Key result
Mitral valve repair acutely reduced LV stroke work index from 4.7 to 2.2 mm Hg x l x m(-2) and improved LV relaxation time constant tau from 52 to 37 ms.
Why the study?
Does mitral valve repair improve LV hemodynamics and diastolic function in patients with severe mitral regurgitation and normal ventricular function?
Observational (n=10)
Does mitral valve repair improve LV hemodynamics and diastolic function in patients with severe mitral regurgitation and normal ventricular function?
Mitral valve repair acutely improves diastolic left ventricular function and pump efficiency in patients with severe mitral regurgitation.
May indicate acute diastolic gains after mitral valve repair in severe MR; hypothesis-generating and should not yet change practice.
BACKGROUND: This study aimed to evaluate the acute effect of mitral valve repair (MVR) on LV hemodynamics and geometry in patients with normal ventricular function. METHODS: In 10 patients with severe mitral regurgitation undergoing MVR, pressure-volume relationships were recorded before annuloplasty prior to and after hemodilution and after MVR during stable circulatory condition, using the conductance catheter technique (CC). Analyses were done off-line; volume calibration was based on data obtained after completion of valve repair (mean +/- s.d.). RESULTS: CC showed that only 61 +/- 15 % of left ventricular output was ejected into the systemic circulation, regurgitation volume being 39 +/- 15 %. MVR led to a reduction in LV stroke work index from 4.7 +/- 1.8 mm Hg x l x m (-2) at before valve repair to 2.2 +/- 1.0 mm Hg x l x m (-2) after surgery at unchanged cardiac index. LV diastolic filling parameters improved: LV relaxation time constant tau decreased from 52 +/- 15 to 37 +/- 11 ms and dP/dt (min) increased from - 873 +/- 231 to - 1286 +/- 283 mm Hg x s (-1). CONCLUSIONS: Despite cardioplegic arrest, MVR leads to acute improvement of diastolic LV function early after the operation. This may explain why valve repair has an acute positive effect in patients with impaired LV function.
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Günzinger et al. (2005) conducted an observational in Severe mitral regurgitation with normal ventricular function (n=10). Mitral valve repair vs. Before valve repair (baseline) was evaluated on Left ventricular stroke work index and diastolic filling parameters (tau and dP/dt min). Mitral valve repair acutely reduced LV stroke work index from 4.7 to 2.2 mm Hg x l x m(-2) and improved LV relaxation time constant tau from 52 to 37 ms.
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