Clinical Evaluation of Ring and Body Size Effect on Left Atrial Reverse Remodeling after Mitral Valve Repair

Ryota Asano＊	Kiyoharu Nakano＊	Atsuhiko Sato＊
Go Kataoka＊	Wataru Tatsuishi＊

（Department of Cardiovascular Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan）

Background:Left atrial reverse remodeling occurs when the left atrial load is reduced after mitral valve repair for mitral valve regurgitation. However, several reports demonstrate mitral valve stenosis after mitral valve repair with a mitral ring, which leads to impaired left atrial reverse remodeling. Objective:To examine the effect of ring size and body size on left atrial reverse remodeling after mitral valve repair. Patients and Methods:Sixty patients underwent transthoracic echocardiography before and after mitral valve repair for mitral valve regurgitation in our hospital. The left atrial volume（LAV）was compared pre- and postoperatively. Ring-size/BSA（mm/m2）was defined as values to express the mismatch between ring-size and body size after mitral valve repair with a mitral ring. In addition, we examined which factors correlated with the left atrial volume reduction rate including ring-size/BSA. The mean ring size was 28mm. The study interval was 17±6 months. Result:LAV changed from 82±37ml to 47±20ml postoperatively. The left atrial volume reduction rate was 39.8±18.6%. The peak pressure gradient measured from the transmitral flow（TMF p-PG）was 7.5±3.0mmHg. Ring size showed a stronger correlation with body height than BSA. The ring-size/BSA was 17.7±2.1mm/m2. Multivariate analysis shows that correlates of the LAV reduction rate were ring-size/BSA, pre LAV and age. Ring-size, TMF p-PG, ring annuloplasty only and postoperative TRPG did not show a strong correlation with the LAV reduction rate. Conclusion:A mismatch between body size and ring size is a negative factor for left atrial reverse remodeling after mitral valve repair with a mitral ring. The ring-size/BSA may be a useful factor to express grade of the mismatch.

 

Jpn. J. Cardiovasc. Surg. 47:1-6（2018）

Keywords：mitral valve repair;left atrial reverse remodeling;ring size;body size;mismatch