Document Detail


Restrictive mitral annuloplasty with or without surgical ventricular restoration in ischemic dilated cardiomyopathy with severe mitral regurgitation.
MedLine Citation:
PMID:  21911799     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background- We assessed changes in left ventricular (LV) volume and function and in regional myocardial wall stress in noninfarcted segments after restrictive mitral annuloplasty (RMA) with or without surgical ventricular restoration (SVR). Methods and Results- Thirty-nine patients with ischemic cardiomyopathy (ejection fraction ≤0.35) and severe mitral regurgitation (≥3) were studied before and 2.8 months after surgery with cine-angiographic multidetector computed tomography (cine-MDCT). Eighteen underwent RMA alone (RMA group) and 21 underwent RMA and SVR (RMA+SVR group). In addition to measuring conventional parameters (LV end-diastolic volume index [LVEDVI], LV end-systolic volume index [LVESVI], and LV ejection fraction), we evaluated the regional circumferential end-systolic wall stress and mean circumferential fiber shortening in both the basal and mid-LV regions using 3-dimensional cine-MDCT images. LV end-diastolic and end-systolic volume indexes were significantly greater in the RMA+SVR group than in the RMA group preoperatively, but these values did not differ significantly postoperatively. LV end-diastolic and end-systolic volume indexes decreased significantly, by 21% and 27% after RMA and by 35% and 42% after RMA and SVR, and the percent reductions in LV end-diastolic and end-systolic volume indexes were significantly larger in the RMA+SVR group. Regional end-systolic wall stress decreased and circumferential fiber shortening increased significantly in the noninfarcted regions after RMA with or without SVR. Conclusions- RMA plus SVR showed a potentially greater reduction of LV end-diastolic and end-systolic volume indexes than RMA alone. In selected patients with more advanced LV remodeling, concomitant SVR may favorably affect the LV reverse-remodeling process induced by RMA.
Authors:
Yasuhiro Shudo; Kazuhiro Taniguchi; Koji Takeda; Taichi Sakaguchi; Toshihiro Funatsu; Hajime Matsue; Shigeru Miyagawa; Haruhiko Kondoh; Satoshi Kainuma; Koji Kubo; Seiki Hamada; Hironori Izutani; Yoshiki Sawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S107-14     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. sawa@surg1.med.osaka-u.ac.jp.
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