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You are here: Contents > 2012 > Volume 21 Number 4 July 2012 > MITRAL VALVE DISEASE > Undersized Annuloplasty for Functional Mitral Regurgitation: Is it Responsible for Clinically Relevant Mitral Stenosis During Exercise?

Undersized Annuloplasty for Functional Mitral Regurgitation: Is it Responsible for Clinically Relevant Mitral Stenosis During Exercise?

Antonio Grimaldi, Michele De Bonis, Federico Pappalardo, Maurizio Taramasso, Alessandro Verzini, Maria Chiara Calabrese, Francesco Maisano, Ottavio Alfieri 

Cardiovascular and Thoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy

Background and aim of the study: The study aim was to assess if an undersized mitral annuloplasty for functional mitral regurgitation (FMR) in dilated
cardiomyopathy can determine a clinically relevant mitral stenosis during exercise.
Methods: Both, rest and stress echocardiography were performed in 12 patients submitted to an undersized ring annuloplasty for FMR in dilated cardiomyopathy. The mean ring size was 27 ± 1.3 mm. All patients were in NYHA functional classes I-II, were in stable sinus rhythm, and without significant residual mitral regurgitation (grade ≤ 2/4).
Results: At peak exercise (mean 81 ± 12 W), the main cardiac performance indices were significantly improved, including systolic blood pressure (121 ± 5.6 versus 169 ± 14 mmHg, p <0.001), stroke volume (63 ± 15 versus 77 ± 14 ml, p <0.001), left ventricular ejection fraction (43 ± 9% versus 47 ± 9%, p = 0.001), and systolic right ventricular function (pulsed tissue Doppler index peak systolic velocity: 8.6 ± 1.7 versus

11.1 ± 3.2 cm/s, p = 0.004). A mild increase in planimetric mitral valve area was observed at peak exercise (2.12 ± 0.4 versus 2.17 ± 0.3 cm2, p = 0.05). Although the transmitral mean gradient was increased from 3.2 ± 1.2 to 6.3 ± 2.3 mmHg
(p <0.0001), the systolic pulmonary artery pressure did not change significantly (27 ± 2.8 versus 30.1 ± 6.4 mmHg, p = 0.3), thus revealing a preserved cardiac adaptation to exercise.
Conclusion: In these preliminary data, postoperative clinically relevant mitral stenosis was not observed in patients submitted to mitral repair for FMR. Stress echocardiography represents a valuable tool to assess an appropriate cardiac response to exercise and to detect a significant exercise-induced pulmonary hypertension after undersized annuloplasty ring
surgery.


The Journal of Heart Valve Disease 2012;21:446-453

Undersized Annuloplasty for Functional Mitral Regurgitation: Is it Responsible for Clinically Relevant Mitral Stenosis During Exercise?

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