Echocardiographically based treatment of chronic ischemic mitral regurgitation.

OBJECTIVES: We evaluated results of an echocardiographically based strategy combining mitral annuloplasty with other procedures to treat chronic ischemic mitral regurgitation. METHODS: From March 2006 to February 2009, 147 patients underwent mitral valve surgery for chronic ischemic mitral regurgitation. Mean effective regurgitant orifice was 36 ± 11 mm(2), and ejection fraction was 35% ± 9%. On the basis of echocardiographic findings, in 10 cases a prosthesis was inserted and mitral annuloplasty was performed in 137 cases, isolated in 83, associated with chordal cutting in 12 cases (in 5 anterior leaflet was augmented with pericardial patch), and with exclusion of anteroseptal (n = 35) or inferior (n = 7) scars in 42. RESULTS: Thirty-day mortality was 4.8%; 3-year survival was 86% ± 3%. None of the 126 survivors were in New York Heart Association functional class III or IV. Among 117 survivors of mitral valve repair, after 18 ± 6 months mean effective regurgitant orifice reduced from 34.1 ± 10.2 mm(2) to 2.3 ± 0.4 mm(2) (P < .001). Nine patients showed residual effective regurgitant orifice 10 to 19 mm(2). Reverse remodeling was present in 69 patients (59.0%), no remodeling in 40 (34.1%), and continuous remodeling in 8 (6.9%). Ejection fraction changed from 37% ± 10% to 43% ± 10% (P < .001), improving in 47, remaining unchanged in 63, and worsening in 7. CONCLUSIONS: Echocardiographically based strategy contributed to reduced postoperative mitral regurgitation persistence (effective regurgitant orifice ≥ 10 mm(2) in 7.7% of cases, with no patients showing effective regurgitant orifice ≥ 20 mm(2)). All patients remained in New York Heart Association functional class I or II, but more than mitral annuloplasty was performed in close to 40%.

[Dilated cardiomyopathy post-chemotherapy]. / Cardiomiopatia post-chemioterapia: curare oggi pensando al domani.

We describe the case of a dilated cardiomyopathy with angiographically normal coronary arteries in a 32-year-old man who underwent head and spine radiotherapy and high dose antracicline chemotherapy at the age of 5 year for acute lymphoblastic leukemia. The long-term detrimental cytotoxic effect of remote life-saving chemotherapy should be considered in survivals of leukemia.

Mitral valve repair for ischemic mitral regurgitation.

Our aim was to evaluate midterm results in patients who underwent mitral valve repair (MVR) for ischemic mitral regurgitation (IMR) in our most recent experience. From March 2006 to March 2008, 105 patients underwent MVR for IMR. Mean IMR grade was 2.6 +/- 1.1, with 46 patients having or=3/4. Five patients (4.8%) died within first month; Two-year freedom from death any cause was 85.5% +/- 3.8, freedom from cardiac death was 88.7% +/- 3.4. NYHA Class of the survivors was 1.3 +/- 0.6, with 3 patients in NYHA Class III. Freedom from death any cause and NYHA Class III-IV was 78.6% +/- 4.6. IMR grade decreased from 2.6 +/- 1.1 to 0.1 +/- 0.3 at the discharge and to 0.5 +/- 0.3 after a mean of 7 +/- 4 months, with no patient with IMR grade 3/4 or 4/4. MVR for IMR should be performed in patients with moderate-or-more IMR grade or when the MV is excessively dilated, to achieve good midterm results.