Serial changes in left ventricular shape following early mitral valve repair

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Degenerative mitral valve disease often requires mitral valve (MV) repair.
• While functional benefits of MV repair are known, its impact on left ventricular (LV) shape is less understood.
• Asymptomatic severe mitral regurgitation with preserved LV function may already involve LV shape alterations.

Purpose of the Study:

• To investigate serial changes in LV performance and 3D shape after MV repair.
• To utilize a novel analytic technique for detailed LV shape assessment.
• To compare pre- and post-operative LV morphology with a normal control group.

Main Methods:

• Fifty patients with severe asymptomatic mitral regurgitation underwent MV repair.
• Transthoracic real-time 3D echocardiography was performed pre-operatively and at 6 and 12 months post-operatively.
• LV endocardial surfaces were analyzed to compute 3D shape indexes (sphericity, conicity) and compared to 50 normal controls.

Main Results:

• Postoperative LV volumes decreased compared to pre-surgical values.
• Ejection fraction slightly decreased at 6 months but recovered by 12 months.
• Pre-operative LV shape showed increased sphericity and decreased conicity compared to controls; these changes reversed by 6 months post-MV repair.

Conclusions:

• Patients with asymptomatic mitral regurgitation and preserved LV function exhibit distinct LV shape changes.
• Early MV repair effectively restores LV morphology towards normal.
• Real-time 3D echocardiography combined with 3D shape analysis provides valuable insights into LV dynamics after MV repair.