Left atrial remodeling early after mitral valve repair for degenerative mitral regurgitation

Francesco Antonini-Canterin ^1*, Carmen Cristiana Beladan ², Bogdan Alexandru Popescu ², Carmen Ginghina ², Andreea Catarina Popescu ³, Rita Piazza ¹, Elisa Leiballi ¹, Bartolo Zingone ⁴ and Gian Luigi Nicolosi ¹

¹ Cardiologia ARC, Azienda Ospedaliera "S. Maria degli Angeli", Pordenone, Italy
² "Prof. Dr. C.C Iliescu" Institute of Cardiovascular Diseases, Bucharest, Romania
³ Cardiology Department, Elias Hospital, Bucharest, Romania
⁴ Cardiochirurgia, Ospedali Riuniti, Trieste, Italy

^* To whom correspondence should be addressed. E-mail: cardiologia{at}aopn.fvg.it.

Accepted 10 July 2007

Abstract

Objective: Left atrial (LA) size is an important predictor of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation (MR). Data on LA remodeling after mitral valve repair (MVr) for chronic non-ischemic MR are scarce. Our aim was to assess changes in LA size early after MVr for chronic severe degenerative MR and to identify clinical and echocardiographic correlates of those changes.

Methods: We analyzed 225 consecutive patients who underwent MVr and were echocardiographically evaluated in our hospital within 1 month before and 1-6 months after surgery. Patients with MR etiology other than degenerative, associated aortic valve replacement, congenital heart disease were excluded. The remaining 79 patients (aged 60 ± 12 years, 55 men) with isolated chronic severe degenerative MR formed the study group. LA reverse remodeling was defined as a decrease in LA volume index (LAVi) 15%.

Results: LA dimensions significantly decreased after MVr (p<0.001). Mean LAVi reduction was 29±18%. LA reverse remodeling was observed in 63 patients (80%). Correlates of LAVi reduction were preoperative LAVi (p=0.008), systolic and diastolic blood pressure (p=0.032, p=0.009), postoperative transmitral mean pressure gradient (p=0.001) and residual MR (p=0.043). LAVi reduction was lower in patients > 45 years (p=0.008) and in hypertensives (p=0.031).

Conclusion: LA reverse remodeling is common early after MVr for chronic severe degenerative MR. Preoperative LAVi, blood pressure, postoperative transmitral mean pressure gradient, residual MR and age > 45 are related to LAVi reduction. The prognostic value of LA reduction in this population needs further study.

Keywords: cardiac remodeling, left atrium, mitral regurgitation, mitral valve repair

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