OBJECTIVE

To identify the predictors of progression of naive functional mitral regurgitation (MR) in patients with severe left ventricular dilation in addition to chronic aortic insufficiency (AI) after isolated surgical correction of the aortic valve disease.

MATERIAL AND METHODS

The study included 80 patients with end-diastolic volume (EDV) of the left ventricle (LV) ≥250 ml in presence of chronic AI with functional MR. AI was the only primary factor of LV remodeling in all patients. Surgical treatment of AI was performed according to the David and Bentall-DeBono methods, as well as AV replacement and isolated plasty of AV leaflets were done on the basis of several centers. The dynamics of functional MR severity was evaluated by transthoracic echocardiography. Evaluation of MR severity and analysis of possible predictors were performed 1—10 days before surgery, 7—10 days after surgery and at least 6 months after surgical treatment.

RESULTS

Mitral annulus diameter (MAD) ≥45 mm at the preoperative stage of observation serves as an independent predictor of MR progression from the post-operative level to long-term one at EDV ≥250 ml in all groups (OR 1.560; 95% confidence interval — CI 1.033—2.358; p=0.035). The MAD/end-diastolic dimension ratio ≥0.539 before surgery is a statistically significant gross predictor of MR aggravation from the post-operative stage to long-term period (AUC=0.734; 95% CI 0.562—0.905; p=0.011). The MAD/end-systolic dimension ratio ≥0.833 before surgery serves as a statistically significant predictor of MR aggravation from the post-operative stage to long-term period (AUC=0.698; 95% CI 0.522—0.875; p=0.031).

CONCLUSION

Functional MR that occurred in presence of chronic AI may progress after correction of the aortic valve disease in severe mitral annular dilatation outpacing the LV dilation.