Immediat and Long Term Results of Mitral Valve Replacement in Patients with Rheumatic Mitral Stenosis and Left Ventricular Dysfunction
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-Objective: The aim of this study was to assess the reversibility of left ventricular dysfunction in patients with rheumatic valve stenosis mitral stenosis after mitral valve surgery.
-Patients and methods: We retrospectively collected 565 patients who underwent mitral valve replacement for mitral stenosis. patients who had moderate tricuspid regurgitation (I-II) were included. Patients were studied under two groups: group with LVFE > 45% (n=535) and group with LVEF≤ 45% (n=30).
All patients underwent mitral valve surgery under cardiopulmonary bypass (CPB). Follow up evaluated the NYHA functional class and LVEF and survival rate.
-Results: The groups were similar for most preoperative characteristics. No statistical difference was observed between groups in term of CPB time and aortic cross clamp time. But 30 days mortality rate was higher in patients with LV dysfunction (13.3%, vs 4.5%, p=0.03). Low output syndrome was more frequent also (p=0.028) in group with MS and poor LVEF. Mean follow up time was 69.6± 29.2 months. Preoperative NYHA class was 2.83± 0.04 vs 1.27±0.04 after surgery p=0.001. LVEF increased from 39.8±45% to 52.8±86% p= 0.017.
No change was seen in LV diameters.
-Conclusion: Despite higher perioperative mortality in patients with MS and poor LV dysfunction, MVR provides excellent outcome and LVEF recovery.
Marcus, R.H., Pocock, W.A & Barlow, J.B.(1994) The spectrum of severe rheumatic mitral valve disease in a developing country: Correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann. Intern. Med., 120, 177-183.
Rivzi, S.F., Khan, M.A., Kundi, A., Marsh, D.R., Samad, A. & Pahsa, O.(2004) Status of rheumatic heart disease in rural Pakistan. Heart, 90, 394-399.
Narin, F., Narin, N., Pasaoglu, H., Halici, C. & Aslan, D. (2003) Nitric oxide metabolities in acute rheumatic fever. Tohoku J. Exp. Med., 199,135-139.
Carapetis JR. The Current Evidence of the Burden of group A Streptococcal Disease. Geneva: World Health Organisation; 2004. p1-57.
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A Streptococcal Diseases. Lancet Infect Dis 5: 685-694.
Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult hart disease. Circulation 1989; I(suppl 79):13-112.
Yildirimturk O. Helvacioglu FF, Tayyareci Y, Yurdakul S. Aytekin S. Subclinical left ventricular systolic dysfunction in patients with mild-to-moderate rheumatic mitral stenos is and a normal left ventricular ejection fraction: an observational study. Anadolu Kardiol Derg 2013; 13: 328-36.
Ibrahim MM. Left ventricular function in rheumatic mitral stenos is. Clinical echocardiographic study. Br Heart J 1979; 42; 514-20. (cross reference).
Dogan S, Aydin M, Gursurer M, Dursun A, Onuk T, Madak H. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild-to-moderate rheumatic mitral stenosis. J Am Soc Echocardiogr 2006; 19: 243-8 ( cross reference).
Cash AK, Carabello BA, Cepin D, Spann JF. Left ventricular ejection performance and systolic muscle function in patients with mitral stenos is. Circulation 1983; 67:148-154.
Goto S, Handa S, Akhaishi M, Abe S, Ogawa S. Left ventricular ejection performance in mital stenos is, and effects of successful percutanous transvenous mitral comissurotomy. Am J Cardiol 1992; 69; 233-237.
Choi BW, Bacharach SL, Barbour dj, Leon MB, Mc Carthy KE, Bonow RO. Left ventricular systolic dysfunction, diastolic filling characteristics, and exercice cardiac reserve in mitral stenosis.Am J Cardiol 1995; 75; 526-529.
Otto CM. Valvular stenosis and valvular regurgitation. In: Otto CM (ed.), Textbook of Clinical Echocardiography. 3rd edn. Elsevier Saunders; 2004, p281-328.
Ozdemir K, Altunkeser BB, Gok H, Icli A, Temizhan A, Analysis of the myocardial velocities in patients with mitral stenosis. J Am Soc Echocardiography 2002; 15: 1472 -8 (Cross ref).
Heller SJ, Carleton RA, Abnormal left ventricular contraction in patients with mitral stenosis. Circulation 1970; 42: 1099-1110.
Ozdemir AO. Kaya CT. Ozcan OU. Ozdol C. Candemir B. Turhan S. et al. Prediction of subclinical left ventricular dysfunction with longitudinal two dimensional strain and strain rate imaging in patients with mitral stenosis. Int J Cardiovasc Imaging 2010; 26: 397-404.
Heller SJ. Carleton RA. Abnormal left ventricular contraction in patients with mitral stenosis. Circulation 1970; 42: 1099-110.
Horwitz LD. Mullins CB, Payne RM. Curry GC. left ventricular function in mitral stenosis. Chest 1973; 64: 609-14.
Liu CP, Ting CT, Yang TM, et al. Reduced left ventricular compliance in humain mitral stenosis. Role of reversible internal constaint. Circulation 1992; 85: 1447-56.
Sengupta PP, Mohan JC, Mehta V, et al. Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamicc in mitral stenosis: quantitative assessment by tissue velocity imaging. J Am Soc Echocardiogr 2004; 17: 824-8.
Ozen N, Can I, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. left ventricular long-axis function is reduced in patients with rheumatic mitral stenosis. Echocardiography 2004; 21: 107-12 (Cross ref).
Chen J, Cao T, Duan Y, Yuan L, Wang Z. Velocity vector imaging in assessing myocardial systolic function of hypertensive patients with left ventricular hypertrophy. Can J Cardiol 2007; 23; 957-61. (Cross ref).
Velocik G, Kamp O. Visser CA. Three-dimentional echocardiography in mitral valve disease. Eur J Echocardiogr 2005; 6: 443-54.
Grant RP. Architectonics of the heart. Am Heart J 1953; 46: 405-431.
Curry GC, Elliott LP, Ramsey HW. Quantitative left ventricular angiocardiographic findings in mitral stenosis: detailed analysis of the anterolateral wall of the left ventricle. Am J Cardiol 1972; 29: 621-627.
D'Hooge J, Heimdal A, Jamal F, Kukulski T , Bijnens B, Rademakers F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000; 1: 154-70. (Cross ref).
Buckberg GD, Weisfeldt ML, Ballester M, Beyar R, Burkhoff D, Coghlan HC, et al. Left ventricular form and function: scientific priorities and strategic planning for development of new views of disease. Circulation 2004; 110: 330-6. (Cross ref).
Jurcut R, Pappas CJ, Masci PG, Herbots L, Szulik M, Bogaert J, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging. J Am Soc Echocardiogr 2008; 21: 879-86. (Cross ref).
Sengupta PP, Mohan JC, Mehta V, Kaul AU, Trehan UK, Arora R,et al. Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamicc in mitral stenosis: quantitative assessment by tissue velocity imaging. J Am Soc Echocardiogr 2004; 17: 824-8. (Cross ref).
Snyder RW, Lange RA, Willard JE, Glamann DB, Landau C, Negus BH, Hillis LD. Frequency, cause, and effect on operative outcome of depressed left ventricular ejection fraction in mitral stenosis. Am J Cardiol 1994; 73: 65-69.
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