Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis
Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis
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DOI：
10.1016/j.jacc.2007.11.082
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发表时间：
2008-04-29
影响因子：
24
通讯作者：
Pibarot, Philippe
中科院分区：
文献类型：
--
作者：
Magne, Julien;Senechal, Mario;Pibarot, Philippe
目的评价缺血性二尖瓣返流（MR）患者行限制性二尖瓣环成形术（MVA）后二尖瓣血流动力学和功能状态背景限制性二尖瓣环狭窄联合冠状动脉旁路移植术是治疗缺血性二尖瓣返流的传统方法。方法对24例限制性MVA和冠状动脉旁路移植术后13 +/-3个月的缺血性二尖瓣返流患者和20例年龄、性别、结果24例MVA患者术后无明显二尖瓣返流。与对照组相比，MVA患者有显著性差异，（p < 0.001）静息和应力峰值梯度较高（静息：13 +/- 4 mm Hg vs. 4 1 mm Hg; DSE：19 6 mm Hg vs. 6 3 mm Hg）和收缩期肺动脉压（PAP）（静息：42 ± 13 mm Hg vs. 27 ± 18 mm Hg; DSE：58 ± 12 mm Hg vs. 38 ± 11 mm Hg）和较低（p = 0.01）6 MWT距离（358 ± 95 m vs. 433 ± 61 m）。MVA组静息二尖瓣峰值压差与收缩期PAP（r = -0.67; p = 0.001）和6 MWT距离（r = -0.78; p < 0.0001）相关。这种血流动力学后遗症与较高的PAP和较差的功能能力有关。
Objectives The purpose of this study was to evaluate mitral valve hemodynamic performance and functional capacity in patients with ischemic mitral regurgitation (MR) who underwent restrictive mitral valve annuloplasty (MVA).Background Restrictive MVA combined with coronary artery bypass graft is the conventional approach for the surgical management of patients with ischemic MR. We hypothesized that the restriction of the mitral annulus could cause an obstruction to antegrade mitral flow that may affect the patient's functional capacity.Methods A dobutamine stress echocardiography (DSE) and a 6-min walk test (6MWT) were performed in 24 patients with ischernic MR 13 +/- 3 months after restrictive MVA and coronary artery bypass graft and in 20 control patients with coronary artery disease matched for age, gender, and left ventricular ejection fraction.Results None of the 24 MVA patients had significant MR after operation. Compared with control patients, MVA patients had significantly (p < 0.001) higher resting and stress peak gradients (rest: 13 +/- 4 mm Hg vs. 4 1 mm Hg; DSE: 19 6 mm Hg vs. 6 3 mm Hg) and systolic pulmonary arterial pressures (PAP) (rest: 42 13 mm Hg vs. 27 +/- 18 mm Hg; DSE: 58 +/- 12 mm Hg vs. 38 +/- 11 mm Hg) and lower (p = 0.01) 6MWT distance (358 +/- 95 m vs. 433 +/- 61 m). The resting peak mitral gradient correlated with systolic PAP (r = -0.67; p = 0.001) and 6MWT distance (r = -0.78; p < 0.0001) in the MVA group.Conclusions The results suggest that performing a restrictive MVA in patients with ischernic MR may create a functional mitral stenosis. This hemodynamic sequel is associated with higher PAP and a worse functional capacity.