Perioperative Predictors for Recurrence of Mitral Regurgitation after Surgery for Ischemic Mitral Regurgitation

BACKGROUND AND OBJECTIVES : In clinical practice, significant recurrence of mitral regurgitation (MR) is observed frequently even after surgical treatment for ischemic MR (IMR). The purpose of this study is to evaluate the recurrence rate of MR and to investigate perioperative predictors for its recurrence following surgery for IMR. SUBJECTS AND METHODS : We retrospectively analyzed 106 patients who underwent surgical management for IMR. Echocardiographic parameters, such as severity of MR, ejection fraction, diastolic left ventricular (LV) dimension, systolic LV dimension, left atrial size, LV sphericity index, mitral valve (MV) tenting area, MV tenting height (TH), tethering distance, MV intraleaflet angle (MVILa), and MV intraleaflet height (MVILh) were measured. RESULTS : Two types of surgery were performed to treat IMR, including valvuloplasty combined with coronary artery bypass graft (CABG)(group A, n=79) and LV volume reduction surgery combined with CABG (group B, n=27). Significant MR was detected echocardiographically 5.4+/-6.7 months after the surgery. The overall recurrence rate of MR was 17% (n=18), and 15.2% (n=12) in group A and 22.2% (n=6) in group B. The preoperative TH and the postoperative MVILh were independent perioperative predictors for the recurrence of significant MR according to multiple logistic regression analysis (p<0.05, respectively). CONCLUSION : The overall postoperative recurrence rate of significant MR after surgical repair is 17% within 6 months. Independent perioperative predictors of recurrent MR after surgery for IMR are the preoperative TH and the postoperative MVILh. For better outcomes in IMR management, those two factors should be considered in the surgical repair of IMR.

Mitral-aortic Intervalvular Fibrosa Pseudoaneurysm with Dual Fistula that Occurred in Prosthetic Aortic Valve Endocarditis

The Iinvolvement of subaortic structures in the aortic valve endocarditis appears more commonly than previously recognized. These subaortic complications are most commonly located in the mitral-aortic intervalvular fibrosa and may be presented as abscess, or as pseudoaneurysm with or without perforation. Perforated pseudoaneurysm can lead to the development of communication between the left ventricular outflow tract and various cardiac chambers, most commonly the left atrium. These complications are related with poor prognosis. Early and precise recognition of these complications is important for optimal treatment. At present, transesophageal echocardiography (TEE) has been validated as the technique of choice. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa featuring the connection of the fistulous simultaneously to the left atrium and aorta. In our case, accurate interpretation of TEE imaging revealing the subaortic structures was not so easy due to interference of both aortic and mitral prosthetic valves. We expect the further development of (Ed-confirming that here you don't intend, "We expect to further develop") TEE and other imaging modalities to substantially improve the future diagnosis of these undesirable complications.

Aneurysm of the Sinus of Valsalva Dissecting into the Ventricular Septum Associated with Paravalvular Leakage After Double Valve Replacement / 대한흉부외과학회지

We experienced a case of aneurysm of the sinus of Valsalva dissecting into the ventricular dseptum. This dissection was induced by paravalvular leakage after aortic and mitral valve replacement. This 37-year-old male was admitted via emergency room due to progressive dyspnea. He had undergone aortic valve replacement(carbomedic(R) 23 mm) and mitral valve replacement(carbomedic(R) 31 mm) due to aortic regurgitation and mitral regurgitation about 6 years prior to admission and followed up regularly. The diagnosis was made by transthoracic and transesophageal echocardiography and reconfirmed by root aortography. The inlet of the ventricular septal aneurysmal sac was repaired by one layer suture with 3-0 prolene of the endocardium, epicardium and homograft muscle shoulder altogether. Postoperative course was uneventful and the patient was discharged on the 11th postoperative day.