Serial radionuclide angiographic assessment of left ventricular ejection fraction and regional wall motion after mitral valve replacement in patients with rheumatic disease

• Published in: The American heart journal 2006-12, Vol.152 (6), p.1201-1207
• Main Authors: Chowdhury, Ujjwal K., Venkataiya, Jayanth K.H., Patel, Chetan D., Seth, Sandeep, Yadav, Rakesh, Singh, Rajvir, Subramaniam, Ganapathy K., Malik, Vishwas, Venugopal, Panangipalli
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood; Cardiac arrhythmia; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular system; Chordae Tendineae - surgery; Diseases of the osteoarticular system; Female; Fractions; Gated Blood-Pool Imaging; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Mitral Valve; Ostomy; Postoperative Period; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Rheumatic diseases; Rheumatic Heart Disease - diagnostic imaging; Rheumatic Heart Disease - mortality; Rheumatic Heart Disease - physiopathology; Rheumatic Heart Disease - surgery; Stroke Volume; Treatment Outcome; Ventricular Function, Left
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2006.08.023

This study was designed to prospectively investigate the effects of total or partial chordal-sparing and chordal-nonsparing mitral valve replacement (MVR) procedures on regional and global ventricular function in a rheumatic population using sequential multiple-gated acquisition scan. One hundred five consecutive patients undergoing different techniques of chordal preservation procedures during MVR are included in this prospective study. Fifteen patients had complete excision of the chordopapillary apparatus (group 1), 34 had total chordal preservation (group 2), and 56 had preservation of the posterior chordopapillary apparatus (group 3). Radionuclide-derived left ventricular ejection fraction (LVEF) and regional wall motion (RWM) studies on 99 survivors were performed preoperatively, at discharge, at 1 year, and at 2 years. At discharge, there was a decline in LVEF in all the 3 groups. Statistically significant improvement in ejection fraction occurred in the chordal preservation groups (2 and 3) ( P < .05) as compared with the nonchordal group immediately and late postoperatively. Only the total chordal group (2) demonstrated complete recovery of LVEF by 2 years postoperatively. Significant and persistent RWM abnormalities were noted in both the nonchordal and posterior chordal groups. We conclude that complete retention of the chordopapillary apparatus during MVR provides superior results compared with nonchordal and partial chordal preservation in terms of preservation of LVEF and reduced incidence of abnormal postoperative RWM.