Changes in left ventricular twist after mitral valve repair

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 141; no. 3; pp. 716 - 724
• Main Authors: Kazui, Toshinobu, Niinuma, Hiroyuki, Tsuboi, Junichi, Okabayashi, Hitoshi
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2011; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Case-Control Studies; Chronic Disease; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Japan; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Pneumology; Severity of Illness Index; Stroke Volume; Torsion, Mechanical; Treatment Outcome; Ultrasonography; Ventricular Function, Left; SV; CRT; MR; MVP; LVEF; VVI; LVESV; HR; LV; 35.4.1; 36.2; 2D; 31.1; LVEDV; left ventricle; mitral valve repair; left ventricular ejection fraction; 2-dimensional; Vector Velocity Imaging; left ventricular end-diastolic volume; left ventricular end-systolic volume; heart rate; cardiac resynchronization therapy; mitral regurgitation; stroke volume; Mitral valve; Cardiac valvular disease; Cardiovascular disease; Anesthesia; Circulatory system; Change; Cardiology; Mitral valve disease; Left ventricle
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.05.004

We performed echocardiographic tissue tracking to investigate whether mitral valve repair preserves left ventricular function. We studied 16 subjects without heart disease (11 male; mean age, 54.6 ± 15.1 years) and 18 patients in normal sinus rhythm undergoing solitary mitral valve repair (12 male; mean age, 53.6 ± 16.6 years). Transthoracic echocardiography was performed before and after surgery, and left ventricular apical and basal short-axis images were recorded. Left ventricular rotation angle was measured with off-line Vector Velocity Imaging (Siemens Medical Solutions USA Inc, Mountain View, Calif) at each slice level. Left ventricular ejection fraction was significantly higher in the control (68.4% ± 3.6%) and preoperative groups (70.9% ± 6.5%) than the postoperative group (59.4% ± 11.4%, P < .05). Left ventricular end-diastolic and end-systolic volumes were significantly greater in the preoperative group than the control group (130.0 ± 41.5 mL and 41.6 ± 16.6 mL vs 80.0 ± 16.7 mL and 26.6 ± 9.2 mL, respectively, P < .05). Left ventricular end-diastolic volume normalized postoperatively. Left ventricular twist was significantly greater in the preoperative group than the other groups (11.7° ± 4.1° versus 7.1° ± 3.8° and 8.2° ± 5.7°, P < .05). Left ventricular twist did not differ significantly between control and postoperative groups. New York Heart Association functional class improved from 1.6 ± 0.5 to 1.0 ± 0.0 after surgery ( P < .05). Although preoperative left ventricular ejection fraction seemed normal, left ventricular twist was greater. Left ventricular twist normalized after surgery, suggesting that it preserves left ventricular function.