Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstruction

The aim of the present study was to analyse left (LV) and right ventricular (RV) function in patients after mitral valve reconstruction (MVR).

Transthoracic echocardiography was performed in 31 patients with severe mitral valve regurgitation (MR) before and after MVR. Furthermore, patients were divided into several subgroups: firstly, asymptomatic (n = 7) and symptomatic (n = 24), secondly, isolated MVR (n = 18) and MVR with tricuspid valve reconstruction (TVR) (n = 7) or aortic valve implantation (AVI) (n = 6) and thirdly, paroxysmal atrial fibrillation (AF) (n = 23) and chronic AF (n = 8).

LV dimensions and volumes were reduced after MVR. LV ejection fraction (EF) did not change after MVR. However, LV global longitudinal peak systolic strain (PSS) was reduced after MVR. In contrast to LV global longitudinal PSS values data of the free RV wall did not show reduced RV PSS values after MVR. However, TAPSE was significantly reduced after MVR. Parameters of diastolic function did not improve and systolic pulmonary pressure (sPAP) and pulmonary vascular resistance (PVR) were reduced after MVR.

LV function after MVR was mostly improved in patients with asymptomatic MR, with SR or paroxysmal AF and after isolated MVR than in symptomatic patients with MR, with chronic AF and MVR with TVR or AVI. Despite of improvement of LV function the reduction of TAPSE indicates impairment of longitudinal RV deformation. However, RV strain analysis after MVR indicates unchanged RV contractility. Thus, RV function should be analysed more accurately by 3D volume changes and radial deformation analysis. In addition, a moderate MR quantified by Vena contracta-method was observed in 6 patients after MVR (20%).