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J Thorac Cardiovasc Surg 2001;121:0091-0096
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery

From the Department of Internal Medicine and Cardiology,^a University of Florence, Italy, the Centre Cardiothoracique de Monaco,^b Monaco, the Kemp Carraway Heart Institute,^c Birmingham, Ala, and the Department of Cardiothoracic Surgery,^d UCLA, Los Angeles, Calif.

Received for publication April 10, 2000. Revisions requested July 10, 2000; revisions received Aug 2, 2000. Accepted for publication Sept 6, 2000. Address for reprints: Marisa Di Donato, MD, Via dei Fossi 12, 50123 Firenze, Italy.

Objectives: In the present study we retrospectively analyzed ventriculographic data from symptomatic patients after myocardial infarction who underwent the Dor procedure (endoventricular circular patch plasty repair) to evaluate left ventricular shape 1 year after the operation and to analyze the geometric correlates of late mitral regurgitation.
Methods: Forty-four patients with previous transmural anterior myocardial infarction comprised the study group. Left ventricular volumes, global left ventricular systolic and diastolic sphericity, the extent of wall motion abnormalities, and the presence and degree of mitral regurgitation were analyzed before and 1 year after operation.
Results: Comparing preoperative diastole to systole within the cardiac cycle, left ventricular shape becomes more elliptical in systole than it was in diastole (eccentricity index closer to 1). The intervention leads to an increased diastolic sphericity, but for each cardiac cycle, the systolic shape is more elliptical relative to its diastolic counterpart in respect to basal conditions. Mitral regurgitation was detected after operations in 17 patients; 14 of them did not have mitral regurgitation before operations. Patients with late mitral regurgitation had greater preoperative volumes and more spherical chamber than did patients without late mitral regurgitation.
Conclusions: Despite a more spherical postoperative left ventricular chamber, systolic pump function improves after the Dor procedure, mainly for the improvement in inferior wall shortening. The presence of late mitral regurgitation is relatively frequent in this series of patients, and this emphasizes the importance of a more accurate quantitative evaluation of preoperative functional mitral regurgitation to repair the valve when appropriate. Geometric correlates of late mitral regurgitation appeared to be greater chamber sphericity and larger ventricular volumes preoperatively.