Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes.
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OBJECTIVE: Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed. DESIGN: A retrospective cohort. SETTING: A tertiary-care hospital. PARTICIPANTS: Patients who underwent OLT between January 1, 2003 and February 4, 2012. INTERVENTIONS: After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS: From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46). CONCLUSIONS: This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.
mitral valve incompetence
mitral valve insufficiency
mitral valve regurgitation
Published Version (Please cite this version)10.1053/j.jvca.2016.10.025
Publication InfoCastleberry, Dr Anthony; Cooter, Mary; Gregory, Stephen; Haney, John Carroll; Hartwig, M; McCartney, Sharon Lorraine; ... Swaminathan, Madhav (2017). Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes. J Cardiothorac Vasc Anesth, 31(3). pp. 924-930. 10.1053/j.jvca.2016.10.025. Retrieved from http://hdl.handle.net/10161/15973.
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Clinical Associate in the Department of Surgery
Assistant Professor of Surgery
Associate Professor of Surgery
Assistant Professor of Anesthesiology
Adjunct Associate Professor in the Department of Medicine
Dr. Zainab Samad is an Adjunct Associate Professor of Medicine at Duke University. She attended Medical School at the Aga Khan University Medical College in Karachi, Pakistan and thereafter completed her residency training in Internal Medicine and fellowship in Cardiology at Duke University Medical Center in Durham, North Carolina. Additionally, she completed advanced training in cardiovascular imaging, specifically in clinical echocardiography, cardiac MRI and SPECT-myocardi
Professor of Anesthesiology
My overall goal is to elucidate mechanisms of and risk factors for perioperative acute kidney injury in patients undergoing heart surgery with emphasis the role of early recovery of kidney function. A special area of interest is the phenomenon of left ventricular diastolic dysfunction. We have successfully developed an algorithm to help simplify the detection of diastolic dysfunction using echocardiography during heart surgery. A future goal is to explore interventions that help prevent or reduc
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Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. Blackstone, Eugene H; Desai, RR; Klein, AL; Krasuski, Richard Andrew; Marwick, TH; Nowicki, ER; Pettersson, Gosta B; ... (10 authors) (J Thorac Cardiovasc Surg, 2013-11)OBJECTIVES: To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. METHODS: From 2001 to 2007, 1833 patients with ...
Colin, BJ; Del Rio, JM; Duane Davis, R; McCartney, Sharon Lorraine; Swaminathan, Madhav (J Cardiothorac Vasc Anesth, 2014-12)A case of MR progression after single-lung transplant as a significant contributor to postoperative respiratory failure is reported. Pre-existing MR may progress due to the decompressive effects of lung transplantation on ...
Two Cases of Late Shone Syndrome With Pulmonary Hypertension: Heart-Lung Transplant or Valve Surgery? Blackstone, Eugene H; Hanna, M; Krasuski, Richard Andrew; Pettersson, Gosta B; Robich, MP; Stewart, RD; Zahka, KG (World J Pediatr Congenit Heart Surg, 2016-01)Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart-lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was ...