Changes of Mitral Regurgitation after Aortic Valve Replacement, according to the Aortic Valve Pathology

Kim, Si Wook; Park, Pyo Won; Lee, Young Tak; Jun, Tae Gook; Sung, Kiick; Kim, Wook Sung; Yang, Ji Hyuk; Choi, Jin Ho

Abstract

BACKGROUND: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the postoperative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). MATERIAL AND METHOD: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, 6~10 months and more than 18 months (mean follow-up duration: 38 months) postoperatively. RESULT: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups.
CONCLUSION
In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.