Evaluation of Left Atrial Functions in Patients with Primary Mitral Regurgitations after Mitral Valve Replacement in Comparison to Mitral Valve Repair: Strain Imaging Study

Background: Mitral regurgitation (MR) is the most often valvular heart illness and is closely related with left atrial (LA) dilation, which reflects both the chronicity and severity of MR. The LA plays a vital role as a reservoir during ventricular filling, and its enlargement is a predictor of adverse results, even in asymptomatic cases. Surgical correction, particularly mitral valve repair (MVr), is recommended for severe MR. Recent advances like two-dimensional speckle tracking echocardiography (2D-STE) enable detailed assessment of LA function, providing valuable guidance for management and prognostic evaluation. Aim: To assess alterations in left atrial strain in cases with chronic severe primary MR before and following MV surgery, and to compare the effects of MV repair and MV replacement (MVR) on LA mechanics. Patients and methods: This research involved 30 cases with chronic primary severe MR and preserved left ventricle (LV) ejection fraction. Cases have been randomized into two equal groups: MVr (n=15) and MVR (n=15). All cases had comprehensive clinical and echocardiographic evaluation, including 2D, Doppler, and 2D-STE imaging, performed preoperatively and six months postoperatively to assess changes in LA strain and cardiac dimensions. Results: Both groups demonstrated significant postoperative improvement in LA strain and reduction in LA size. The MVr group showed a slightly greater improvement in LA mechanics compared with MVR. Conclusion: In cases with chronic severe 1^ry MR, mitral valve surgery—either repair or replacement—outcomes in significant left atrial reverse functional and remodeling recovery, with MVr offering superior outcomes, as shown by 2D speckle tracking.