Importance of Mitral Valve Repair Associated With Left Ventricular Reconstruction for Patients With Ischemic Cardiomyopathy: A Real-Time Three-Dimensional Echocardiographic Study
Importance of Mitral Valve Repair Associated With Left Ventricular Reconstruction for Patients With Ischemic Cardiomyopathy: A Real-Time Three-Dimensional Echocardiographic Study
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二尖瓣修复与左心室重建对缺血性心肌病患者的重要性：实时三维超声心动图研究
DOI：
10.1161/01.cir.0000087653.99527.50
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
James D. Thomas
中科院分区：
文献类型：
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作者：
J. Qin;T. Shiota;P. McCarthy;C. Asher;Melanie D. Hail;D. Agler;Z. Popović;N. Greenberg;N. Smedira;R. Starling;James B. Young;James D. Thomas
背景：左心室重建手术可使缺血性心肌病患者的左心室功能得到早期改善。本研究旨在通过实时三维超声心动图（3DE）评估ICM患者术后1年二尖瓣（MV）修复联合LV重建对LV功能的影响。方法和结果：研究了60例接受联合手术的ICM患者（60例左心室重建，30例二尖瓣修复，52例血运重建）。进行实时3DE，并在基线、出院、6个月和≥12个月随访时获得LV容积。术后即刻显示舒张末期容积（EDV）减少29%，收缩末期容积减少38%，并在随后的随访中保持不变（P <0.0001）。左室射血分数在出院时显著增加约10%，并维持≥12个月（P <0.0001）。尽管术前二尖瓣修复患者的左心室容积明显较大（EDV，235±87 mL vs 193±67 mL，P <0.05），但在后续随访时，其与未进行二尖瓣修复患者的左心室容积相似。7例二尖瓣返流患者EDV由139±24 mL增至227±79 mL（P <0.01）。在后期随访中，81%的患者纽约心脏协会心功能分级改善。结论-实时三维超声心动图显示，左心室重建可显著减少左心室容积，改善左心室功能，在1年随访期间，无心脏事件生存率为84%。如果成功，二尖瓣修复可以防止左心室再扩张，而复发性二尖瓣返流与左心室容积增加有关。
Background—Left ventricular (LV) reconstruction surgery leads to early improvement in LV function in ischemic cardiomyopathy (ICM) patients. This study was designed to evaluate the impact of mitral valve (MV) repair associated with LV reconstruction on LV function 1-year after surgery in ICM patients assessed by real-time 3-dimensional echocardiography (3DE). Methods and Results—Sixty ICM patients who underwent the combination surgery (LV reconstruction in 60, MV repair in 30, and revascularization in 52 patients) were studied. Real-time 3DE was performed and LV volumes were obtained at baseline, discharge, 6-month and ≥12-month follow-up. Reduction in end-diastolic volumes (EDV) by 29% and in end-systolic volumes by 38% were demonstrated immediately after surgery and remained at subsequent follow-up (P <0.0001). The LV ejection fraction significantly increased by about 10% at discharge and was maintained ≥12-month (P <0.0001). Although the LV volumes were significantly larger in patients with MV repair before surgery (EDV, 235±87 mL versus 193±67 mL, P <0.05), they were similar to LV volumes of the patients without MV repair at subsequent follow-ups. However, the EDV increased from 139±24 mL to 227±79 mL (P <0.01) in 7 patients with recurrent mitral regurgitation (MR). Improvement in New York Heart Association functional class occurred in 81% patients during late follow-up. Conclusion—Real-time 3DE demonstrates that LV reconstruction provides significant reduction in LV volumes and improvement in LV function which is sustained throughout the 1-year follow-up with 84% cardiac event free survival. If successful, MV repair may prevent LV redilation, while recurrent MR is associated with increased LV volumes.