Anesth Pain Med.  2020 Apr;15(2):187-192. 10.17085/apm.2020.15.2.187.

Systolic anterior motion of mitral chordae tendineae: prevalence and clinical implications in liver transplantation

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
Although systolic anterior motion (SAM) of the mitral valve anterior leaflet is well-known to cause hemodynamic perturbation in many anesthetic situations, the prevalence and clinical implication of SAM of mitral chordae tendineae (chordal SAM) in liver transplantation (LT) has not been evaluated. We aimed to assess the impact of chordal SAM on intraoperative postreperfusion syndrome and short and long-term all-cause mortality.
Methods
We retrospectively evaluated 1751 LT recipients from January 2011 to June 2017 who had preoperative echocardiography. Echocardiography-derived parameters and the prevalence of post-reperfusion syndrome between those with chordal SAM and without chordal SAM were compared. The cumulative mortality rate according to the presence of chordal SAM was evaluated by the Kaplan-Meier survival curve.
Results
Of the enrolled recipients, 21 (1.2%) had chordal SAM in preoperative echocardiography. Compared to those without chordal SAM, patients with chordal SAM had a smaller end-systolic volume index (median 18 ml/m2 vs. 22 ml/m2, P = 0.015) and end-diastolic volume index (median 52 ml/m2 vs. 63 ml/m2, P = 0.011). However, there was no difference in systolic and diastolic function in echocardiography. The prevalence of intraoperative post-reperfusion syndrome did not show any difference (42.9% vs. 45.3%, P = 1.000). Over the mean 4.8-year follow-up, cumulative 90-day and overall mortality also did not show a difference (Log rank P > 0.05, both).
Conclusions
Preoperative screening of echocardiography in LT recipients detects 1.2% of chordal SAM. It is found with small left ventricular volume, but is not related with intraoperative post-reperfusion syndrome and short- and long-term postoperative all-cause mortality in LT.

Keyword

Liver transplantation; Mitral chordae tendineae; Mortality; Post-reperfusion syndrome; Systolic anterior motion

Figure

  • Fig. 1. Representative figure of echocardiographic finding of chordae systolic anterior motion of mitral valve in parasternal long axis view.Arrow represents the systolic motion of mitral valve.

  • Fig. 2. Comparison of rate of 90-day (A) and overall mortality (B) between patients with or without chordae systolic anterior motion of the mitral valve. SAM: systolic anterior motion of mitral valve.

  • Fig. 3. Cumulative 90-day (A) and overall mortality (B) compared between the groups of patients with or without chordae systolic anterior motion of mitral valve. No difference was found between the patients. SAM: systolic anterior motion of mitral valve.


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