergoing MVR and could largely be avoided by using a prospective strategy at the time of operation. Objective: Edge-to-edge mitral repair could be a limiting factor for exercise tolerance due to increasing transmitral gradient
more » ... during stress test. Methods: Between June 2000 and December 2002, 28 patients with an echographic grade 3 to 4 mitral regurgitation were operated on according to Alfieri's technique. The mean age was 64.3 ± 16.2 years. In 17 cases, there was a bileaflet prolapsed degenerative valve, in 7 cases there was a pure or associated ischemic mitral regurgitation, and in 4 cases an endocarditis. The operation consisted on suturing the free margins of the prolapsed segments of the two leaflets in 100% of cases. Associated procedures were Carpentier's ring annuloplasty in 62.4% and CABG in 14.3% of cases. After a mean of followup of 7.5 months, all patient were seen at the outpatient clinic for a clinical evaluation, an echocardiogram at rest and at peak exercise, and a cardio respiratory exercise testing with maximal oxygen uptake (VO2 max) recording. Results: There was no early or late death. Improvement of the NYHA class was observed in all patients with a conversion from a mean preoperative value of 3.1 ± 1 to a postoperative value of 1.3 ± 0.5 (p< 0.0001). Eighty-two per cent of patients have had no residual mitral regurgitation. In all cases there was a lowering of the arterial systolic pulmonary pressure from a mean of 45 ± 19 mmHg preoperatively to 36 ± 11 mmHg postoperatively (p= 0.02) and LVEF remained unchanged from 59 ± 10 to 63 ± 12 (p=0.17). The mean transmitral gradient was 3.6 ± 1.6 at rest and increased to 8 ± 3.3mmHg during peak exercise (p<0.0001). The mean mitral area was 2.4 ± 0.1cm 2 . Among the 21 interpretable cardio respiratory exercise testing, 57.1% of the patients had normal exercise tolerance (mean VO2 max >85% normal value), 33.3% patients had a moderate cardiogenic limitation (69.8% mean VO2 max), and 9.6% of the patients had a muscular exercise limitation due to exercise deconditioning. Conclusion: According to these results, this technique seems to induce a restrictive aspect of the repair as demonstrated by the valve area, the transvalvular gradients and the limitation of VO2 max, but its impact on clinical status seems moderate.
doi:10.1016/s0735-1097(04)91812-8 fatcat:qz37kaugh5c4jjwczsdyf6httu