The authors declare that they have no competing interests.
LS, AR, and SB conceived and designed the study; LS, AR, GT, CP, MR, and SM participated in patient selection and performed echocardiographic analysis; MG carried out the mitral valve repair; LS and AR gathered the data; LS, AR, AD, and SB performed the statistical analysis and interpreted the data; LS drafted the manuscript; AR, MG, GT, CP, MR, AD, SM, and SB critically revised the manuscript; AR and SB provided administrative, technical, or material support; SB supervised the study. All authors read and approved the final version of the manuscript.
Repair of anterior leaflet prolapse is technically more challenging and this might influence outcomes as compared to the repair of posterior leaflet prolapse in patients undergoing surgical correction of mitral regurgitation. We investigated the association of anterior leaflet prolapse with minor residual mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) who underwent valve repair.
Eligible for this study were consecutive patients with severe MR due to MVP, who underwent mitral valve repair with residual MR by postpump transesophageal echocardiography ≤2+ during a 20-month period at Pasquinucci Hospital, Massa. Patients undergoing other cardiovascular surgical interventions were excluded. Two groups were defined according to the involvement of mitral valve leaflets: group 1, consisting of patients with anterior leaflet prolapse (isolated or not); and group 2, consisting of patients with isolated posterior leaflet prolapse.
A total of 70 patients (18 in group 1 and 52 in group 2) were analyzed. Patients in group 2 were younger than those in group 1, but the difference was not significant (P = 0.052). There were no significant differences between the 2 study groups with respect to other variables. The proportion of patients with residual MR 1+/2+ was higher in group 1 than in group 2 (61.1% vs. 32.7%, respectively; P = 0.034). In a logistic regression model, anterior leaflet prolapse was an independent predictor of residual MR 1+/2+ (odds ratio, 4.0; 95% confidence interval, 1.14 to 14.04; P = 0.03).
In our study population, patients with anterior leaflet prolapse had a higher proportion of residual MR 1+/2+ as compared to those with posterior leaflet prolapse after repair of mitral valve.
Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography Anesthesiology 1996, 84: 986-1006.
Carpentier A: Cardiac valve surgery-the "French correction". J Thorac Cardiovasc Surg 1983, 86: 323-337. PubMed
Lessana A, Carbone C, Romano M, Palsky E, Quan YH, Escorsin M, Jegier B, Ruffenach A, Lutfalla G, Aime F: Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases. J Thorac Cardiovasc Surg 1990, 99: 622-630. PubMed
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003, 16: 777-802. CrossRefPubMed
Duebener LF, Wendler O, Nikoloudakis N, Georg T, Fries R, Schäfers HJ: Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using polytetrafluoroethylene sutures for chordal replacement. Eur J Cardiothorac Surg 2000, 17: 206-212. CrossRefPubMed
Fukui T, Yoshida K, Akasaka T, Hozumi T, Yamaura Y, Izumi C, Okada Y, Shomura T, Yoshikawa J: Serial change of mitral regurgitation after mitral valve repair: comparison of anterior with posterior leaflet lesions. J Cardiol 1996, 27: 73-76. PubMed
Rizza A, Sulcaj L, Glauber M, Trianni G, Palmieri C, Mariani M, Maffei S, Berti S: Predictive value of less than moderate residual mitral regurgitation as assessed by transesophageal echocardiography for the short-term outcomes of patients with mitral regurgitation treated with mitral valve repair. Cardiovascular Ultrasound 2007, 5: 25. CrossRefPubMedPubMedCentral
- Influence of involvement of anterior leaflet versus posterior leaflet on residual regurgitation as assessed by transesophageal echocardiography in patients undergoing valve repair for mitral regurgitation due to mitral valve prolapse
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II