The Viable Mitral Annular Dynamics and Left Ventricular Function after Mitral Valve Repair by Biological Rings

Objective: Considering the importance of annular dynamics in the valvular and ventricular
function, we sought to evaluate the effects of treated pericardial annuloplasty rings on mitral
annular dynamics and left-ventricular (LV) function after mitral valve repair. The results
were compared with the mitral annular dynamics and LV function in patients with rigid and
flexible rings and also in those without any heart problems.
Materials and Methods: One hundred and thirty-six consecutive patients with a myxomatous
mitral valve and severe regurgitation were prospectively enrolled in this observational
cohort study. The patients underwent comparable surgical mitral valve reconstruction; of
these 100 received autologous pericardium rings (Group I), 20 were given flexible prosthetic
rings (Group II), and 16 received rigid rings (Group III). Other repair modalities were also
performed, depending on the involved segments. The patients were compared with 100
normal subjects in whom an evaluation of the coronary artery was not indicative of valvular
or myocardial abnormalities (Group IV). At follow-up, LV systolic indices were assessed via
two-dimensional echocardiography at rest and during dobutamine stress echocardiography.
Mitral annular motion was examined through mitral annulus systolic excursion (MASE). Peak
transmitral flow velocities (TMFV) and mitral valve area (MVA) were also evaluated by means
of continuous-wave Doppler.
Results: A postoperative echocardiographic study showed significant mitral regurgitation
(>=2+) in one patient in Group I, one patient in Group II, and none in Group III. None of
the patients died. There was a noteworthy increase in TMFV with stress in all the groups, the
increase being more considerable in the prosthetic ring groups (Group I from 1.10 ± 0.08 to
1.36 ± 0.13 m/s, Group II from 1.30 ± 0.11 to 1.59 ± 0.19 m/s, Group III from 1.33 ± 0.09 to
1.69 ± 0.21 m/s, and Group IV from 1.08 ± 0.08 to 1.21 ± 0.12 m/s). Recruitment of LVEF
reserve during stress was observed in the pericardial ring and normal groups (Group I from
54.6±6.2 to 64.6±7.3%, P<0.005; and Group IV from 55.3 ± 5.7 to 66 ± 6.2%, P<0.05), but no
significant changes were detected in the prosthetic ring groups (Group II from 50.4 ± 5 to 55.0 ± 5.1, and Group III from 51.1 ± 6.6 to 53.8 ± 4.7). There was a significant MASE increase
in both of the studied longitudinal segments at rest and during stress in Groups I and IV
compared with the prosthetic ring groups. There was no calcification of the pericardial rings.
Conclusions: The use of treated autologous pericardium rings for mitral valve annuloplasty
yields excellent mitral annular dynamics, preserves LV function during stress conditions, and leaves no echocardiographic signs of degeneration.