Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: the Impact of Myocardial Fibrosis

Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry.

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Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

International Journal of Angiology ◽

10.1055/s-0039-1693457 ◽

2019 ◽

Vol 28 (04) ◽

pp. 237-244

Author(s):

Teuku Muhammad Haykal Putra ◽

Renan Sukmawan ◽

Elen Elen ◽

Celly A. Atmadikoesoemah ◽

Dwita Rian Desandri ◽

...

Keyword(s):

Cardiac Surgery ◽

Late Gadolinium Enhancement ◽

Mitral Valve ◽

Myocardial Fibrosis ◽

Mitral Stenosis ◽

Postoperative Morbidity ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Gadolinium Enhancement ◽

Rheumatic Mitral Stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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Atrial fibrillation and early clinical outcomes after mitral valve surgery in patients with rheumatic vs. non-rheumatic mitral stenosis

Heart Views ◽

10.4103/1995-705x.105730 ◽

2012 ◽

Vol 13 (4) ◽

pp. 136 ◽

Cited By ~ 2

Author(s):

SJ Mirhosseini ◽

Sadegh Ali-Hassan-Sayegh ◽

Mehdi Hadadzadeh ◽

S. M. Y Mostafavi Pour Manshadi ◽

Nafiseh Naderi

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Clinical Outcomes ◽

Mitral Stenosis ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Rheumatic Mitral Stenosis ◽

Early Clinical Outcomes

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Impact of MitraClip Program on the Volume and Outcomes of Mitral Valve Surgery: A Single-Center Retrospective Study

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.0591 ◽

2020 ◽

Vol 5 (2) ◽

pp. 131-137

Author(s):

Wei Zhang ◽

Clifton Lewis ◽

Sriniya Mallela ◽

Ali Ebrahimi ◽

Gregory Von Mering ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Perioperative Complications ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Mortality Data ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

The Impact

Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction. Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery. However, clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery. The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes. Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program. The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017. Since the initiation of the MitraClip program in 2015, the volume of both mitral valve replacement and mitral valve repair also increased (43 vs. 60 and 110 vs. 154, respectively). Importantly, we observed improved surgical outcomes, including fewer perioperative complications and lower operative mortality and in-hospital mortality. Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes. The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.

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Improvement of exercise capacity after early phase II cardiac rehabilitation in patients who undergo rheumatic mitral valve surgery

Indonesian Journal of Cardiology ◽

10.30701/ijc.1038 ◽

2020 ◽

Author(s):

Ade Meidian Ambari ◽

Budhi Setianto ◽

Anwar Santoso ◽

Basuni Radi ◽

Bambang Dwiputra ◽

...

Keyword(s):

Mitral Valve ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Phase Ii ◽

Mitral Stenosis ◽

Early Phase ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Rheumatic Mitral Stenosis ◽

Rheumatic Heart

Background: Rheumatic heart disease still become a major concern in developing countries. Recent studies showed the benefits of early phase II cardiac rehabilitation (CR) on improving the exercise capacity but the evidence in patients after rheumatic mitral valve surgery due to rheumatic heart disease is limited. This study aims to investigate the effects of early phase II CR program on increasing exercise capacity in the rheumatic mitral valve surgery patients. Methods: This is a cohort retrospective study. A review of medical records identified 254 patients who underwent early phase II CR after rheumatic mitral valve surgery between July 2009 – June 2019. Effects of CR was assessed by 6 Minutes Walking Distance (6MWD) pre and post early phase II CR and peak oxygen uptake (VO2 peak) calculated by Cahallin formula. In this study, we observed and analyzed the increasing of 6MWD and VO2 peak. Results: Our findings showed that 6MWD and VO2 peak increased significantly in these patients after early phase II CR program (p = 0.001). Mean of 6MWD increased from 316.3 ± 71.7 meters to 378.6 ± 60.3 meters and VO2 peak increased from 7.7 ±2.4 mL/kg/min to 8.9 ± 2.2 mL/kg/min. The mean difference of 6MWD was 62.3 meters and VO2 peak was 1.2 mL/kg/min. There was a strong correlation between VO2 peak and 6MWD (r = 71%; R2 = 51%; p = 0.001). Conclusion: Early phase II CR in patients with Rheumatic Mitral Stenosis after mitral valve surgery improved the exercise capacity. Based on 6MWD, we can predict the value of VO2 peak patients with rheumatic mitral stenosis surgery patients. Keywords: Cardiac rehabilitation, rheumatic mitral stenosis, 6MWD, VO2 peak

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Mitral valve surgery in patients with severe impaired left ventricular function - early and midterm results

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269207 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

S Tugtekin ◽

J Straub ◽

D Joskowiak ◽

U Kappert ◽

L Neumann ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricular Function ◽

Ventricular Function ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Impaired Left Ventricular Function ◽

Midterm Results

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Takotsubo syndrome after mitral valve surgery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa327 ◽

2020 ◽

Author(s):

Ana Devesa ◽

Rafael Hernández-Estefanía ◽

José Tuñón ◽

Álvaro Aceña

Keyword(s):

Mitral Valve ◽

Fatal Outcome ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Lv Function ◽

Partial Recovery ◽

Takotsubo Syndrome ◽

Left Circumflex Artery ◽

Coronary Syndrome

Abstract Background Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. Case summary We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. Discussion Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.

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