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Clinical significance of local myocardial viability in patients with severe ischemic heart failure
Natallia Maroz-Vadalazhskaya, Olga Kardash
Seminars in Cardiovascular Medicine 2009; 15: 1 |
Objectives: In coronary patients, the ischemic or scared myocardium may be the primary cause of mitral valve incompetence due to papillary muscle dysfunction and/or distortion. The estimation of the link between myocardial viability in a segment of the papillary muscle and left ventricular (LV) remodelling on mitral valve (MV) competence after its surgery in patients with severe ischemic heart failure was aimed.
Design and Methods: A cohort of 26 patients (LVEF 0.31±0.04, NYHA 3.1±0.5, mitral regurgitation (MR) >3 degree, systolic pulmonary artery pressure (PAP) 50.0± 6.9 mm Hg, EDV 245.2 ± 45.6 ml, WMI 2.56 ± 0.34, the global positive inotropic response of the LV during low dose dobutamine echo (p = 0.0004, the pair t-test) was operated on by the simultaneous technique of coronary artery bypass grafting (mean shunts 2.9 ± 0.4), left ventricular plasty (for apical aneurysm – 12 cases, for diffuse LV dilatation – 14 cases) and mitral valve plasty (the original durable ring – 16 patients, the Calafiore method – 10 patients).
Results: In the early postoperative period, all patients demonstrated the improvement (the pair t-test) in LV pump function (p = 0.003), WMI (p = 0.0002), the reduction of the degree of MR (p = 0.004), and the improvement of the functional status (p < 0.001). In spite of the similar basal heart condition and the type of the mitral valve surgery patients without viability in the zone of anterior-lateral papillary muscles (segment 9 of the 16-segment LV model) (Group 1) had poor dynamics of MR early after surgery (MR grade was 2.1 ± 0.4 in Group 1 and 0.9± 0.3 in Group 2, p < 0.01 between the groups).
Conclusions: The positive inotropic response of segment 9 of the 16-segment LV model had a great value on the MV closure function in spite of basal papillary muscle distortion and a non-elliptic form of the LV.
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