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Dynamic changes of mitral annulus in patients with degenerative mitral regurgitation and chronic atrial fibrillation undergoing mitral valve reconstruction

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Abstract

Objective

This study was designed to assess structural and dynamic changes in the mitral annulus in patients before mitral valve reconstruction for degenerative mitral regurgitation with or without chronic atrial fibrillation.

Methods

One hundred and fifty one consecutive patients undergoing mitral valve reconstruction for mitral regurgitation due to myxomatous disease between July 2013 and May 2016 were included. Of these, 117 had a sinus rhythm (SR group) and 34 had chronic AF (AF group). Patients who underwent aortic surgery and were found to have no underlying cardiac valve disease nor coronary artery disease were included as the control group (n = 20). Real-time three-dimensional trans-esophageal echocardiography (3D-TEE) was used to assess mitral annulus shape, size, and movements.

Results

Annular areas in the control group were the smallest of the three groups and changed considerably through the cardiac cycle. Mean anteroposterior and intercommissural diameter measurements in the SR group were significantly larger but oscillated less than in the control group. Those diameters were the largest in the AF group and oscillated very little. Dilatation of the annulus in the AF and SR groups was accompanied by flattening and marked loss of oscillation in the height-to-intercommissural-width ratio which should peak in early systole.

Conclusions

In patients with degenerative mitral regurgitation undergoing mitral valve surgery, preoperative chronic atrial fibrillation is associated with more progressed annular remodeling, characterized by marked enlargement of annular area, circumference, and anteroposterior diameter.

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References

  1. Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8:162–72.

    Article  Google Scholar 

  2. Gammie JS, Haddad M, Milford-Beland S, Welke KF, Ferguson TB Jr, O’Brien SM, et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg. 2008;85:909–14.

    Article  Google Scholar 

  3. Cox JL, Ad N, Palazzo T, Fitzpatrick S, Suyderhoud JP, DeGroot KW, et al. The Maze-III procedure combined with valve surgery. Semin Thorac Cardiovasc Surg. 2000;12:53–5.

    Article  CAS  Google Scholar 

  4. Wang B, Xu ZY, Han L, Zhang GX, Lu FL, Song ZG. Impact of preoperative atrial fibrillation on mortality and cardiovascular outcomes of mechanical mitral valve replacement for rheumatic mitral valve disease. Eur J Cardiothorac Surg. 2013;43:513–9.

    Article  Google Scholar 

  5. Lim E, Barlow CW, Hosseinpour AR, Wisbey C, Wilson K, Pidgeon W, et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation. 2001;104:I59–63.

    Article  CAS  Google Scholar 

  6. Bando K, Kasegawa H, Okada Y, Kobayashi J, Kada A, Shimokawa T, et al. Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2005;129:1032–40.

    Article  Google Scholar 

  7. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91:1022–8.

    Article  CAS  Google Scholar 

  8. Suri RM, Schaff HV, Dearani JA, Sundt TM 3rd, Daly RC, Mullany CJ, Enriquez-Sarano M, Orszulak TA. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg. 2006;82:819–26.

    Article  Google Scholar 

  9. Clavel MA, Manitoban F, Malouf J, Michelena HI, Vatury O, Jain MS, et al. Dynamic phenotypes of degenerative myxomatous mitral valve disease: quantitative 3-dimensional echocardiographic study. Circ Cardiovasc Imaging. 2015;8(5):e002989.

    Article  Google Scholar 

  10. Adams DH, Anyanwu AC. Seeking a higher standard for degenerative mitral valve repair: begin with etiology. J Thorac Cardiovasc Surg. 2008;136:551–6.

    Article  Google Scholar 

  11. Grewal J, Suri R, Mankad S, Tanaka A, Mahoney DW, Schaff HV, et al. Mitral annular dynamics in myxomatous valve disease: new insights with real-time 3-dimensional echocardiography. Circulation. 2010;121:1423–31.

    Article  Google Scholar 

  12. Levack MM, Jassar AS, Shang EK, Vergnat M, Woo YJ, Acker MA, et al. Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection. Circulation. 2012;126:S183–S188188.

    Article  Google Scholar 

  13. Otsuji Y, Kumanohoso T, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Isolated annular dilatation does not usually cause important mitral regurgitation: comparison between patients with lone atrial fibrillation and idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol. 2002;39:1651–6.

    Article  Google Scholar 

  14. Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, et al. American Society of Echocardiography; European Association of Echocardiography. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr. 2012;25:3–46.

    Article  Google Scholar 

  15. Asai T, Kinoshita T, Suzuki T, Shiraishi S, Koike M. Early and follow-up results of butterfly resection of prolapsed posterior leaflet in 76 consecutive patients. J Thorac Cardiovasc Surg. 2015;149:1296–300.

    Article  Google Scholar 

  16. Asai T, Kinoshita T, Hosoba S, Takashima N, Kambara A, Suzuki T, Matsubayashi K. Butterfly resection is safe and avoids systolic anterior motion in posterior leaflet prolapse repair. Ann Thorac Surg. 2011;92:2097–102.

    Article  Google Scholar 

  17. Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL, Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44.

    Article  Google Scholar 

  18. Clavel MA, Mantovani F, Malouf J, Michelena HI, Vaturi O, et al. Dynamic phenotypes of degenerative myxomatous mitral valve disease: quantitative 3-dimensional echocardiographic study. Circ Cardiovascular Imaging. 2015;8:e002989.

    Article  Google Scholar 

  19. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–68.

    Article  CAS  Google Scholar 

  20. Mihalia S, et al. Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodeling in patients with primary mitral regurgitation. Eur Heart J Cardiovasc Imaging. 2016;17:918–29.

    Article  Google Scholar 

  21. Pai RG, Varadaraian P, Tanjmoto M. Effect of atrial fibrillation on the dynamics of mitral annular area. Heart Valve Dis J Heart Valve Dis. 2003;12(1):31–7.

    PubMed  Google Scholar 

  22. Biaggi P, Jedrzkiewicz S, Gruner C, Meineri M, Karski J, Vegas A, Tanner FC, Rakowski H, Ivanov J, David TE, Woo A. Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J Am Soc Echocardiogr. 2012;25(7):758–65.

    Article  Google Scholar 

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Acknowledgements

We thank Mr. Piers Vigers for reviewing our manuscript.

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Author notes

  1. Nurun Nahar and Takeshi Kinoshita have contributed equally to this article.

Authors and Affiliations

  1. Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, 520-2192, Japan

    Nurun Nahar, Takeshi Kinoshita, Tomoaki Suzuki & Tohru Asai

  2. Department of Public Health, Shiga University of Medical Science, Setatsukinowa, Otsu, 520-2192, Japan

    Nurun Nahar & Katsuyuki Miura

Authors
  1. Nurun Nahar
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  2. Takeshi Kinoshita
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  3. Tomoaki Suzuki
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Correspondence to Takeshi Kinoshita.

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Nahar, N., Kinoshita, T., Suzuki, T. et al. Dynamic changes of mitral annulus in patients with degenerative mitral regurgitation and chronic atrial fibrillation undergoing mitral valve reconstruction. Gen Thorac Cardiovasc Surg 68, 1405–1411 (2020). https://doi.org/10.1007/s11748-020-01406-2

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  • DOI: https://doi.org/10.1007/s11748-020-01406-2

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