Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation
Tóm tắt
We hypothesized that a giant left atrium may oppress the posterior left ventricle and aggravate diastolic dysfunction and heart failure. We evaluated the effect of left atrial plication (LAP) on atrial functional mitral regurgitation. We retrospectively reviewed patients who underwent LAP for atrial functional mitral regurgitation at our institution between January 2017 and December 2021. Early outcomes, follow-up echocardiography data, and heart failure indicators were compared. Eighteen patients were divided into two groups: LAP + (n = 9) or LAP- (n = 9). There were no significant differences in patient characteristics and preoperative echocardiographic parameters, except for the preoperative New York Heart Association classification. Operative (505.7 [standard deviation: 100.0] minutes vs. 382.9 [standard deviation: 58.1] minutes, P = .0055) and cardiopulmonary bypass times (335.6 [standard deviation: 50.4] minutes vs. 246.9 [standard deviation: 62.7] minutes, P = .0044) were significantly longer in the LAP + group. No in-hospital mortalities were observed in both groups. The postoperative left atrial volume was significantly reduced in the LAP + group, and mitral regurgitation was controlled at less than mild levels in both groups. At follow-up, the left ventricular end-diastolic volume was reduced significantly in the LAP + group. Brain natriuretic peptide, cardiothoracic ratio, and the New York Heart Association classification were improved in the LAP + group. Additional left atrial plication contributes to the control of atrial functional mitral regurgitation and heart failure at a later stage. A careful long-term follow-up is needed as re-expansion of the left atrium is possible.
Tài liệu tham khảo
Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43. https://doi.org/10.1016/s0195-668x(03)00201-x.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: A population-based study. Lancet. 2006;368:1005–11. https://doi.org/10.1016/S0140-6736(06)69208-8.
Takahashi Y, Abe Y, Sasaki Y, Bito Y, Morisaki A, Nishimura S, et al. Mitral valve repair for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. Interact Cardiovasc Thorac Surg. 2015;21:163–8. https://doi.org/10.1093/icvts/ivv119.
Machino-Ohtsuka T, Seo Y, Ishizu T, Sugano A, YamamotoM K, Sato K, et al. Novel mechanistic insights into atrial functional mitral regurgitation-3-dimensional echocardiographic study. Circ J. 2016;80:2240–8. https://doi.org/10.1253/circj.CJ-16-0435.
Ito K, Abe Y, Takahashi Y, Shimada Y, Fukumoto H, Matsumura Y, et al. Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: A study using three-dimensional transesophageal echocardiography. J Cardiol. 2017;70:584–90. https://doi.org/10.1016/j.jjcc.2017.03.013.
Abe Y, Akamatsu K, Ito K, Matsumura Y, Shimeno K, Naruko T, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J. 2018;82:1451–8. https://doi.org/10.1253/circj.CJ-17-1334.
Saito C, Minami Y, Arai K, Haruki S, Yagishita Y, Jujo K, et al. Prevalence, clinical characteristics, and outcome of atrial functional mitral regurgitation in hospitalized heart failure patients with atrial fibrillation. J Cardiol. 2018;72:292–9. https://doi.org/10.1016/j.jjcc.2018.04.002.
Ito K, Abe Y, Watanabe H, Shimada Y, Shibayama K, Oe H, et al. Prognostic significance of residual functional mitral regurgitation in hospitalized heart failure patients with chronic atrial fibrillation and preserved ejection fraction after medical therapies. J Echocardiogr. 2019;17:197–205. https://doi.org/10.1007/s12574-018-0412-6.
Kagiyama N, Hayashida A, Toki M, Fukuda S, Ohara M, Hirohata A, et al. Insufficient leaflet remodeling in patients with atrial fibrillation: Association with the severity of mitral regurgitation. Circ Cardiovasc Imaging. 2017;10:e005451. https://doi.org/10.1161/CIRCIMAGING.116.005451.
Kim DH, Heo R, Handschumacher MD, Lee S, Choi YS, Kim KR, et al. Mitral valve adaptation to isolated annular dilation: Insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging. 2019;12:665–77. https://doi.org/10.1016/j.jcmg.2017.09.013.
Cong T, Gu J, Lee AP, Shang Z, Sun Y, Sun Q, et al. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound. 2018;16:13. https://doi.org/10.1186/s12947-018-0131-1.
Beppu S, Kawazoe K, Nimura Y, Nagata S, Park YD, Sakakibara H, et al. Echocardiographic study of abnomal position and motion of the posterobasal wall of the left ventricle in cases of giant left atrium. Am J Cardiol. 1982;49:467–72. https://doi.org/10.1016/0002-9149(82)90526-4.
Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–9. https://doi.org/10.1016/s0002-9149(02)02864-3.
Wu VC, Takeuchi M, Kuwaki H, Iwataki M, Nagata Y, Otani K, et al. Prognostic value of LA volumes assessed by transthoracic 3D echocardiography: Comparison with 2D echocardiography. JACC Cardiovasc Imaging. 2013;6:1025–35. https://doi.org/10.1016/j.jcmg.2013.08.002.
Osranek M, Bursi F, Bailey KR, Grossardt BR, Brown RD Jr, Kopecky SL, et al. Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: Three-decade follow-up. Eur Heart J. 2005;26:2556–61. https://doi.org/10.1093/eurheartj/ehi483.
Kaneyuki D, Nakajima H, Asakura T, Yoshitake A, Tokunaga C, Tochii M, et al. Midterm results of mitral valve repair for atrial functional mitral regurgitation: A retrospective study. J Cardiothorac Surg. 2020;15:312. https://doi.org/10.1186/s13019-020-01362-1.
Sakaguchi T, Totsugawa T, Orihashi K, Kihara K, Tamura K, Hiraoka A, et al. Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. J Card Surg. 2019;34:767–73. https://doi.org/10.1111/jocs.14136.
Shibata T, Takahashi Y, Fujii H, Morisaki A, Abe Y. Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism. Gen Thorac Cardiovasc Surg. 2021;69:1041–9. https://doi.org/10.1007/s11748-021-01629-x.
Fukunaga N, Matsuo T, Saji Y, Imai Y, Koyama T. Mitral valve stenosis progression due to severe calcification on glutaraldehyde-treated autologous pericardium: Word of caution for an attractive repair technique. Ann Thorac Surg. 2015;99:2203–5. https://doi.org/10.1016/j.athoracsur.2014.07.087.
Matsumori M, Kawashima M, Aihara T, Fujisue J, Fujimoto M, Fukase K, et al. Efficacy of left atrial plication for atrial functional mitral regurgitation. Gen Thorac Cardiovasc Surg. 2021;69:458–65. https://doi.org/10.1007/s11748-020-01483-3.