Kiyoshi Doi1,3, Tetsuhiro Yamano2, Hirokazu Shiraishi2, Sachiko Yamazaki1, Satoshi Numata1, Hitoshi Yaku11Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
2Department of Cardiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
3Electronic correspondence: email@example.com
Background and aim of the study: Mitral valve repair for degenerative mitral regurgitation (MR) is occasionally associated with functional mitral stenosis (FMS), a condition characterized by a high mitral pressure gradient (MPG) that can be exacerbated by exercise. The study aim was to assess the clinical impact of exercise-induced FMS, using a cardiopulmonary exercise test.
Methods: Exercise stress echocardiography and cardiopulmonary exercise tests were performed in 41 patients who underwent mitral valve repair for degenerative MR beyond three months after surgery.
Results: All 41 patients were in sinus rhythm at the time of the exercise tests. The mean postoperative left ventricular ejection fraction, mean left ventricular systolic diameter, and mean left atrial diameter were 59.8 ± 8.2%, 33.0 ± 5.8
mm, and 38.8 ± 7.0 mm, respectively. None of the patients exhibited more than mild residual MR. All patients showed significant correlation between exercise intensity and mean MPG. A linear regression line for each patient could therefore be drawn, and the MPG at a constant exercise intensity of 100 W was estimated to compensate for the impact of each patient’s exercise tolerance. The estimated MPG at 100 W exercise was 10.9 ± 5.7 mmHg. The percent-predicted oxygen pulse was 93.6 ± 17.7% on average, and was significantly negatively correlated with the estimated MPG at 100 W exercise (R = -0.428, p = 0.005).Conclusion: Exercise-induced FMS after mitral valve repair for degenerative disease may be associated with a diminished postoperative exercise capacity.
The Journal of Heart Valve Disease 2018;27:165-172
|Functional Mitral Stenosis after Valve Repair for Degenerative Disease May Limit Exercise Capacity|
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