Abstract
Cardiologists and cardiac surgeons frequently must decide when it is appropriate to offer early surgical intervention to prevent compromise of left ventricular function from regurgitant lesions of the aortic or mitral valve. Both aortic and mitral regurgitation place a volume load on the left ventricle leading to dilatation and eventually impairment of left ventricular systolic function. This chapter however deals with the opposite issue: that of late surgical intervention after deterioration of left ventricular systolic function has occurred and reached advanced levels. Important questions to consider include (1) whether surgical intervention is contraindicated once advanced left ventricular dysfunction has become established (2) whether the risks of surgery are too high in this setting and (3) whether, even after successful surgery, improvements in left ventricular function, symptoms, or survival can realistically be anticipated.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Bonow RO. Management of chronic aortic regurgitatton. N Engl J Med 1994;331:736–7.
Scognamiglio R, Rahimtoola S, Fasoli G et al. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994;331:689–94.
Forman R, Firth BF, Barnard MS. Prognostic significance of pre-operative left ventriculaar ejection fraction and valve lesion in patients with aortic valve replacement. Am J Cardiol 1980;45:1120–5.
Bonow RO, Picone AL, McIntosh CL et al. Survival and functional results after valve replacement for aortic regurgitation from 1976–1983: Impact of preoperative left ventricular function. Circulation 1985;72:1244–56.
Cohn PF, Gorlin R, Cohn LH et al. Left ventricular ejection fraction as a prognostic guide in surgical treatment of coronary and valvular heart disease. Am J Cardiol 1974; 34:136–41.
Copeland JG, Griepp RB, Stinson EB et al. Long-term follow-up after isolated aortic valve replacement. J Thorac Cardiovasc Surg 1977; 74:875–89.
Greves J, Rahimtoola SH, McAnulty JH et al. Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation. Am Heart J 1981; 101:300–8.
Bonow RO: Radionuclide angiography in the management of aortic regurgitation. Circulation 1991;84(Suppl 1): I-296–302.
Ross J Jr. Afterload mismatch in aortic and mitral valve disease: Implications for surgical therapy. J Am Coll Cardiol 1985; 5:811–26.
Ross J Jr. Afterload mismatch and preload reserve. A conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis 1976; 18:255–64.
Bonow RO, Lakatos E, Maron BJ et al. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation 1991; 84:1625–35.
Bonow RO, Rosing DR, Kent KM et al. Timing of operation for chronic aortic regurgitation Am J Cardiol 1982; 50:325–36.
Daniel WG, Hood WP Jr, Siart A et al. Chronic aortic regurgitation: Reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening. Circulation 1985; 71:669–80.
Fioretti P, Roelandt J, Bos RJ et al. Echocardiography in chronic aortic insufficiency: Is valve replacement too late when left ventricular end-systolic dimension reaches 55 mm? Circulation 1983; 67:216–21.
Gaasch WH, Andrias CW, Levine HJ. Chronic aortic regurgitation: The effect of aortic valve replacement on left ventricular volume, mass, and function. Circulation 1978; 58:825–36.
Gaasch WH, Carroll JD, Herbert HJ et al. Chronic aortic regurgitation: Prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio. J Am Coll Cardiol 1983; 1:775–82.
Bonow RO, Dodd JT, Maron BJ et al. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation 1988; 78:1108–20.
Michel PL, Iung B, Jaoude SA et al. The effect of left ventricular systolic function on long term survival in mitral and aortic regurgitation. J Heart Valve Dis 1996; 4(Supp II):S160–169.
Klodas E, Enriquez-Sarano M, Tajik AJ et al. Aortic regurgitation complicated by extreme left ventricular dilation long-term outcome after surgical correction. J Am Coll Cardiol 1996; 27:670–7
Bonow RO, Nikas D, Elefteriades JA. Valve replacement for regurgitant lesions of theaortic or mitral valve in advanced left ventricular dyefunction. In: Cardiology Clinics 1995; Volume 13: WB Saunders, Toronto.
Wisenbaugh T, Spann JF, Carabello BA. Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitation. J Am Coll Cardiol 1984; 3:916–23.
Bonow RO. The value of radioisotope blood pool imaging for evaluation of valvular heart disease. In Comparative Cardiac Imaging 1990; Aspen Publishers.
Gaasch WH, Zile MR. Lett ventricular function after surgical correction of chronic mitral regurgitation. Eur Heart J 1991; 12(Suppl B):48–51.
Hansen DE, Cahill PD, DeCampli WM et al. Valvular-ventricular interaction: Importance of the mitral apparatus in canine left ventricular systolic performance. Circulation 1986; 73:1310–20.
Hilder FJ, Javier RP, Cohen LS. Myocardial dysfunction associated with valvar heart disease. Am J Cardiol 1972; 30:319–26.
Rozich JD, Carabello BA, Usher BW et al. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation: Mechanisms for differences in postoperative ejection performance. Circulation 1992; 86:1718–26.
Schuler G, Peterson KL, Johnson A. Temporal response of left ventricular performance to mitral valve surgery. Circulation 1979; 59:1218–31.
Tyers G. Mitral valve replacement: What should be the standard technique? Ann Thorac Surg 1990; 49:861–2.
Phillips UR, Levine FH, Carter JE et al. Mitral valve replacement for isolated mitral regurgitation: Analysis of clinical course and late postoperative left ventricular ejection fraction. Am J Cardiol 1981; 48:647–54.
Enriquez-Sarano M, Tajik AJ, Schaff HV et al. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 1994; 90:830–7.
Yun KL, Rayhill SC, Niczyporuk MA et al. Mitral valve replacement in dilated canine hearts with chronic mitral regurgitation: Importance of the mitral subvalvular apparatus Circulation 1991; 84(Suppl 3):112–24.
Lillehei CW, Levy MJ, Bonnabeau RC. Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg 1964; 47:532–543.
Sarris GE, Cahill PD, Hansen DE et al. Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. J Thorac Cardiovasc Surg 1998; 95:969–79.
Moon MR, DeAnda A, Daughters GT, et al. Experimental evaluation of different chordal preservation methods during mitral valve replacement. Ann Thorac Surg 1994; 58:931–44.
Yun KL, Farm JI, Rayhill S et al. Importance of the mitral subvalvular apparatus for left ventricular segmental systolic mechanics. Circulation 1990; 82(5 Suppl):IV89–104.
Yun KL, Niczyporuk MA, Sams GE et al. Importance of mitral subvalvular apparatus in terms of cardiac-energetics and systolic mechanics in the ejecting canine heart. J Clin Invest 1991; 87:247–51.
David TK, Uden DE, Strauss HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 1983; 68(Suppl II):1176–82.
Goldman ME, Mora F, Guarino T et al. Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function: An intraoperative two-dimensional echocardiographic study. J Am Coll Cardiol 1987; 10:568–75.
Hennein HA, Swain JA, McIntosh CL et al. Comparative assessment of chordal preservation versus chordal resection during mitral valve replacement. J Thorac Cardiovasc Surg 1980; 99:828–37.
Horstkotte D, Schulte HD, Bircks W et al. The effect of chordal preservation on late outcome after mitral valve replacement: A randomized study. J Heart Valve Dis 1993:2:150–8.
Miki S, Kusuhara K, Ueda Y et al. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg 1988; 45:28–34.
Carpentier A, Chauvaud S, Fabiani JN et al. Reconstructive surgery of mitral valve incompetence: Ten year appraisal. J Thorac Cardiovasc Surg 1980; 79:338–345.
Cosgrove DM, Stewart WJ: Mitral valvuloplasty. Curr Probl Cardiol 1989; 7:355–415.
Kaul TK, Ramsdale DR, Meek D et al. Mitral valve replacement in patients with severe mitral regurgitation and impaired left ventricular function. Int J Cardiol 1992; 35:169–79.
Yacoub M, Halin M, Radley-Smith R et al. Surgical treatment of mitral regurgitation caused by floppy valves: Repair versus replacement. Circulation 1981; 64(Suppl II):II-210–6.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1999 Kluwer Academic Publishers
About this chapter
Cite this chapter
Bonow, R.O., Masters, R.G. (1999). Valve surgery for regurgitant lesions of the aortic or mitral valves in advanced left ventricular dysfunction. In: Masters, R.G. (eds) Surgical Options for the Treatment of Heart Failure. Developments in Cardiovascular Medicine, vol 225. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-29191-8_3
Download citation
DOI: https://doi.org/10.1007/978-0-585-29191-8_3
Publisher Name: Springer, Dordrecht
Print ISBN: 978-0-7923-6130-5
Online ISBN: 978-0-585-29191-8
eBook Packages: Springer Book Archive