Search

Introduction Preoperative accurate assessment of biventricular systolic function is, essential for the decision of the operative timing in patients with MR. Objectives This study sought to compare the value of 2-dimensional (2D) left ventricular (LV) speckle tracking (STE) and feature tracking (FT) against cardiac magnetic resonance (CMR) LV ejection fraction (EF) on predicting postoperative LV dysfunction and in the other hand, evaluate the remodeling of the RV after mitral valve repair. Methods A total of 85 patients with degenerative mitral regurgitation (57,51±9,96 of age, 21,2% women) underwent LV and RV function assessment using CMR and 2D echocardiography a few days before and 7,7 months after mitral valve repair. Pre- and postoperative indexed LV and RV end-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), Echocardiographic GLS, GCS, and CMR GLS, GCS, GRS were measured. Results Prior to surgery LV volumes were significantly larger, 2D LV and RV STE and FT lower than normal volunteers. After a median follow-up of 7,7 after mitral repair, not only left and right ventricular volume indexed: LV EDVi, ESVi; RV EDVi, atrial volume but also STE (LVGLS-GCS) and FT (LVGLS, GCS, GRS) were significantly decreased (all P Conclusions 2D LV GLS provides strong additionaL value to predict postoperative LV dysfunction in degenerative mitral regurgitation, with higher predictive value than CMR-LVEF, CMR-FT-LVGLS, or FAC. This supports the use of STE-LVGLS to find the best surgical timing in patients with severe MR to prevent LV dysfunction and allow RV recovery.

Background Paradoxical low gradient (PLG) severe aortic stenosis (SAS) is a recently described subset of SAS, which is a matter of intense debate. Some authors indeed consider this new entity as a more advanced form of SAS, whereas others believe the opposite. To get further insight into the pathophysiology of PLG SAS, we compared the weight of the valves explanted at the time of surgery (AVR) and the degree of valve calcification among consecutive patients with PLG SAS and high-gradient (HG) SAS. Methods We prospectively recruited 38 consecutive patients (20 men; mean age: 73 yrs) with isolated non-rheumatic SAS (indexed aortic valve area (AVAi) Results PLG and HG SAS had similar baseline characteristics with the exception of AVAi which was higher (0.44±0.06 vs 0.36±0.10 cm2m2, p=0.008) and MG which was lower (32±7 vs 55±12 mmHg, p 0.90) and in-vivo (r2=0.71) Agatston scores. Interestingly, valves explanted from patients with PLG SAS were lighter (1.58±0.65 vs 2.65±1,24g, p=0.001) and showed lower ex-vivo Agatston scores (363±282 vs 1211±840, p Conclusion The valves weight and degree of valve calcification reported in our study indicate that PLG SAS valves are less severely affected than HG SAS valves. These data thus reinforce the hypothesis that PLG SAS is a lesser advanced form of aortic stenosis than HG SAS.

BackgroundDespite the absence of randomized studies comparing mitral valve (MV) repair and replacement, international guidelines strongly recommend MV repair as the optimal surgical treatment for severe degenerative mitral regurgitation (dMR). Yet, the level of evidence supporting these recommendations is low, owing to the lack of available clinical trial data. In this context, analysis of large multicenter registries becomes critical.ObjectiveTo compare very long-term survival among patients (pts) undergoing MV repair versus replacement for the treatment of severe dMR using the technique of propensity score (PS) matching to reduce bias in nonrandomized cohorts.MethodsThe Mitral Regurgitation International DAtabase (MIDA) is a prospective multicenter registry that includes 2,569 consecutive pts with dMR, who were recruited in 6 tertiary centers (France, Italy, Belgium, and the United States) between 1980 and 2005. Among these, we identified 1,922 pts who underwent mitral surgery, including 1,709MV repairs and 213MV replacements. We compared operative mortality and overall survival in both the entire study population and in 615 PS-matched (2:1) pts.ResultsOperative mortality was lower after MV repair than after MV replacement, both in the entire population (2 vs 7%; p=0.001) and in the PSmatched pts (4 vs 8%; p=0.04). Similarly, 20-year survival was better after MV repair than after MV replacement, both in the entire population (46% [(95% CI, 39%-52%] vs 23% [95% CI, 14%-32%], p

BackgroundValvular heart disease is associated with left ventricular hypertrophy, remodeling and development of diffuse interstitial fibrosis. So far, histopathology remains the gold standard for evaluating diffuse myocardial fibrosis. Gadolinium enhanced Cardiac Magnetic Resonance (CMR) T1 mapping is new method which allows to quantify the myocardial extracellular volume (ECV). Hence, it was suggested that this ECV measurements allows to non-invasive estimate diffuse fibrosis. However validations studies are scars. Therefore the aim of this study was to validate measurements of ECV by T1-Modified Lock-locker (MOLLI) CMR against histological measurement.Methods and resultsBetween June 2012 and September 2013, 15 patients (age=57±15 years, 73% men) with either severe aortic valve disease (stenosis or regurgitation) or severe mitral regurgitation, but without coronary artery disease preoperatively underwent ECV measurement by CMR MOLLI T1 mapping. LV biopsies were performed at the time of surgery 7±8 days later and stained with Sirius red. The amount of fibrosis quantified by biopsy was 6.6±4.8% [2.1;15.9]. ECV by T1 mapping was 28.3±4.7% [23.3;38.6] (values are presented as mean±SD [min;max]). There was a good correlation between histologically measured fibrosis and T1 mapping ECV (r=0.77, p