PMID- 10319614
OWN - NLM
STAT- MEDLINE
DCOM- 19990521
LR  - 20190921
IS  - 0023-5679 (Print)
IS  - 0023-5679 (Linking)
VI  - 46
IP  - 1
DP  - 1999
TI  - An evaluation of left ventricular function after surgery for pure mitral 
      regurgitation using dobutamine-stress echocardiography--should the mitral complex 
      be preserved?
PG  - 61-70
AB  - To evaluate the importance of preserving the mitral complex, clinical outcomes 
      and postoperative left ventricular (LV) functions of 175 patients with pure 
      mitral regurgitation (MR) were analyzed. They were divided into three groups; 
      patients who had conventional mitral valve replacement (cMVR; n = 47), posterior 
      mitral leaflet preserved MVR (pMVR; n = 66) or mitral valvuloplasty (MVP; n = 
      62). There was no operative death or hospital death in this study. The actuarial 
      survival rate was 85.2% in cMVR, 78.5% in pMVR, and 84.7% in MVP at 10 years 
      after operation. The actuarial freedom from reoperation 10 years postoperatively 
      was 100% in cMVR, 97.9% in pMVR, 85.8% in MVP. The actuarial freedom from 
      thromboembolism (TE) at 10 years was 92.2% in cMVR, 87.1% in pMVR, 93.5% in MVP. 
      Freedom from all types of events including non-cardiac death was 78.3% in cMVR, 
      64.8% in pMVR, 65.3% in MVP at 10 years, respectively. Pre- and postoperative LV 
      function was evaluated using echocardiography. Patients with MVP had better LV 
      performance than those with MVR. However, there was no significant difference 
      between the cMVR and pMVR groups. For further estimation of postoperative LV 
      function, dobutamine-stress echocardiography (DSE) was performed. The results of 
      DSE revealed that the LV contractility in MVP was obviously better than those in 
      MVR groups especially in systole. The change in ejection fraction (EF) from 
      baseline to peak dobutamine stress in the pMVR group was significantly greater 
      than in cMVR. This study supports the concept that the preservation of continuity 
      between the mitral annulus and papillary muscle plays an important role in 
      clinical outcome and postoperative LV function. In conclusion, MVP should be a 
      first choice as an operative method for pure MR when technically feasible. When 
      it is impossible to perform MVP, pMVR, not cMVR, should be the next choice. This 
      study suggests that preservation of papillary muscle-mitral annular continuity 
      during mitral valve surgery for pure MR is beneficial to LV systolic function.
FAU - Oda, T
AU  - Oda T
AD  - Department of Surgery, Kurume University School of Medicine, Japan.
LA  - eng
PT  - Journal Article
PL  - Japan
TA  - Kurume Med J
JT  - The Kurume medical journal
JID - 2985210R
RN  - 3S12J47372 (Dobutamine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Dobutamine
MH  - *Echocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*physiopathology/surgery
MH  - Postoperative Complications/etiology
MH  - Reoperation
MH  - Thromboembolism/etiology
MH  - *Ventricular Function, Left
EDAT- 1999/05/13 00:00
MHDA- 1999/05/13 00:01
CRDT- 1999/05/13 00:00
PHST- 1999/05/13 00:00 [pubmed]
PHST- 1999/05/13 00:01 [medline]
PHST- 1999/05/13 00:00 [entrez]
AID - 10.2739/kurumemedj.46.61 [doi]
PST - ppublish
SO  - Kurume Med J. 1999;46(1):61-70. doi: 10.2739/kurumemedj.46.61.