Abstract 16004: Functional Mitral Stenosis After Mitral Valve Repair: Comparison of Complete Ring With Posterior Band
We have shown that functional mitral stenosis (MS) is common following mitral valve (MV) repair. In this study we assessed the mechanism of MS in these patients and compared patients with posterior MV band with those who had complete MV ring as a part of the MV repair procedure. We studied 12 patients, who had MV repair (5 with MV band and 7 with MV ring) with none or mild MR by 3 dimensional (3D) TEE.
MV annulus area and circumference were measured from the 3D dataset. We also measured the MV diastolic flow at the levels of the annulus and MV leaflet tips, and the maximum diastolic flow by continuous wave (CW) Doppler to calculate the MR area at the leaflet tips and the MV area by CW using the continuity equation. The heart rate was similar between patients with MV band (69±12 bpm) and those with MV ring (71±16 bpm). The MV area and circumference were larger in patients with MV band (6.5±1.3 cm2 and 10.1±1.1 cm versus 2.7±0.4 cm2 and 6.2±0.5 cm respectively, P<0.05). The gradients and areas are listed in the Table.
MV gradients were lower and MV areas larger in patients with MV band than those in patients with MV ring (P<0.05). There was a 34% reduction of area at the leaflet tips and 44% reduction when measured by CW, and the latter probably due to the cumulative effect of stenosis at the chordal level. The magnitudes of reduction in areas from annulus to leaflet tips and to the minimum area by CW were similar in patients with MV band and those with MV ring.
In conclusion, to minimize MS following MV repair MV band should be preferred. Our results also suggest that leaflet preservation rather than resection will further reduce the risk of MS after MV repair, as there is a substantial reduction in MV area at the leaflet level.
Author Disclosures: K. Chan: None. K. Hay: None.
- © 2016 by American Heart Association, Inc.