Document Detail


Preoperative left ventricular systolic dysfunction correlates with the adverse postoperative consequences of annular-papillary disconnection in the course of mitral valve replacement for stenosis.
MedLine Citation:
PMID:  9697067     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS OF THE STUDY: Preservation of chordae tendineae helps maintain ventricular performance in patients having surgery for mitral regurgitation. The importance of chordal integrity in patients with rheumatic mitral stenosis is unknown. The purpose of this study was to determine the influence of chordal preservation on left ventricular function following relief of rheumatic mitral stenosis. METHODS: A total of 142 patients with mitral stenosis had balloon valvulotomy (group 1, n = 63), surgical commissurotomy (group 2, n = 33) or mitral valve replacement (group 3, n = 46). Chordae were resected in all group 3 patients. Left ventricular dimension in end-diastole (LVEDD), end-systole (LVESD) and fractional shortening (FS) were measured at baseline and at a mean interval of 11 +/- months post intervention. RESULTS: At one year, FS increased in groups 1 and 2, but decreased in group 3 (+11.5%, +9%, -6.1%, p < 0.005 for group 3 versus groups 1 and 2). a borderline significant increase LVEDD was seen in group 1 compared with groups 2 and 3 (11%, 5%, 4% respectively, p = 0.05). Differences in FS at follow up were due mainly to diametrically opposite changes in LVESD in the subgroup of patients with baseline left ventricular dysfunction (-1.9%, 0%, +9.8%, p < 0.005 for group 3 versus groups 1 and 2). CONCLUSIONS: Deterioration of left ventricular function only in patients having mitral valve replacement indicates chordal resection as a putative mechanism. The result of this study suggest that chordal preservation is particularly important in patients with mitral stenosis who have depressed preoperative left ventricular systolic function.
Authors:
M R Essop; L Kontozis; P Sareli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  7     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-10-19     Completed Date:  1998-10-19     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  431-7     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Baragwanath Hospital, Johannesburg, South Africa.
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MeSH Terms
Descriptor/Qualifier:
Adult
Balloon Dilatation
Chordae Tendineae / physiology,  surgery
Cohort Studies
Echocardiography, Doppler, Color
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Humans
Male
Mitral Valve / surgery
Mitral Valve Stenosis / surgery*
Postoperative Complications / epidemiology,  etiology*
Rheumatic Heart Disease / surgery*
Time Factors
Ventricular Dysfunction, Left / complications*

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


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