RESULTATS HEMODYNAMIQUES ET ANGIOGRAPHIQUES APRES CORRECTION CHIRURGICALE DE L'INSUFFISANCE MITRALE. A PROPOS DE 51 CATHETERISMES ITERATIFS

Translated title of the contribution: Hemodynamic and angiographic results of surgical correction of mitral incompetence: results of 51 control catheterisations

M. Enriquez Sarano, M. Hannachi, J. M. Jais, J. Acar

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre- and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43,5 ± 12,3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 ± 22 months after surgery. The following angiographic parameters were measured: indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient: HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgical comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 ± 5 compared to 17 ± 6 mmHg, p < 0,09) and mean pulmonary artery pressures (19 ± 7 compared to 27 ± 11, p < 0,01) and increase in cardiac index (2,8 ± 0,7 compared to 2,3 ± 0,6 l/min/m2, p < 0,01). There was an associated decrease in ventricular volumes (EDV: 115 ± 44 compared to 165 ± 43, p < 0,01) (ESV: 60 ± 39 compared to 77 ± 22, p < 0,001). The reduction in myocardial mass was less spectacular (129 ± 40 compared to 148 ± 32, p < 0,01) with a resulting increase in the HC (1,10 ± 0,26 compared to 0,88 ± 0,17, p < 0,001). The geometry of the LV was less spherical in diastole (DE 0,76 ± 0,08 compared to 0,70 ± 0,08, p < 0,001) and in systole (SE = 0,83 ± 0,06 compared to 0,77 ± 0,08, p < 0,001). The EF fell slightly but this was not statistically significant (0,51 ± 0,13 compared to 0,53 ± 0,09 NS). The surgical result of 14 patients with PCP ≥ 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2,4 ± 0,5 compared to 3,0 ± 0,7, p < 0,01). The postoperative state of the left ventricle was essentially responsible for the incomplete result due to a deterioration in systolic function (EF: 0,41 ± 0,16 compared to 0,55 ± 0,09, p < 0,001; ESV: 83 ± 45 compared to 52 ± 34, p < 0,01; SE: 0,08 ± 0,07 compared to 0,85 ± 0,06, p < 0,05). The preoperative factors affecting postoperative EF were therefore analysed. The two main parameters were the preoperative EF which was closely related to postoperative EF (r = 0.69, p < 0,001) and the short duration of symptoms (< 1 year) which, for a given preoperative value of EF was associated with a better result. In conclusion, this study underlines the influence of LV systolic function on the postoperative results of correction of mitral incompetence and also the value of its assessment to judge the timing of surgery.

Translated title of the contributionHemodynamic and angiographic results of surgical correction of mitral incompetence: results of 51 control catheterisations
Original languageFrench
Pages (from-to)1194-1203
Number of pages10
JournalArchives des Maladies du Coeur et des Vaisseaux
Volume76
Issue number10
StatePublished - Jan 1 1983

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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