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European Heart Journal 1991 12(Supplement B):22-25; doi:10.1093/eurheartj/12.suppl_B.22
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Right ventricular function in severe non-ischaemic mitral insufficiency

J. S. Borer, C. Hochreiter and S. Rosen

Cornell University Medical College, The New York Hospital New York, N.Y., U.S.A.

Correspondence: Jeffrey S. Borer, MD, New York Hospital-Cornell Medical Center. 525 Dast 68th Strat, New York, N.Y. 10021, U.S.A.

Mitral insuficiency (regurgitation) is a disease of both ventricles. To determine the pathophysiological implications and clinical value of assessment of right ventricular function in this disease, right ventricular ejection fraction was determined by radionuclide cineangiography (r=0·73, P<0·01, vs contrast angiography, n=30) in patients with severe, non-inchaemic mitral regurgitation. Among 31 patients with isolated mitral regurgitation treated medically, five died, all within 2 years of follow-up; all five were among the eight patients with left ventricular ejection fraction ≤45% (lower limit of normal), and among the six patients with right ventricular ejection fraction ≤30% (almost invariably associated with at least mild pulmonary hypertension). During the same period, valve replacement was performed in 22 patiem with kolated mitral regurgitation; among the six patients with right ventricular ejection fraction ≤30% before operation, only one died (P <0·05), indicating the rkkmitigating effect of valve replacement. Among eight pre-perative patients with combined mitral and aortic regurgitation, four died within 7 years after double valve replacement; all patients with right ventricular ejection fraction during exercise <20% died. After mitral valve replacement for kolated mitral regurgitation, right ventricular ejection fraction improved rapidly (average 8% in <1 year (P<0·05); 3% more at 3 years after operation (P<0·05)). Post-operative symptom persistence was predictable from ventricular ejection fraction before operation <30% (P<0·05). Finally, among patients with no or minimal symptoms and nortnal left and right ventricular ejection fraction at rest at study entry, subsequent development of operable indications was best predicted by a fall in right ventricular ejection fraction during exercke (P<0·05). Thus, right ventricular performance k a primary descriptor of risk and is useful in management deckion-making in severe, non-ischaemic mitral regurgitation.

Key Words: Mitral regurgitation • right ventricle • radionuclide cineangiography


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