Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography.

BACKGROUND: Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects. METHODS: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated. RESULTS: Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol-max reduction were preoperative diastolic blood pressure (coefficient = -0.004; P = 0.02), lateral mitral annular early diastolic velocity (e') (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = -0.035; P < 0.001). Furthermore, e' was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027). CONCLUSION: Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.

Valvopatias / Valvular heart disease

A doença valvar apresenta particularidades relacionadas ao sexo. A identificação dessas diferenças é fundamental para o manejo clínico adequado. Com o declínio da doença reumática nos países desenvolvidos, a doença valvar degenerativa tornou-se a etiologia preponderante. Entretanto, nos países em desenvolvidos, a doença cardíaca reumática com comprometimento valvar é ainda bastante comum. A prevalência de insuficiência mitral resultante de prolapso da valva mitral é semelhante em ambos os sexos, porém aumenta nos homens com mais de 50 anos de idade. A estenose mitral ocorre quase que exclusivamente no sexo feminino, e no países em desenvolvimento é comum o aparecimento dos primeiros sintomas na gestação, ao contrário do que ocorre nos países desenvolvidos, em que a afecção se manifesta na quinta e na sexta década da vida. Nas gestantes muito sintomáticas, portadoras de estenose mitral, a valvotomia mitral percutânea é o tratamento mais indicado, com resultado clínico favorável imediato. A insuficiência aórtica predomina nos homens e os parâmetros ecocardiográficos de gravidade foram direcionados para eles. As mulheres são encaminhadas para cirurgia sobretudo pelos sintomas, pois dificilmente atingem os diâmetros ventriculares recomendados pelas diretrizes do American College of Cardiology/Americam Heart Association (ACC/AHA). Na estenose aórtica...

Valvular heart disease has gender-related peculiarities. The identification of these differences is essential for adequate clinical management. With the decrease of rheumatic disease in developed countries, degenerative valvular disease has become the most prevalent etiology. Nevertheless in developing countries, rheumatic heart disease with valvular commitment is still very common. The prevalence of mitral valve insufficiency as a consequence of mitral valve prolapse is similar in both genders, however it increases in men over 50 years of age. Mitral stenosis occurs almost exclusively in women and in developing countries the onset of symptoms is usually observed during pregnancy, whereas in developed countries it is manifested in the 5th and 6th decades of life. Percutaneous mitral valvulotomy is the most indicated treatment, with immediate favorable clinical results in very symptomatic pregnant women with mitral stenosis. Aortic insufficiency is prevalent in men and the echocardiographic severity parameters were developed for them. Women are referred to surgery especially because of their symptoms since they rarely achieve the ventricular diameters recommended by the guidelines of the American College of Cardiology/American Heart Association (ACC/AHA). There is a differentiated gender-related response to ventricular hypertrophy in aortic stenosis. Women develop more hypertrophy than men. All of these evidences affect the course of women with valvular heart disease.