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You are here: Contents > 2013 > Volume 22 Number 5 September 2013 > MITRAL VALVE DISEASE > Effect of Mitral Valve Repair versus Replacement on Left Ventricular Rotational Deformation: A Study with Speckle Tracking Echocardiography

Effect of Mitral Valve Repair versus Replacement on Left Ventricular Rotational Deformation: A Study with Speckle Tracking Echocardiography

Özkan Candan, Nihal Ozdemir, Soe Moe Aung, Ruken Bengi Bakal, Cetin Gecmen, Suzan Hatipoglu Akpinar, Dogan Cem, Omaygenc Onur, Cihangir Kaymaz

Kartal Kosuyolu Heart and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey

Background and aim of the study: Radial and longitudinal movements of the heart do not fully reflect cardiac hemodynamics and physiology. Twist deformation of the heart is essential for adequate cardiac filling and stroke volume. The study aim was to examine the effects of mitral valve replacement or repair on left ventricular rotational parameters, evaluated by speckle tracking echocardiography, in patients with severe mitral regurgitation (MR).

Methods: A total of 51 patients (22 males, 29 females; mean age 45.7 ± 13.5 years) with severe MR, sinus rhythm and left ventricular ejection fraction (LVEF) >50% was included in the study. Mitral valve repair was performed in 29 patients (group A), and mitral valve replacement in 22 patients (group B). Rotational parameters (basal rotation, apical rotation, twist and untwist), LVEF and left ventricular diameters and volumes were compared before and after surgery. The postoperative percentage change in twist was calculated as follows: (preoperative twist - postoperative twist)/preoperative twist ×100.

Results: Rotational parameters of basal rotation were significantly decreased in both groups (group A: -5.6 ± 3.1° versus -4.0 ± 3.0°; p = 0.035; group B: -6.7 ± 3.0° versus -3.4 ± 2.6°; p <0.001). However, apical rotation

(group A: 11.4 ± 6.6° versus 9.7 ± 8.3°; p = 0.4; group B: 10.9 ± 5 ° versus 7.2 ± 6.8°; p = 0.009), twist (group A: 16.9 ± 8.4° versus 13.4 ± 8.4°; p = 0.1); group B: 17.1 ± 5.7° versus 10.1 ± 8.7°; p <0.001) and untwist (group A: -109.2 ± 57.8° versus -104.6 ± 56.0°; p = 0.69; group B: -120.4 ± 47.8° versus -79.2 ± 39.5°; p = 0.002) were decreased significantly in the replacement group, but the decreases were not statistically significant in the repair group. The change in twist was observed to be significantly higher in the replacement group compared to the repair group (43.2 ± 34.7% versus 9.4 ± 54.1%; p = 0009; overall twist change 24 ± 49.3%). To identify independent predictors of change in twist, a multivariate regression analysis was performed, whereby the left ventricular end-diastolic volume and type of operation were identified as independent predictors of change in twist.

Conclusion: Compared to mitral valve replacement, mitral valve repair results in better rotational deformation parameters. Maintaining the mitral apparatus and enabling valvular-ventricular interaction contributes to a preservation of left ventricular twist and untwist. However, the prognostic and clinical impact of preserved rotational deformation parameters need to be determined.

The Journal of Heart Valve Disease 2013;22:651-659

Effect of Mitral Valve Repair versus Replacement on Left Ventricular Rotational Deformation: A Study with Speckle Tracking Echocardiography

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