Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

Teuku Muhammad Haykal Putra; Renan Sukmawan; Elen Elen; Celly A. Atmadikoesoemah; Dwita Rian Desandri; Manoefris Kasim

doi:10.1055/s-0039-1693457

International Journal of Angiology, Table of Contents

Int J Angiol 2019; 28(04): 237-244
DOI: 10.1055/s-0039-1693457

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

Authors

Teuku Muhammad Haykal Putra

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Renan Sukmawan

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Elen Elen

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Celly A. Atmadikoesoemah

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Dwita Rian Desandri

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Manoefris Kasim

¹Department of Cardiology and Vascular Medicine, Division of Nuclear Cardiology and Cardiovascular Imaging, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

Abstract

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.

The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.

This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.

This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.

More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

Keywords

myocardial fibrosis - rheumatic heart disease - mitral valve surgery

Full Text

References

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