PREOPERATIVE LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION CORRELATES WITH THE ADVERSE POSTOPERATIVE CONSEQUENCES OF ANNULAR-PAPILLARY DISCONNECTION IN THE COURSE OF MITRAL-VALVE REPLACEMENT FOR STENOSIS

Background and aims of the study: Preservation of chordae tendineae he lps maintain ventricular performance in patients having surgery for mi tral regurgitation. The importance of chordal integrity in patients wi th rheumatic mitral stenosis is unknown. The purpose of this study was to determine the influence of chordal preservation on left ventricula r function following relief of rheumatic mitral stenosis. Methods: A t otal of 142 patients with mitral stenosis had balloon valvulotomy (gro up 1, n = 63), surgical commissurotomy (group 2, n = 33) or mitral val ve replacement (group 3, n = 46). Chordae were resected in all group 3 patients. Left ventricular dimension in end-diastole (LVEDD), end-sys tole (LVESD) and fractional shortening (FS) were measured at baseline and at a mean interval of 11 +/- 3 months post intervention. Results: At one year, FS increased in groups 1 and 2, but decreased in group 3 (+11.5%, +9%, -6.1%, p<0.005 for group 3 versus groups 1 and 2). A bor derline significant increase in LVEDD was seen in group 1 compared wit h groups 2 and 3 (11%, 5%, 4% respectively, p = 0.05). Differences in FS at follow up were due mainly to diametrically opposite changes in L VESD in the subgroup of patients with baseline left ventricular dysfun ction (-1.9%, 0%, +9.8%, p<0.005 for group 3 versus groups 1 and 2). C onclusions: Deterioration of left ventricular function only in patient s having mitral valve replacement indicates chordal resection as a put ative mechanism. The results of this study suggest that chordal preser vation is particularly important in patients with mitral stenosis who have depressed preoperative left ventricular systolic function.