Key result
Open mitral commissurotomy improved postoperative left ventricular systolic wall motion along the posteromedial hemiaxis (p<0.05), whereas mitral valve replacement impaired systolic wall motion along the long axis (p<0.001).
Why the study?
Does commissurotomy compared to mitral valve replacement improve postoperative left ventricular systolic function in patients with mitral stenosis?
Cohort (n=26)
No
Does commissurotomy compared to mitral valve replacement improve postoperative left ventricular systolic function in patients with mitral stenosis?
Preservation of the papillary muscles and chordae tendineae during mitral valve surgery is likely important for better postoperative functional recovery of the left ventricle.
Commissurotomy was associated with better wall motion than MVR in MS; hypothesis-generating for subvalvular preservation and needs RCT confirmation.
Preoperative and postoperative left ventricular cineangiograms of 26 patients with mitral stenosis (MS) were analyzed to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and systolic regional wall motion. Nine patients underwent commissurotomy (OMC group) and 17 patients underwent mitral valve replacement (MVR group). In both groups, postoperative EDV, SV and EF tended to increase, while ESV remained unchanged. In the OMC group, systolic wall motion of the left ventricle was found to be improved postoperatively, whereas systolic wall motion in the MVR group was found to be impaired postoperatively. The latter finding was assumed to be due to excision of the papillary muscles and chordae tendineae. Preservation of these structures is likely to be important for better postoperative functional recovery of the left ventricle.
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Kazama et al. (1986) conducted a cohort in Mitral stenosis (n=26). Open mitral commissurotomy (OMC) vs. Mitral valve replacement (MVR) was evaluated on Left ventricular systolic regional wall motion. Open mitral commissurotomy improved postoperative left ventricular systolic wall motion along the posteromedial hemiaxis (p<0.05), whereas mitral valve replacement impaired systolic wall motion along the long axis (p<0.001).