Key result
Dobutamine stress echocardiography increases mitral valve area by ~55% after Barlow's disease repair.
Why the study?
The efficacy, durability, and hemodynamic performance under stress of surgical anatomical repair for mitral regurgitation due to severe myxomatous valve disease remain debated.
Does Dobutamine stress echocardiography effectively evaluate the mid-term hemodynamic function of repaired mitral valves in patients with Barlow's disease?
Observational (n=20)
No
Does Dobutamine stress echocardiography effectively evaluate the mid-term hemodynamic function of repaired mitral valves in patients with Barlow's disease?
Absolute Event Rate: 4.5% vs 2.9%
p-value: p=<0.001
Dobutamine stress echocardiography is a valuable tool for evaluating the mid-term hemodynamic performance and functional reserve of surgically repaired mitral valves in Barlow's disease.
Supports dobutamine stress echocardiography for mid-term assessment after Barlow's repair; leaves open need for prospective validation before routine adoption.
BACKGROUND: Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up. METHODS AND RESULTS: Twenty patients selected for the study (12 men and 8 women, mean age 60 +/- 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 +/- 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed. CONCLUSION: Basal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods.
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Minardi et al. (2007) conducted an observational in Barlow's disease with severe mitral regurgitation (n=20). Mitral valve repair vs. Pre-operative/baseline status was evaluated on Mitral valve area during dobutamine stress echocardiography (p=<0.001). In patients with Barlow's disease who underwent mitral valve repair, dobutamine stress echocardiography at 20 months demonstrated good valve function with a significant increase in mitral valve area from 2.9 to 4.5 cm2.
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