Examination of Anterior Leaflet Pseudoprolapse Causing Severe Mitral Regurgitation and Its Ideal Surgical Procedure

Abstract

<jats:p>Background: The aim of this study is to evaluate severe mitral regurgitation caused by so called atrial leaflet “pseudoprolapse” and verify the effect of simple annular stabilization.&#x0D; Methods: One-hundred-twenty-two patients underwent surgery for severe mitral regurgitation at our institute between January 2015 to July 2018. Of those, 32 cases diagnosed as anterior leaflet prolapse that underwent mitral repair were analyzed. Ten cases with pseudoprolapse, which is defined as anterior leaflet prolapse without dropping into the left atrium beyond the annular line causing eccentric regurgitation flow directed to the posterior atrium, were classified as the Pseudoprolapse Group. The other 22 cases had obvious anterior leaflet prolapse dropping into the left atrium; these cases were classified as the True Prolapse Group. We compared clinical findings between the 2 groups and reviewed pseudoprolapse cases.&#x0D; Results: Patients in the Pseudoprolapse Group had lower ejection fraction and lower regurgitation volume than those in the True Prolapse Group. A2 lesion as main inflow of regurgitation was more included in the Pseudoprolapse Group. All but one patient in the Pseudoprolapse Group received only simple annuloplasty, and all patients in the True Prolapse Group received leaflet repair and annuloplasty. In both groups, mid-term regurgitation grade and the reoperation rate were satisfactory. In the Pseudoprolapse Group, 6 cases were clarified as atrial functional mitral regurgitation, and 4 cases were considered to have focal posterior leaflet tethering.&#x0D; Conclusions: Pseudoprolapse cases could be characterized by low ejection fraction, low regurgitation volume, and A2 prolapse. For most cases with pseudoprolapse, simple annuloplasty may be enough, however further study is needed.</jats:p>

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

“…Cumulatively, 366 (74%) patients had AF at the time the diagnosis of AFMR was made. Notably, nine studies had a 100% rate of AF in their cohorts, whereases Balogh et al 20 and Tanaka et al 13 reported AF in 93% and 60% of their patients, respectively. Four studies (33.3%) included information on prognostic scores such as the European System for Cardiac Operative Risk Evaluation II and the Society of Thoracic Surgeons Score.…”

“…Two studies (16.6%) identified a central MR jet as inclusion criteria, and one study (8.3%) considered Carpentier type 1 leaflet motion as inclusion criteria. Conversely, both Carpentier types 1 and 3 leaflet motion were excluded in Tanaka et al, 13 as well as Carpentier type 2 was excluded in the study by Matsumori et al 14 Interestingly, Tanaka et al 13 considered AFMR patients to be a subgroup of those affected by anterior leaflet pseudoprolapse rather than being a unique category, thus suggesting an overlap between the ways they defined these diseases.…”

“…Notably, nine studies had a 100% rate of AF in their cohorts, whereases Balogh et al 20 and Tanaka et al 13 reported AF in 93% and 60% of their patients, respectively. Four studies (33.3%)…”

“…Vohra et al 15 Takahashi et al 16 Takahashi et al 17 Sakaguchi et al 7 Kaneyuki et al 18 Chen et al 19 Matsumori et al 14 Balogh et al 20 Tanaka et al 13 Hirji et al 21 Carino et al 22 Inclusion criteria Chronic AF Carpentier Type 2…”