Vaidya Vaibhav R, DeSimone Christopher V, Damle Namrata, Naksuk Niyada, Syed Faisal F, Ackerman Michael J, Ponamgi Shiva P, Nkomo Vuyisile T, Suri Rakesh M, Noseworthy Peter A, Asirvatham Samuel J
Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
University of Minnesota, Minneapolis, MN, USA.
J Interv Card Electrophysiol. 2016 Aug;46(2):137-43. doi: 10.1007/s10840-015-0090-5. Epub 2016 Jan 15.
Bileaflet mitral valve prolapse (MVP) can be associated with malignant ventricular arrhythmias. It is unknown whether surgical correction alone of this mitral valve pathology leads to a reduction in ventricular dysrhythmias.
We retrospectively analyzed 4477 patients who underwent mitral valve surgery from 1993-2013 at Mayo Clinic in Rochester, MN. Among these, eight patients with bileaflet MVP who had an internal cardioverter defibrillator (ICD) in place both pre- and post-surgery were identified. ICD interrogation records were evaluated for episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), and appropriate ICD shock therapy.
Of these eight patients, five had a malignant ventricular arrhythmia prior to surgery. Data was available 4.6 ± 2.9 years before versus 6.6 ± 4.2 years following surgical intervention. Among these patients, there was a reduction in VF (0.6 versus 0.14 events per-person-year pre- and post-surgery, respectively), VT (0.4 versus 0.05 events per-person-year pre- and post-surgery, respectively), and ICD shocks (0.95 versus 0.19 events per-person-year pre- and post-surgery) following mitral valve surgery.
We report a series of cases where the surgical correction of bileaflet MVP alone was associated with a reduction in malignant arrhythmia and appropriate shocks. These early observations merit further investigation involving larger cohorts to further evaluate the association between abnormal mechanical forces in degenerative mitral valve disease and ventricular dysrhythmias.
二尖瓣叶脱垂（MVP）可能与恶性室性心律失常有关。仅对这种二尖瓣病变进行手术矫正是否会导致室性心律失常减少尚不清楚。
我们回顾性分析了1993年至2013年在明尼苏达州罗切斯特市梅奥诊所接受二尖瓣手术的4477例患者。其中，确定了8例双叶MVP患者，他们在手术前后均植入了体内除颤器（ICD）。对ICD询问记录进行评估，以确定室性心动过速（VT）、室颤（VF）发作以及适当的ICD电击治疗情况。
在这8例患者中，5例在手术前有恶性室性心律失常。手术干预前的数据可得时间为4.6±2.9年，术后为6.6±4.2年。在这些患者中，二尖瓣手术后VF（分别为术前和术后每人每年0.6次和0.14次事件）、VT（分别为术前和术后每人每年0.4次和0.05次事件）以及ICD电击（分别为术前和术后每人每年0.95次和0.19次事件）均有所减少。
我们报告了一系列病例，其中仅对双叶MVP进行手术矫正与恶性心律失常减少和适当电击有关。这些早期观察结果值得进一步开展涉及更大队列的研究，以进一步评估退行性二尖瓣疾病中异常机械力与室性心律失常之间的关联。
