Abstract Mitral Regurgitation (MR) is characterized by a high morbidity and mortality that often finds a solution only in the reparative surgical treatment, in particular in presence of myxomatous degeneration that cause the prolapse of one or both leaflets. This results in an increase in diastolic pressure that leads to a progressive dilation of the left atrium. The increase in Left Atrium Volume Index (LAVI) during stress test represents a negative prognostic factor in the clinical evolution of many pathologies, such as ischemic heart disease, hypertrophic cardiomyopathy, heart failure. An increase in peak/rest LAVI >6.8 ml/m2 correlates with a higher incidence of heart failure decompensation, reduced left ventricular contractile reserve (LVCR), pulmonary congestion. We evaluate the effect of MR reparative surgery on the changes of LAVI during stress–echo. We enrolled 19 patients, 11 females and 8 males, affected by MR candidate to cardiac surgery. We performed a physical stress–echo test by using the ABCDE protocol suggested by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), before and after 12 weeks from surgery. During each test, the changes in LAVI (ΔLAVI) expressed as peak/rest difference in ml/m2 was measured. In addition, the prognostic score deriving from the sum of the ABCDE criteria was calculated, such as the LVCR (C parameter of the score) that represents a parameter of the force deriving from the hemodynamic changes during the test. In all patients we observed a significant reduction in ΔLAVI (8.4+0.5 mL/m2 vs 9.7+0.7 mL/m2; p<0.0001). In addition, there was a significant reduction in the ABCDE prognostic score (from 4.19+0.43 to 3.48+0.37; p=0.002), secondary to the increase in the LVCR observed approximately 3 months after surgery (from 1.77 mmHg/ml to 2.44 mmHg/ml, p<0.0001), as well as a significant reduction in pulmonary congestion during stress (B parameter). There were no significant changes in ejection fraction, wall motion score index–WMSI (A parameter), coronary reserve (D parameter) and heart rate reserve (E parameter). These data demonstrate for the first time that mitral valve plastic surgery is able to reduce the ΔLAVI during stress echocardiography in patients with severe MR. The surgical procedure also resulted in both an improvement in the LVCR and a reduction in the degree of pulmonary congestion, that ultimately led to an improvement in the ABCDE prognostic score.
Abstract Introduction Since the beginning of the actual pandemia, several patients with positive anamnesis for Covid 19, are undergoing a cardiac operation. Aim of the study is to analize if the Covid 19 past infection may impact on cardiac surgery outcome. Method All the patients with a history of Covid 19 positivity, who underwent a cardiac operation at the Clinica Mediterranea in Naples from the 1st of february 2021 to the 31st dicember 2021, have been included in the study. For those patients we evaluated the basal respiratory condition, with a chest Xray or CT scan, a pneumology consult and a spirometry if required. Postoperative outcome has been evaluated analizing ventilation time, intensive care and postoperative lenght of stay, acute renal failure, acute espiratory failure, postoperative complications and death. Results Thirtheen patients on 358 had a positive anamnesis for Covid19, but a negative swab at the admission. The mean time from the infection has been 5.1 +/– months, 5 patients have had poor or no symptoms, while the remnants moderate or sever ones with evidence of interstitial pneumonia, one patient had developed extrapulmonary complications (valvular thrombosis).
