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INTRA-OPERATIVE MITRAL GRADIENTS AND AREA IN PREDICTING FUNCTIONAL MITRAL STENOSIS FOLLOWING MITRAL VALVE REPAIR FOR DEGENERATIVE MITRAL REGURGITATION
A1983 JACC April 1, 2014 Volume 63, Issue 12
Valvular Heart Disease Intra-Operative Mitral Gradients and Area in Predicting Functional Mitral Stenosis following Mitral Valve Repair for Degenerative Mitral Regurgitation Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Valvular Heart Disease: Functional Imaging Abstract Category: 28. Valvular Heart Disease: Clinical Presentation Number: 1195-343 Authors: Kwan-Leung Chan, Buu-Khanh Lam, Thierry Mesana, Mark Hynes, University of Ottawa Heart Institute, Ottawa, Canada Background: We have previously demonstrated that functional mitral stenosis (MS) is a common but under-recognized complication which is associated with adverse functional impact in patients following mitral valve (MV) repair for degenerative mitral regurgitation. The objective of the present study was to determine whether intra-operative measures of transmitral gradients (peak and mean) and planimetered MV area following MV repair can predict the development of functional MS during follow-up. Methods: Functional MS was defined as resting mean MV diastolic gradient > 5 mmHg during follow-up. We studied 67 patients who had < mild mitral regurgitation, and intra-operative MV gradients and area measurements after MV repair. Results: The mean age was 59 + 11 years and body mass index 26.3 + 3.8 kg/m2. Of these, 23 patients (34%) had functional MS at a follow-up of 3.8 + 2.4 years. The intra-operative peak and mean MV gradients were lower than the follow-up resting gradients (6.7 + 2.9 and 3.6 + 1.8 mmHg vs. 10.4 + 4.6 and 4.8 + 2.4 mmHg respectively, p < 0.05), despite a higher heart rate during the intra-operative assessment (79.7 + 9.1 vs 73.2 + 11.1 bpm, p < 0.0003). The intra-operative planimetered MV area was larger than the follow-up MV area by the continuity method (3.20 + 1.0 cm2 vs. 2.11 + 0.62 cm2, p < 0.05). There was good correlations between the intra-operative mean MV gradient and the follow-up resting peak and mean MV gradient (r=0.33 and 0.45, p = 0.006 and 0.0001 respectively). The relationship between the intra-op mean gradient (x) and the follow-up mean MV gradient (y) can be expressed as follows: y=2.7 + 0.6x. An intra-operative mean MV gradient > 4 mmHg detected 17 of 23 patients with mean MV gradient > 5 mmHg during follow-up. There was poor correlation between intra-operative MV area and follow-up resting mean MV gradient and MV area. Conclusion: Intra-operative mean MV gradient and not MV area correlated well with follow-up MV gradients. Our findings suggest that intraoperative mean MV gradient > 4 mmHg can be useful in predicting functional MS during follow-up, and should be included in the intra-operative assessment of the result of MV repair.
Valvular Heart Disease Intra-Operative Mitral Gradients and Area in Predicting Functional Mitral Stenosis following Mitral Valve Repair for Degenerative Mitral Regurgitation Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Valvular Heart Disease: Functional Imaging Abstract Category: 28. Valvular Heart Disease: Clinical Presentation Number: 1195-343 Authors: Kwan-Leung Chan, Buu-Khanh Lam, Thierry Mesana, Mark Hynes, University of Ottawa Heart Institute, Ottawa, Canada Background: We have previously demonstrated that functional mitral stenosis (MS) is a common but under-recognized complication which is associated with adverse functional impact in patients following mitral valve (MV) repair for degenerative mitral regurgitation. The objective of the present study was to determine whether intra-operative measures of transmitral gradients (peak and mean) and planimetered MV area following MV repair can predict the development of functional MS during follow-up. Methods: Functional MS was defined as resting mean MV diastolic gradient > 5 mmHg during follow-up. We studied 67 patients who had < mild mitral regurgitation, and intra-operative MV gradients and area measurements after MV repair. Results: The mean age was 59 + 11 years and body mass index 26.3 + 3.8 kg/m2. Of these, 23 patients (34%) had functional MS at a follow-up of 3.8 + 2.4 years. The intra-operative peak and mean MV gradients were lower than the follow-up resting gradients (6.7 + 2.9 and 3.6 + 1.8 mmHg vs. 10.4 + 4.6 and 4.8 + 2.4 mmHg respectively, p < 0.05), despite a higher heart rate during the intra-operative assessment (79.7 + 9.1 vs 73.2 + 11.1 bpm, p < 0.0003). The intra-operative planimetered MV area was larger than the follow-up MV area by the continuity method (3.20 + 1.0 cm2 vs. 2.11 + 0.62 cm2, p < 0.05). There was good correlations between the intra-operative mean MV gradient and the follow-up resting peak and mean MV gradient (r=0.33 and 0.45, p = 0.006 and 0.0001 respectively). The relationship between the intra-op mean gradient (x) and the follow-up mean MV gradient (y) can be expressed as follows: y=2.7 + 0.6x. An intra-operative mean MV gradient > 4 mmHg detected 17 of 23 patients with mean MV gradient > 5 mmHg during follow-up. There was poor correlation between intra-operative MV area and follow-up resting mean MV gradient and MV area. Conclusion: Intra-operative mean MV gradient and not MV area correlated well with follow-up MV gradients. Our findings suggest that intraoperative mean MV gradient > 4 mmHg can be useful in predicting functional MS during follow-up, and should be included in the intra-operative assessment of the result of MV repair.