Ischemic mitral valve repair: Correlations between the mechanisms of mitral regurgitation and left ventricular function prior to and following surgery

Figures & data

Table I.  Mechanisms of functional ischemic MR and corresponding MV repair techniques.

Group	MR type	MR mechanism	MR jet	No. of pts	MV repair technique
1	I	Annular dilation	Central	22	1. Ring annuloplasty (10 pts) 2. Suture annuloplasty (12 pts)
2	II	A3P3 commissural prolapse due to elongation of posterior papillary muscle after inferior MI and papillary muscle ischemic damage	Two-directional at the posteromedial commissural and paracommissural zone	11	Ring annuloplasty with papillary muscle shortening plasty (11 pts)
3	IIIb	1. Restriction of posterior mitral leaflet (especially P3) due to leaflet tethering and A3 pseudoprolapse – bulging as a result of relative slackness of chordae tendineae after inferior MI and papillary muscle ischemic damage and displacement	1. Eccentric at the posteromedial commissure directed to the posterolateral wall of the left atrium	13	1. Ring annuloplasty with shortening of the primary – free edge chords of the anterior leaflet (13 pts)
		2. Restriction of posterior mitral leaflet due to leaflet tethering after inferobasal MI and displacement of posterior papillary muscle without its ischemic damage	2. Central and eccentric at the posteromedial commissure	7	2. Ring annuloplasty (7 pts)

MI = myocardial infarction; MR = mitral regurgitation; MV = mitral valve.

Table II.  Demographic and clinical data.

Characteristics	Group 1 (n=22)	Group 2 (n=11)	Group 3 (n=20)
Age (years)	65.15±6.78	63.12±10.3	66.5±9.18
Previous MI	100%	100%	100%
Anterior (septal)	20/22	–	3/20
Inferior	5/22	11/11	20/20
Multiple	6/22	–	3/20
Three-vessel CAD	100%	8/11 73%	18/20 90%
NYHA functional class III–IV	100%	9/11 82%	18/20 90%
Bypass grafts/pt	3.3±0.6	3.3±0.9	3.2±0.2

CAD = coronary artery disease; MI = myocardial infarction.

Table III.  Echocardiographic data.

	Group 1 (n=22)			Group 2 (n=11)			Group 3 (n=20)
Indices	Preoperatively	10–14 d following surgery	1 year following surgery	Preoperatively	10–14 d following surgery	1 year following surgery	Preoperatively	10–14 d following surgery	1 year following surgery
MR grade	2.7±0.5	1.1±0.82^a	1.95±1.26^abc	2.89±0. 46	0.89±0.6^a	1.35±1.06^ac	2.93±0.52	0.8±0.71^a	1.26±0.92^ab
ERA (mm^2)	27.5±4.08	–	18.75±5.6^bc	31.0±7.5	–	9.7±6.7^ac	30.5±8.06	–	10.1±9.49^ab
LVEDDI (mm/m^2)	31.8±3.05	30.8±4.4	32.6±5.6^b	29.8±3.9	28.2±3.1	28. 8±4.1	30.17±3.05	28.12±2.9^a	28.7±3.3^b
LVESDI (mm/m^2)	26.46±3.3^bc	25.7±4.8	26.6±6.1^bc	22.9±3.1^c	22.1±3.3	21.9±4.5^c	23.11±2.9^b	21.0±2.94^a	20.7±3.3^ab
LVEF (%)	29.05±6.9^bc	30.2±9.3	30.5±11.3^bc	35.82±8.4^c	40.7±9.6^a	41.8±8.4^ac	34.95±7.78^b	39.1±2.72^a	41.29±7.9^ab
WMSI	2.08±0.24	1.98±0.31	2.03±0.44^bc	1.92±0.45	1.8±0.42^a	1.7±0.54^c	1.9±0.32	1.74±0.33^a	1.67±0.33^ab
PAP mean (mmHg)	35.9±5.46	36.1±6.2	37.5±8.17^bc	33.2±8.4	32.5±7.6	29.9±6.7^c	35.6±6.13	33.5±6.54	30.6±7.8^ab
PAP systolic (mmHg)	44.2±6.35	43.1±7.7	47.9±9.6^bc	42.73±7.5	36.8±11.6	35.8±11.8^c	44.25±10.17	38.4±7.9^a	37.6±11.2^b

^ap<0.05 pre- and postoperatively.

^bp<0.05 between groups 1 and 3.

^cp<0.05 between groups 1 and 2.

EDDI = end-diastolic diameter index; ESDI = end-systolic diameter index; EF = ejection fraction; ERA = effective regurgitant area; LV = left ventricle; MR = mitral regurgitation; PAP = pulmonary artery pressure; WMSI = wall motion score index.

Figure 1. NYHA functional class III–IV rate.