Efficacy of Mitral Valve Replacement for Patients With Mitral Regurgitation and a Dilated Left Ventricle

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Mitral regurgitation is a significant complication of end-stage cardiomyopathy, and its existence predicts poor survival. In general, it is thought that mitral valve replacement (MVR) alone is ineffective; however, there are few detailed reports of the clinical course of patients who have undergone MVR. Five patients with mitral regurgitation whose preoperative left ventricular end-systolic volume index was more than 100ml/m2 were studied. Although their prognosis late after MVR became poor, none of them died within 30 days of the operation. Postoperative cardiac catheterization was performed 6.3±1.1 months after surgery; the end-diastolic volume had reduced (before: 193±26ml/m2; after: 166±34ml/m2, p<0.05), but the end-systolic volume had not (before: 110±7ml/m2; after: 112±32ml/m2). The end-systolic wall stress was substantially elevated preoperatively (238±29kdyne/cm2) and tended to increase after surgery (295±96kdyne/cm2). All the patients were able to return to work at some stage postoperatively (their New York Heart Association functional class improved to I or II), but 3 of the 5 patients died suddenly of heart failure at 3.3±1.6 years after surgery and the New York Heart Association functional class of the others worsened to III again. Mitral valve surgery, including MVR, can manage severe end-stage heart disease with mitral regurgitation.
社団法人　日本循環器学会の論文