Depends on the etiology, the surgical approach (sub-valve continuity) and the amount of LV dysfunction and possible underestimated AI
LV détérioration after MVR may be multifactorial that includes leaking valve AF development Concommitant Aortic valve pathology
Its multifactorial that includes Concommitant other valvular pathology , associated comorbidités ( HTN) CAD uncontrolled AF even after MVR
Potential Causes of Deteriorating LV Function Post-Mitral Valve Replacement
Gradual deterioration of left ventricular (LV) function following mitral valve replacement is a serious concern. While this outcome is not always expected, several factors can contribute to this phenomenon. Here are some potential causes:
1. Myocardial Damage
- Pre-existing damage: The LV may have already sustained damage due to chronic mitral regurgitation, which can be exacerbated by the surgical procedure.
- Perioperative ischemia: Despite careful management, some patients may experience episodes of myocardial ischemia during or after surgery, leading to further damage.
- Valve dysfunction: In rare cases, the newly implanted valve may malfunction, leading to increased hemodynamic stress on the LV.
2. Hemodynamic Factors
- Increased afterload: If the patient develops aortic stenosis or other conditions that increase afterload, the LV may struggle to maintain adequate function. 1. Physiology, Left Ventricular Function - StatPearls - NCBI Bookshelf www.ncbi.nlm.nih.gov📷
- Arrhythmias: Atrial fibrillation or other arrhythmias can disrupt the heart's rhythm and reduce LV filling, leading to decreased cardiac output.
3. Infections and Inflammation
- Endocarditis: Bacterial or fungal infections can damage the heart valves and lead to LV dysfunction.
- Pericarditis: Inflammation of the pericardium can restrict LV filling and impair function.
4. Valve-Related Issues
- Valve thrombosis: The valve may become thrombotic, leading to obstruction of blood flow and LV dysfunction.
- Valve degeneration: Over time, the valve may experience wear and tear, leading to leakage or stenosis.
5. Other Factors
- Cardiomyopathy: Underlying cardiomyopathies can contribute to LV dysfunction, even after mitral valve replacement.
- Renal dysfunction: Impaired kidney function can lead to fluid overload and increased LV stress.
It's important to note that these are just a few potential causes, and the specific reasons for LV dysfunction in a given patient may vary. Regular follow-up with a cardiologist is crucial to monitor LV function and address any underlying issues promptly.
Potential Causes of Deteriorating LV Function Post-Mitral Valve Replacement
Gradual deterioration of left ventricular (LV) function following mitral valve replacement is a serious concern. While this outcome is not always expected, several factors can contribute to this phenomenon. Here are some potential causes:
1. Myocardial Damage
- Pre-existing damage: The LV may have already sustained damage due to chronic mitral regurgitation, which the surgical procedure can exacerbate.
- Perioperative ischemia: Despite careful management, some patients may experience episodes of myocardial ischemia during or after surgery, leading to further damage.
- Valve dysfunction: In rare cases, the newly implanted valve may malfunction, leading to increased hemodynamic stress on the LV.
2. Hemodynamic Factors
- Increased afterload: If the patient develops aortic stenosis or other conditions that increase afterload, the LV may struggle to maintain adequate function. 1. Physiology, Left Ventricular Function - StatPearls - NCBI Bookshelf www.ncbi.nlm.nih.gov📷
- Arrhythmias: Atrial fibrillation or other arrhythmias can disrupt the heart's rhythm and reduce LV filling, leading to decreased cardiac output.
3. Infections and Inflammation
- Endocarditis: Bacterial or fungal infections can damage the heart valves and lead to LV dysfunction.
- Pericarditis: Inflammation of the pericardium can restrict LV filling and impair function.
4. Valve-Related Issues
- Valve thrombosis: The valve may become thrombotic, obstructing blood flow and LV dysfunction.
- Valve degeneration: The valve may experience wear and tear over time, leading to leakage or stenosis.
5. Other Factors
- Cardiomyopathy: Underlying cardiomyopathies can contribute to LV dysfunction, even after mitral valve replacement.
- Renal dysfunction: Impaired kidney function can lead to fluid overload and increased LV stress.
It's important to note that these are just a few potential causes, and the specific reasons for LV dysfunction in a given patient may vary. Regular follow-up with a cardiologist is crucial to monitor LV function and address any underlying issues promptly.
Work of the left ventricle = Srock Volume x Systolic Pressure. Mitral Valve insufficiency allows blood to flow back into the atrium when the pressure is excessive for the ventricle. The mitral prosthesis can increas work against pressur (in aorta) which is mach mor expencive in the oxigen consamption level. In this case very important to make coronarography before operation for patients older 40 years. To be shure that oxigen debt will be covered after valve replacement. Another pathology - in case of mitral sthenosis the heart is underloaded with volume. After operation ventricle needs time to accept an additional volume. The ventricle needs time for remodeling and adaptation. The strategy of the intecive care is different in both cases
LV détérioration after MVR , may be multifactorial Its vary from patients to patient so Regular follow up and tailored appoach is the best way to treat
What about LV remodelling after a few years due to resection of the cords and pillars that play an anatomical and physiological role in giving it an oval shape to maximise ejection?
If you are asking re: mitral replacement for mitral regurgitation/prolapse, the possibility of unappreciated myocardial fibrosis may help explain deterioration after surgical repair. I would refer you to an article in Circulation published March 12, 2021, by Anne-Laure Constant Dit Beaufils, MD et al. "Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling, and Arrhythmia.", where they found more adverse cardiac events in patients with myocardial fibrosis detected by cardiac MRI with late gadolinium enhancement.
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