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The Relief Of Arrhythmia Following Mitral Valve Surgery For Mitral Annular Disjunction
Aysen Yaprak Engin, Serkan Ertugay, Evrim Şimşek, Sedat Karaca, Zehra Unlu, Mustafa Ozbaran.
Ege University Medical School Hospital, Izmir, Turkey.
BACKGROUND: The aim of this study was to evaluate the effect of mitral valve surgery on arrhythmias in patients diagnosed with mitral annular disjunction, a condition that is increasingly being recognized as a potential cause of life threatening arrhythmias.
METHODS: The study included 33 patients who underwent total endoscopic mitral valve surgery between 2017 and 2024 and were diagnosed with mitral annular disjunction based on imaging findings. All patients had type 2 dysfunction. In the pre- and post-operative period, all cases underwent 24-hour Holter electrocardiography to assess arrhythmias. Arrhythmia analysis was categorized into two groups, supraventricular arrhythmias (SVA) and ventricular arrhythmias (VA).
RESULTS: Approximately half of the patients included in the study were male. The mean age was 36.4 years. Bileaflet prolapse was present in 21 patients while posterior leaflet prolapse was observed in 12 patients. Severe mitral regurgitation was present in 22 patients, and moderate to severe mitral regurgitation was present in 11 patients. The mean left atrial diameter was 46.6 mm and the mean left ventricular end-diastolic diameter was 57.4 mm. The mean mitral annular distance was 8.76 mm. The mean cardiopulmonary bypass duration was 132.2 minutes and the mean cross-clamp duration was 95.6 minutes. All patients underwent mitral valve repair. Mean follow-up was 29.4 months. Analysis of arrhythmias in the preoperative and postoperative periods showed that the SVA and VA rates decreased from 0.144 to 0.03 (78.6%) and from 0.074 to 0.027 (63.5%), respectively (Figure 1). No mortality was observed during the follow-up period.
CONCLUSIONS: Mitral annular disjunction is a serious clinical condition that may be associated with malignant arrhythmias. Mitral valve surgery may reduce arrhythmias in the presence of mitral annular disjunction. Therefore, even in the absence of severe mitral regurgitation, early surgery should be considered in cases with life-threatening arrhythmias.
LEGEND 1: Preoperative characteristics
LEGEND 2: Preoperative echocardiographic findings and measurements
LEGEND 3: Operative characteristics
LEGEND 4: SVA and VA rates in the preoperative and postoperative periods
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