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Purpose: To evaluate clinical outcomes of customized mitral valve plasty (MVP) for the treatment of functional mitral regurgitation (FMR) with a low ejection fraction (EF) and to determine which preoperative factors affected the clinical outcome. Methods and Results: MVP was adjusted according to the degree of left ventricle (LV) remodeling. We performed mitral annuloplasty (MAP) alone in 14 patients and added subvalvular procedures (SVPs) in 22 patients at a high risk of recurrent MR. During follow-up, reverse LV remodeling was obtained and the 3-year and 5-year non-recurrence rates of MR grade ≥2 were 94% and 89%, respectively. Two patients died during their hospital stay, and four more patients died of cardiac causes during follow-up. The 3-year and 5-year rates of freedom from cardiac-related mortality were 86% and 81%, respectively; no significant difference was observed between the two treatment groups. Right ventricular fractional area change (RVFAC) was a significant predictor of cardiac mortality. Patients with an RVFAC of <26% had significantly poorer cardiac-related mortality (71% at 3 years) than those with an RVFAC of ≥26% (95% at 3 years). Conclusion: Customized MVP provided durable mitral competence and reverse LV remodeling. Preoperative RV function was associated with cardiac-related mortality.

We have previously reported that during the interdigestive state repeated episodes of high-amplitude contractions interrupted by long-lasting motor quiescence were seen to occur regularly until the next meal in the dog. However, none of the dogs used in our laboratory showed such regular changes in gastric motor pattern all the time during the interdigestive state. In the present study, we measured plasma motilin concentrations and intraduodenal pH together with gastric motor activity in conscious dogs. It was found that as long as intraduodenal pH remained between 7.0 and 8.5 the regular occurrence of the interdigestive contractions was closely associated with increases in the plasma immunoreactive motilin (IRM) concentration. However, when intraduodenal pH became acid, there were no typical interdigestive contractions even though plasma IRM concentration was elevated. We consider that high-amplitude contractions like the interdigestive contractions could not be evoked in the acid-secreting stomach even if the plasma IRM concentration was elevated during the interdigestive state. Acid secretion during the fasted state, the cause of which is not known, seems to be one of the main factors in disturbing the regularity of the interdigestive motor pattern.

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