Toward a Better Understanding of the Etiology of Left Ventricular Dysfunction after Mitral Valve Replacement: An Experimental Study with Possible Clinical Implications

Paul A. Spence, Charles M. Peniston, Tirone E. David, Nick Mihic, A. Karim Jabr, P. Narini, Tomas A. Salerno

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

The relative high morbidity and mortality of mitral valve replacement (MVR) appears to be related to an impairment in left ventricular (LV) function. This two-part investigation was designed to assess the effect of MVR on global LV function in an isolated heart preparation and to evaluate whether a mitral prosthesis with a flexible annulus would be of benefit. In part I (14 pigs), the effects of each step in MVR were studied. Division of the chordae tendinae caused a severe deterioration in LV function (systolic pressure, 180 ± 13 versus 120 ± 10 mm Hg; p < 0.05; developed pressure, 167 ± 13 versus 108 ± 11 mm Hg; p < 0.05; first derivative of LV pressure [dP/dt], 2,630 ± 300 versus 1,610 ± 180 mm Hg/sec; p < 0.05; balloon volume, 30 ml). Fixation of the mitral annulus prior to division of the chordae tendineae resulted in a small decrease (no significant) in LV function but had no effect after the chordae tendineae were divided. In Part II (10 pigs), two mitral annular prostheses were studied: a standard rigid prosthesis and a prosthesis of identical size but with a flexible annulus. LV function was better with the flexible than the right prosthesis (systolic presure, 118 ± 10 versus 89 ± 5% control, p < 0.02; developed pressure, 120 ± 11 versus 87 ± 5% control; p < 0.02; dP/dt, 119 ± 10 versus 85 ± 4% control; p < 0.02; balloon volume, 30 ml). These results demonstrate that MVR causes a profound deterioration in LV function, a deterioration primarily due to division of the chordae tendineae. Fixation of the mitral annulus with a rigid prosthesis may also be an important cause of LV dysfunction.

Original languageEnglish (US)
Pages (from-to)363-371
Number of pages9
JournalAnnals of Thoracic Surgery
Volume41
Issue number4
DOIs
StatePublished - Jan 1 1986
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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