Predictive Geometric Analysis of Mitral Valve for Recurrence of Mitral Regurgitation after Mitral Annuloplasty in Patients with Atrial Functional Mitral Regurgitation

MO063 

Abstract Submission 

shusuke imaoka (1), Takumi Kawamura (2), Daisuke Yoshioka (3), Takuji Kawamura (4), Ryohei MATSUURA (4), Ai Kawamura (5), Yusuke Misumi (6), Shigeru Miyagawa (6)

(1) N/A, Japan, (2) Osaka univercity hosipital, Suita city, NA, (3) Osaka University Hospital, Osaka, (4) N/A, Osaka, (5) N/A, N/A, (6) Osaka University Hospital, Suita, Osaka

しゅうすけ いまおか    -  Contact Me
N/A

Masashi Kawamura    -  Contact Me
Osaka univercity hosipital

Daisuke Yoshioka    -  Contact Me
Osaka University Hospital

Takuji Kawamura    -  Contact Me
N/A

Ryohei MATSUURA    -  Contact Me
N/A

Ai Kawamura    -  Contact Me
N/A

Yusuke Misumi    -  Contact Me
Osaka University Hospital

Shigeru Miyagawa    -  Contact Me
Osaka University Hospital

しゅうすけ いまおか    -  Contact Me
N/A

Objective: Recent studies reveal precise recognition and increased prevalence of atrial functional mitral regurgitation (AFMR). However, the mechanism of AFMR is not fully addressed, and appropriate surgical intervention is still unknown. We herein reviewed patients with AFMR underwent mitral annuloplasty (MAP) in our institution and investigated preoperative geometric characters of the mitral valve in terms of recurrence of MR after surgery.

Method: We retrospectively reviewed 20 patients with AFMR underwent mitral valve surgery from 2010 to 2022 (median age: 75±7 years, male: 30%). Mean follow-up period was 3.2±2.3years. Preoperative three-dimensional transesophageal echocardiogram (3D TEE) was available in all patients and geometric analysis of the mitral valve was performed by software of the Philips Q-Lab.

Result: All patients survived during the follow-up period. MAP was performed in all patients, anterior mitral leaflet chordal reconstruction using artificial chordae in 2 patients, and patch augmentation of mitral posterior leaflet in 1 patient. Freedom rate from recurrent of MR was 79% and 57% at 1year and 3 years, respectively. Recurrent MR occurred in 6 patients and the causes were recurrent of functional MR in 4 patients and detachment of MAP ring in 2 patients. Preoperative 3D TEE examination revealed that patients with recurrent MR had longer circumstance of mitral annulus and larger area of posterior mitral leaflet (PML) than patients without recurrent MR (circumstance of mitral annulus; 137±11 vs. 124±12 mm, p = 0.02, PML area; 797±231 vs. 552±144 mm2 p = 0.01). Especially, lateral side of PML in patients with recurrent MR was longer than those in patients without recurrent MR (P1; 15±5 vs.10±3 mm, p＜0.01, P2; 14±4 vs.11±4 mm, p =0.23, P3; 10±3 vs.8±3 mm, p =0.13).

Conclusion: AFMR patients with longer circumstance of mitral annulus, larger PML area, and asymmetric PML remodeling tended to recur MR after MAP. Those factors in the mitral valve could indicated progressed remodeling and advanced disease stage of AFMR, and MAP only might not be sufficient for those patients.

Other Mitral Valve Disease