Long Term Predictors of Recurrent Mitral Regurgitation after Mitral Valve Plasty evaluated by Three Dimensional Transesophageal Echocardiography.
Keitaro Mahara, Haruka Fujimaki, Shuichiro Takanashi.
Sakakibara Heart Institute, Tokyo, Japan.
OBJECTIVE:We sought to determine the prognostic factors of recurrent mitral regurgitation (MR) during long term follow up after mitral valve plasty (MVP) by three dimensional transesophageal echocardiography (3DTEE).
METHODS: We investigated consecutive 339 patients (age60±15, 215male) who scheduled MVP for mitral valve prolapse from January 2012 to July 2014. Eight patients who were converted to mitral valve replacement and four patients who experienced recurrent MR caused by infective endocarditis (n=3) or ring detachment (n=1) were excluded. Of these 327 patients, 207 patients who underwent MVP for A2 or P2 prolapse were enrolled. We performed transthoracic echocardiography (TTE) and 3DTEE before and within 2 weeks after surgery. TTE was also undergone 6 months, 1 year after surgery and annually after 1 year. We defined recurrent MR as more than or equal to moderate regurgitation by TTE.
RESULTS: During a mean follow-up of 17.7± 9.9 months after MVP, 11 patients (5.2%) experienced recurrent MR and 6 patients (2.8%) needed reoperation. Ten out of 11 patients had less than moderate degree of MR before discharge. TTE parameters before surgery including left ventricular ejection fraction, left ventricular end systolic and diastolic diameters, and severity of MR (effective orifice area, regurgitant volume, regurgitant fraction) were similar in with or without recurrent MR. The preoperative 3DTEE parameters including A2 height, P2 height and mitral annulus circumference, mitral valve annulus sphericity were similar in with or without recurrent MR. Three dimensional TEE after surgery revealed that the coaptation heights at repaired lesions in patients with recurrent MR were significantly shorter than those without recurrent MR. (5.1 ± 1.6 vs 7.3 ± 1.6 mm, p < 0.01, n = 11, 196 ).
CONCLUSIONS:Coaptation heights measured by postoperative 3DTEE can predict the tendency of recurrent MR. When postoperative TEE revealed short coaptation length, the patients need to receive a careful follow up, even though there is no significant recurrent MR before discharge.