This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kuwahara, E. Articles by Tei, C. Search for Related Content PubMed PubMed Citation Articles by Kuwahara, E. Articles by Tei, C. Related Collections Echocardiography CV surgery: valvular disease

(Circulation. 2006;114:I-529 – I-534.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mechanism of Recurrent/Persistent Ischemic/Functional Mitral Regurgitation in the Chronic Phase After Surgical Annuloplasty

Importance of Augmented Posterior Leaflet Tethering

Eiji Kuwahara, MD; Yutaka Otsuji, MD; Yoshifumi Iguro, MD; Tetsuya Ueno, MD; Fang Zhu, MD; Naoko Mizukami, RDCS; Kayoko Kubota, MD; Kenichi Nakashiki, MD; Toshinori Yuasa, MD; Bo Yu, MD; Takeshi Uemura, MD; Kunitsugu Takasaki, MD; Masaaki Miyata, MD; Shuichi Hamasaki, MD; Akira Kisanuki, MD; Robert A. Levine, MD; Ryuzo Sakata, MD; Chuwa Tei, MD

From Department of Cardiovascular Medicine (E.K., Y.O., F.Z., K.K., K.N., T.Y., B.Y., T. Uemura, K.T., M.M., S.H., A.K., C.T.), Department of Clinical Laboratory (N.M.), Department of Cardiovascular Surgery (Y.I, T. Ueno, R.S.), Kagoshima University, Kagoshima, Japan; Massachusetts General Hospital (R.A.L.), Boston, Mass.

Correspondence to Yutaka Otsuji, Department of Cardiovascular Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan. E-mail yutaka{at}m.kufm.kagoshima-u.ac.jp

Background— Surgical annuloplasty can potentially hoist the posterior annulus anteriorly, exaggerate posterior leaflet (PML) tethering, and lead to recurrent ischemic/functional mitral regurgitation (MR). Characteristics of leaflet configurations in late postoperative MR were investigated.

Methods and Results— In 30 patients with surgical annuloplasty for ischemic MR and 20 controls, the anterior leaflet (AML) and PML tethering angles relative to the line connecting annuli, posterior and apical displacement of the coaptation and the MR grade were measured by echocardiography before, early after, and late after surgery. Early after surgery, grade of MR and AML tethering generally decreased (P<0.01), whereas PML tethering significantly worsened (P<0.01). Nine of the 30 patients showed recurrent/persistent MR late after surgery. Compared with patients without late MR, those with the MR showed similar reduction in the annular area, significant re-increase in posterior displacement of the coaptation, and progressive worsening in PML tethering (P<0.05) late after surgery in comparison to the early phase. Both preoperative MR and late postoperative MR were significantly correlated with all tethering variables in univariate analysis. Although apical displacement of the coaptation was the primary determinant of preoperative MR (r²=0.60, P<0.0001), increased PML tethering was the primary determinant of late MR (r²=0.75, P<0.0001).

Conclusions— Whereas both leaflets tethering is related to preoperative ischemic MR, both leaflets tethering but with predominant contribution from augmented and progressive PML tethering is related to recurrent/persistent ischemic/functional MR late after surgical annuloplasty.

Key Words: coronary disease • mitral valve • valvuloplasty

This article has been cited by other articles:

				M. Penicka, H. Linkova, O. Lang, R. Fojt, V. Kocka, M. Vanderheyden, and J. Bartunek Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft Surgery Circulation, October 13, 2009; 120(15): 1474 - 1481. [Abstract] [Full Text] [PDF]

				B. de Varennes, R. Chaturvedi, S. Sidhu, A. V. Cote, W. L. P. Shan, C. Goyer, R. Hatzakorzian, J. Buithieu, and A. Sniderman Initial Results of Posterior Leaflet Extension for Severe Type IIIb Ischemic Mitral Regurgitation Circulation, June 2, 2009; 119(21): 2837 - 2843. [Abstract] [Full Text] [PDF]