Title: Improvement Following Correction of Secondary Mitral Regurgitation in End-Stage Cardiomyopathy With Mitral Annuloplasty
Abstract: Secondary or functional mitral regurgitation (MR) is a common complication of ischemic and nonischemic dilated cardiomyopathy. Occurring as a result of mitral annular dilation and altered left ventricular geometry,[ 1 Boltwoo CM Tei C Wong M Shah PM Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation. Circulation. 1983; 68: 498-508 Crossref PubMed Scopus (257) Google Scholar , 2 Kono T Sabbah HN Rosman H Alam M Jafri S Goldstein S Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol. 1992; 20: 1594-1598 Abstract Full Text PDF PubMed Scopus (334) Google Scholar ]secondary MR adds to left ventricular volume overload.[ 3 Yellin EL, Yoran C, Frater RWM, Sonnenblick EH. Dynamics of acute experimental mitral regurgitation. In: Ionescu MI and Cohn LH, ed. Mitral Valve Disease: Diagnosis and Treatment. Boston, MA: Butterworth & Co. Publishers, 1985: 11–25. Google Scholar ]This may result in a "vicious cycle," in which chamber and annular dilation lead to progressive MR with greater left ventricular volume overload, progressive annular dilation, and worsening MR. Functional MR is also a marker for high mortality among patients with cardiomyopathy,[ 4 Romeo F Pelliccia F Cianfrocca C Gallo P Barilla F Cristofani R Reale A Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients. Clin Cardiol. 1989; 12: 387-392 Crossref PubMed Scopus (78) Google Scholar , 5 Blondheim DS Jacobs LE Kotler MN Costacurta GA Parry WR Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J. 1991; 122: 763-771 Abstract Full Text PDF PubMed Scopus (249) Google Scholar ]with 1-year survival estimates as low as 30%.[ 5 Blondheim DS Jacobs LE Kotler MN Costacurta GA Parry WR Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J. 1991; 122: 763-771 Abstract Full Text PDF PubMed Scopus (249) Google Scholar ]High operative mortality[ 6 Hammermeister KE Fisher L Kennedy JW Samuels S Dodge HT Prediction of late survival in patients with mitral valve disease from clinical, hemodynamic, and quantitative angiographic variables. Circulation. 1978; 57: 341-349 Crossref PubMed Scopus (67) Google Scholar , 7 Phillips HR Levine FH Carter JE Boucher CA Osbakken MD Okada RD Akins CW Daggett WM Buckley MJ Pohost GM Mitral valve replacement for isolated mitral regurgitation: analysis of clinical course and late postoperative left ventricular ejection fraction. Am J Cardiol. 1981; 48: 647-654 Abstract Full Text PDF PubMed Scopus (131) Google Scholar ]has tradionally precluded surgical intervention for MR in patients with severe ventricular systolic dysfunction. We have previously reported on the feasibility[ 8 Bolling SF Deeb GM Brunsting LA Bach DS Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovasc Surg. 1995; 109: 676-683 Abstract Full Text Full Text PDF PubMed Scopus (331) Google Scholar ]and short-term outcome[ 9 Bach DS Bolling SF Early improvement in congestiveheart failure after correction of secondary mitral regurgitation in end-stage cardiomyopathy. Am Heart J. 1995; 129: 1165-1170 Abstract Full Text PDF PubMed Scopus (136) Google Scholar ]of mitral annuloplasty in patients with end-stage cardiomyopathy. This study describes the 1-year follow-up for a cohort of 20 consecutive patients with end-stage dilated cardiomyopathy who underwent mitral annuloplasty to treat severe secondary MR and refractory symptoms of congestive heart failure (CHF).
Publication Year: 1996
Publication Date: 1996-10-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 171
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