Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct;49(5):350-355.
doi: 10.5090/kjtcs.2016.49.5.350. Epub 2016 Oct 5.

Clinical Effect of Left Ventricular Dysfunction in Patients with Mitral Stenosis after Mitral Valve Replacement

Kwon Jae Park  1 , Jong Soo Woo  1 , Jong Yoon Park  1 , Jae Hwa Jung  1
Affiliations

Clinical Effect of Left Ventricular Dysfunction in Patients with Mitral Stenosis after Mitral Valve Replacement

Kwon Jae Park et al. Korean J Thorac Cardiovasc Surg. 2016 Oct.

Abstract

Background: Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction.

Methods: Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 (EF≤45%) included 13 patients and group 2 (EF>45%) included 97 patients.

Results: Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304).

Conclusion: This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and as more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation.

Keywords: Heart failure; Mitral valve; Mitral valve stenosis; Stroke.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Actuarial freedom from thromboembolic events. EF, ejection fraction.
Fig. 2
Fig. 2
The actuarial survival rate of group 1 and group 2. EF, ejection fraction.
Fig. 3
Fig. 3
Survival effect of the maze procedure for each group. (A) Survival functions in group 1. (B) Survival functions in group 2.
Fig. 4
Fig. 4
Actuarial freedom from reoperation. EF, ejection fraction.
See this image and copyright information in PMC

References

    1. Ward C, Hancock BW. Extreme pulmonary hypertension caused by mitral valve disease. Natural history and results of surgery. Br Heart J. 1975;37:74–8. doi: 10.1136/hrt.37.1.74. - DOI - PMC - PubMed
    1. Rowe JC, Bland EF, Sprague HB, White PD. The course of mitral stenosis without surgery: ten- and twenty-year perspectives. Ann Intern Med. 1960;52:741–9. doi: 10.7326/0003-4819-52-4-741. - DOI - PubMed
    1. Olesen KH. The natural history of 271 patients with mitral stenosis under medical treatment. Br Heart J. 1962;24:349–57. doi: 10.1136/hrt.24.3.349. - DOI - PMC - PubMed
    1. Klein AJ, Carroll JD. Left ventricular dysfunction and mitral stenosis. Heart Fail Clin. 2006;2:443–52. doi: 10.1016/j.hfc.2006.09.006. - DOI - PubMed
    1. Wisenbaugh T, Essop R, Middlemost S, Skoularigis J, Sareli P. Excessive vasoconstriction in rheumatic mitral stenosis with modestly reduced ejection fraction. J Am Coll Cardiol. 1992;20:1339–44. doi: 10.1016/0735-1097(92)90246-J. - DOI - PubMed

LinkOut - more resources