Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

<p>Abstract</p> <p>Objectives</p> <p>We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR).</p> <p>Background</p> <p>Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined.</p> <p>Methods</p> <p>136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained.</p> <p>Results</p> <p>There was significant association between MR severity and echocardiogarphic indices (all p values < 0.001). Severe MR occurred more frequently in dilated cardiomyopathy (DCM) patients compared to ischemic patients, (p < 0.001). Based on the model, only Mitral valve tenting distance (TnD) (OR = 22.11, CI 95%: 14.18 – 36.86, p < 0.001) and Interpapillary muscle distance (IPMD), (OR = 6.53, CI 95%: 2.10 – 10.23, p = 0.001) had significant associations with MR severity.</p> <p>Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity.</p> <p>Conclusion</p> <p>Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.</p

Neochordameter: A new technology in mitral valve repair

Background: Mitral valve repair has shown superior results compared to mitral valve replacement in patients with mitral valve prolapse. Using premeasured neochordae (the loop technique) has been proposed for both anterior and posterior leaflet repairs. However, there are two major problems that are usually experienced using this method. One is deciding the length of the neo-chordae, and the other is tying the knot at the intended length. Objectives: This study introduced a new technology in mitral valve repair that reduces the complexity of making neo-chordae loops, especially in minimally invasive surgeries. Patients and Methods: Neochordameter is a new device which utilizes preoperative transthoracic echocardiography to determine the exact length of required neochordae and enable surgeons to make neochordae loops before starting the cardiopulmonary bypass. In this study, we applied this technique in mitral valve repair of three patients. Results: Two of these patients were male and the other one was female. All of them had severe mitral regurgitation requiring anterior leaflet repair. Total eight neochordae loops were used in these patients. No change in the length of neochordae was required after saline test and all of these patients had none or trivial mitral regurgitation by intraoperative and follow up transesophageal echocardiography. No complication was seen in six-month follow up. Conclusions: The ability of this technology in developing premeasured neo-chordae loops with accurate sizes and not needing the post-implantation length adjustment which is efficient in reducing the complexity of both minimally invasive and conventional surgeries are the issues which is going to be regarded

Neochordameter: A new technology in mitral valve repair

Background: Mitral valve repair has shown superior results compared to mitral valve replacement in patients with mitral valve prolapse. Using premeasured neochordae (the loop technique) has been proposed for both anterior and posterior leaflet repairs. However, there are two major problems that are usually experienced using this method. One is deciding the length of the neo-chordae, and the other is tying the knot at the intended length. Objectives: This study introduced a new technology in mitral valve repair that reduces the complexity of making neo-chordae loops, especially in minimally invasive surgeries. Patients and Methods: Neochordameter is a new device which utilizes preoperative transthoracic echocardiography to determine the exact length of required neochordae and enable surgeons to make neochordae loops before starting the cardiopulmonary bypass. In this study, we applied this technique in mitral valve repair of three patients. Results: Two of these patients were male and the other one was female. All of them had severe mitral regurgitation requiring anterior leaflet repair. Total eight neochordae loops were used in these patients. No change in the length of neochordae was required after saline test and all of these patients had none or trivial mitral regurgitation by intraoperative and follow up transesophageal echocardiography. No complication was seen in six-month follow up. Conclusions: The ability of this technology in developing premeasured neo-chordae loops with accurate sizes and not needing the post-implantation length adjustment which is efficient in reducing the complexity of both minimally invasive and conventional surgeries are the issues which is going to be regarded

Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study

Background It has been well documented that reduced left ventricular ejection fraction (LVEF) has adverse effect on the outcome of patients with severe mitral regurgitation (MR) after mitral valve repair (MVr). However, the best method for early detection of LV dysfunction in asymptomatic or mildly symptomatic patients with MR still has not been established. Recently two dimensional speckle tracking echocardiography (2DSTE) has been used to identify subclinical alterations of myocardial deformation in many clinical settings. Objectives Our aim was to assess the value of regional and global LV two dimensional strains to predict postoperative LV dysfunction after MVr. Methods Twenty six patients with severe MR were evaluated. Patients were divided into two groups according to their post-operative LVEF difference, those with a post-op LVEF reduction of < 10% at 3 months (Group 1), and those with post-op LVEF reduction of ≥ 10% at 3 months (Group 2). All data were measured after 3 months follow-up and compared with pre-operative measures. Results The occurrence of post-operative LV dysfunction was significantly related to left ventricular end-systolic dimension index (LVESDI), NYHA functional class and global longitudinal strain (GLS). A cut-off value of 19% for GLS could predict post-op LV dysfunction with a sensitivity of 89% and specificity of 77%. In addition a cut-off value of - 17.7% for long axis strain with a sensitivity of 78% and specificity of 77% and a cut off value of -20% for 2-chamber strain with a sensitivity of 77% and specificity 83% could predict LV dysfunction after MVr. Conclusions Among all measured data LV global longitudinal strain seems to be the most sensitive predictor of postoperative LV dysfunction in patients with severe MR and normal LVEF after surgical repair

Assessment of Subclinical Left Ventricular Dysfunction in Patients with Chronic Mitral Regurgitation Using Torsional Parameters Described by Tissue Doppler Imaging

Background: Left ventricular (LV) twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR) on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI). LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs.13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively), both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020), but there was statistically no significant difference in the LV twist rate. Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patient