Subscribe to RSS
DOI: 10.1055/s-0039-1693457
Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis
Funding Sources None.Publication History
Publication Date:
06 August 2019 (online)
![](https://www.thieme-connect.de/media/ija/201904/lookinside/thumbnails/10-1055-s-0039-1693457_190004-1.jpg)
Abstract
Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.
The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.
This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.
This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.
More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.
-
References
- 1 Soesanto AM. Penyakit jantung katup di Indonesia: masalah yang hampir terlupakan. J Kardiol Indones 2012; 33: 205-208
- 2 Bhaya M, Panwar S, Beniwal R, Panwar RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27 (04) 448-453
- 3 Marijon E, Ou P, Celermajer DS. , et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357 (05) 470-476
- 4 Shaper AG, Hutt MSR, Coles RM. Necropsy study of endomyocardial fibrosis and rheumatic heart disease in Uganda 1950-1965. Br Heart J 1968; 30 (03) 391-401
- 5 Saraiva LR, Carneiro RW, Arruda MB, Brindeiro Filho D, Lira V. Mital valve disease with rheumatic appearance in the presence of left ventricular endomyocardial fibrosis. Arq Bras Cardiol 1999; 72 (03) 327-332
- 6 Perennec J, Herreman F, Ameur A, Degeorges M, Hatt PY. Ultrastructural and histological study of left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function (in 11 observations). Basic Res Cardiol 1980; 75 (02) 353-364
- 7 Wedum BG, McGUIRE JW. Origin of the Aschoff body. Ann Rheum Dis 1963; 22: 127-141
- 8 Shah DJ. Cardiac magnetic resonance for mitral regurgitation diagnosis: when is it needed?. Curr Opin Cardiol 2012; 27 (05) 485-491
- 9 Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 2011; 57 (08) 891-903
- 10 Choi EY, Yoon SJ, Lim SH. , et al. Detection of myocardial involvement of rheumatic heart disease with contrast-enhanced magnetic resonance imaging. Int J Cardiol 2006; 113 (02) e36-e38
- 11 Chaikriangkrai K, Lopez-Mattei JC, Lawrie G. , et al. Prognostic value of delayed enhancement cardiac magnetic resonance imaging in mitral valve repair. Ann Thorac Surg 2014; 98 (05) 1557-1563
- 12 Kancharla K, Weissman G, Elagha AA. , et al. Scar quantification by cardiovascular magnetic resonance as an independent predictor of long-term survival in patients with ischemic heart failure treated by coronary artery bypass graft surgery. J Cardiovasc Magn Reson 2016; 18 (01) 45
- 13 Barone-Rochette G, Piérard S, De Meester de Ravenstein C. , et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol 2014; 64 (02) 144-154
- 14 Mikami Y, Kolman L, Joncas SX. , et al. Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2014; 16: 85
- 15 Flett AS, Hasleton J, Cook C. , et al. Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC Cardiovasc Imaging 2011; 4 (02) 150-156
- 16 Rodriguez-Fernandez R, Amiya R, Wyber R, Widdodow W, Carapetis J. Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort. Heart Asia 2015; 7 (02) 44-48
- 17 Park KJ, Woo JS, Park JY, Jung JH. Clinical effect of left ventricular dysfunction in patients with mitral stenosis after mitral valve replacement. Korean J Thorac Cardiovasc Surg 2016; 49 (05) 350-355
- 18 Rajesh GN, Thottian JJ, Subramaniam G, Desabandhu V, Sajeev CG, Krishnan MN. Prevalence and prognostic significance of left ventricular myocardial late gadolinium enhancement in severe aortic stenosis. Indian Heart J 2017; 69 (06) 742-750
- 19 Zhao L, Ma X, Feuchtner GM, Zhang C, Fan Z. Quantification of myocardial delayed enhancement and wall thickness in hypertrophic cardiomyopathy: multidetector computed tomography versus magnetic resonance imaging. Eur J Radiol 2014; 83 (10) 1778-1785
- 20 Cunningham MW. Rheumatic fever, autoimmunity, and molecular mimicry: the streptococcal connection. Int Rev Immunol 2014; 33 (04) 314-329
- 21 Horwitz LD, Mullins CB, Payne RM, Curry GC. Left ventricular function in mitral stenosis. Chest 1973; 64 (05) 609-614
- 22 Lee YS, Lee CP. Ultrastructural pathological study of left ventricular myocardium in patients with isolated rheumatic mitral stenosis with normal or abnormal left ventricular function. Jpn Heart J 1990; 31 (04) 435-448
- 23 Klein AJ, Carroll JD. Left ventricular dysfunction and mitral stenosis. Heart Fail Clin 2006; 2 (04) 443-452
- 24 Bastien O, Vallet B. French study group AGIR. French multicenter survey on the use of inotropes after cardiac surgery. Crit Care 2005; 9: 241-242
- 25 Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A. Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology 2008; 108 (06) 979-987
- 26 Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-cardiac-output syndrome after cardiac surgery. J Cardiothorac Vasc Anesth 2017; 31 (01) 291-308
- 27 Pérez Vela JL, Jiménez Rivera JJ, Alcalá Llorente MA. , et al; en representación del Grupo ESBAGA. Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study. Med Intensiva 2018; 42 (03) 159-167
- 28 Trouillet JL, Combes A, Vaissier E. , et al. Prolonged mechanical ventilation after cardiac surgery: outcome and predictors. J Thorac Cardiovasc Surg 2009; 138 (04) 948-953
- 29 Murthy SC, Arroliga AC, Walts PA. , et al. Ventilatory dependency after cardiovascular surgery. J Thorac Cardiovasc Surg 2007; 134 (02) 484-490
- 30 Chrustowicz A, Simonis G, Matschke K, Strasser RH, Gackowski A. Right ventricular dilatation predicts survival after mitral valve repair in patients with impaired left ventricular systolic function. Eur J Echocardiogr 2009; 10 (02) 309-313
- 31 Ye Y, Desai R, Vargas Abello LM. , et al. Effects of right ventricular morphology and function on outcomes of patients with degenerative mitral valve disease. J Thorac Cardiovasc Surg 2014; 148 (05) 2012-2020.e8
- 32 Reed D, Abbott RD, Smucker ML, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size. Circulation 1991; 84 (01) 23-34
- 33 Sabry AM, Mansour HAE, Abo El-Azm TH, Mostafa SA, Zahid BS. Echocardiographic predictors of atrial fibrillation after mitral valve replacement. Egypt Heart J 2017; 69 (04) 281-288
- 34 Dokhan A, El-Raouf M, Ibrahim I, Abdellatif M. Evaluation of early outcomes after mitral replacement in rheumatic heart patients with pulmonary hypertension. Menoufia Med J 2016; 29: 674-679
- 35 Severino ES, Petrucci O, Vilarinho KA. , et al. Late outcomes of mitral repair in rheumatic patients. Rev Bras Cir Cardiovasc 2011; 26 (04) 559-564
- 36 Cesnjevar RA, Feyrer R, Walther F, Mahmoud FO, Lindemann Y, von der Emde J. High-risk mitral valve replacement in severe pulmonary hypertension--30 years experience. Eur J Cardiothorac Surg 1998; 13 (04) 344-351 , discussion 351–352
- 37 Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation 2005; 112 (9, Suppl) I323-I327
- 38 McNeely C, Vassileva C. Mitral valve surgery in women: another target for eradicating sex inequality. Circ Cardiovasc Qual Outcomes 2016; 9 (02) (Suppl. 01) S94-S96
- 39 Rayburn BK, Fortuin NJ. Severely symptomatic mitral stenosis with a low gradient: a case for low-technology medicine. Am Heart J 1996; 132 (03) 628-632