Document Detail


Annular-to-leaflet mismatch and the need for reductive annuloplasty in patients undergoing mitral repair for chronic mitral regurgitation due to mitral valve prolapse.
MedLine Citation:
PMID:  17493475     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Annular dilation is a common feature of chronic degenerative mitral regurgitation caused by leaflet prolapse. Accordingly, patients undergoing surgical repair usually undergo concomitant reductive annuloplasty to restore a normal annular-to-leaflet relation. With the evolution of transcatheter valve repair technologies, patient selection criteria for those who do not require annuloplasty are needed. A series of patients undergoing mitral repair was analyzed, and the role of annular-to-leaflet mismatch in identifying patients requiring reductive annuloplasty was explored. Preoperative data for 82 patients undergoing mitral repair with annuloplasty for degenerative mitral regurgitation were prospectively collected, including annular intercommissural (IC) and septolateral (SL) dimensions and heights of anterior (ALH) and posterior leaflets. An SL/ALH ratio >1.4 was used to define annular-to-leaflet mismatch. After mitral repair, the ratio between preoperative IC distance and the size of the implanted annular prosthesis (Seguin ring [SR], IC/SR <1.2) was used to identify patients for whom annuloplasty was nonreductive. All patients underwent successful mitral repair. Mean preoperative IC was 46 +/- 6 mm, SL was 42 +/- 5 mm, and ALH was 31 +/- 5 mm. Mean SR was 34 +/- 3 mm, with a mean IC/SR ratio of 1.34 +/- 0.14. Sixteen patients (19%) had an IC/SR ratio <1.2. IC/SR ratio <1.2 was predicted by a SL/ALH ratio < or =1.4 (p = 0.009). In conclusion, annular dilation is negligible in <20% of surgical candidates. In this subgroup, an isolated leaflet repair may be indicated. SL/ALH ratio is a good indicator of annular-to-leaflet mismatch and could be used as an adjunct to other methods of annular function assessment to select patients for ringless mitral repair.
Authors:
Francesco Maisano; Giovanni La Canna; Antonio Grimaldi; Giorgio Viganò; Andrea Blasio; Andrea Mignatti; Antonio Colombo; Attilio Maseri; Ottavio Alfieri
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-04-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  99     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-11     Completed Date:  2007-08-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1434-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chronic Disease
Dilatation, Pathologic / etiology
Echocardiography
Female
Health Services Needs and Demand
Heart Valve Prosthesis Implantation* / methods
Humans
Male
Middle Aged
Mitral Valve Insufficiency / etiology*,  physiopathology,  surgery*,  ultrasonography
Mitral Valve Prolapse / complications*,  physiopathology,  surgery*,  ultrasonography
Prospective Studies
Regression Analysis
Research Design
Sensitivity and Specificity
Stroke Volume
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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