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Mitral-septal Angle Changes By Left Atrial Plication And Artificial Chord For Atrial Functional Mitral Regurgitation
Tomomi Nakajima, Hiroyuki Nakajima, Chiho Tokunaga, Yu Kumagai, Yuto Hori, Satoru Murata, Akitoshi Takazawa, Masatoshi Akiyama, Toshihisa Asakura, Akihiro Yoshitake.
Saitama Medical University International Medical Center, Hidaka, Japan.

OBJECTIVE:
The standard strategy for atrial functional mitral regurgitation (MR) has not been established. Narrowing of the mitral-septal angle (MSA) has been reported to alter the left ventricle (LV) blood flow pattern affecting the LV function. In this study, we investigated the role of left atrial (LA) plication, artificial chord reconstruction, and ring annuloplasty in the change of MSA by mitral valve repair for atrial functional MR. METHODS:
We retrospectively reviewed surgical outcomes of 43 cases of mitral valve repair for atrial functional MR from January 2011 to July 2021 with a median age of 71.0 7.8 years old and 20 cases were female. Mitral leaflet lesions, chordal ruptures, obsolete myocardial infarction, and concomitant aortic valve surgery were excluded. RESULTS:
The follow-up period was 42.6 31.0 months and echocardiography follow-up period was 30.3 28.6 months. Procedure was performed with artificial annuloplasty ring or band of 29.0 2.3 mm in all cases, LA plication in 11 cases, artificial chord reconstruction in 23 cases, Maze procedure in 18 cases, additional LA appendage closure in 14 cases, tricuspid annuloplasty in 36 cases. MSA was decreased from 82.2 11.0 preoperatively to 74.8 11.0 at one week after surgery (p<0.01) and 77.6 12.5 at final evaluation (p=0.08). However, it has not changed as from 79.8 11.1 to 79.9 7.6 (p=0.98) and 81.8 7.3 (p=0.20) after LA plication and as from 79.3 to 76.5 (p=0.28), 78.9 (p=0.90) after artificial chord reconstruction, respectively. The freedom-from-MR (moderate or severe) rate was 89.3 % over 3 years. The survival rate was 88.2 % over 3 years. CONCLUSIONS: LA plication and artificial chord reconstruction can preserve MSA even in mid-postoperative term. This may contribute to the preservation or recovery of LV function and the recurrence prevention of anterior pseudo-prolapse.


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