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Mitral regurgitation (MR) occurs when any of the valve and ventricular mitral apparatus components are disturbed. As MR progresses, left ventricular remodelling occurs, ultimately causing heart failure when the enlarging left ventricle (LV) loses its conical shape and becomes globular. Heart failure and lethal ventricular arrhythmias may develop if the left ventricular end-systolic volume index exceeds 55 ml/m2. These adverse changes persist despite satisfactory correction of the annular component of MR. Our goal was to describe this process and summarize evolving interventions that reduce the volume of the left ventricle and rebuild its elliptical shape. This ‘valve/ventricle’ approach addresses the spherical ventricular culprit and offsets the limits of treating MR by correcting only its annular component. [ABSTRACT FROM AUTHOR]

Aims Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging. Methods and results Patients with moderate to severeMRand high surgical risk underwent MitraClipTM-implantation andCMRimaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strainwas applied.Twenty patients (age: 76+8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33+16 underwent both successful MitraClipTM implantation and CMR imaging. MR fraction (36+10 vs. 19+12%; P , 0.001) and LV end-diastolic volume (115+36 vs. 105+41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42+15 vs. 41+16%, P = 0.8) and cardiac index (1.7+0.5 vs. 1.8+0.4 L/min/2, P = 0.4) remained unchanged. MitraClipTM implantation resulted in a significant impairment of circumferential (212.8+4.8 vs. 28.2+3.3; P = 0.002) and radial strain (15.4+7.7 vs. 9.6+5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83+19 vs. 84+18 mL/2, P = 0.8), ejection fraction (42+9 vs. 43+11%, P = 0.8), or tricuspid regurgitation fraction (24+17 vs. 25+19%, P = 0.7). MitraClipTM implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P , 0.001). Conclusion In severely compromised patients, marked reduction in MR by MitraClipTM implantation might not result in immediate improved cardiac output and effective biventricular forward flow. [ABSTRACT FROM AUTHOR]

Background: The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction. Objectives: This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography. Patients and Methods: This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute. Results: The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed aþ1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload. Conclusion: This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings. [ABSTRACT FROM AUTHOR]