Isolated Undersized Mitral Annuloplasty for Functional Mitral Regurgitation in Non-Ischemic Dilated Cardiomyopathy Reconsideration of the Relationship Between Preoperative Coaptation Depth and Persistent Mitral Regurgitation

Abstract

Background A preoperative coaptation depth (CD) ≥11 mm is apparently a predictive factor for persistent mitral regurgitation (MR) after undersized mitral annuloplasty for functional MR. The results of studies of isolated undersized mitral annuloplasty in non-ischemic dilated cardiomyopathy (DCM) are reported, including the relationship between the preoperative CD and recurrent MR. Methods and ResultsSix patients (mean age, 61 years) with severe functional MR in non-ischemic DCM underwent isolated undersized mitral annuloplasty. There were no hospital deaths. At intermediate follow-up of 2.2±1.9 years, New York Heart Association functional class improved significantly from 3.3±0.5 before surgery to 2.2±0.4 after surgery (p=0.0016). At a mean echocardiographic follow-up of 1.9±1.7 years, MR grade improved significantly from 4.0±0.0 before surgery to 1.0±0.6 after surgery (p<0.001). In 4 of 5 patients with a preoperative CD ≥11 mm, functional MR improved to mild or less than mild after surgery. Conclusions Isolated undersized mitral annuloplasty improved clinical symptoms and functional MR in nonischemic DCM. These results suggest that preoperative CD ≥11 mm does not always predict recurrent MR after isolated undersized mitral annuloplasty for functional MR in cases of non-ischemic DCM. (Circ J 2008; 72: 1744 -1750

Outcome of Non-Transplant Surgical Strategy for End-Stage Dilated Cardiomyopathy in Young Children

“…23 Considering all the results, an alternative mitral valve repair technique, such as the non-circular ring and subvalvular procedure, might be considered instead of the Alfieri method at the time of PLV. 19,24,25 As seen in the present cases of pediatric DCM, deterioration of HF is rapid, so the decision to perform a surgical intervention should be made without too much delay, particularly because emergency surgery results in a poor prognosis. However, on the basis of the onset data for both the non-surgical and surgical cases ( Table 3), onset data alone cannot predict the necessity for a surgical intervention.…”