Valvular heart diseaseEchocardiographic Predictors of Successful Versus Unsuccessful Mitral Valve Repair in Ischemic Mitral Regurgitation
Section snippets
Study patients
Examination of the Cardiovascular Information Registry and Echocardiography Databases at the Cleveland Clinic identified 365 patients who had undergone annuloplasty for ischemic MR and who had complete preoperative transesophageal echocardiographic (TEE) studies from April 1990 to November, 2002. The institutional review board approved the use of the database for clinical research. All patients had functional ischemic MR according to established definitions,5 and none had organic MV disease.
Baseline characteristics
The mean patient age was 66 ± 9 years (range 41 to 83). A total of 344 patients (94%) underwent coronary artery bypass grafting in addition to MV repair, and 21 patients (6%) underwent isolated MV repair. Also, 21 patients (6%) underwent tricuspid valve annuloplasty for severe tricuspid regurgitation.
Success and failure of MV repair
According to the follow-up echocardiographic criteria, 297 patients (81%) had successful mitral repair and 68 (19%) had failed repair (Figure 2). The patients with successful and unsuccessful MV
Discussion
The results of this study demonstrated that routine measurements on preoperative transesophageal echocardiography can be used to identify patients with ischemic MR who are likely to have recurrent MR after surgical annuloplasty. Specifically, increased mitral annular diameter, tethering area, and MR grade were associated with repair failure.
Several echocardiographic studies have detailed the mechanisms of ischemic MR and the results of surgical annuloplasty.12, 13, 14 The recognition that the
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Preoperative assessment of mitral valve regurgitation with two- and three-dimensional transesophageal echocardiography
2022, Cirugia CardiovascularCitation Excerpt :Indeed, in patients without advanced LV remodeling and severe leaflet tethering, mitral valve repair with an undersized complete ring may offer satisfactory results.45 Conversely, in patients with echocardiographic predictors of annuloplasty failure46–48 (Table 4), additional valvular/subvalvular techniques or chordal sparing valve replacement should be considered to achieve a more durable solution.49 Nevertheless, it is important to acknowledge that no one of these singular echocardiographic parameters demonstrated a strong and highly reproducible association with annuloplasty failure, while discrepant results have been reported by different studies on this topic.50,51
Dynamic Geometric Tricuspid Valve Assessment: Extending from Bench to Bedside
2022, Journal of Cardiothoracic and Vascular AnesthesiaThree-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study
2022, Journal of the American Society of EchocardiographyRecurrence of Functional Versus Organic Mitral Regurgitation After Transcatheter Mitral Valve Repair: Implications from Three-Dimensional Echocardiographic Analysis of Mitral Valve Geometry and Left Ventricular Dilation for a Point of No Return
2021, Journal of the American Society of EchocardiographyMitral Regurgitation in 2020: The 2020 Focused Update of the 2017 American College of Cardiology Expert Consensus Decision Pathway on the Management of Mitral Regurgitation
2021, Journal of Cardiothoracic and Vascular Anesthesia
This study was supported in part by Bangkok Metropolitan Administration, Bangkok, Thailand.
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Dr. Gillinov is a consultant to Edwards Lifesciences, LLC and has an equity interest in Viacor, Inc., Wilmington, Massachusetts.
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Dr. McCarthy is a consultant to Edwards Lifesciences, LLC and an inventor, for which he receives royalties from Edwards Lifesciences, LLC, Irvine, California.