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Left ventricular remodelling after minimal mitral valve reconstruction: a prospective cMRI and 3D TEE study
Inna Kammerer, Armin Vomend, Bernd Cornelius, GŁnther Layer, Falk-Udo Sack.
Academic City Hospital Ludwigshafen, Ludwisghafen, Germany.

OBJECTIVE: The aim of this prospective study is the evaluation of the postoperative remodelling of the left ventricle (LV) after mitral valve reconstruction (MVR) in patients with isolated mitral valve disease.
METHODS: Since 2011 36 patients were enrolled. In a prospective trial, LV geometry was assessed by the cardio magnetic resonance imaging (cMRI) and the real-time 3-dimensional echocardiography (3D TEE) pre- and postoperatively. Of these, 27 (75%) were men, the mean age was 60 + 16 years. Minimal invasive operation technique (MIC) was done in more than 86% of MVR.
RESULTS: One patient died 4 months after MVR due to an aortic dissection Stanford A. The 1year freedom from reoperation or severe recurrent insufficiency was 86% (n=31). The mean ischemia time observed 77 + 20min, the mean hospital duration was 9 + 3days. The mean ring size was 34mm by 83% (n=30) of posterior leaflet correction with ring, 14% (n=5) only ring without leaflet surgery and 3% (n=1) anterior leaflet rectification.
The end-systolic and -diastolic volumes in cMRI measurement observed incurred levels in hospital history: EDV 161 + 37ml (preOP) vs. 124 + 24ml (postOP), ESV 61 + 16ml vs. 56 + 18ml. Other remodelling parameters from 3D TEE and cMRI showed no differences in methods and in early postoperatively results (Table I).
CONCLUSIONS: Measurements of ventricular geometry with 3D TEE and cMRI proved to be important imaging tools in assessing reverse LV remodelling. There is a clear tendency for postop-erative remodelling. Long term follow-up (1years) will provide more information of the dynamics of this process.
Table I: cMRI and 3D TEE parameters in pre- and postoperatively clinical dates (EF= ejection fractio
n=36EF preOP meanEF postOP meanEDP preOP meanEDP postOP meanESP preOP meanESP postOP meanCor weight preOP meanCor weight preOP mean
cMRI64% + 954% + 1355mmHg + 651mmHg + 6144mg + 33140mg + 29
3 D TEE60% + 857% + 1352mmHg + 854mmHg + 635mmHg + 939mmHg + 8


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