Anthropometric normalization of left ventricular size in chronic mitral regurgitation

Prevalence and clinical characteristics of nondilated cardiomyopathy and the effect of atrial fibrillation

The treatment of patients with chronic heart failure and those with asymptomatic left ventricular (LV) dysfunction has focused primarily on patients with LV enlargement and a low ejection fraction (EF). Little attention has been paid to those with a normal chamber size and a low EF. We sought to examine the LV geometry and clinical characteristics in such patients with nondilated cardiomyopathy. Of 3,350 transthoracic echocardiograms performed during a 6-month period, 696 showed an EF of < or =0.45. The patients with an end-diastolic diameter of >56 mm, regional wall motion abnormalities, or valvular disease were excluded. Of the 696 patients, 98 met these criteria, and their medical records were reviewed. The average age was 71 +/- 14 years, and 56% were men. Common co-morbidities included hypertension in 52% and atrial fibrillation (AF) in 43%. Only 22% had disabling cardiac symptoms (functional class III or greater). The average end-diastolic dimension was 49 +/- 5 mm, and the EF was 34 +/- 8%. LV hypertrophic remodeling was present in 53%. A second echocardiogram (422 +/- 177 days after the baseline study) was available for 54 patients. The chamber size was unchanged, but the EF had increased from 33 +/- 8% to 40 +/- 14% (p <0.01). The improvement in EF was seen in the group with AF (33 +/- 6% to 44 +/- 15%, p <0.01) but not in those with normal sinus rhythm (33 +/- 9% to 37 +/- 12%, p = NS). In conclusion, 14% of patients with an EF of < or =0.45 had nondilated cardiomyopathy, often with LV hypertrophic remodeling and/or AF. An improvement in LV function can be expected in many patients with nondilated cardiomyopathy, particularly those with AF.

Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important?

OBJECTIVE

This study was undertaken to determine hemodynamic and clinical outcomes of annuloplasty with a standard-sized (63 mm) posterior band in adult patients undergoing mitral valve repair for degenerative valve disease.

METHODS

We studied 511 patients who underwent isolated mitral valve repair for degenerative disease with a 63-mm posterior band used for annuloplasty. Operations were performed between 1994 and 2001, and average follow-up was 4.8 +/- 3.1 years. Echocardiographic data were reviewed, with specific focus on the relationship between patient size and residual mitral regurgitation and gradient.

RESULTS

Mean age at the time of operation was 59.3 +/- 13.5 years, and 72% were male. Body mass index was 25.8 +/- 4.1 kg/m(2), and body surface area was 1.97 +/- 0.24 m(2). Preoperative mean ejection fraction was 64% +/- 7%, and 96% of patients had severe mitral regurgitation on preoperative echocardiography. The 30-day mortality was 0.8%. At hospital discharge, the mean gradient was 4.7 +/- 3.1 mm Hg. Body surface area, body mass index, and weight were not associated with postoperative gradients or residual regurgitation at discharge. At last follow-up, 89% of patients had no or mild regurgitation, and the mean ejection fraction was 58% +/- 9%. At 5 years, survival was 95% and cumulative risk of reoperation was 3%.

CONCLUSION

A standard-sized (unmeasured) posterior annuloplasty band provided excellent intermediate results with good durability. There were neither excess gradients in larger patients nor excess regurgitation in smaller patients. Measured annuloplasty is unnecessary for most adults undergoing mitral valve repair.