Document Detail


Systolic anterior motion after mitral valve repair: is surgical intervention necessary?
MedLine Citation:
PMID:  17198799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The natural history and management of patients with systolic anterior motion after mitral valve repair are uncertain. METHODS: We performed a retrospective chart review and survey follow-up of all patients in whom systolic anterior motion developed intraoperatively after mitral valve repair. RESULTS: From January 1993 to December 2002, mitral valve repair was performed in 2076 patients, and in 174 cases (8.4%) systolic anterior motion was identified on intraoperative echocardiography. These patients form the study group. Initially, patients were managed with a combination of beta-blockade, vasoconstriction with phenylephrine, and/or intravascular volume expansion. Four patients had revision of repair because of persistent systolic anterior motion, and 3 additional patients had revision of repair because of mitral regurgitation from other causes. The median follow-up of the remaining 167 patients was 5.4 years (range 0-13.2 years). There were 2 late reoperations, but none were caused by systolic anterior motion or left ventricular outflow tract obstruction. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV. Echocardiograms were available for review in 93 patients at a median interval of 5.4 years (range 0.2-12.2 years); 13 patients had systolic anterior motion, and 4 patients had systolic anterior motion with left ventricular outflow tract obstruction. CONCLUSIONS: In this experience, most cases of systolic anterior motion resolved with conservative measures including beta-blockade, vasoconstriction, and fluid administration. Persistent systolic anterior motion with left ventricular outflow tract obstruction was documented in 2.3% of patients who had early systolic anterior motion, but late reoperation was not required. Furthermore, the clinical outcomes of patients with systolic anterior motion are comparable to the current norms for mitral valve repair. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV.
Authors:
Morgan L Brown; Martin D Abel; Roger L Click; Ronald G Morford; Joseph A Dearani; Thoralf M Sundt; Thomas A Orszulak; Harzell V Schaff
Related Documents :
20014189 - Endocarditis complicating central venous catheter bloodstream infections: a unique form...
14532939 - Infective endocarditis due to streptococcus bovis in a series of nonaddict patients: cl...
7426149 - Chronic q fever endocarditis.
2053509 - Floppy mitral valves in elderly patients: clinical features and associated echocardiogr...
6687009 - Discrete subaortic stenosis: the value of cross-sectional sector echocardiography in ev...
2917099 - Abnormal cardiac signs after fontan type of operation: indicators of residua and sequelae.
7163969 - Regional cerebral blood flow in patients with vertebrobasilar disease.
12052379 - Enteral feeding in patients with major burn injury: the use of nasojejunal feeding afte...
9590329 - Protein c in the treatment of coagulopathy in meningococcal disease.
Publication Detail:
Type:  Journal Article     Date:  2006-12-04
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  133     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-02     Completed Date:  2007-01-30     Revised Date:  2007-07-24    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  136-43     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic, Rochester Minn 55905, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Echocardiography, Transesophageal
Female
Humans
Intraoperative Complications* / ultrasonography
Male
Middle Aged
Mitral Valve / physiopathology*,  surgery*,  ultrasonography
Mitral Valve Insufficiency / complications,  surgery*,  ultrasonography
Reoperation
Systole*
Ventricular Outflow Obstruction / complications
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2007 Jul;134(1):265-6; author reply 266   [PMID:  17599533 ]

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


Previous Document:  The fate of the distal aorta after repair of acute type A aortic dissection.
Next Document:  Surgical treatment of active infective endocarditis: a continued challenge.