Restrictive Mitral Annuloplasty With or Without Surgical Ventricular Restoration in Ischemic Dilated Cardiomyopathy With Severe Mitral Regurgitation
- 13 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 124 (11_suppl_1), S107-14
- https://doi.org/10.1161/circulationaha.110.010330
Abstract
Background— We assessed changes in left ventricular (LV) volume and function and in regional myocardial wall stress in noninfarcted segments after restrictive mitral annuloplasty (RMA) with or without surgical ventricular restoration (SVR). Methods and Results— Thirty-nine patients with ischemic cardiomyopathy (ejection fraction ≤0.35) and severe mitral regurgitation (≥3) were studied before and 2.8 months after surgery with cine-angiographic multidetector computed tomography (cine-MDCT). Eighteen underwent RMA alone (RMA group) and 21 underwent RMA and SVR (RMA+SVR group). In addition to measuring conventional parameters (LV end-diastolic volume index [LVEDVI], LV end-systolic volume index [LVESVI], and LV ejection fraction), we evaluated the regional circumferential end-systolic wall stress and mean circumferential fiber shortening in both the basal and mid-LV regions using 3-dimensional cine-MDCT images. LV end-diastolic and end-systolic volume indexes were significantly greater in the RMA+SVR group than in the RMA group preoperatively, but these values did not differ significantly postoperatively. LV end-diastolic and end-systolic volume indexes decreased significantly, by 21% and 27% after RMA and by 35% and 42% after RMA and SVR, and the percent reductions in LV end-diastolic and end-systolic volume indexes were significantly larger in the RMA+SVR group. Regional end-systolic wall stress decreased and circumferential fiber shortening increased significantly in the noninfarcted regions after RMA with or without SVR. Conclusions— RMA plus SVR showed a potentially greater reduction of LV end-diastolic and end-systolic volume indexes than RMA alone. In selected patients with more advanced LV remodeling, concomitant SVR may favorably affect the LV reverse-remodeling process induced by RMA.Keywords
This publication has 24 references indexed in Scilit:
- Coronary Bypass Surgery with or without Surgical Ventricular ReconstructionNew England Journal of Medicine, 2009
- Surgical Ventricular Restoration: Left Ventricular Shape Influence on Cardiac Function, Clinical Status, and SurvivalThe Annals of Thoracic Surgery, 2009
- The post–myocardial infarction scarred ventricle and congestive heart failure: The preeminence of magnetic resonance imaging for preoperative, intraoperative, and postoperative assessmentThe Journal of Thoracic and Cardiovascular Surgery, 2008
- Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance studyEuropean Heart Journal, 2008
- Surgery for Severe Mitral Regurgitation and Left Ventricular Failure: What Do We Really Know?Journal of Cardiac Failure, 2008
- Estimation of global and regional cardiac function using 64-slice computed tomography: A comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonanceInternational Journal of Cardiology, 2007
- Multi–detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonanceAmerican Heart Journal, 2006
- Left ventricular reconstruction: Early and late resultsThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in patients with ischemic cardiomyopathyThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Postinfarction Left-Ventricular Aneurysm: Regional Stress, Function, and Remodeling After AneurysmectomyThe Thoracic and Cardiovascular Surgeon, 1998