scholarly journals Evolution of concomitant moderate and moderate to severe functional mitral regurgitation, following aortic valve surgery for severe aortic stenosis

2020 ◽  
Vol 77 (5) ◽  
pp. 479-486
Author(s):  
Petar Dabic ◽  
Sasa Borovic ◽  
Predrag Milojevic ◽  
Jelena Kostic ◽  
Zoran Trifunovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Ventricular Remodeling ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Prognostic Indicators ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling

Background/Aim. Functional mitral regurgitation (FMR) is a common entity in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR). The aim of this study was to examine evolution of moderate and moderate to severe FMR after an isolated AVR, to identify prognostic indicators for persistent MR postoperatively, and to offer the recommendation regarding surgical intervention for moderate and moderate to severe FMR at the time of AVR for AS. Methods. We retrospectively reviewed 39 consecutive patients with moderate and moderate to severe FMR at the time of isolated AVR from January 2007 to December 2013. We collected preoperative and postoperative echocardiographic data to determine the evolution of FMR after AVR. Patients were divided into the persistent (n = 14) and improved FMR group (n = 25). Secondary division was into the prosthesis-patient mismatch (PPM, n = 7) and non prosthesis-patient mismatch group (non PPM, n = 32 patients). Late follow-up echocardiography was completed in 100% (39/39) of patients. Results. FMR improved postoperatively (MR ? 2+) in 64% (25/39) of patients, while 36% (14/39) of patients had persistent MR ? 2). In comparison to the persistent group, the patient with improved FMR had significant decrease in the left ventricular enddiastolic diameter, left ventricular end-systolic diameter, posterior wall and septum thickness postoperatively. The same indicators of reverse remodeling were found in the non PPM group in comparison to the PPM group. The incidence of postoperative FMR improvement was higher in the non PPM group (65.6%, p = 0.001) in comparison to the PPM group (42.9%, p = 0.125). The mean follow-up duration was 39.5 ? 23.5 months. Conclusion. In accordance with previous studies, this study also showed improvement in FMR following AVR surgery. Improvement in MR degree was associated with echocardiographic parameters of reverse left ventricular remodeling. Conservative approach is advisable in patients with moderate and moderate to severe FMR, believing that repair or replacement is unnecessary at the time of AVR for severe AS. PPM could prevent downgrading of FMR, stressing out the importance of choosing the prosthesis of adequate size.

Abstract 121: Improvement in Functional Mitral Regurgitation After Isolated Aortic Valve Replacement for Aortic Insufficiency

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Griffin Boll ◽  
Frederick Y Chen
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Lv Remodeling

Objective: Aortic insufficiency (AI) can lead to left ventricular (LV) remodeling characterized by dilation and increased LV mass. This remodeling can cause altered mitral valve coaptation and functional mitral regurgitation (FMR). While there is growing evidence that aortic valve replacement (AVR) for aortic stenosis promotes sufficient ventricular reverse remodeling that FMR improves or resolves, this effect is not well characterized for patients with AI. Methods: All cases of AVR for AI that were performed at a single center between January 2003 and December 2015 were reviewed. Cases with any concomitant procedures, any degree of aortic stenosis, any evidence of ischemic etiology, absence of mitral regurgitation, or significant primary mitral pathology were excluded from analysis. The primary outcome was change in FMR after isolated AVR. Secondary outcomes included change in LV ejection fraction (EF), left atrial (LA) dimension, and change in end-diastolic and –systolic LV dimensions. Two-tailed paired t-test was used to evaluate for difference between the two time points. Results: Over the course of 13.4 years, 31 cases of isolated aortic valve replacement for pure aortic insufficiency with concurrent functional mitral regurgitation were identified. 54.8% (17/31) of cases had some evidence of bacteremia or aortic vegetations at time of surgery, with 41.9% (13/31) of cases completed urgently. Postoperatively, FMR was improved in 74.2% (23/31) of the patients, and decreased by a mean 1.0 ± 0.8 grades (1.6 ± 0.8 vs 0.6 ± 0.7, p < 0.001). There was no significant change in LV EF (50.5 ± 13.4 vs. 50.2 ± 12.9, p = 0.892) or LA dimension (42.5 ± 7.2 vs 40.7 ± 5.9, p = 0.341), but there were significant reductions in the dimension of the LV at end-diastole (56.7 ± 7.1 vs 47.7 ± 8.5, p < 0.001) and end-systole (38.5 ± 9.7 vs 34.0 ± 8.3, p = 0.011). Conclusions: Significant reduction in ventricular size and subsequent improvement in functional mitral regurgitation is expected after isolated aortic valve replacement for pure aortic insufficiency.

scholarly journals P650Influence of fetunin-a level on progression of calcific aortic valve stenosis The COFRASA - GENERAC StudyP651Common carotid artery remodeling 1 year after aortic valve surgeryP652Low gradient aortic stenosis with preserved ejection fraction: reclassification of severity by 3D transesophageal echocardiography. P653Results of balloon aortic valvuloplasty in patients with impaired left ventricle ejection fraction.P654Burden of associated aortic regurgitation in patients with mitral regurgitationP655Differences in right ventricular mechanics in acute and chronic ischemic mitral regurgitation after inferoposterior myocardial infarctionP656Tricuspid regurgitation in patients operated for severe symptomatic native aortic stenosis: pre-operative determinantsP657Echocardiographic diagnosis in patients with prosthetic or annuloplasty ring dysfunction: correlation with surgical findingsP659Agreement analisys of different three-dimensional transoesophageal echocardiographic modalities and cardiac CT scan in aortic annulus sizing for transapical heart valve implantationP660Elevated gradients after TAVR are associated with increased rehospitalization, but have no impact on mortality and major adverse cardiac eventsP661Echocardiographic characteristics of post-TAVI thrombosis and endocarditis: single-centre experienceP662Impact of mixed aortic valve disease in long-term mortality after transcatheter aortic valve implantationP663Quantification of mitral regurgitation during interventional valve repair: correlation between haemodynamic parameters and 3D color Doppler echocardiographyP664Mitraclip in functional mitral regurgitation: are immediate results the same in ischemic and non ischemic etiology?P665Left ventricular contractile reserve by stress echocardiography as a predictor of response to cardiac resynchronization therapy in heart failure: a meta-analysisP666Regardless of the definition used, left ventricular reverse remodeling is not different in fibrosis positive and negative dilated cardiomyopathy patientsP667Heterogeneity of LV contractile function by multidimensional strain in patients with EF<35%: Insights for the hemodynamic burdenP668Ability of 99mTc-DPD scintigraphy to predict conduction disorders requiring permanent pacemaker in patients with transthyretin-related cardiac amyloidosisP669Provocation of left ventricular outflow tract obstruction using nitrate inhalation in hypertrophic cardiomyopathy: relation to electromechanical delayP670Could echocardiographic features differentiate Fabry cardiomyopathy from sarcomeric forms of hypertrophic cardiomyopathy?P671Pregnancy is well tolerated in women with arrhythmogenic right ventricular cardiomyopathy P672Glycogen storage cardiomyopathy (PRKAG2): do particular echocardiography findings in established and advanced techniques are helpful in suggesting the diagnosis?P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii130-ii136
Author(s):  
N. Kubota ◽  
J. Petrini ◽  
A. Gonzalez Gomez ◽  
DS. Sorysz ◽  
JM. Monteagudo Ruiz ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Ventricular Mechanics

scholarly journals Effect of persistence of left ventricular hypertrophy and left atrial dilatation after aortic valve replacement on early outcomes and survival: a prospective study

2019 ◽  
Vol 6 (10) ◽  
pp. 3786
Author(s):  
Hari Krishna Murthy P. ◽  
Abha Chandra
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Ventricular Hypertrophy ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Significant Difference ◽  
A Prospective Study

Background: The objective of the study was to evaluate the early outcomes and survival in patients with severe aortic stenosis associated with concentric left ventricular hypertrophy following aortic valve replacement.Methods: This is a prospective study done at SVIMS, Tirupati, from June 2014 to September 2015 evaluating out comes and survival in patients undergoing primary isolated aortic valve replacement (AVR) for severe aortic stenosis, severe aortic stenosis with mild aortic regurgitation and severe aortic stenosis with moderate aortic regurgitation.Results: A total of 40 cases 26 males and 14 females aged 18 to 60 years (mean age, 48.5±13.4 years) underwent elective AVR. Left ventricular end diastolic diameter (p=0.008) at 6 months, a statistically highly significant difference in left ventricular mass  preoperatively, at discharge, at 3rd and 6th month follow up. The difference in mean left ventricular mass index (LVMI) had declined from 244.425 to 141.100 at 6 months, showing a statistically highly significant difference in LVMI preop, at discharge, at 3rd month and at 6th month follow up.Conclusions: Patients with preoperative increase in LVMI, with large left atrial diameter carries a strong predictor of postoperative mortality for patients undergoing aortic valve surgery. We also conclude that there will be significant regression of LVMI following successful AVR. But, the decrease in LVMI is maximum during early three months and it is minimal though significant in the later course of follow up. 

Clinical significance of energy loss index in patients with low-gradient severe aortic stenosis and preserved ejection fraction

2020 ◽  
Vol 21 (6) ◽  
pp. 608-615 ◽  
Author(s):  
Alexandre Altes ◽  
Anne Ringle ◽  
Yohann Bohbot ◽  
Océane Bouchot ◽  
Ludovic Appert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Cardiac Mortality ◽  
Cardiac Events ◽  
Loss Index

Abstract Aims  We hypothesized that among patients with low-gradient severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), reclassification of AS severity as moderate by pressure recovery adjusted indexed aortic valve area (AVAi) = energy loss index (ELI), may identify a subgroup of patients with a better outcome. Methods and results  Three hundred and seventy-nine patients with low-gradient AS (defined by AVAi ≤ 0.6 cm2/m2 and mean aortic pressure gradient &lt; 40 mmHg) and preserved LVEF ≥50% were studied. Reclassification as moderate AS by ELI was defined as AVAi ≤0.6 cm2/m2 but with an ELI &gt;0.6 cm2/m2. Cardiac events [cardiac mortality and/or need for aortic valve replacement (AVR)] during follow-up were studied. One hundred and forty-eight patients (39%) were reclassified as moderate AS by ELI. Reclassification as moderate AS was independently associated with decreased body surface area, normal flow status, decreased left ventricular mass index, and left atrial volume index (all P &lt; 0.05). After adjustment for variables of prognostic interest, reclassification as moderate AS by ELI was associated with a considerable reduction of risk of cardiac events {adjusted hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.33–0.72]; P &lt; 0.001}, need for AVR [adjusted HR 0.52 (95% CI 0.34–0.81); P = 0.004], and cardiac mortality [adjusted HR 0.46 (95% CI 0.22–0.98); P = 0.044]. Conclusion  In patients with low-gradient severe AS and preserved LVEF, calculation of ELI permits to reclassify almost 40% of patients as having moderate AS. These reclassified patients have a considerable reduction of the risk of cardiac events during follow-up. Calculation of ELI is useful for decision-making in patients with low-gradient severe AS and preserved ejection fraction.

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