Reverse Remodeling of Mitral Valve Apparatus after Surgical Repair of Acquired Left Ventricular Aneurysms of Posterior versus Anterior Localization Assessed with Multislice Computed Tomography

Objectives: Involvement of the mitral valve (MV) apparatus represents a challenge in surgical ventricular repair (SVR), especially of posterior left ventricular (LV) aneurysms. This study sought to find out the differences in reverse remodeling of MV apparatus in posterior versus anterior aneurysm localization to optimize the technique of SVR regarding MV function.

Methods: Thirty consecutive patients (m:w = 24:6, age 38–78, median 66 years; mean NYHA class 2.98) with posterior LV aneurysm (group 1) and 35 consecutive patients (m:w=26:9, age 33–75, median 56 years; mean NYHA class 3.02) with anterior LV aneurysm (group 2) were operated upon. Multislice computed tomography (MSCT) was performed in 24 patients of group 1 and in all patients of group 2 before and after surgery. End-diastolic and end-systolic volumes of LV and aneurysm were indexed to body surface area (LVEDVI/LVESVI, AEDVI/AESVI). The MV apparatus was characterized by coaptation distance, tenting area, MV closure angle, MV annulus area, intercommissural and anteroposterior MV annulus diameter and interpapillary muscle distance (CD, TA, MVCA, MVAA, ICD, APD, IMD).

Results: Groups 1 and 2 showed 30-day mortality of 10% and 0% and 5-year survival of 83% and 93.5%, respectively. Volumetric parameters of LV showed adequate reduction after surgery in both groups. Preoperative MSCT assessment showed significantly higher values of MVAA, CD and TA in patients who needed MV repair or replacement in group 1. Postoperative reduction of mitral regurgitation in patients of group 1 without MV surgery corresponded with significant reduction in ICD, APD, MVAA, TA, CD, MVCA and IMD. Group 2 demonstrated a slight reduction of MVAA and significant reduction of TA, CD and IMD after SVR without concomitant mitral surgery.

Conclusion: SVR for LV aneurysms of both localizations leads to remarkable changes in mitral geometry even without concomitant MV repair, whereby the mechanisms are obviously different. Based on the MSCT assessment we propose algorithms for surgical planning in posterior and anterior LV aneurysms. MSCT guided SVR of LV aneurysms leads to excellent mid-term results.

No conflict of interest has been declared by the author(s).