Circulation, Vol 89, 132-137, Copyright © 1994 by American Heart Association
MD Tischler, KA Cooper, M Rowen and MM LeWinter
BACKGROUND: Standard mitral valve replacement (MVR) in patients with
chronic mitral regurgitation results in consistent reductions in resting
postoperative ejection fraction. This has been attributed to removal of the
low-impedance ejection pathway into the left atrium or to disruption of the
chordal apparatus. Mitral valve repair (MVP) does not reduce ejection
fraction at rest. However, whether MVP confers any advantages with regard
to dynamic left ventricular performance has not been investigated. The aim
of this study was to directly compare standard MVR with MVP and to
determine their respective influences on ventricular ejection performance
during bicycle exercise. METHODS AND RESULTS: Ten consecutive patients with
pure chronic mitral regurgitation who underwent MVP and 10 patients matched
for age, sex, and preoperative ejection fraction who underwent standard MVR
for pure chronic mitral regurgitation performed symptom-limited, graded
upright bicycle exercise with simultaneous Doppler and quantitative two-
dimensional echocardiography. Patients with MVP had significantly greater
rest (55 +/- 12%) and exercise (63 +/- 11%) ejection fractions than matched
patients with MVR (40 +/- 13% [P < .0001] and 42 +/- 17% [P < .005],
respectively). End-systolic circumferential wall stress was significantly
lower at rest (190 +/- 36 versus 244 +/- 46; P < .03) and at peak
exercise (231 +/- 46 versus 300 +/- 52; P < .02) in patients with MVP.
At peak exercise, left ventricular shape was significantly more spherical
in patients with MVR than those with MVP (1.84 +/- 0.31 versus 2.45 +/-
0.59; P < .02). CONCLUSIONS: MVR with chordal transection resulted in
significant reductions in rest and exercise ejection fraction. This was
caused in part by a significant increase in end-systolic circumferential
wall stress. MVP resulted in improved rest and exercise ejection indexes,
primarily due to a marked reduction in end-systolic stress and maintenance
of a more ellipsoidal chamber geometry.
ARTICLES
Mitral valve replacement versus mitral valve repair. A Doppler and quantitative stress echocardiographic study
Cardiology Unit, Medical Center Hospital of Vermont, Burlington 05401.
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