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Sample records for asymptomatic mitral regurgitation

  1. Quantification of Mitral Regurgitation in Anatolian Shepherd Dogs with Asymptomatic Degenerative Mitral Valve Disease

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    Kursad Turgut1*, Yilmaz Koc2, Hasan Guzelbektes1,3, Amir Naseri1, Mehmet Ege Ince1 and Ismail Sen1

    2016-11-01

    Full Text Available Degenerative mitral valvular disease (DMVD is the most frequent cardiac disease, causing mitral regurgitation (MR in dogs. The purpose of this study was to compare the ratio of the regurgitant jet area (RJA to the left atrial area (LAA (RJA/LAA with subtracting method to quantify regurgitant volume (RegV and regurgitant fraction (RF in asymptomatic Anatolian Shepherd Dogs (ASHs with DMVD. Thirty-eight ASHs with DMVD were used as experimental group. The control group consisted of 35 healthy ASHs. In 38 ASHs with DMVD (20 B1 dogs and 18 B2 dogs, the severity of MR was assessed by RJA/LAA and subtraction method. No differences were noted between the assays measuring the severity of MR by χ2 analysis. The observed agreement between the assays was 81% for RJA/LAA vs RegV and was 73% for RJA/LAA vs RF, and the kappa statistic values for RJA/LAA vs RegV and for RJA/LAA vs RF were 0.63 (substantial agreement and 0.50 (moderate agreement, respectively. Our results indicate that each quantification method was valuable to estimate the acuteness of the disease in ASHs with MR and all were in good accordance with the echocardiographic heart size and N-terminal Pro-Brain Natriuretic Peptide (NT-proBNP measurements. Therefore, the each of these non-invasive methods may be functional to serially estimate the acuteness of MR in DMVD in order to monitor the progression of disease. Future studies have to evaluate, if these will be useful to anticipate the risk or time of decompensation in asymptomatic dogs.

  2. Neurohormonal and circulatory effects of short-term treatment with enalapril and quinapril in dogs with asymptomatic mitral regurgitation

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Pedersen, Lotte Gam; Teerlink, Tom

    2005-01-01

    Mitral regurgitation (MR) is a common cause of heart failure in dogs. Cavalier King Charles Spaniels (CKCS) are predisposed to the disease and often develop asymptomatic MR at a young age, which seems to be associated with a decreased production of nitric oxide (NO) (measured as the stable...

  3. Problem: Mitral Valve Regurgitation

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    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... each time the left ventricle contracts. Watch an animation of mitral valve regurgitation A leaking mitral valve ...

  4. Mitral valve regurgitation

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    ... around the valve. You are at risk for mitral valve regurgitation if you have: Coronary heart disease and high blood pressure Infection of the heart valves Mitral valve prolapse (MVP) Rare conditions, such as untreated syphilis or Marfan ... heart disease. This is a complication of untreated strep throat ...

  5. Neurohormonal and circulatory effects of short-term treatment with enalapril and quinapril in dogs with asymptomatic mitral regurgitation

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Pedersen, Lotte Gam; Teerlink, Tom

    2005-01-01

    The aim of the study was to compare the effect of 2 angiotensin-converting enzyme (ACE) inhibitors on neurohormonal and circulatory variables in Cavalier King Charles Spaniels (CKCSs) with asymptomatic mitral regurgitation (MR). Ten CKCSs with mild to severe untreated MR were treated with 2 ACE...... renin activity (Pconcentration (Pinhibitors had no effect on the concentrations of nitrate and nitrite (NOx) or asymmetric dimethylarginine (ADMA). On day 0, a lower NOx concentration (P = .02) was found in samples taken in the clinic as compared...... the effects of the 2 treatments on MR. These results suggest that ACE inhibitors do not affect NOx and ADMA concentrations in asymptomatic dogs, but exercise, stress, or some combination may influence NOx concentrations in these dogs....

  6. Mitral regurgitation: challenges and solutions

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    Ejiofor JI

    2016-05-01

    Full Text Available Julius I Ejiofor, Lawrence Cohn,† Tsuyoshi Kaneko Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA †Lawrence Cohn passed away on January 9, 2016 Abstract: Since the first mitral valvuloplasty in 1923, the technique of mitral valvuloplasty has matured over the years and now has become the first-line treatment, especially in patients with myxomatous mitral regurgitation (MR. We have highlighted some of the major problems that are encountered with the various etiologies of MR. We believe that repair is always the optimal surgical procedure for any of the above etiologies if it is consistent with a long-term result. However, replacement has shown to be a safer procedure in some instances such as severe functional MR or destructive endocarditis. Keywords: mitral regurgitation, mitral valvuloplasty, systolic anterior motion, functional mitral regurgitation, rheumatic valve disease

  7. Effects of Dobutamine Infusion on Mitral Regurgitation.

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    Sonoda, Makoto; Takenaka, Katsu; Sakamoto, Tsuguya; Watanabe, Fumiyoshi; Nakajima, Yoshie; Yang, Wei Dong; Omata, Masao

    1998-01-01

    Both intensity of mitral regurgitant murmur and color-coded Doppler regurgitant signal area have been reported to correlate with the degree of regurgitation. To evaluate the relationship between the intensity of regurgitant murmur and severity of mitral regurgitation, phonocardiography, echocardiography, and Doppler ultrasound were performed in 18 patients with mitral regurgitation before and during dobutamine infusion. Mitral regurgitation was due to mitral valve prolapse with ruptured chordae tendineae in 8 patients, rheumatic change in 5 patients, and dilated cardiomyopathy in 5 patients. With intravenous dobutamine infusion, heart rate (77-103 beats/min), systolic blood pressure (119-144 mmHg), peak mitral regurgitant jet velocity (4.5-5.4 m/sec), intensity of mitral regurgitant murmur (to 201% of that before infusion in early systole) increased, while left ventricular end-diastolic volume (124-102 mm), left ventricular end-systolic volume (57-42 mm), mitral anular diameter (33-28 mm), and color Doppler mitral regurgitant signal area (704-416 mm(2)) decreased (P flow/beat, regardless of etiology of mitral regurgitation, which was probably due to the decrease of left ventricular size and mitral annular diameter. Although total (forward + backward) left ventricular stroke volume was unchanged, dobutamine effectively increased forward left ventricular stroke volume by decreasing backward regurgitation. Mitral regurgitant murmur became louder despite the decrease of mitral regurgation, indicating the uselessness of auscultation in the grading of the severity of mitral regurgitation.

  8. Prognostic Implications of Magnetic Resonance - Derived Quantification in Asymptomatic Patients with Organic Mitral Regurgitation: Comparison with Doppler Echocardiography-Derived Integrative Approach.

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    Penicka, Martin; Vecera, Jan; Mirica, Daniela C; Kotrc, Martin; Kockova, Radka; Van Camp, Guy

    2017-12-21

    Background -Magnetic resonance imaging (MRI) is an accurate method for the quantitative assessment of organic mitral regurgitation (OMR). The aim of the present study was to compare the discriminative power of MRI quantification and the recommended Doppler-echocardiography (ECHO)-derived integrative approach to identify asymptomatic patients with OMR and adverse outcome. Methods -The study population consisted of 258 asymptomatic patients (63±14 years, 60% males) with preserved left ventricular (LV) ejection fraction (>60%) and chronic moderate and severe OMR (flail 25%, prolapse 75%) defined using the ECHO-derived integrative approach. All patients underwent MRI to quantify regurgitant volume (RV) of OMR by subtracting the aortic forward flow volume from the total LV stroke volume. Severe OMR was defined as RV≥60ml. Results -Mean ECHO-derived RV was on average 17.1ml larger than the MRI-derived RV (pderived LV end-systolic volume index, RV and OMR category (severe vs. moderate), and the ECHO-derived OMR category were independent predictors of all-cause mortality (all pderived RV showed the largest area under the curve to predict mortality (0.72) or its combination with development of indication for mitral valve surgery (0.83). Conclusions -The findings of the present study suggest that the MRI-derived assessment of OMR can better identify patients with severe OMR and adverse outcome than ECHO-derived integrative approach warranting close follow-up and perhaps, early mitral valve surgery.

  9. Severe mitral regurgitation after radiotherapy.

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    Cozzarín, Alberto; Cianciulli, Tomás F; Saccheri, María C; Lax, Jorge A; Simonetti, Mario E; Zappi, Andrea; Laguens, Rubén P

    2014-02-01

    We present the case of a 69-year-old patient with a history of gynecological neoplasia and a pulmonary metastasis, who in 1996 underwent chemotherapy and mediastinal radiotherapy followed by cancer remission. Ten years later she presented with heart failure and her Doppler echocardiogram showed severe mitral regurgitation with pulmonary hypertension. In 2011, she underwent a mitral valve replacement with a biological prosthesis and the pathology exam revealed valve damage consistent with radiotherapy-induced changes. This unusual mechanism of mitral regurgitation can be demonstrated clearly by echocardiography and should be disseminated among cardiology physicians and in patients who have survived for long periods after radiotherapy, it is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for detecting them. © 2013, Wiley Periodicals, Inc.

  10. Mitral valve regurgitation in twins

    DEFF Research Database (Denmark)

    Bakkestrøm, Rine; Larsen, Lisbeth Aagaard; Møller, Jacob Eifer

    2016-01-01

    BACKGROUND: Smaller observational studies have suggested familial clustering of mitral regurgitation (MR). Using a large twin cohort, the aims were to assess MR concordance rates and assess mortality in MR twins and unaffected cotwins. METHODS: Through the Danish Twin Registry, twins with an Inte......BACKGROUND: Smaller observational studies have suggested familial clustering of mitral regurgitation (MR). Using a large twin cohort, the aims were to assess MR concordance rates and assess mortality in MR twins and unaffected cotwins. METHODS: Through the Danish Twin Registry, twins...... with an International Classification of Diseases, Eighth Revision and Tenth Revision diagnosis code of MR born 1880-1989 were identified and proband-wise concordance rates were calculated. To assess whether having a cotwin with MR affected survival, 10 matched twins without MR (n = 5,575) were selected for each MR twin...

  11. Effectiveness of Percutaneous Balloon Mitral Valvuloplasty for Rheumatic Mitral Stenosis with Mild to Severe Mitral Regurgitation

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    LinXiang Lu

    2016-01-01

    Full Text Available This study is designed to test whether percutaneous balloon mitral valvuloplasty (PBMV is effective for rheumatic mitral stenosis in Chinese patients with moderate to severe mitral regurgitation. Fifty-six patients with rheumatic mitral valve stenosis were divided into the mild, moderate, and severe regurgitation groups. Cardiac ultrasonography was measured before and 1 to 2 days after PBMV. Following PBMV, the mitral orifice was enlarged, and the left atrial diameter was reduced in the 3 patient groups. The enlargement of the mitral orifice in the mild regurgitation group was greater than that observed in the moderate and severe regurgitation groups. The size of the regurgitation area increased in the mild regurgitation group and decreased in the moderate and severe regurgitation groups, with the decrease in the severe regurgitation group being greater than that in the moderate regurgitation group. Therefore, PBMV is effective for treating rheumatic mitral stenosis in Chinese patients with mild to severe mitral regurgitation.

  12. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

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    Maleki Majid

    2008-10-01

    Full Text Available Abstract Objectives We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR. Background Functional mitral regurgitation (FMR occurs as a consequence of systolic left ventricular (LV dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined. Methods 136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained. Results There was significant association between MR severity and echocardiogarphic indices (all p values Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity. Conclusion Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.

  13. Treatment of severe mitral regurgitation caused by lesions in both ...

    African Journals Online (AJOL)

    Mitral valve plasty (MVP) is preferred over mitral valve replacement (MVR) for mitral regurgitation in humans because of its favorable effect on quality of life. In small dogs, it is difficult to repair multiple lesions in both leaflets using MVP. Herein, we report a case of severe mitral regurgitation caused by multiple severe lesions ...

  14. Diverticulum of the mitral valve, a rare cause of mitral regurgitation.

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    Soo, Alan

    2010-12-01

    Non-infective mitral valve diverticulum is extremely rare. We present a case of intraoperatively diagnosed mitral valve diverticulum of a 69-year-old man presenting with mitral regurgitation who was successfully treated with mitral valve replacement.

  15. Perforation of anterior mitral leaflet aneurysm: A rare cause of severe mitral regurgitation

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    Ahmet Seyfeddin Gurbuz

    2016-06-01

    Full Text Available Mitral valve perforation is a rare cause of severe mitral regurgitation. Infective endocarditis, connective tissue disease, cardiac surgery and aortic regurgitation jet are blaming causes of mitral valve perforation. We present a case of anterior mitral leaflet perforation accompanied with mitral valve prolapse identified by real-time three-dimensional transesophageal echocardiography.

  16. Moderate exercise does not increase the severity of mitral regurgitation due to mitral valve prolapse

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    Pecini, Redi; Dalsgaard, Morten; Møller, Daniel Vega

    2010-01-01

    Mitral regurgitation (MR) secondary to ischemic heart disease (IHD) increases during exercise. We tested the hypothesis that the same is also true for MR due to mitral valve prolapse (MVP).......Mitral regurgitation (MR) secondary to ischemic heart disease (IHD) increases during exercise. We tested the hypothesis that the same is also true for MR due to mitral valve prolapse (MVP)....

  17. Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy.

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    Roth, R B; Block, P C; Palacios, I F

    1990-05-01

    Left ventriculography (LVG) was performed to assess severity of mitral regurgitation (MR) on a scale of 0-4+ in 157 patients before and immediately after percutaneous mitral balloon valvotomy (PMV). There were 129 women and 28 men aged 51 +/- 1 (range 13-87) yr. With PMV, mitral valve area increased from 0.9 +/- 0.1 cm2 to 2.0 +/- 0.1 cm2 (P less than .0001). Increase in mitral regurgitation (MR) occurred in 69 patients (44%). Patients were divided into two groups based on increase in MR after PMV. Group A (n = 136) had 0-1+ increase in MR. Group B (n = 20) had greater than or equal to 2+ increase in MR after PMV. The only predictor of increase in MR greater than or equal to 2+ was the ratio of effective balloon dilating area to body surface area (EBDA/BSA). EBDA/BSA was 4.0 +/- 0.1 cm2/m2 in Group A vs. 4.37 +/- 0.2 cm2/m2 in Group B (P = .02). Follow-up of patients in Group B showed: Four patients remained NYHA Class III and required mitral valve replacement 4.3 +/- 1.1 (range 5-21) mo after PMV. One patient who had undergone combined aortic and mitral valvotomy died in the hospital of worsening heart failure. One patient died 1 mo later of sepsis related to a dental abscess. Follow-up of the remaining 14 patients at 9.5 +/- 1.1 (range 2-7) mo showed 10 in NYHA Class I and four in NYHA Class II. Eight of 15 patients (53%) who had repeat left ventriculogram at 9.0 +/- 0.8 mo after PMV had a decrease in MR of one grade when compared to LVG immediately after PMV.

  18. Treatment of severe mitral regurgitation caused by lesions in both ...

    African Journals Online (AJOL)

    Ibrahim Eldaghayes

    2017-11-02

    MVR) for mitral regurgitation in humans because of its favorable effect on quality of life. In small dogs, it is difficult to repair multiple lesions in both leaflets using MVP. Herein, we report a case of severe mitral regurgitation caused ...

  19. Percutaneous mitral valve repair: A new treatment for mitral regurgitation

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    Claire Kelley

    2016-05-01

    Full Text Available Mitral valve disease affects more than 4 million people in the United States. The gold standard of treatment in these patients is surgical repair or replacement of the valve with a prosthesis. The MitraClip (Abbott Vascular, Menlo Park, CA is a new technology, which offers an alternative to open surgical repair or replacement via a minimally invasive route. We present an evidence-based clinical update that provides an overview of this technology as it relates to managing patients with significant mitral regurgitation. This review article is particularly useful to noninterventional cardiologists and interventional cardiologists who will be managing patients with this novel technology in increased volumes over the next decade but who do not perform this procedure.

  20. Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantitation

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    Myerson, SG; D'Arcy, J; Christiansen, JP; Dobson, LE; Mohiaddin, R; Francis, JM; Prendergast, B.; Greenwood, JP; Karamitsos, TD; Neubauer, S

    2016-01-01

    Background—Surgery for severe mitral regurgitation is indicated if symptoms or left ventricular dilation or dysfunction occur. However, prognosis is already reduced by this stage, and earlier surgery on asymptomatic patients has been advocated if valve repair is likely, but identifying suitable patients for early surgery is difficult. Quantifying the regurgitation may help, but evidence for its link with outcome is limited. Cardiovascular magnetic resonance (CMR) can accurately quantify mitra...

  1. [Approach to chronic mitral regurgitation in 2016].

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    Antiochos, Panagiotis; Muller, Olivier; Kirsch, Matthias; Agostini, Melissa; Qanadli, Salah; Eeckhout, Eric; Vogt, Pierre; Prêtre, René; Delabays, Alain; Jeanrenaud, Xavier; Monney, Pierre

    2016-05-25

    Mitral regurgitation (MR) is the most frequent valvular disease in industrialised countries. MR is classified as primary (mostly degenerative with valve prolapse) or secondary (mainly due to underlying ischemic heart disease resulting in deformation of the valve structure). Surgical repair represents the optimal treatment for severe primary MR, whereas the benefits of surgical correction of secondary MR are controversial. Over the past few years, transcatheter techniques have been developed to treat MR, such as the percutaneous edge-to-edge procedure (MitraClip). These approaches represent a novel therapeutic choice for patients judged inoperable by the "heart team". This review article aims to summarize the principles of MR assessment and discuss current therapeutic options for severe MR, taking into account the latest advances in the field.

  2. Transcatheter mitral valve repair in osteogenesis imperfecta associated mitral valve regurgitation.

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    van der Kley, Frank; Delgado, Victoria; Ajmone Marsan, Nina; Schalij, Martin J

    2014-08-01

    Osteogenesis imperfecta is associated with increased prevalence of significant mitral valve regurgitation. Surgical mitral valve repair and replacement are feasible but are associated with increased risk of bleeding and dehiscence of implanted valves may occur more frequently. The present case report describes the outcomes of transcatheter mitral valve repair in a patient with osteogenesis imperfecta. A 60 year-old patient with osteogenesis imperfecta and associated symptomatic moderate to severe mitral regurgitation underwent transthoracic echocardiography which showed a nondilated left ventricle with preserved systolic function and moderate to severe mitral regurgitation. On transoesophageal echocardiography the regurgitant jet originated between the anterolateral scallops of the anterior and posterior leaflets (A1-P1). Considering the comorbidities associated with osteogenesis imperfecta the patient was accepted for transcatheter mitral valve repair using the Mitraclip device (Abbott vascular, Menlo, CA). Under fluoroscopy and 3D transoesophageal echocardiography guidance, a Mitraclip device was implanted between the anterolateral and central scallops with significant reduction of mitral regurgitation. The postoperative evolution was uneventful. At one month follow-up, transthoracic echocardiography showed a stable position of the Mitraclip device with no mitral regurgitation. Transcatheter mitral valve repair is feasible and safe in patients with osteogenesis imperfecta and associated symptomatic significant mitral regurgitation. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  3. Chronic ischemic mitral regurgitation – adiagnostic and therapeutic challenge

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    Jana Ambrožič

    2014-02-01

    Full Text Available Chronic ischemic mitral regurgitation (IMR is a valvular disorder caused by left ventricular dysfunction due to chronic coronary artery disease. It represents a valvular consequence of left ventricular contractile dysfunction and/or pathologic remodeling that indirectly impairs appropriate closing of the mitral valve. IMR is not caused by a structural change of the mitral valve. Acute postinfarction mitral regurgitation is also differentiated from chronic IMR. Chronic IMR occurs in the chronic stage of myocardial infarction in 20–50 % of the patients; its prevalence in the population is increasing. In patients after myocardial infarction, impaired contractility and mitral regurgitation are the most important negative prognostic factors. Furthermore, regurgitation that would be considered mild in patients with organic mitral valve disease already has a negative prognostic implication in patients with IMR.Echocardiogram is the fundamental tool for diagnostic evaluation and treatment planning in patients with IMR. The key parameters that have to be assessed include left ventricular contractile dysfunction, degree of left ventricular remodeling, pathologic changes in mitral valve geometry and quantification of regurgitation severity. In some patients, significant IMR can only be identified by stress echocardiography.Although IMR has an important negative impact on prognosis, indications for treatment and best treatment options have still not been well defined. According to the European and American guidelines, significant IMR should be treated, particularly in patients who are candidates for surgical coronary artery revascularisation. However, there is still no conclusive evidence that any surgical or percutaneous treatment of IMR improves patients’ prognosis.

  4. Should a Regurgitant Mitral Valve Be Replaced Simultaneously with a Stenotic Aortic Valve?

    OpenAIRE

    Christenson, Jan T.; Jordan, Bernard; Bloch, Antoine; Schmuziger, Martin

    2000-01-01

    Mitral valve regurgitation frequently accompanies aortic valve stenosis. It has been suggested that mitral regurgitation improves after aortic valve replacement alone and that the mitral valve need not be replaced simultaneously. Furthermore, mitral regurgitation associated with coronary artery disease, particularly in patients with poor left ventricular function, shows immediate improvement after coronary artery bypass grafting.

  5. Tricuspid but not Mitral Regurgitation Determines Mortality After TAVI in Patients With Nonsevere Mitral Regurgitation.

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    Amat-Santos, Ignacio J; Castrodeza, Javier; Nombela-Franco, Luis; Muñoz-García, Antonio J; Gutiérrez-Ibanes, Enrique; de la Torre Hernández, José M; Córdoba-Soriano, Juan G; Jiménez-Quevedo, Pilar; Hernández-García, José M; González-Mansilla, Ana; Ruano, Javier; Tobar, Javier; Del Trigo, María; Vera, Silvio; Puri, Rishi; Hernández-Luis, Carolina; Carrasco-Moraleja, Manuel; Gómez, Itziar; Rodés-Cabau, Josep; San Román, José A

    2017-10-24

    Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI, as well as the impact of concomitant TR and its interaction with MR. Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015. The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P < .001). The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility. Copyright © 2017. Published by Elsevier España, S.L.U.

  6. Mitral regurgitation jet around neoannulus: Mitral valve replacement in erysipelothrix rhusiopathiae endocarditis

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    Rahul Basu

    2013-01-01

    Full Text Available A 50-year-old male presented with erysipelothrix rhusiopathiae (ER endocarditis of the mitral valve, severe mitral regurgitation, and heart failure. The ER endocarditis destroyed the native mitral annulus therefore a new annulus was created for the suspension of the mitral bioprosthesis. Postoperative neoannulus dehiscence and leak prompted to redo surgery where transesophageal echocardiography (TEE played an important role in pointing out the exact location of perineoannular leaks for repair.

  7. European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 2: Mitral and tricuspid regurgitation (native valve disease)

    NARCIS (Netherlands)

    P. Lancellotti (Patrizio); L. Moura (Luis); L. Pié rard (Luc); E. Agricola (Eustachio); B.A. Popescu (Bogdan); C. Tribouilloy (Christophe); A. Hagendorff (Andreas); J.L. Monin; L. Badano (Luigi); J.L. Zamorano (Jose); R. Sicari (Rosa); A. Vahanian (Alec); J.R.T.C. Roelandt (Jos)

    2010-01-01

    textabstractMitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the

  8. Mitral and aortic regurgitation in Behçet's syndrome.

    OpenAIRE

    Peńa, J M; Garcia-Alegria, J; Garcia-Fernandez, F; Arnalich, F; Barbado, F J; Vazquez, J J

    1985-01-01

    A 35-year-old man with definite Behçet's disease developed acute mitral and aortic regurgitation. Valvular disease, we believed, was another manifestation of this disease. Cardiac involvement in Behçet's disease and the role of prednisone therapy are discussed.

  9. Mitral valve aneurysm associated with aortic valve endocarditis and regurgitation.

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    Raval, Amish N; Menkis, Alan H; Boughner, Derek R

    2002-01-01

    Mitral valve aneurysms are rare complications occurring most commonly in association with aortic valve infective endocarditis. [Decroly 1989, Chua 1990, Northridge 1991, Karalis 1992, Roguin 1996, Mollod 1997, Vilacosta 1997, Cai 1999, Vilacosta 1999, Teskey 1999, Chan 2000, Goh 2000, Marcos- Alberca 2000] While the mechanism of the development of this lesion is unclear, complications such as perforation can occur and lead to significant mitral regurgitation. [Decroly 1989, Karalis 1992, Teskey 1999, Vilacosta 1999]; The case of a 69-year-old male with Streptococcus Sanguis aortic valve endocarditis and associated anterior mitral leaflet aneurysm is presented. Following surgery, tissue pathology of the excised lesion revealed myxomatous degeneration and no active endocarditis or inflammatory cells. This may add support to the hypothesis that physical stress due to severe aortic insufficiency and structural weakening, without infection of the anterior mitral leaflet, can lead to the development of this lesion.

  10. Cine MR imaging in mitral valve prolapse; Study on mitral regurgitation and left atrial volume

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    Kumai, Toshihiko (Chiba Univ. (Japan). School of Medicine)

    1993-02-01

    This study was undertaken to assess the ability of cine MR imaging to evaluate the direction, timing, and severity of mitral regurgitation in patients with mitral valve prolapse (MVP). The population of this study was 33 patients with MVP diagnosed by two-dimensional echocardiography and 10 patients with rheumatic mitral valve disease (MSR) for comparison. 7 patients with MVP and 5 with MSR had atrial fibrillation and/or history of congestive heart failure as complications. Mitral regurgitation was graded for severity by color Doppler flow imaging in all patients. Direction and size of systolic flow void in the left atrium were analyzed by contiguous multilevel cine MR images and the maximum volumes of flow void and left atrium were measured. Although flow void was found at the center of the left atrium in most of MSR, it was often directed along the postero-caudal atrial wall in anterior leaflet prolapse and along the anterocranial atrial wall in posterior leaflet prolapse. In MVP, the maximum volume of flow void was often seen in late systole. The maximum volume of flow void and that of left atrium were significantly larger in patients with atrial fibrillation and/or history of congestive heart failure. The length and volume of flow void were increased with clinical severity and degree of regurgitation determined by color Doppler flow imaging. Thus cine MR imaging provides a useful means for detection and semiquantitative evaluation of mitral regurgitation in subjects with MVP. (author).

  11. Effect of mitral inflow pattern on diagnosis of severe mitral regurgitation in patients with chronic organic mitral regurgitation.

    Science.gov (United States)

    Quader, Nishath; Katta, Prasanth; Najib, Mohammad Q; Chaliki, Hari P

    2013-12-01

    To determine sensitivity and specificity of E wave velocity in patients with severe chronic organic mitral regurgitation (MR) and normal left ventricular ejection fraction (EF) and to evaluate prevalence of A wave dominance in patients with severe MR. We compared 35 patients with quantified severe, chronic, quantified, organic MR due to flail/prolapsed leaflets who had reparative surgery with 35 age-matched control subjects. EF < 60%, atrial fibrillation, and more than mild aortic regurgitation. Mean [standard deviation (SD)] age [70 (8) years vs. 69 (8) years; p = 0.94] and mean (SD) EF [66% (6%) vs. 65% (4%); p = 0.43] were not different between the two groups. Mean (SD) E wave velocity was greater in case patients than control subjects [1.2 (0.3) m/sec vs. 0.7 (0.15) m/sec; p < 0.001]. However, E wave velocity of 1.2 m/sec had a sensitivity of only 57% [95% confidence interval (CI), 41-7 and a specificity of 100% (95% CI, 90-100%) in identifying severe MR. E wave velocity of 0.9 m/sec had a more optimal combined sensitivity (89%; 95% CI, 74-95%) and specificity (86%; 95% CI, 71-94%). A wave dominance was seen in 18% of case patients and 66% of control subjects (p < 0.001). E wave velocity of 1.2 m/sec is specific not sensitive for severe organic MR; E wave velocity of 0.9 m/sec has better sensitivity and specificity. A wave dominance pattern alone cannot exclude patients with severe organic MR. Our findings highlight the importance of a comprehensive echocardiographic exam rather than relying on a few Doppler parameters in diagnosing MR.

  12. PISA method for assessment of mitral regurgitation in children.

    Science.gov (United States)

    Başpinar, Osman; Karaaslan, Sevim; Oran, Bülent

    2005-09-01

    The purpose of this study was to determine the feasibility and significance of the proximal isovelocity surface area (PISA) method in children with rheumatic mitral regurgitation (MR). Thirty-one children (mean age 12.3+/-3.1 years), with chronic MR, were evaluated by semiquantitative and quantitative Doppler, quantitative two-dimensional echocardiography and the PISA methods. Also, we compared the effective regurgitant orifice area, regurgitation volume and systolic left ventricular functions in mild-moderate and severe MR. There were no statistically significant differences in the regurgitant orifice area and regurgitant volume values obtained by the PISA method and the quantitative Doppler (p>0.05) but they were different from the same values obtained by two dimensional echocardiography (pPISA and left ventricular end-diastolic diameters, the ratio of the jet/left atrial area, grading with color Doppler imaging (r=0.763, r=0.745, r=0.618; pPISA method as like as the Doppler method.

  13. Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging.

    Science.gov (United States)

    Sargent, J; Connolly, D J; Watts, V; Mõtsküla, P; Volk, H A; Lamb, C R; Fuentes, V Luis

    2015-11-01

    Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic measures of mitral regurgitation in dogs have not been compared with other quantitative methods. The study aim was to compare echocardiographic measures of mitral regurgitation with cardiac magnetic resonance imaging-derived mitral regurgitant fraction in small-breed dogs. Dogs with myxomatous mitral valve disease scheduled for magnetic resonance imaging assessment of neurological disease were recruited. Correlations were tested between cardiac magnetic resonance imaging-derived mitral regurgitant fraction and the following echocardiographic measures: vena contracta/aortic diameter, transmitral E-wave velocity, amplitude of mitral prolapse/aortic diameter, diastolic left ventricular diameter:aortic diameter, left atrium:aortic diameter, mitral regurgitation jet area ratio and regurgitant fraction calculated using the proximal isovelocity surface area method. Measurement of cardiac magnetic resonance imaging-derived mitral regurgitant fraction was attempted in 21 dogs. Twelve consecutive, complete studies were obtained and 10 dogs were included in the final analysis: vena contracta/aortic diameter (r = 0 · 89, p = 0 · 001) and E-wave velocity (r = 0 · 86, p = 0 · 001) had the strongest correlations with cardiac magnetic resonance imaging-derived mitral regurgitant fraction. E velocity had superior repeatability and could be measured in all dogs. The presence of multiple jets precluded vena contracta/aortic diameter measurement in one dog. Measurement of cardiac magnetic resonance imaging-derived mitral regurgitant fraction is feasible but technically demanding. The echocardiographic measures that correlated most closely with cardiac magnetic resonance imaging-derived mitral regurgitant fraction were vena contracta/aortic diameter and E-wave velocity. © 2015 British Small Animal Veterinary Association.

  14. Mitral regurgitation after anteroapical myocardial infarction: new mechanistic insights.

    Science.gov (United States)

    Yosefy, Chaim; Beeri, Ronen; Guerrero, J Luis; Vaturi, Mordehay; Scherrer-Crosbie, Marielle; Handschumacher, Mark D; Levine, Robert A

    2011-04-12

    Mitral regurgitation (MR) generally accompanies inferobasal myocardial infarction (MI), with leaflet tethering by displaced papillary muscles. Mitral regurgitation is also reported with anteroapical MI without global dilatation or inferior wall motion abnormalities. We hypothesized that anteroapical MI extending to the inferior apex displaces the papillary muscles, tethering the mitral leaflets to cause MR. In the retrospective part of the study, consecutive anteroapical MI patients were studied. Moderate-severe MR occurred in 9% of 234 patients with only anteroapical MI versus 17% of 242 with inferoapical extension (Panteroapical MI patients (20 with only 2 apical segments involved and 40 with involvement of all 4 apical segments; 20 with MR and 20 without MR) were compared with 20 normal controls. Those with MR (≥ moderate) had higher systolic papillary muscle-to-annulus tethering length (P Anteroapical MI with inferoapical extension can mechanically displace papillary muscles, causing MR despite the absence of basal and midinferior wall motion abnormalities. This suggests the possibility of repositioning treatments for this condition.

  15. Impact of mitral valve geometry on hemodynamic efficacy of surgical repair in secondary mitral regurgitation.

    Science.gov (United States)

    Padala, Muralidhar; Gyoneva, Lazarina I; Thourani, Vinod H; Yoganathan, Ajit P

    2014-01-01

    Mitral valve geometry is significantly altered secondary to left ventricular remodeling in non-ischemic and ischemic dilated cardiomyopathies. Since the extent of remodeling and asymmetry of dilatation of the ventricle differ significantly between individual patients, the valve geometry and tethering also differ. The study aim was to determine if mitral valve geometry has an impact on the efficacy of surgical repairs to eliminate regurgitation and restore valve closure in a validated experimental model. Porcine mitral valves (n = 8) were studied in a pulsatile heart simulator, in which the mitral valve geometry can be precisely altered and controlled throughout the experiment. Baseline hemodynamics for each valve were measured (Control), and the valves were tethered in two distinct ways: annular dilatation with 7 mm apical papillary muscle (PM) displacement (Tether 1, symmetric), and annular dilatation with 7 mm apical, 7 mm posterior and 7 mm lateral PM displacement (Tether 2, asymmetric). Mitral annuloplasty was performed on each valve (Annular Repair), succeeded by anterior leaflet secondary chordal cutting (Sub-annular Repair). The efficacy of each repair in the setting of a given valve geometry was quantified by measuring the changes in mitral regurgitation (MR), leaflet coaptation length, tethering height and area. At baseline, none of the valves was regurgitant. Significant leaflet tethering was measured in Tether 2 over Tether 1, but both groups were significantly higher compared to baseline (60.9 +/- 31 mm2 for Control versus 129.7 +/- 28.4 mm2 for Tether 1 versus 186.4 +/- 36.3 mm2 for Tether 2). Consequently, the MR fraction was higher in Tether 2 group (23.0 +/- 5.7%) than in Tether 1 (10.5 +/- 5.5%). Mitral annuloplasty reduced MR in both groups, but remnant regurgitation after the repair was higher in Tether 2. After chordal cutting a similar trend was observed with trace regurgitation in Tether 1 group at 3.6 +/- 2.8%, in comparison to 18.6 +/- 4

  16. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar

    2014-01-01

    Full Text Available Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  17. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease.

    Science.gov (United States)

    Kumar, Bhupesh; Raj, Ravi; Jayant, Aveek; Kuthe, Sachin

    2014-01-01

    Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  18. Real-world experience of MitraClip for treatment of severe mitral regurgitation

    DEFF Research Database (Denmark)

    Chan, Pak Hei; She, Hoi Lam; Alegria-Barrero, Eduardo

    2012-01-01

     Percutaneous edge-to-edge mitral valve repair with the MitraClip(®) was shown to be a safe and feasible alternative compared to conventional surgical mitral valve repair. Herein is reported our experience on MitraClip(®) for high-risk surgical candidates with severe mitral regurgitation (MR)....

  19. Mitral subvalvular plasty for chronic ischemic mitral regurgitation: a preliminary experimental model.

    Science.gov (United States)

    Evtushenko, Alexey V; Evtushenko, Vladimir V; Petlin, Konstantin A; Vaizov, Valery Kh; Petlin, Alexander V; Vassileva, Christina M

    2013-07-01

    Restrictive annuloplasty remains the most widespread technique for the correction of chronic ischemic mitral regurgitation (IMR). However, this technique only partially corrects the underlying pathophysiology and does not address the restricted leaflet motions during systole that result from progressive left ventricular (LV) remodeling. A novel experimental model of IMR was developed using an isolated pig heart placed on a hydrodynamic test-stand. A T-shaped LV patch was sutured onto the posterior wall of the left ventricle to simulate LV dilatation secondary to post-MI remodeling. Using this model, a novel technique of subvalvular mitral valvuloplasty was described that reduces the distance between the posterior mitral annulus and the papillary muscle base and appears to be effective in eliminating IMR. Pledgetted 2-0 non-absorbable sutures were placed at the base of one papillary muscle, then through the other papillary muscle and then brought to the posterior mitral annulus. The same sequence was repeated in the other direction. A specific formula was then used to calculate the length of the subvalvular support prior to suture tying. Subvalvular support of the mitral apparatus in chronic IMR can be achieved using this simple method, which appears to be effective in eliminating IMR. Further data relating to the use of this technique in the clinical setting as an adjunct to mitral annuloplasty are forthcoming.

  20. Management of mitral regurgitation in Marfan syndrome: Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease.

    Science.gov (United States)

    Helder, Meghana R K; Schaff, Hartzell V; Dearani, Joseph A; Li, Zhuo; Stulak, John M; Suri, Rakesh M; Connolly, Heidi M

    2014-09-01

    The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P = .09). Concomitant aortic surgery was performed to a similar extent (repair, 45% [18/40] vs replacement, 43% [9/21]; P = .87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80% vs 41%; P = .01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27% vs 15%; P = .64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84% vs 78%; P = .63), as was cumulative risk of reoperation (17% vs 12%; P = .61). Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Effect of physiological overload on pregnancy in women with mitral regurgitation

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    Vera T. M Borges

    2011-01-01

    Full Text Available OBJECTIVES: to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy. INTRODUCTION: Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established. METHODS: This is a case-control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age-matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group. RESULTS: Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p<0.05. Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p<0.05 and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²;p<0.05 was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls. CONCLUSIONS: Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.

  2. Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation.

    Science.gov (United States)

    Bayer-Topilsky, Tali; Trenerry, Max R; Suri, Rakesh; Topilsky, Yan; Antiel, Ryan M; Marmor, Yariv; Mahoney, Douglas W; Schaff, Hartzell V; Enriquez-Sarano, Maurice

    2013-10-01

    To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression. PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001). PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Effects of mitral valve surgery on myocardial energetics in patients with severe mitral regurgitation.

    Science.gov (United States)

    Chow, Benjamin J W; Abunassar, Joseph G; Ascah, Kathryn; Dekemp, Robert; Dasilva, Jean; Mesana, Thierry; Beanlands, Rob S; Ruddy, Terrence D

    2010-05-01

    Hemodynamically significant mitral regurgitation (MR) may alter left ventricular (LV) myocardial energy requirements. The effects of MR and subsequent corrective mitral valve (MV) surgery on myocardial energetics are not well understood. A better understanding of myocardial energetics and the LV responses to changes in preload and afterload may assist with the understanding of mitral regurgitation and its effect on the LV. We sought to determine the effects of MV surgery on forward stroke work, myocardial oxidative metabolism, and myocardial efficiency. Prospectively enrolled patients with chronic, severe, nonischemic mitral regurgitation underwent echocardiography, radionuclide angiography, and C-11 acetate positron emission tomography to measure LV volumes, ejection fraction, and oxidative metabolism before and 1 year after MV surgery. Forward and total stroke work corrected for oxidative metabolism was used to estimate efficiency using the work metabolic index. Fourteen patients (age, 59+/- 8 years) with myxomatous MV were enrolled. One year after MV surgery, there was a reduction in LV end-diastolic and end-systolic volumes (231+/-86 to 131+/-21 mL; P<0.01 and 98+/-53 to 55+/-17 mL; P<0.01). Forward stroke volume increased (58.1+/-15.0 to 75.5+/-23 mL; P<0.01), LV ejection fraction was preserved without a significant change in oxidative metabolism. Forward work metabolic index improved (4.99+/-1.32 x 10(6) to 6.59+/-2.45 x 10(6) mm Hg x mL/m(2); P=0.02). This was not at the expense of total work metabolic index, which was preserved. MV surgery has a beneficial effect on forward stroke volume and forward work metabolic index without adverse effects on oxidative metabolism or total work metabolic index.

  4. R-R interval variations influence the degree of mitral regurgitation in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Reimann, M. J.; Moller, J. E.; Haggstrom, J.

    2014-01-01

    Mitral regurgitation (MR) due to myxomatous mitral valve disease (MMVD) is a frequent finding in Cavalier King Charles Spaniels (CKCSs). Sinus arrhythmia and atrial premature complexes leading to R-R interval variations occur in dogs. The aim of the study was to evaluate whether the duration...

  5. Exercise Dynamics in Secondary Mitral Regurgitation: Pathophysiology and Therapeutic Implications.

    Science.gov (United States)

    Bertrand, Philippe B; Schwammenthal, Ehud; Levine, Robert A; Vandervoort, Pieter M

    2017-01-17

    Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic workup and treatment of patients with heart failure. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. An exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of patients with heart failure, it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, in particular the dynamic component during exercise, is of timely importance. This review summarizes the pathophysiological mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general. © 2017 American Heart Association, Inc.

  6. [Impact of mitral annuloplasty combined with surgical revascularization in ischemic mitral regurgitation].

    Science.gov (United States)

    Tribak, M; Konaté, M; Ould Hbib, B; Konan, P; Mahfoudi, L; Hassani, A El; Daouda, A; Lachhab, F; Bendagha, N; Soufiani, A; Fila, J; Maghraoui, S; Bensouda, A; Marmade, L; Moughil, S

    2017-08-08

    Ischemic Mitral Regurgitation (IMR) is a serious complication of coronary artery disease and is associated with a poor prognosis. The optimal surgical treatment of IMR involves controversies in its indications and modalities. To determine whether mitral annuloplasty associated with surgical revascularization improved short and mid terms outcomes compared with revascularization alone in patients with IMR. Between January 2007 and January 2011, 81 patients operated on Department of Cardiovascular Surgery "B" were included in this study divided into 3 groups. Group 1: 28 patients with IMR had mitral valve surgery associated with surgical revascularization. Group 2: 26 patients with IMR had surgical revascularization without mitral valve surgery. Group 3: 27 patients without IMR had isolated revascularization. Clinical end-points were operative mortality, late mortality, postoperative functional status (NYHA), and the Effective Regurgitant Orifice (ERO) at last follow-up. The mean follow-up was 5 years for groups 1 and 2 and 4 years for group 3. There was no difference between the 3 groups regarding age, sex, cardiovascular risk factors, and extension of coronary artery disease. The Left Ventricle End Diastolic Diameter (LVEDD) and the Left Ventricle Ejection Fraction (LVEF) were slightly different. Late and operative mortality were higher in group 2 compared to groups 1 and 3. Postoperative functional status (NYHA) improved both in groups 1 and 2. In group 1, there was a decrease in ERO. Mitral annuloplasty combined to revascularization improves symptoms, postoperative ERO and short- and mid-term survival compared with revascularization alone. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Severe mitral regurgitation-relations between magnetic resonance imaging, echocardiography and natriuretic peptides.

    Science.gov (United States)

    Hellgren, Laila; Landelius, Johan; Stridsberg, Mats; Kvidal, Per; Ståhle, Elisabeth; Bjerner, Tomas

    2008-02-01

    Assessment of the severity of mitral regurgitation by echocardiography can be technically demanding in certain patients and supplementary methods are therefore desirable. This study addressed the agreement between magnetic resonance imaging (MRI) and echocardiography, and their relations to natriuretic peptides (NT-proANP and NT-proBNP), in quantifying severe mitral regurgitation. Eighteen patients with severe mitral regurgitation scheduled for surgery underwent MRI, echocardiography and assay of natriuretic peptides preoperatively for clinical assessment. MRI and echocardiography were comparable in measuring severity of regurgitation qualitatively but not quantitatively, mitral regurgitant fraction (mean difference 27.5 (11) ml). There was a correlation between increasing regurgitant fraction on MRI and increased levels of plasma NT-proANP and NT-proBNP. In echocardiography, increasing vena contracta width and increasing PISA correlated to increased levels of plasma NT-proANP and NT-proBNP. No other correlation was found between measures on MRI and echocardiography and natriuretic peptides. MRI and echocardiography were comparable grading the severity of mitral regurgitation with qualitative measures but not with quantitative measures. MRI might be a complement to echocardiography when a more distinct measure of the regurgitant volume is needed, as in paravalvular leakage.

  8. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation

    Directory of Open Access Journals (Sweden)

    Omar Ahmad Araji Tiliani

    2013-04-01

    Conclusiones: La sustitución de la válvula mitral es una opción adecuada para los pacientes con insuficiencia mitral isquémica crónica y deterioro de la función ventricular izquierda. Proporciona mejores resultados en términos de ausencia de reoperaciónes con comparables tasas de complicaciones relacionadas con la válvula

  9. Current Status of Catheter-Based Treatment of Mitral Valve Regurgitation.

    Science.gov (United States)

    Gössl, Mario; Farivar, Robert S; Bae, Richard; Sorajja, Paul

    2017-05-01

    This review examines the current status of catheter-based repair and replacement for mitral valve disease, with a focus on native primary and secondary mitral valve regurgitation. Transcatheter mitral valve repair with the MitraClip®, with >40,000 performed procedures worldwide, has significantly advanced the field of transcatheter therapy for mitral valve regurgitation. Transcatheter mitral valve replacement remains in the early stages of development, mainly due to the complex anatomy and physiology of the mitral valve. Early feasibility studies in high-risk patients show promising procedural success, yet the adverse events require further study. Transcatheter therapies for mitral valve disease are the next endeavor for the pioneers of percutaneous structural heart disease interventions. Early results are encouraging but also show that further rigorous study is needed to determine efficacy and safety.

  10. Mitral Annular Kinetics, Left Atrial and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation

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    Chun eSchiros

    2015-08-01

    Full Text Available Objective: The relationship of mitral annular (MA kinetics to left ventricular (LV and left atrial (LA function before and after mitral valve repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, LA and LV diastolic function post mitral valve repair. Methods: Three-dimensional analyses of mitral annular motion, LA function and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR patients at baseline and 1-year post mitral valve repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging. Results: All had normal LV ejection fraction (EF at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early-diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early-diastolic filling rate, E/A ratio and early-diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate. Conclusions— MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function and left ventricular diastolic strain rates are still impaired one year post mitral valve repair. Long term effects of these impairments should be prospectively evaluated.

  11. Surgical Strategies for Management of Mitral Regurgitation: Recent Evidence from Randomized Controlled Trials.

    Science.gov (United States)

    Tolis, George; Sundt, Thoralf M

    2015-12-01

    In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.

  12. Identification and quantification of prosthetic mitral regurgitation by flow convergence method using transthoracic approach

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    Roux Emmanuel

    2009-02-01

    Full Text Available Abstract The present case report illustrates the clinical applicability of the proximal isovelocity surface area (PISA method in identifying, locating and assessing paravalvular prosthetic mitral regurgitation by transthoracic echocardiography.

  13. Identification and quantification of prosthetic mitral regurgitation by flow convergence method using transthoracic approach

    OpenAIRE

    Roux Emmanuel; Leonnet Caroline; Arques Stephane; Avierinos Jean-François

    2009-01-01

    Abstract The present case report illustrates the clinical applicability of the proximal isovelocity surface area (PISA) method in identifying, locating and assessing paravalvular prosthetic mitral regurgitation by transthoracic echocardiography.

  14. Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling.

    Science.gov (United States)

    Enomoto, Yoshiharu; Gorman, Joseph H; Moainie, Sina L; Guy, T Sloane; Jackson, Benjamin M; Parish, Landi M; Plappert, Theodore; Zeeshan, Ahmad; St John-Sutton, Martin G; Gorman, Robert C

    2005-03-01

    Surgical treatment for ischemic mitral regurgitation has become more aggressive. However, no clinical study has demonstrated that surgical correction of chronic ischemic mitral regurgitation improves survival. We used 4 well-developed ovine models of postinfarction left ventricular remodeling to test the hypothesis that ischemic mitral regurgitation does not significantly contribute to postinfarction left ventricular remodeling. Infarction of 21% to 24% of the left ventricular mass was induced by means of coronary ligation in 77 sheep. Infarctions varied only by anatomic location in the left ventricle: anteroapical, n = 26; anterobasal, n = 16; laterobasal, n = 9; and posterobasal, n = 20. Six additional sheep had ring annuloplasty before posterobasal infarction. End-systolic and end-diastolic left ventricular volume, end-systolic muscle-to-cavity area ratio, left ventricular sphericity, ejection fraction, and degree of ischemic mitral regurgitation, as determined by means of quantitative echocardiography, were assessed before infarction and at 2, 5, and 8 weeks after infarction. All infarcts resulted in significant postinfarction remodeling and decreased ejection fraction. Anteroapical infarcts lead to left ventricular aneurysms. Only posterobasal infarcts caused severe and progressive ischemic mitral regurgitation. Remodeling because of posterobasal infarcts was not more severe than that caused by infarcts at other locations. Furthermore, prophylactic annuloplasty prevented the development of mitral regurgitation after posterobasal infarction but had no effect on remodeling. The extent of postinfarction remodeling is determined on the basis of infarct size and location. The development of ischemic mitral regurgitation might not contribute significantly to adverse remodeling. Ischemic mitral regurgitation is likely a manifestation rather than an important impetus for postinfarction remodeling.

  15. Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation-new devices and emerging outcomes

    Directory of Open Access Journals (Sweden)

    Fadi E Shamoun

    2015-01-01

    Full Text Available Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education.

  16. Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: difference between functional mitral regurgitation and prolapse regurgitation.

    Science.gov (United States)

    Matsumura, Yoshiki; Fukuda, Shota; Tran, Hung; Greenberg, Neil L; Agler, Deborah A; Wada, Nozomi; Toyono, Manatomo; Thomas, James D; Shiota, Takahiro

    2008-02-01

    The geometry of the proximal isovelocity surface area (PISA) of functional mitral regurgitation (MR), which is conventionally assumed to be a hemisphere, remains to be clarified. We investigated the 3-dimensional (3D) geometry of PISA of functional MR as opposed to that of MR due to mitral valve prolapse (MVP) by real-time 3D echocardiography with color Doppler capability. Twenty-seven patients with functional MR and 27 patients with MVP were examined. The horizontal PISA length in the commissure-commissure plane and each PISA radius in 3 anteroposterior planes (medial, central, and lateral) were measured by real-time 3D echocardiography with 3D software. The effective regurgitant orifice (ERO) area was calculated with the maximum PISA radius and compared to that by 2D quantitative Doppler method. En-face 3D color Doppler images showed an elongated and slightly curved PISA geometry along the leaflet coaptation in functional MR, whereas the geometry was rounder in MVP. The PISA horizontal length in functional MR was longer than that in MVP (2.3 +/- 0.4 vs 1.2 +/- 0.2 cm, P PISA method with the maximum radius underestimated the ERO area by 2D quantitative Doppler method (by 24%) in functional MR, but not in MVP. The geometry of PISA in functional MR was elongated, distinctly different from the more focal pathology of MVP, leading to underestimation of the ERO area by PISA method.

  17. Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction

    DEFF Research Database (Denmark)

    Meris, Alessandra; Amigoni, Maria; Verma, Anil

    2012-01-01

    Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate th...

  18. Mitral and aortic regurgitation following transcatheter aortic valve replacement.

    Science.gov (United States)

    Szymański, Piotr; Hryniewiecki, Tomasz; Dąbrowski, Maciej; Sorysz, Danuta; Kochman, Janusz; Jastrzębski, Jan; Kukulski, Tomasz; Zembala, Marian

    2016-05-01

    To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days. In-hospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002). Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance

    OpenAIRE

    Van De Heyning, Caroline M.; Magne, Julien; Pierard, Luc; Bruyere, Pierre-Julien; Davin, Laurent; De Maeyer, Catherine; Paelinck, Bernard P.; Vrints, Christiaan J; Lancellotti, Patrizio

    2013-01-01

    BACKGROUND: Two-dimensional transthoracic echocardiography (2DTTE) remains the first-line diagnostic imaging tool to assess primary mitral regurgitation although cardiovascular magnetic resonance (CMR) has proven to establish left ventricular function more accurately and might evaluate mitral regurgitation severity more reliably. We sought to compare routine evaluation of left ventricular function and mitral regurgitation severity by 2DTTE with assessment by CMR in moderate to severe primary ...

  20. Regurgitation Hemodynamics Alone Cause Mitral Valve Remodeling Characteristic of Clinical Disease States In Vitro.

    Science.gov (United States)

    Connell, Patrick S; Azimuddin, Anam F; Kim, Seulgi E; Ramirez, Fernando; Jackson, Matthew S; Little, Stephen H; Grande-Allen, K Jane

    2016-04-01

    Mitral valve regurgitation is a challenging clinical condition that is frequent, highly varied, and poorly understood. While the causes of mitral regurgitation are multifactorial, how the hemodynamics of regurgitation impact valve tissue remodeling is an understudied phenomenon. We employed a pseudo-physiological flow loop capable of long-term organ culture to investigate the early progression of remodeling in living mitral valves placed in conditions resembling mitral valve prolapse (MVP) and functional mitral regurgitation (FMR). Valve geometry was altered to mimic the hemodynamics of controls (no changes from native geometry), MVP (5 mm displacement of papillary muscles towards the annulus), and FMR (5 mm apical, 5 mm lateral papillary muscle displacement, 65% larger annular area). Flow measurements ensured moderate regurgitant fraction for regurgitation groups. After 1-week culture, valve tissues underwent mechanical and compositional analysis. MVP conditioned tissues were less stiff, weaker, and had elevated collagen III and glycosaminoglycans. FMR conditioned tissues were stiffer, more brittle, less extensible, and had more collagen synthesis, remodeling, and crosslinking related enzymes and proteoglycans, including decorin, matrix metalloproteinase-1, and lysyl oxidase. These models replicate clinical findings of MVP (myxomatous remodeling) and FMR (fibrotic remodeling), indicating that valve cells remodel extracellular matrix in response to altered mechanical homeostasis resulting from disease hemodynamics.

  1. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation.

    Science.gov (United States)

    Cameli, M; Incampo, E; Mondillo, S

    2017-12-01

    In chronic mitral regurgitation (MR) left atrium is one of the first cardiac structures that is involved in remodeling and ultrastructural changes for a progressive volume overload. Severe left atrial (LA) dilation on echocardiography and new onset of atrial fibrillation in asymptomatic patients with preserved Left Ventricular (LV) function, appeared as a Class IIb recommendation for consideration for surgical mitral valve repair in the actual guidelines. However, before atrial dilatation and dysfunction, several ultrastructural changes appear in the atrial muscle tissue that are difficult to identify with the standard echocardiography. Speckle tracking echocardiography (STE) can analyze LA function: it has been showed that it can indirectly identify structural tissue modifications from excessive atrial effort in the early stages of MR up to the full depression of atrial function in the late stages where there are advanced ultrastructural alterations. This review aims to summarize current knowledge on the role of atrial strain identifying early structural alterations of the atrial tissue in the rising stages of MR considering that Left Atrial Peak Longitudinal Strain (PALS) considered useful parameter for a more extensive evaluation of MR patients.

  2. Feasibility of Doppler hemodynamic evaluation of primary and secondary mitral regurgitation during exercise echocardiography.

    Science.gov (United States)

    Coisne, Augustin; Levy, Franck; Malaquin, Dorothée; Richardson, Marjorie; Quéré, Jean Paul; Montaigne, David; Tribouilloy, Christophe

    2015-02-01

    Exercise transthoracic echocardiography (ExE) was recently proposed to evaluate tolerance and help risk stratification of mitral regurgitation (MR). Few data are available on the feasibility of Doppler echocardiographic recordings at exercise in daily practice in both secondary and primary MR. Comprehensive resting and ExE were performed in 72 unselected patients (age 59 ± 15 years, 62 % men), with no or minimal symptoms, with at least moderate (mean effective regurgitant orifice area (ERO) = 36 ± 14 mm(2)) primary or secondary MR in two French university hospitals. At rest, quantification of ERO was more challenging in semi-supine position than in classic left lateral decubitus position (55/72; 76 % vs 66/72; 92 %; p = 0.012), particularly in mitral valve (MV) prolapse (35/47; 74 %). During exercise, ERO was only obtained in 30/55 (55 %) patients and was more difficult to assess in MV prolapse than in rheumatic or ischemic MR (respectively in 43, 67 and 88 %, p = 0.046). At peak exercise, ERO was more frequently obtained in symptomatic than asymptomatic patients (77 vs 37 %, p = 0.046) because peak heart rate was lower (113 ± 20 vs 133 ± 23 bpm, p = 0.026). Systolic pulmonary artery pressure (SPAP) was obtained in 69 patients (96 %) at rest and in 60 patients (83 %) at peak exercise (Pex). LV contractile reserve (CR), monitored in all patients (100 %), was found in 51/72 patients (71 %). In daily ExE, monitoring of the CR and SPAP appeared less challenging than MR quantification by the PISA method. Monitoring of ERO was more feasible in ischemic MR than in MV prolapse.

  3. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

    Science.gov (United States)

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-01-01

    Abstract Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE. Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm2; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm2; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes). Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement. PMID:27930514

  4. Animal models of mitral regurgitation induced by mitral valve chordae tendineae rupture.

    Science.gov (United States)

    Leroux, Aurelia A; Moonen, Marie L; Pierard, Luc A; Kolh, Philippe; Amory, Helene

    2012-07-01

    Mitral regurgitation (MR) is a common valvular disease throughout the world. Various diagnostic techniques have been developed to assess the causes and severity of MR, and the therapeutic approaches to this disease have been widely documented. However, treatments for chronic MR remain controversial, and various animal models of chronic MR (including chordae tendineae rupture, rapid pacing and ischemia) have been developed to study the pathophysiology and therapeutic approaches to this condition. The study aim was to review the animal MR models that have been developed using a mitral valve chordae tendineae rupture technique. Among the animals used for these investigations, dogs and sheep have been most commonly used as models of MR induced by mitral valve chordae tendineae rupture, mainly due to considerations of cardiac size. Chordae tendineae cutting is performed using either closed- or open-chest techniques. In the closed-chest model, long flexible grasping forceps are positioned percutaneously in order to tear the mitral valve chordae. In the open-chest model, cardiopulmonary bypass is performed, and either selected chordae are cut under direct visualization or a non-specified number of chordae are cut, using a metal device inserted through the left ventricular apex. Whichever model is used, MR has been found to become chronic at three to six months after the induction of MR by chordae rupture. The reported mortality and complication rates of these models are high. In the long term, the experimental evolution of chronic MR is similar to the evolution occurring naturally in patients suffering from the condition. Hence, these models could be useful in understanding the disease better, and in testing new therapeutic modalities. The present review summarizes the physiological effects of each of these techniques, and compares the advantages and disadvantages of each procedure.

  5. [Severe mitral regurgitation following resection of a giant atrial myxoma: Case report and literature review].

    Science.gov (United States)

    Orozco Vinasco, D M; Abello Sánchez, M; Osorio Esquivel, J E

    2013-01-01

    Evaluation of the competence of a mitral valve can often be impossible in the clinical setting of a giant atrial myxoma. A 50-year-old woman with severe mitral regurgitation in the post-bypass period following a myxoma resection was managed with a mitral valve replacement. The absence of mitral insufficiency in the preoperative examination should not be taken as a reliable predictor of normal valve function. So herein, we discuss the role of the intraoperative echocardiographic examination, the underlying mechanisms, and the proposed management of severe mitral regurgitation following the resection of an atrial myxoma. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  6. Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral Regurgitation.

    Science.gov (United States)

    Mihos, Christos G; Santana, Orlando; Pineda, Andrés M; Stone, Gregg W; Hasty, Frederick; Beohar, Nirat

    2015-01-01

    The optimal treatment strategy in patients with coronary artery disease and ischemic mitral regurgitation (IMR) remains controversial. A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery, rather than combined median sternotomy coronary artery bypass and valve surgery, may be a viable alternative. We retrospectively evaluated 31 consecutive patients with coronary artery disease and severe IMR who underwent a staged procedure at our institution between February 2009 and April 2014. The mean ± SD age, preoperative left ventricular ejection fraction, and mitral regurgitation grade were 72 ± 7 years, 35% ± 11%, and 3.6 ± 0.6, respectively. The mean ± SD Society of Thoracic Surgeons-predicted mortality score was 5.1% ± 4.2%. Percutaneous coronary intervention was performed for 1- and 2-vessel disease in 22 patients (71%) and 9 patients (29%), respectively, with 23 patients (74%) having drug-eluting stents placed. Minimally invasive valve surgery was performed within a median of 36 days after PCI, with 61% of the patients being on dual antiplatelet therapy. Postoperatively, there was 1 case of acute kidney injury, 1 case of reoperation for bleeding, and no cerebrovascular accidents. The 30-day mortality was 3%. The median total hospital length of stay was 8 days (interquartile range, 7-10). At a mean ± SD follow-up of 2.4 ± 1.6 years, 2 patients required PCI for target-vessel revascularization. Actuarial survival at 1 and 5 years was 84% and 80%, respectively. A staged approach in patients with coronary artery disease and IMR can be performed with a low perioperative morbidity and good midterm survival.

  7. Mechanisms of recurrent functional mitral regurgitation after mitral valve repair in nonischemic dilated cardiomyopathy: importance of distal anterior leaflet tethering.

    Science.gov (United States)

    Lee, Alex Pui-Wai; Acker, Michael; Kubo, Spencer H; Bolling, Steven F; Park, Seung W; Bruce, Charles J; Oh, Jae K

    2009-05-19

    Recurrent functional mitral regurgitation (MR) has been reported after mitral valve repair with annuloplasty in patients with dilated cardiomyopathy, but the mechanism is not understood completely. The authors sought to identify abnormalities of the mitral valve and left ventricle that are associated with recurrent MR after mitral annuloplasty. In 104 patients with idiopathic dilated cardiomyopathy who underwent annuloplasty for functional MR, basal mitral anterior leaflet angle, distal mitral anterior leaflet angle (ALAtip), posterior leaflet angle, coaptation depth, tenting area, mitral annular dimensions, left ventricular volumes, and MR severity were quantified by echocardiography before surgery and at 6-month intervals after it. Compared with patients without MR recurrence (n=79), patients with recurrent MR (defined as > or =2+) (n=25) had greater ALAtip (P25 degrees, the sensitivity, specificity, and positive and negative predictive values in predicting recurrent MR were 88%, 94%, 82%, and 93%, respectively. Three distinct patterns of anterior leaflet tethering (minimal, basal, and distal) with an increasing risk of recurrent MR were identified. Posterior leaflet tethering is invariable after mitral annuloplasty, rendering postoperative mitral competence highly dependent on distal anterior leaflet mobility.

  8. Assessing functional mitral regurgitation with exercise echocardiography: rationale and clinical applications

    Directory of Open Access Journals (Sweden)

    Bovenzi Francesco

    2009-12-01

    Full Text Available Abstract Secondary or functional mitral regurgitation (FMR represents an increasing feature of mitral valve disease characterized by abnormal function of anatomically normal leaflets in the context of the impaired function of remodelled left ventricles. The anatomic and pathophysiological basis of FMR are briefly analyzed; in addition, the role of exercise echocardiography for the assessment of FMR is discussed in view of its relevance to clinical practice.

  9. How do we use imaging to aid considerations for intervention in patients with severe mitral regurgitation?

    Science.gov (United States)

    Martin, Randolph P

    2013-11-01

    Increasing life expectancy and comorbid conditions, like obesity, especially in industrialized countries, have led to Valvular Heart Disease (VHD) becoming a major epidemic. Mitral valve disease currently accounts for nearly 10% of Valvular Heart Disease in industrialized countries worldwide. It is a known fact that, left untreated, degenerative mitral valve disease not only shortens an individual's life, but is also associated with increased morbidity. Despite current guidelines, there is often marked delay in appropriately sending patients for consideration of surgical intervention-interventions that when performed well can dramatically restore patients to a more normal lifespan. The critical question is really not what the severity of the mitral regurgitation is, but what the effect of the mitral regurgitation is on the heart. Modern day echocardiography utilizing Transthoracic Echo, Stress Echo, and Transesophageal Echo, can provide the clinician and the surgeon with six key factors that when taken together provide clear direction as to the proper timing for consideration for mitral valve repair. Thinking of these in an integrative fashion, the clinician and the surgeon can more appropriately time proper surgical intervention in primary degenerative mitral regurgitation.

  10. Percutaneous Mitral Valve Repair in Mitral Regurgitation Reduces Cell-Free Hemoglobin and Improves Endothelial Function.

    Directory of Open Access Journals (Sweden)

    Christos Rammos

    Full Text Available Endothelial dysfunction is predictive for cardiovascular events and may be caused by decreased bioavailability of nitric oxide (NO. NO is scavenged by cell-free hemoglobin with reduction of bioavailable NO up to 70% subsequently deteriorating vascular function. While patients with mitral regurgitation (MR suffer from an impaired prognosis, mechanisms relating to coexistent vascular dysfunctions have not been described yet. Therapy of MR using a percutaneous mitral valve repair (PMVR approach has been shown to lead to significant clinical benefits. We here sought to investigate the role of endothelial function in MR and the potential impact of PMVR.Twenty-seven patients with moderate-to-severe MR treated with the MitraClip® device were enrolled in an open-label single-center observational study. Patients underwent clinical assessment, conventional echocardiography, and determination of endothelial function by measuring flow-mediated dilation (FMD of the brachial artery using high-resolution ultrasound at baseline and at 3-month follow-up. Patients with MR demonstrated decompartmentalized hemoglobin and reduced endothelial function (cell-free plasma hemoglobin in heme 28.9±3.8 μM, FMD 3.9±0.9%. Three months post-procedure, PMVR improved ejection fraction (from 41±3% to 46±3%, p = 0.03 and NYHA functional class (from 3.0±0.1 to 1.9±1.7, p<0.001. PMVR was associated with a decrease in cell free plasma hemoglobin (22.3±2.4 μM, p = 0.02 and improved endothelial functions (FMD 4.8±1.0%, p<0.0001.We demonstrate here that plasma from patients with MR contains significant amounts of cell-free hemoglobin, which is accompanied by endothelial dysfunction. PMVR therapy is associated with an improved hemoglobin decompartmentalization and vascular function.

  11. Dumb-bell in the heart: rare case of biatrial myxoma with mitral regurgitation.

    Science.gov (United States)

    Ananthanarayanan, Chandrasekaran; Bishnoi, Arvind Kumar; Ramani, Jayadip; Gandhi, Hemang

    2016-10-01

    Cardiac myxomas are rare intracardiac tumors, and the majority are benign myxomas involving the left atrium. We report a case of the very rare occurrence of biatrial myxoma associated with mitral regurgitation, which was successfully treated. © The Author(s) 2016.

  12. Determinants of exercise-induced increase of mitral regurgitation in patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Pecini, Redi; Hammer-Hansen, Sophia; Dalsgaard, Morten

    2010-01-01

    Mechanisms behind exercise-induced increase of mitral regurgitation (MR) in patients with chronic ischemic heart disease have been described earlier. We describe the determinants of exercise-induced changes in MR in patients with non-ST-elevation acute coronary syndrome (NSTACS)....

  13. Does Down-Sized Ring Annuloplasty Induce Papillary Muscle Relocation in Ischemic Mitral Regurgitation?

    DEFF Research Database (Denmark)

    Jensen, Henrik; Jensen, Morten O; Smerup, Morten H

    2010-01-01

    Down-sized ring annuloplasty has been shown to induce left ventricular remodeling in patients with functional ischemic mitral regurgitation (FIMR). To determine if this remodeling comprised papillary muscle (PM) relocation, a chronic FIMR porcine model was used to assess the impact on three...

  14. Relationship between severity of mitral regurgitation and renal function in patients with ischemic chronic heart failure

    Directory of Open Access Journals (Sweden)

    D. A. Lashkul

    2015-10-01

    Full Text Available Mitral regurgitation (MR - frequent complication of prolonged and severe coronary artery disease, left ventricular systolic dysfunction (LV of different genesis and plays an important role in the onset and progression of chronic heart failure (CHF. Aim. In order to identify relationships between severity of mitral regurgitation and renal function 318 patients with ischemic chronic heart failure were included. Methods and results. Biochemical analysis was used for study of the filtration capacity of the kidneys, echocardiography – the structural and functional parameters of the heart. It was established that the increase in severity of mitral regurgitation sweeping in chronic heart failure accompanied by a decline of kidney function, left ventricular ejection fraction, increase in left atrial volume index, increased systolic pulmonary artery pressure and E/Eann ratio increase. Conclusions. This indicates that mitral regurgitation formation of on the background of abnormal left ventricular remodeling in patients with ischemic chronic heart failure is associated with a reduction of kidney function and needs more attention in order to be detected at an earlier stage.

  15. Quantification of mitral regurgitation orifice area by 3-dimensional echocardiography: comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter.

    Science.gov (United States)

    Lange, Aleksandra; Palka, Przemyslaw; Donnelly, J; Burstow, Darryl

    2002-11-01

    The evaluation of mitral regurgitation (MR) by 3-dimensional (3D) echo has generally been performed by reconstruction of Doppler regurgitant jets but there are little data on measuring anatomic regurgitant orifice area (AROA) directly from 3D mitral valve (MV) reconstructions. Transoesophageal echo (TOE) 3D images were acquired from 38 unselected patients (age 59+/-11 years, ten in atrial fibrillation) with various degrees of MR. In all patients MV was reconstructed en face from the left atrium (LA) and the left ventricle (LV). AROA was measured by planimetry from 3D pictures and compared to the effective regurgitant orifice area (EROA) by proximal isovelocity surface area and proximal MR jet width from 2D echo. AROA was measured in 95% of patients from LA, 89% from LV and in 84% from both LA and LV. Good correlation was found between EROA and AROA measured from both LA (r=0.97, Por=25 mm(2) differentiated mild MR (graded 1-2) from moderately severe (graded 3-4) with 80-90% accuracy. 3D TOE provides important quantitative information on both the mechanism and the severity of MR in an unselected group of patients. AROA enables quantification of MR with excellent agreement with the accepted clinical method of proximal flow convergence.

  16. Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

    Directory of Open Access Journals (Sweden)

    Zhang-Qiang Chen

    2015-01-01

    Full Text Available Background: Tricuspid regurgitation (TR is frequently associated with severe mitral stenosis (MS, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV procedure in rheumatic heart disease patients with mitral valve (MV stenosis and tricuspid valve regurgitation. Methods: Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA, TR area (TRA, atrial pressure and diameter, and pulmonary artery pressure (PAP. The patients were followed for 6 months to 9 years. Results: After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm 2 vs. 0.9 ± 0.3 cm 2 , P 0.05. The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05, the remaining patients without serious complications. Conclusions: PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.

  17. Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study.

    Science.gov (United States)

    Vincenti, Gabriella; Masci, Pier Giorgio; Rutz, Tobias; De Blois, Jonathan; Prša, Milan; Jeanrenaud, Xavier; Schwitter, Juerg; Monney, Pierre

    2017-07-27

    To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson's method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson's method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR. In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSVuncorr was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESVcorr was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5-29% regurgitant fraction (RF)), moderate (30-49% RF), or severe (≥50% RF). In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p < 0

  18. Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation.

    Science.gov (United States)

    Bouchard, Denis; Jensen, Henrik; Carrier, Michel; Demers, Philippe; Pellerin, Michel; Perrault, Louis P; Lambert, Jean

    2014-05-01

    Functional ischemic mitral regurgitation (FIMR) increases mortality independently of the baseline characteristics and ventricular function. The effect of treating FIMR with annuloplasty is unclear when mitral regurgitation is moderate. Myocardial revascularization alone has been shown to improve mitral valve function. We randomized 31 patients with moderate (grade 2-4) FIMR to receive either coronary artery bypass grafting (CABG) alone or CABG plus downsizing mitral ring annuloplasty. The patients were followed up for clinical outcomes and echocardiographic assessment of mitral valve function and left ventricular dimensions at 3 and 12 months. Clinical improvement was assessed using the Minnesota quality-of-life questionnaire, 6-minute walk test, and brain natriuretic peptide levels. The clinical course was similar in the 2 groups of patients during the study period. FIMR was perfectly corrected intraoperatively in the ring group. Echocardiographic follow-up at 3 months showed no difference in the FIMR grade between the 2 groups (66% less than grade 2 in the CABG alone and 86% in the CABG plus ring group; P = .316). The improvement in the CABG alone group was even more marked at 12 months (85% less than grade 2 in the CABG group and 85% in the CABG plus ring group). The left ventricular ejection fraction was significantly better at 3 months in the CABG alone group, although at 12 months, the left ventricular ejection fraction in the 2 groups had improved similarly. Although initially effective at reducing moderate FIMR, the addition of a ring did not change the clinical course after CABG surgery. At 12 months, no echocardiographic difference was found in terms of residual mitral regurgitation, left ventricular dimensions and function, or clinical outcomes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  19. Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge.

    Science.gov (United States)

    Battisha, Ayman; Abdelhaleem, Ahmed; Srialluri, Swetha; Arisha, Mohammed J; Farhoud, Adel A; Kamel, Hassan; Mahmoud, Mohamed S; Tageldin, Omar; Salama, Ahmed Y; Ibeche, Bashar; Nanda, Navin C

    2017-10-01

    Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame-by-frame analysis of two-dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR. © 2017, Wiley Periodicals, Inc.

  20. Mitral Regurgitation Severity and Left Ventricular Systolic Dimension Predict Survival in Young Cavalier King Charles Spaniels

    DEFF Research Database (Denmark)

    Reimann, M J; Møller, J E; Häggström, J

    2017-01-01

    BACKGROUND: Development and progression of myxomatous mitral valve disease (MMVD) in dogs are difficult to predict. Identification at a young age of dogs at high risk of adverse outcome in the future is desirable. HYPOTHESIS/OBJECTIVES: To study the predictive value of selected clinical...... was assessed by telephone interview with owners. The value of variables for predicting mortality was investigated by Cox proportional hazard and Kaplan-Meier analyses. RESULTS: Presence of moderate to severe mitral regurgitation (MR) (hazard ratio (HR) = 3.03, 95% confidence interval (95% CI) = 1.48-6.23, P...

  1. Cerebral perfusion using the tissue oxygenation index in mitral valve repair in a patient with porcelain aorta and aortic regurgitation.

    Science.gov (United States)

    Kasahara, Hirofumi; Shin, Hankei; Mori, Mitsuharu

    2007-12-01

    We report successful mitral valve repair in a patient with porcelain aorta, complicated by aortic regurgitation, severe cerebrovascular disease, and multiple cerebral infarctions. The patient was a 77-year-old male who had congestive heart failure as a result of severe mitral regurgitation. Mitral valve repair was performed without aortic cross-clamping, using moderate hypothermic cardiopulmonary bypass. Aortic regurgitation was likely to worsen upon retracting the atrial septum to expose the mitral valve, complicating the operative procedure. We therefore controlled the regurgitation by lowering the blood temperature and using systemic perfusion flow. During systemic low-flow perfusion, we used near-infrared spectroscopy (NIRS) and the bispectral index to prevent cerebral hypoperfusion. The tissue oxygenation index value derived from NIRS was maintained above 55% during the procedure. The repair was performed safely with no difficulty. The postoperative course was satisfactory, with no neurological complications; echocardiography revealed no mitral regurgitation. The use of NIRS is valuable in preventing neurological complications in mitral valve operations complicated by porcelain aorta and aortic regurgitation.

  2. Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance.

    Science.gov (United States)

    Van De Heyning, Caroline M; Magne, Julien; Piérard, Luc A; Bruyère, Pierre-Julien; Davin, Laurent; De Maeyer, Catherine; Paelinck, Bernard P; Vrints, Christiaan J; Lancellotti, Patrizio

    2013-12-27

    Two-dimensional transthoracic echocardiography (2DTTE) remains the first-line diagnostic imaging tool to assess primary mitral regurgitation although cardiovascular magnetic resonance (CMR) has proven to establish left ventricular function more accurately and might evaluate mitral regurgitation severity more reliably. We sought to compare routine evaluation of left ventricular function and mitral regurgitation severity by 2DTTE with assessment by CMR in moderate to severe primary mitral regurgitation without overt left ventricular dysfunction. We prospectively included 38 patients (79% of male, age 57 ± 14 years) with at least moderate primary mitral regurgitation, a left ventricular ejection fraction ≥60% and a left ventricular end-systolic diameter ≤45 mm. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for 2DTTE and CMR. Left ventricular end-diastolic and end-systolic volumes were significantly underestimated by 2DTTE in comparison with CMR, although there was a strong correlation (Pearson r = 0.81, p PISA method and planimetry by CMR (47 ± 24 vs. 42 ± 16 mm2, p = 0.12) with a strong correlation between both imaging techniques (Pearson r = 0.76, p PISA method by 2DTTE and thus may be a valuable alternative to assess mitral regurgitation severity.

  3. A pig model of ischemic mitral regurgitation induced by mitral chordae tendinae rupture and implantation of an ameroid constrictor.

    Science.gov (United States)

    Cui, Yong-Chun; Li, Kai; Tian, Yi; Yuan, Wei-Min; Peng, Peng; Yang, Jian-Zhong; Zhang, Bao-Jie; Zhang, Hui-Dong; Wu, Ai-Li; Tang, Yue

    2014-01-01

    A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10-20% at one week, 30-40% at two weeks and 90-100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients.

  4. Determinants of survival after surgery for mitral valve regurgitation in patients with and without coronary artery disease

    NARCIS (Netherlands)

    van Herwerden, L. A.; Tjan, D.; Tijssen, J. G.; Quaegebeur, J. M.; Bos, E.

    1990-01-01

    Mortality and its determinants were assessed in 181 consecutive patients undergoing primary mitral valve surgery for pure mitral regurgitation with coronary artery disease (MR + CAD, 79 patients) or without (MR no CAD, 102 patients). Early mortality (C10% vs. 3%) and 6-year estimate of survival (55%

  5. Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation.

    Science.gov (United States)

    Kılıcgedik, Alev; Kahveci, Gokhan; Gurbuz, Ahmet Seyfeddin; Karabay, Can Yucel; Guler, Ahmet; Efe, Suleyman Cagan; Aung, Soe Moe; Arslantas, Ugur; Demir, Serdar; Izgi, Ibrahim Akin; Kirma, Cevat

    2017-04-01

    The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais

  6. Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China

    Directory of Open Access Journals (Sweden)

    Li Zong-Xiao

    2012-04-01

    Full Text Available Abstract Background Functional tricuspid regurgitation (TR occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6% had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc. and 40 patients (88.9% had atrial fibrillation. Twenty-six patients (57.8% were in New York Heart Association (NYHA functional class III, and 19 (42.2% in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%, 4 for bioprosthetic mitral valve replacement (8.9%, and 7 for tricuspid annuloplasty (15.6%. Results The tricuspid valves were repaired with Kay's (7 cases, 15.6% or De Vega technique (4 cases, 8.9%. Tricuspid valve replacement was performed in 34 cases (75.6%. One patient (2.2% died. Postoperative low cardiac output (LCO occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.

  7. Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation.

    Science.gov (United States)

    Marchese, Nicola; Facciorusso, Antonio; Vigna, Carlo

    2015-12-01

    Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury. This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms).

  8. Regression of severe tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis

    Directory of Open Access Journals (Sweden)

    Mohamed Eid Fawzy

    2014-03-01

    Conclusions: Regression of significant TR after successful MBV in patients with severe mitral stenosis was observed in patients who had severe pulmonary hypertension. This improvement in TR occurred even in the presence of organic tricuspid valve disease.

  9. Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults

    Science.gov (United States)

    Rahimi, Kazem; Mohseni, Hamid; Tran, Jenny; Woodward, Mark

    2017-01-01

    Background Mitral regurgitation in people without prior cardiac disease is considered a degenerative disease with no established risk factors for its prevention. We aimed to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation. Methods and findings We used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) from 1 January 1990 to 31 December 2015. CPRD covers approximately 7% of the current UK population and is broadly representative of the population by age, sex, and ethnicity. About 5.5 million UK patients with no known cardiovascular or valve disease at baseline were included in this cohort study. We investigated the relationship between blood pressure (BP) and risk of mitral regurgitation using Cox regression models. Our primary exposure variable was SBP and our primary outcome was incident reports of mitral regurgitation, which were identified from hospital discharge reports or primary care records. Of the 5,553,984 patients in the CPRD that met our inclusion criteria, during the 10-year follow-up period, 28,655 (0.52%) were diagnosed with mitral regurgitation and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation with no evidence of a nadir down to 115 mmHg (p < 0.001). Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation (hazard ratio [HR] 1.26; CI 1.23, 1.29). The observed association was partially mediated by diseases affecting the left ventricle during follow-up (myocardial infarction [MI], ischaemic heart disease [IHD], cardiomyopathy, and heart failure). However, the percentage of excess risk mediated (PERM) by these proximate causes of secondary mitral regurgitation was only 13% (CI 6.1%, 20%), and accounting for them had little effect on the long-term association between SBP and mitral regurgitation

  10. Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters.

    LENUS (Irish Health Repository)

    Arnous, Samer

    2012-02-01

    PURPOSE: To assess whether cardiac computed tomographic angiography (CCTA) can quantify the severity of chronic mitral regurgitation (MR) compared to qualitative and quantitative echocardiographic parameters. MATERIALS AND METHODS: Cardiac computed tomographic angiography was performed in 23 patients (mean +\\/- SD age, 63 +\\/- 16 years; range, 24-86 years) with MR and 20 patients without MR (controls) as determined by transthoracic echocardiography. Multiphasic reconstructions (20 data sets reconstructed at 5% increments of the electrocardiographic gated R-R interval) were used to analyze the mitral valve. Using CCTA planimetry, 2 readers measured the regurgitant mitral orifice area (CCTA ROA) during systole. A qualitative echocardiographic assessment of severity of MR was made by visual assessment of the length of the regurgitant jet. Quantitative echocardiographic measurements included the vena contracta, proximal isovelocity surface area, regurgitant volume, and estimated regurgitant orifice (ERO). Comparisons were performed using the independent t test, and correlations were assessed using the Spearman rank test. RESULTS: All controls and the patients with MR were correctly identified by CCTA. For patients with mild, moderate, or severe MR, mean +\\/- SD EROs were 0.16 +\\/- 0.03, 0.31 +\\/- 0.08, and 0.52 +\\/- 0.03 cm(2) (P < 0.0001) compared with mean +\\/- SD CCTA ROAs 0.09 +\\/- 0.05, 0.30 +\\/- 0.04, and 0.97 +\\/- 0.26 cm(2) (P < 0.0001), respectively. When echocardiographic measurements were graded qualitatively as mild, moderate, or severe, strong correlations were seen with CCTA ROA (R = 0.89; P < 0.001). When echocardiographic measurements were graded quantitatively, the vena contracta and the ERO showed modest correlations with CCTA ROA (0.48 and 0.50; P < 0.05 for both). Neither the proximal isovelocity surface area nor the regurgitant volume demonstrated significant correlations with CCTA ROA. CONCLUSIONS: Single-source 64-slice CCTA provides a

  11. Treatment of severe mitral regurgitation caused by lesions in both leaflets using multiple mitral valve plasty techniques in a small dog

    Directory of Open Access Journals (Sweden)

    Satoko Yokoyama

    2017-11-01

    Full Text Available Mitral valve plasty (MVP is preferred over mitral valve replacement (MVR for mitral regurgitation in humans because of its favorable effect on quality of life. In small dogs, it is difficult to repair multiple lesions in both leaflets using MVP. Herein, we report a case of severe mitral regurgitation caused by multiple severe lesions in the posterior leaflet (PL in a mixed Chihuahua. Initially, we had planned MVR with an artificial valve. However, MVP combined with artificial chordal reconstruction of both leaflets, semicircular suture annuloplasty, and valvuloplasty using a newly devised direct scallop suture for the PL was attempted in this dog. The dog recovered well and showed no adverse cardiac signs, surviving two major operations. The dog died 4 years and 10 months after the MVP due to non-cardiovascular disease. Our additional technique of using a direct scallop suture seemed useful for PL repair involving multiple scallops in a small dog.

  12. Mitraclip Followed by Surgical Aortic Valve Replacement: Hybrid Techniques for Regurgitant Aortic and Mitral Valve Disease.

    Science.gov (United States)

    Eudailey, Kyle; Hamid, Nadira; Hahn, Rebecca T; Kodali, Susheel; Gray, William; George, Isaac

    2016-08-01

    With the advent of percutaneous valve interventions, the landscape for management of high-risk valve replacement and repair has changed dramatically. Transcatheter valve repair/replacement techniques can be used in conjunction with open surgery to facilitate a hybrid approach in patients with multivalve disease. We present a case of staged hybrid valve repair followed by surgical replacement for a high-risk patient with mitral regurgitation and aortic regurgitation. This case illustrates the effectiveness of the staged hybrid approach for high-risk patients with incomplete transcatheter options. We expect these techniques to play an increasingly larger role in the treatment algorithm for high-risk multivalve disease. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Tricuspid and mitral regurgitation detected by color flow Doppler in the acute phase of Kawasaki disease

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, A.; Kamiya, T.; Tsuchiya, K.; Sato, I.; Arakaki, Y.; Kohata, T.; Ono, Y.

    1988-02-01

    Valvular lesions in the acute phase of Kawasaki disease were studied in 19 children. The patients were intensively observed by color flow Doppler every day from the day of hospitalization up to 12 days after the onset of the disease and 2 or more times a week thereafter, for up to 28 days. Mitral regurgitation (MR) was found in 9 patients (47%) and tricuspid regurgitation (TR) in 10 (53%). MRs were of transient type and confirmed from 7.5 +/- 1.6 (mean +/- standard deviation) to 13.1 +/- 6.5 days after the onset of the disease. Both types of valvular regurgitation were mild. The direction of regurgitation was from the center of valvular coaptation toward the posterior wall of the atrium. Neither valvular prolapse nor valvular deformity was noted. In patients with MR, left ventricular ejection fraction on M-mode echocardiography was significantly lower in the acute phase than in the convalescent phase of the disease (p less than 0.05). Using gallium-67 scintigram, the positive uptake of the isotope was noted in 7 (88%) of 8 patients with MR, but not found at all in 8 patients free of MR. These results suggest that MR and TR are often transient in the acute phase of Kawasaki disease and could be attributed to myocarditis.

  14. [Re-implantation of a mitraclip device in a patient with recurrent mitral regurgitation].

    Science.gov (United States)

    Perl, Leor; Assali, Abid; Vaknin-Assa, Hana; Shapira, Yaron; Vaturi, Mordehay; Sagie, Alex; Kornowski, Ran

    2015-07-01

    Mitral regurgitation is a common disease in patients with cardiomyopathies, constituting poor prognosis when present. In patients with an increased risk for surgery, a minimally-invasive, percutaneous procedure currently exists, in the form of an edge-to-edge repair technique using the MitraClip device. This approach allows for great flexibility in specific situations, such as in the addition of another clip when necessary, either during the procedure or after a follow-up period. The following case study depicts the course of therapy for a patient with ischemic cardiomyopathy and severe bi-ventricular failure. The patient was implanted with a MitraClip device five months before the current event, and now presents with clinical deterioration, and a renewed mitral valve insufficiency.

  15. A technical review of subvalvular techniques for repair of ischaemic mitral regurgitation and their associated echocardiographic and survival outcomes.

    Science.gov (United States)

    Athanasopoulos, Leonidas V; Casula, Roberto P; Punjabi, Prakash P; Abdullahi, Yusuf S; Athanasiou, Thanos

    2017-12-01

    Subvalvular techniques are gaining ground as adjunct procedures for addressing ischaemic mitral regurgitation. The aim of this study was to describe the different techniques and assess their results. A systematic review of the literature was performed. The end points of interest were recurrence of mitral regurgitation, cardiac events and early and late echocardiographic measurements. After initial screening, 450 articles were identified, of which 24 provided the best available evidence on the topic. The different subvalvular techniques had similar mortality rates when compared with the standard restrictive annuloplasty. Recurrence of mitral regurgitation was of lower degree and the remodelling process was better for these techniques. Reoperation rates were also quite low. The subvalvular techniques showed superiority, addressing more successfully the leaflet tethering. However, larger randomized studies are needed to confirm these early positive results. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction

    DEFF Research Database (Denmark)

    Samad, Zainab; Shaw, Linda K; Phelan, Matthew

    2015-01-01

    AIMS: The management and outcomes of patients with functional moderate/severe mitral regurgitation and severe left ventricular (LV) systolic dysfunction are not well defined. We sought to determine the characteristics, management strategies, and outcomes of patients with moderate or severe mitral...... regurgitation (MR) and LV systolic dysfunction. METHODS AND RESULTS: For the period 1995-2010, the Duke Echocardiography Laboratory and Duke Databank for Cardiovascular Diseases databases were merged to identify patients with moderate or severe functional MR and severe LV dysfunction (defined as LV ejection...

  17. Examination of mitral regurgitation with a goat heart model for the development of intelligent artificial papillary muscle.

    Science.gov (United States)

    Shiraishi, Y; Yambe, T; Yoshizawa, M; Hashimoto, H; Yamada, A; Miura, H; Hashem, M; Kitano, T; Shiga, T; Homma, D

    2012-01-01

    Annuloplasty for functional mitral or tricuspid regurgitation has been made for surgical restoration of valvular diseases. However, these major techniques may sometimes be ineffective because of chamber dilation and valve tethering. We have been developing a sophisticated intelligent artificial papillary muscle (PM) by using an anisotropic shape memory alloy fiber for an alternative surgical reconstruction of the continuity of the mitral structural apparatus and the left ventricular myocardium. This study exhibited the mitral regurgitation with regard to the reduction in the PM tension quantitatively with an originally developed ventricular simulator using isolated goat hearts for the sophisticated artificial PM. Aortic and mitral valves with left ventricular free wall portions of isolated goat hearts (n=9) were secured on the elastic plastic membrane and statically pressurized, which led to valvular leaflet-papillary muscle positional change and central mitral regurgitation. PMs were connected to the load cell, and the relationship between the tension of regurgitation and PM tension were measured. Then we connected the left ventricular specimen model to our hydraulic ventricular simulator and achieved hemodynamic simulation with the controlled tension of PMs.

  18. Backpropagation artificial neural network classifier to detect changes in heart sound due to mitral valve regurgitation.

    Science.gov (United States)

    Sinha, Rakesh Kumar; Aggarwal, Yogender; Das, Barda Nand

    2007-06-01

    The phonocardiograph (PCG) can provide a noninvasive diagnostic ability to the clinicians and technicians to compare the heart acoustic signal obtained from normal and that of pathological heart (cardiac patient). This instrument was connected to the computer through the analog to digital (A/D) converter. The digital data stored for the normal and diseased (mitral valve regurgitation) heart in the computer were decomposed through the Coifman 4th order wavelet kernel. The decomposed phonocardiographic (PCG) data were tested by backpropagation artificial neural network (ANN). The network was containing 64 nodes in the input layer, weighted from the decomposed components of the PCG in the input layer, 16 nodes in the hidden layer and an output node. The ANN was found effective in differentiating the wavelet components of the PCG from mitral valve regurgitation confirmed person (93%) to normal subjects (98%) with an overall performance of 95.5%. This system can also be used to detect the defects in cardiac valves especially, and other several cardiac disorders in general.

  19. Revascularization alone (without mitral valve repair) suffices in patients with advanced ischemic cardiomyopathy and mild-to-moderate mitral regurgitation.

    Science.gov (United States)

    Tolis, George A; Korkolis, Dimitris P; Kopf, Gary S; Elefteriades, John A

    2002-11-01

    Whether or not to perform adjunctive mitral repair in patients undergoing coronary artery bypass grafting (CABG) for advanced ischemic cardiomyopathy with moderately severe mitral regurgitation (MR) remains controversial. We examine the clinical and echocardiographic outcome after isolated CABG in 49 patients with ischemic cardiomyopathy and 1+ to 3+ MR undergoing surgical revascularization. The patients were identified for analysis of mitral valve-related issues from a larger series of 183 patients with ischemic cardiomyopathy (MUGA ejection fraction < or = 30%) undergoing CABG by a single surgeon from 1986 to 1996. Patient age was 66.3 years (mean, range 45 to 83 years). There were 5 women (10.2%) and 44 men (89.8%). Mean ejection fraction was 22.4% with a range of 10% to 30%. Thirty-four patients had preoperative congestive heart failure (70%) and 12 (25%) had pulmonary edema. Number of grafts was 2.8 (mean, range 1 to 5). The MR was 1+ in 18 patients (37.5%), 2+ in 26 (52%) and 3+ in 5 patients (10.5%). Hospital mortality was 2.0% (1 of 49 patients). Ejection fraction improved from 22.0% to 31.5% (p < 0.05) after CABG. Mean degree of MR improved with CABG alone from 1.73 to 0.54 (p < 0.05) as measured at a mean interval of 36.9 months from CABG. New York Heart-Association congestive heart failure class improved from 3.3 to 1.8 (p < 0.05). Long-term survival was 88%, 65%, and 50% at 1, 3, and 5 years postoperatively. No patient required subsequent mitral valve operation or heart transplantation in long-term follow-up. We conclude that, in patients with advanced ischemic cardiomyopathy and mild-to-moderate MR, isolated CABG (without mitral valve, repair) suffices, producing dramatic improvement in ejection fraction, in congestive heart failure, and in degree of MR, with excellent (relative) long-term survival. The improvement in MR likely results from improved left ventricular function and size consequent upon revascularization.

  20. Novel parameters of global and regional mitral annulus geometry in man: comparison between normals and organic mitral regurgitation, before and after mitral valve repair.

    Science.gov (United States)

    Ben Zekry, S; Jain, S; Alexander, S K; Li, Y; Aggarwal, A; Jajoo, A; Little, S H; Lawrie, G M; Azencott, R; Zoghbi, W A

    2016-04-01

    The mitral annulus (MA) saddle shape is complex but vital for a normal functioning mitral apparatus. Although conventional parameters of MA geometry such as area and height are helpful, they fall short of describing its complex regional geometry. In this prospective study, novel parameters of MA curvature and torsion were derived from three-dimensional (3D) transoesophageal echocardiography. These quantitative indices were computed in 15 patients with normal valves (age 53 ± 8 years) and in 15 patients with organic significant mitral regurgitation (MR, age 66 ± 11 years), before and after mitral valve repair (MVR). The MA was traced and modelled in mid- and end-systole. Curvature and torsion were computed at 500 points across the MA to derive regional and global indices. Overall, patients with organic MR presented the smallest global curvature and torsion; this decrease in curvature and torsion reflects a loss of tonicity of the MA tissue. These changes were largely corrected with MVR surgery, to higher values, compared with normals. The regional analysis revealed similar trends. The maximal MA curvature was found to be at the MA 'anterior horn', whereas the MA 'posterior horn' had the lowest curvature values. Novel MA parameters of curvature and torsion can be computed from 3D echocardiography and provide quantitative characteristics of dynamic regional MA geometry. In patients with organic MR, the reduced regional and global curvatures improve following surgical MVR. These quantitative parameters may help further refine the quantitative description of MA geometry in various mitral valve pathologies and after MVR. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  1. Cardiopulmonary effects of enoximone or dobutamine and nitroglycerin on mitral valve regurgitation and pulmonary venous hypertension.

    Science.gov (United States)

    Hachenberg, T; Möllhoff, T; Holst, D; Hammel, D; Brüssel, T

    1997-06-01

    To compare the cardiovascular and pulmonary effects of the phosphodiesterase III inhibitor enoximone (EN) or a combination of dobutamine (DOB) and nitroglycerin (NTG) before and after mitral valve repair or replacement. Prospective, randomized, controlled clinical study. University hospital. Twenty patients with mitral regurgitation and pulmonary venous hypertension scheduled for elective mitral valve surgery. Patients fulfilling the inclusion criteria of the study were randomly allocated into a group treated with EN (group 1, n = 10) or DOB and NTG (group 2, n = 10). A cardiopulmonary status was obtained after induction of anesthesia and mechanical ventilation during stable hemodynamic conditions (control). Then the patients received either EN (bolus dose 1.0 mg/kg followed by a continuous infusion of 10 micrograms/kg/min) or DOB (8.0 micrograms/kg/min) and NTG (1.0 microgram/kg/min) according to the randomization. After a period of 20 minutes, all parameters were measured again. The study drugs were stopped, and cardiac surgery was performed. Infusions of EN (without additional loading dose) or DOB and NTG were started again in the above-described doses 10 minutes before separation from cardiopulmonary bypass (CPB). Respiratory and hemodynamic measurements were made 20 minutes after weaning from CPB and 60 minutes after admission of the patient to the intensive care unit. Both groups were comparable regarding preoperative and control data. Before mitral valve surgery, cardiac output (CO) and heart rate (HR) increased by 46% (p < 0.05) and 31% (p < 0.01) during infusion of EN with minor changes of mean systemic arterial pressure (PSA) and gas exchange. Mean pulmonary arterial pressure (PPA) decreased from 32 +/- 11 mmHg to 23 +/- 11 mmHg (p < 0.05). Similar alterations were observed in group 2 (delta CO + 26%, p < 0.05, delta HR + 39%, p < 0.01); however, PPA and calculated pulmonary vascular resistance remained unchanged. After separation from CPB, EN and DOB

  2. Response of functional mitral regurgitation during dobutamine infusion in relation to changes in left ventricular dyssynchrony and mitral valve geometry.

    Science.gov (United States)

    Choi, Woong Gil; Kim, Soo Hyun; Kim, Soo Han; Park, Sang Don; Baek, Young Soo; Shin, Sung Hee; Woo, Sung Il; Kim, Dae Hyeok; Park, Keum Soo; Kwan, Jun

    2014-05-01

    Functional mitral regurgitation (FMR) and myocardial dyssynchrony commonly occur in patients with dilated cardiomyopathy (DCM). The aim of this study was to elucidate changes in FMR in relation to those in left ventricular (LV) dyssynchrony as well as geometric parameters of the mitral valve (MV) in DCM patients during dobutamine infusion. Twenty-nine DCM patients (M:F=15:14; age: 62±15 yrs) with FMR underwent echocardiography at baseline and during peak dose (30 or 40 ug/min) of dobutamine infusion. Using 2D echocardiography, LV end-diastolic volume, end-systolic volume (LVESV), ejection fraction (EF), and effective regurgitant orifice area (ERO) were estimated. Dyssynchrony indices (DIs), defined as the standard deviation of time interval-to-peak myocardial systolic contraction of eight LV segments, were measured. Using the multi-planar reconstructive mode from commercially available 3D image analysis software, MV tenting area (MVTa) was measured. All geometrical measurements were corrected (c) by the height of each patient. During dobutamine infusion, EF (28±8% vs. 39±11%, p=0.001) improved along with significant decrease in cLVESV (80.1±35.2 mm³/m vs. 60.4±31.1 mm³/m, p=0.001); cMVTa (1.28±0.48 cm²/m vs. 0.79±0.33 cm²/m, p=0.001) was significantly reduced; and DI (1.31±0.51 vs. 1.58±0.68, p=0.025) showed significant increase. Despite significant deterioration of LV dyssynchrony during dobutamine infusion, ERO (0.16±0.09 cm² vs. 0.09±0.08 cm², p=0.001) significantly improved. On multivariate analysis, ΔcMVTa and ΔEF were found to be the strongest independent determinants of ΔERO (R²=0.443, p=0.001). Rather than LV dyssynchrony, MV geometry determined by LV geometry and systolic pressure, which represents the MV closing force, may be the primary determinant of MR severity.

  3. Prevalence of severe mitral regurgitation eligible for edge-to-edge mitral valve repair (MitraClip).

    Science.gov (United States)

    Wallenborn, Julia; Störk, Stefan; Herrmann, Sebastian; Kukuy, Olga; Fette, Georg; Puppe, Frank; Gorski, Armin; Hu, Kai; Voelker, Wolfram; Ertl, Georg; Weidemann, Frank

    2016-08-01

    We assessed the prevalence of moderately severe or severe mitral regurgitation (MR) justifying edge-to-edge mitral valve (MV) repair (MitraClip(®)) in patients attending the University Hospital Wuerzburg, a tertiary care centre located in Wuerzburg, Germany. Transcatheter edge-to-edge MV repair of advanced MR is a non-surgical treatment option in inoperable and high-risk patients. It is unknown how many patients are potentially eligible for MitraClip(®) since several anatomical prerequisites of the MV apparatus have to be met for optimal treatment results. Using a novel clinical data warehouse we searched for all patients attached to our Department of Internal Medicine from 01/2008 to 01/2012 with moderately severe or severe MR and aged ≥18 years. The current status of their treatment regime and eligibility for MitraClip(®) was assessed and re-evaluated according to current guidelines and echocardiographic criteria. The search of electronic medical records amongst 43,690 patients employed an innovative validated text extraction method and identified 331 patients with moderately severe or severe MR who had undergone echocardiographic assessment at our institution. Of these, 125 (38 %) received MV surgery and 206 (62 %) medical therapy only. Most patients not undergoing surgery had secondary MR (70 %). After evaluation of medical and echocardiographic data of medically treated patients (n = 206), 81 (39 %) were potential candidates for MitraClip(®) therapy, and 90 (44 %) died during the median follow-up time of 23 months. A large fraction of patients with moderately severe or severe MR but not operated was detected. Medically treated patients had a bad prognosis and about 40 % of them were potential candidates for MitraClip(®) therapy.

  4. Mitral Valve Adaptation to Isolated Annular Dilation: Insights Into the Mechanism of Atrial Functional Mitral Regurgitation.

    Science.gov (United States)

    Kim, Dae-Hee; Heo, Ran; Handschumacher, Mark D; Lee, Sahmin; Choi, Yun-Sil; Kim, Kyu-Ri; Shin, Yewon; Park, Hong-Kyung; Bischoff, Joyce; Aikawa, Elena; Song, Jong-Min; Kang, Duk-Hyun; Levine, Robert A; Song, Jae-Kwan

    2017-12-08

    This study hypothesized that compensatory mitral leaflet area (MLA) adaptation occurs in patients with persistent atrial fibrillation (AF) without left ventricular (LV) dysfunction but has limitations that augment mitral regurgitation (MR). The study also explored whether asymmetrical annular dilation is matched by relative leaflet enlargement. Functional MR occurs in patients with AF and isolated annular dilation, but the relationship of MLA adaptation with annular area (AA) is unknown. Three-dimensional echocardiographic images were acquired from 86 patients with quantified MR: 53 with nonvalvular persistent AF (23 MR+ with moderate or greater MR, 30 MR-) without LV dysfunction or dilation and 33 normal controls. Comprehensive 3-dimensional analysis included total diastolic MLA, adaptation ratios of MLA to annular area and MLA to leaflet closure area, and annular and tenting geometry. Total MLA was 22% larger in patients with AF than in controls, thus paralleling the increased AA. However, as AA increased, adaptive indices (MLA/AA ratio and ratio of MLA to closure area) plateaued, becoming lowest in MR+ patients (ratio of MLA to closure area = 1.63 ± 0.17 controls, 1.60 ± 0.11 MR-, 1.32 ± 0.10 MR+; p MLA to closure area decreased (R2 = 0.68; p MLA ratio remained constant, whereas the posterior-to-anterior mitral annulus perimeter increased (1.21 ± 0.16 controls, 1.32 ± 0.20 MR-, 1.46 ± 0.19 MR+; p MLA to closure area, and posterior-to-anterior perimeter ratios. MLA adaptively increases in AF with isolated annular dilation and normal LV function. This compensatory enlargement becomes insufficient with greater annular dilation, and the leaflets fail to match asymmetrical annular remodeling, thereby increasing MR. These findings can potentially help optimize therapeutic options and motivate basic studies of adaptive growth processes. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Mitral Regurgitation after Antero-Apical Myocardial Infarction: New Mechanistic Insights

    Science.gov (United States)

    Yosefy, Chaim; Beeri, Ronen; Guerrero, J. Luis; Vaturi, Mordehay; Scherrer-Crosbie, Marielle; Handschumacher, Mark D.; Levine, Robert A.

    2011-01-01

    Background Mitral regurgitation (MR) generally accompanies infero-basal myocardial infarction (MI), with leaflet tethering by displaced papillary muscles (PMs). MR is also reported with antero-apical MI without global dilatation or inferior wall-motion abnormalities. We hypothesized that anteroapical MI extending to the inferior apex displaces the PMs, tethering the mitral leaflets to cause MR. Methods and Results Retrospective study: Consecutive anteroapical MI patients were studied. Moderate-severe MR occurred in 9% of 234 pts with only anteroapical MI versus 17% of 242 with inferoapical extension (panteroapical MI patients (20 with only two apical segments involved and 40 with involvement of all 4 apical segments, 20 with MR and 20 without MR), were compared to 20 normal controls. Those with MR (moderate) had higher systolic PM-to-annulus tethering length (TL) (pAnteroapical MI with inferoapical extension can mechanically displace PMs, causing MR despite the absence of basal and mid-inferior wall motion abnormalities. This suggests the possibility of repositioning treatments for this condition. PMID:21444880

  6. Pulmonary venous structural remodeling in a canine model of chronic atrial dilation due to mitral regurgitation.

    Science.gov (United States)

    Sun, Qi; Tang, Min; Pu, Jielin; Zhang, Shu

    2008-04-01

    Structural remodelling plays an important role in the genesis and maintenance of atrial fibrillation (AF). Although some studies that associate structural remodelling with atrial dilation have been reported, structural pulmonary venous (PV) remodelling due to chronic atrial dilation remains unclear. Six sham dogs and five mitral regurgitation (MR) dogs (three months after partial mitral valve avulsion) were studied. Separate cryosections from the PV and left atrium (LA) were immunolabelled with antibodies against connexin (Cx) 40 and Cx43 and analyzed by confocal laser scanning microscopy. Tissue samples from the PV and LA were stained with hematoxylin and eosin, and Masson's trichrome. In MR models, a decrease in Cx40 (0.57+/-0.2% versus 1.18+/-0.3%, Pfibrosis were present in the PV. Thickness in the PV and the PV-LA junction did not change in the MR group. The present study demonstrated a decrease in Cx40 and Cx43 expression and increased interstitial fibrosis in PV due to MR. These changes may potentially be a mechanism that renders the dilated atria more susceptible to AF.

  7. Adverse impact of diabetes mellitus on left ventricular remodelling in patients with chronic primary mitral regurgitation.

    Science.gov (United States)

    Ernande, Laura; Beaudoin, Jonathan; Piro, Victoria; Meziani, Souhila; Scherrer-Crosbie, Marielle

    2018-01-03

    Diabetes mellitus (DM) has an impact on left ventricular (LV) geometry and function, and is associated with worsening of pressure-overload LV remodelling; however, its impact on volume-overload LV remodelling is unknown. The objective of the study was to examine the association between DM and LV remodelling in patients with chronic mitral regurgitation (MR) caused by mitral valve prolapse. During a median follow-up of 3.26 [interquartile range 1.59-6.06] years, we evaluated the evolution of echocardiographic variables in 375 consecutive patients, including 61 (16%) patients with DM. The main endpoint was LV remodelling evaluated by LV end-diastolic diameter (LVEDD) and LV mass index increase. LV end-systolic diameter (LVESD) and ejection fraction (LVEF) were also evaluated. Patients with DM increased their LVEDD more than patients without DM (1.98±4.1 vs 0.15±4.54mm/year of follow-up; P=0.002). LVEF remained stable in the two groups. After adjustment for potential confounders, including age, sex, hypertension, body mass index, MR severity, medications and follow-up duration, DM remained independently associated with LVEDD increase (β=2.30; P<0.001). When comparing patients with DM with patients without DM matched for age, sex and LVEDD at baseline, DM was independently associated with increased LVEDD (β=2.14; P=0.002), LV mass index (β=10.7; P=0.004) and LVESD (β=2.07; P=0.01). DM is associated with worsening of LV remodelling in patients with moderate or severe chronic MR caused by mitral valve prolapse. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  8. Assessment of Subclinical Left Ventricular Dysfunction in Patients with Chronic Mitral Regurgitation Using Torsional Parameters Described by Tissue Doppler Imaging

    Directory of Open Access Journals (Sweden)

    Zahra Ojaghi-Haghighi

    2015-10-01

    Full Text Available Background: Left ventricular (LV twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR on the torsional mechanics of the left human ventricle using tissue Doppler imaging.Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI. LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle.Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs.13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively, both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020, but there was statistically no significant difference in the LV twist rate.Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients

  9. Effects of tilting disk heart valve gap width on regurgitant flow through an artificial heart mitral valve.

    Science.gov (United States)

    Maymir, J C; Deutsch, S; Meyer, R S; Geselowitz, D B; Tarbell, J M

    1997-09-01

    While many investigators have measured the turbulent stresses associated with forward flow through tilting disk heart valves, only recently has attention been given to the regurgitant jets formed as fluid is squeezed through the gap between the occluder and housing of a closed valve. The objective of this investigation was to determine the effect of gap width on the turbulent stresses of the regurgitant jets through a Björk-Shiley monostrut tilting disk heart valve seated in the mitral position of a Penn State artificial heart. A 2 component laser-Doppler velocimetry system with a temporal resolution of 1 ms was used to measure the instantaneous velocities in the regurgitant jets in the major and minor orifices around the mitral valve. The gap width was controlled through temperature variation by taking advantage of the large difference between the thermal expansion coefficients of the Delrin occluder and the Stellite housing of Björk-Shiley monostrut valves. The turbulent shear stress and mean (ensemble averaged) velocity were incorporated into a model of red blood cell damage to assess the potential for hemolytic damage at each gap width investigated. The results revealed that the minor orifice tends to form stronger jets during regurgitant flow than the major orifice, indicating that the gap width is not uniform around the circumference of the valve. Based on the results of a red blood cell damage model, the hemolytic potential of the mitral valve decreases as the gap width increases. This investigation also established that the hemolytic potential of the regurgitant phase of valve operation is comparable to, if not greater than, the hemolytic potential of forward flow, consistent with experimental data on hemolysis.

  10. Concomitant mitral regurgitation and aortic stenosis: one step further to low-flow preserved ejection fraction aortic stenosis.

    Science.gov (United States)

    Benfari, Giovanni; Clavel, Marie-Annick; Nistri, Stefano; Maffeis, Caterina; Vassanelli, Corrado; Enriquez-Sarano, Maurice; Rossi, Andrea

    2017-07-27

    Patients with severe aortic stenosis (AS) and normal ejection fraction (EF) can paradoxically present low-transaortic flow and worse prognosis. The role of co-existing mitral regurgitation (MR) in determining this haemodynamic inconsistency has never been quantitatively explored. The hypothesis is that MR influences forward stroke volume and characterizes the low-flow AS pattern. Consecutive patients with indexed aortic valve area (AVA) ≤0.6 cm2/m2 and EF > 50% formed the study population. Complete echocardiographic data were collected, and mitral effective regurgitant orifice area (ERO) and regurgitant volume were obtained with proximal isovelocity surface area method. Patients were divided into subgroups according to indexed stroke volume (SV index). Included patients were 273 [age 79 ± 10 years, 53% female, EF 65 ± 7%, indexed AVA 0.47 ± 0.09 cm2/m2, mean transaortic gradient (MG) 32 ± 17 mmHg]. Mitral regurgitation was present in 89 (32%); ERO was 0.12 ± 0.08 cm2 (range 0.02-0.49 cm2). A low-flow state (SV index ≤35 mL/m2) was diagnosed in 41 (15%) patients. The prevalence of MR was higher in with low-flow vs. normal-flow group (56 vs. 28%, P = 0.03). Effective regurgitant orifice was associated to low-flow state univariately (OR: 1.75 [1.59-2.60]; P = 0.004) and after comprehensive adjustment (OR:1.76 [1.12-2.75]; P = 0.01). When MG was forced in the model, ERO remained significant (P flow condition. Furthermore, MR quantification by ERO predicts the presence of reduced flow independently of chamber volumes, systolic function, and transaortic gradient.

  11. Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling: a functional and molecular study.

    Science.gov (United States)

    Beeri, Ronen; Yosefy, Chaim; Guerrero, J Luis; Abedat, Suzan; Handschumacher, Mark D; Stroud, Robert E; Sullivan, Suzanne; Chaput, Miguel; Gilon, Dan; Vlahakes, Gus J; Spinale, Francis G; Hajjar, Roger J; Levine, Robert A

    2007-09-11

    Mitral regurgitation (MR) doubles postmyocardial infarction (MI) mortality. We have shown that moderate MR augments remodeling in an apical MI model (no intrinsic MR) with independent left ventricle-to-left atrial MR-type flow. We hypothesized that repairing moderate MR 1 month after MI reverses this remodeling. Anteroapical MIs were created in 18 sheep, and a left ventricle-to-left atrial shunt implanted in 12 (regurgitant fraction, 30%). Six sheep had the shunt closed at 1 month (repair group). Sheep were compared at baseline, and at 1 and 3 months. Sheep in the MI+MR (unrepaired) and repaired groups remodeled during the first month (120% increased left ventricular end-systolic volume [ESV; P<0.01]), but shunt closure reversed remodeling at 3 months, with end-diastolic volume (EDV) and ESV 135% and 128% of baseline versus 220% and 280% without repair (P<0.001). At 3 months, dP/dt and preload-recruitable stroke work were relatively maintained in the repaired and MI-only groups versus nearly 50% decreases without repair. Prohypertrophic gp130 and antiapoptotic pAkt increased followed by exhaustion below baseline without repair, but remained elevated at 3 months with repair or MI only. With repair, matrix metalloproteinase-2 decreased to < or = 50% that without repair in remote and border zones at 3 months, and the matrix metalloproteinase inhibitor TIMP-4 increased dramatically. Early repair of moderate MR in the setting of apical MI substantially reverses the otherwise progressive remodeling process, with reduced left ventricular volumes, relatively maintained contractility, persistently activated intracellular signals promoting hypertrophy and opposing apoptosis, and reduced matrix proteolytic activity. These findings are of interest for the current controversy regarding potential benefits of repair of MR after MI.

  12. Routine Cine-CMR for Prosthesis Associated Mitral Regurgitation – A Multicenter Comparison to Echocardiography

    Science.gov (United States)

    Simprini, Lauren A.; Afroz, Anika; Cooper, Mitchell A.; Klem, Igor; Jensen, Christoph; Kim, Raymond J.; Srichai, Monvadi B.; Heitner, John F.; Sood, Michael; Chandy, Elizabeth; Shah, Dipan J.; Lopez-Mattei, Juan; Biederman, Robert W.; Grizzard, John D.; Fuisz, Anthon; Ghafourian, Kambiz; Farzaneh-Far, Afshin; Weinsaft, Jonathan

    2016-01-01

    Background/Aim MR is an important complication after PMV. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-CMR holds potential to non-invasively assess regurgitant severity based on MR-induced inter-voxel dephasing. This study evaluated routine cine-CMR for visual assessment of prosthetic mitral valve (PMV) associated mitral regurgitation (MR). Methods Routine cine-CMR was performed at 9 sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild 2/3): MR was graded in each long axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PSFR). Visual interpretation was compared to quantitative analysis in a single center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. Results The population comprised 85 PMV patients (59% mechanical, 41% bioprosthetic). Among the derivation cohort (n=25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p=0.001): Patients with severe MR had nearly a 3-fold increase in quantitative jet area (p=0.002), and 2-fold increase in density (p=0.04) than did others. Among the multicenter cohort, cine-CMR and TEE (Δ=2±3 days) demonstrated moderate agreement (κ=0.44); 64% of discordances differed by ≤ 1 grade (Δ=1.2±0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value=100%). Patients with visually graded severe MR also had more frequent PVSFR (pcine-CMR. Conclusions Cine-CMR is useful for assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for

  13. Routine cine-CMR for prosthesis-associated mitral regurgitation: a multicenter comparison to echocardiography.

    Science.gov (United States)

    Simprini, Lauren A; Afroz, Anika; Cooper, Mitchell A; Klem, Igor; Jensen, Christoph; Kim, Raymond J; Srichai, Monvadi B; Heitner, John F; Sood, Michael; Chandy, Elizabeth; Shah, Dipan J; Lopez-Mattei, Juan; Biederman, Robert W; Grizzard, John D; Fuisz, Anthon; Ghafourian, Kambiz; Farzaneh-Far, Afshin; Weinsaft, Jonathan

    2014-09-01

    Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR. Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild 2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ =. 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤ 1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p cine-CMR. Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR

  14. Left ventricular outflow track obstruction and mitral valve regurgitation in a patient with takotsubo cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Yin Wu

    2015-12-01

    Full Text Available Introduction: Takotsubo cardiomyopathy (TCM can be complicated by left ventricular outflow tract (LVOT obstruction and severe acute mitral regurgitation (MR, leading to hemodynamic instability in an otherwise benign disorder. Despite the severity of these complications, there is a paucity of literature on the matter. Because up to 20–25% of TCM patients develop LVOT obstruction and/or MR, it is important to recognize the clinical manifestations of these complications and to adhere to specific management in order to reduce patient morbidity and mortality. We report the clinical history, imaging, treatment strategy, and clinical outcome of a patient with TCM that was complicated with severe MR and LVOT obstruction. We then discuss the pathophysiology, characteristic imaging, key clinical features, and current treatment strategy for this unique patient population. Case report: A postmenopausal woman with no clear risk factor for coronary artery disease (CAD presented to the emergency department with chest pain after an episode of mental/physical stress. Physical examination revealed MR, mild hypotension, and pulmonary vascular congestion. Her troponins were mildly elevated. Cardiac catheterization excluded obstructive CAD, but revealed severe apical hypokinesia and ballooning. Notably, multiple diagnostic tests revealed the presence of severe acute MR and LVOT obstruction. The patient was diagnosed with TCM complicated by underlying MR and LVOT obstruction, and mild hemodynamic instability. The mechanism of her LVOT and MR was attributed to systolic anterior motion of the mitral valve (SAM, which the transesophageal echocardiogram clearly showed during workup. She was treated with beta-blocker, aspirin, and ACE-I with good outcome. Nitroglycerin and inotropes were discontinued and further avoided. Conclusions: Our case illustrated LVOT obstruction and MR associated with underlying SAM in a patient with TCM. LVOT obstruction and MR are severe

  15. Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    OBJECTIVE: To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE). METHODS: Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global\\/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis. RESULTS: All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30 +\\/- 7 mm vs. 22 +\\/- 4 mm, P < 0.02) and thickness (3.0 +\\/- 1 mm vs. 2.2 +\\/- 1 mm, P < 0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P < 0.001). Significant differences in those with\\/without MV prolapse were detected in MV tent area (-1.0 +\\/- 0.6 mm vs. 1.3 +\\/- 0.9 mm, P < 0.0001) and MV tent height (-0.7 +\\/- 0.3 mm vs. 0.8 +\\/- 0.8 mm, P < 0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9 +\\/- 19.1 degrees vs. 22.9 +\\/- 14 degrees , P < 0.018) and less for valvular MR (0.6 +\\/- 35.5 degrees vs. 22.9 +\\/- 14 degrees, P < 0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%. CONCLUSION: Cardiac MDCT allows the differentiation between functional and valvular causes of MR.

  16. Ventricular energetics early after surgery for chronic mitral regurgitation: repair versus replacement.

    Science.gov (United States)

    Imasaka, Ken-ichi; Motomatsu, Yuma; Hori, Hidetsugu; Kono, Takanori; Tanoue, Yoshihisa; Tayama, Eiki; Tomita, Yukihiro

    2013-11-01

    The study aim was to compare the effects of mitral valve (MV) repair and replacement with partial (posterior leaflet only) chordal preservation on left ventricular (LV) performance in chronic degenerative mitral regurgitation (MR) by assessing ventricular energetics. Contractility (end-systolic elastance), afterload (effective arterial elastance), and ventricular efficiency (ventriculoarterial coupling and the ratio of stroke work to pressure-volume area were determined using transthoracic echocardiography data obtained before and at one month after surgery in 29 patients undergoing MV repair, and in 12 patients undergoing partial chordal-sparing MV replacement. A two-way analysis of variance with repeated measures was used for comparisons among patients who underwent MV surgery (valve repair versus valve replacement). The LV diastolic volume index was decreased significantly in both groups (p<0.0001), whereas the LV systolic volume index did not change significantly (p=0.956). Despite the similar remarkable decrease in ejection fraction (p<0.0001) in both groups, end-systolic elastance remained unchanged (p=0.312). Effective arterial elastance was increased significantly in both groups (p<0.0001). Ventriculoarterial coupling and the ratio of stroke work to pressure-volume area deteriorated similarly in both groups (p<0.0001 and p<0.0001). Compensation of LV geometry after correction of chronic MR preserved ventricular contractility. Furthermore, the results of MV repair were not superior to those of MV replacement with partial chordal preservation in the early postoperative period. This suggested that partial chordal-sparing MV replacement is an effective method for the treatment of chronic MR in selected patients.

  17. Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction.

    Science.gov (United States)

    Fernández-Golfín, Covadonga; De Agustin, Alberto; Manzano, M Carmen; Bustos, Ana; Sánchez, Tibisay; Pérez de Isla, Leopoldo; Fuentes, Manuel; Macaya, Carlos; Zamorano, José

    2011-04-01

    Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.

  18. Downsizing annuloplasty in ischemic mitral regurgitation: double row overlapping suture to avoid ring disinsertion in valve repair.

    Science.gov (United States)

    Nappi, Francesco; Spadaccio, Cristiano; Al-Attar, Nawwar; Chello, Massimo; Lusini, Mario; Barbato, Raffaele; Acar, Christophe

    2014-11-01

    The long-term outcomes of undersizing annuloplasty for the treatment of ischemic mitral regurgitation (IMR) is affected by the progressive dilation of the annulus, which carries increased risk for ring disinsertion. Reasons underlying this phenomenon might be found in the excess of physical stress on the annuloplasty sutures during the ventricular remodeling process. We report a technique based on the placement of a double row of overlapping sutures aiming at reducing the potential for ring disinsertion. Eleven patients with IMR undergoing mitral valve repair associated with coronary bypass grafting were treated with this technique and echocardiographically followed up at 6 and 12 months. The overall annular dimension decreased significantly with a significant reduction of the tenting area and no recurrence of mitral regurgitation at 1 year. A double row of overlapping sutures allowed firm attachment of the prosthetic ring while downsizing the annulus in IMR, limiting the consequences of changes in subannular ventricular geometry. This technique might therefore be considered a useful aid during mitral valve repair.

  19. Severe mitral regurgitation is associated with increased copeptin levels in heart failure with reduced ejection fraction.

    Science.gov (United States)

    Kılıcgedık, Alev; Eroglu, Elıf; Kahvecı, Gokhan; Isgandarov, Khaganı; Acar, Emrah; Ozturk, Semi; Zehir, Regayip; Kulahcıoglu, Seyhmus; Toprak, Cuneyt; Yaman, Ali; Izgı, Ibrahım Akın; Kirma, Cevat

    2017-01-01

    The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8-12.1; p = 0.002). Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.

  20. Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.

    Science.gov (United States)

    Nair, Chandra K; Aronow, Wilbert S; Shen, Xuedong; Anand, Kishlay; Holmberg, Mark J; Esterbrooks, Dennis J

    2009-11-01

    The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up. Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.

  1. Echocardiographic predictors of adverse short-term outcomes after heart surgery in patients with mitral regurgitation and pulmonary hypertension.

    Science.gov (United States)

    Corciova, Flavia Catalina; Corciova, Calin; Georgescu, Catalina Arsenescu; Enache, Mihai; Anghel, Diana; Bartos, Oana; Tinica, Grigore

    2012-06-01

    Pulmonary hypertension (PH) is a frequent occurrence and a negative prognostic indicator in patients with mitral regurgitation. Preoperative PH causes higher early and late mortality rates after heart surgery, adverse cardiac events, and postoperative systolic dysfunction in the left ventricle (LV). The research consisted of a retrospective study of a group of 171 consecutive patients with mitral regurgitation and preoperative PH who had undergone mitral valve surgery between January 2008 and October 2011. The PH diagnosis was based on echocardiographic evidence (systolic pulmonary artery pressure [sPAP] >35 mm Hg). The echocardiographic examination included assessment of the following: LV volume, LV ejection fraction (LVEF), sPAP, right ventricular end-diastolic diameter, right atrium area indexed to the body surface area, the ratio of the pulmonary acceleration time to the pulmonary ejection time (PAT/PET), tricuspid annular plane systolic excursion (TAPSE), determination of the severity of the associated tricuspid regurgitation, and presence of pericardial fluid. Surgical procedures consisted of mitral valve repair in 55% of the cases and mitral valve replacement in the remaining 45%. Concomitant coronary artery bypass grafting (CABG) surgery was carried out in 52 patients (30.41%), and De Vega tricuspid annuloplasty was performed in 29 patients (16.95%). The primary end point was perioperative mortality. The secondary end points included the following: pericardial, pleural, hepatic, or renal complications; the need for a new surgical procedure; postoperative mechanical ventilation >24 hours; length of stay in the intensive care unit; duration of postoperative inotropic support; need for an intra-aortic balloon pump; and need for pulmonary vasodilator drugs. The mortality rate was 2.34%. In the univariate analysis, the clinical and echocardiographic parameters associated with mortality were preoperative New York Heart Association (NYHA) class IV, the PAT

  2. Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Frati Giacomo

    2008-11-01

    Full Text Available Abstract A 48 year old man was transferred to our department with cardiogenic shock, pyrexia, a high white cell count and significant serum troponin T level. Clinical evaluation revealed severe mitral regurgitation secondary to a flail of both mitral valve leaflets. An emergency cardiac catheterisation did not reveal any significant coronary artery disease. Left ventricular angiogram and echocardiography demonstrated a good left ventricular function and massive mitral regurgitation. Blood cultures were negative for aerobics, anaerobics and fungi. The patient underwent emergency mitral valve replacement with a mechanical valve. Intraoperatively, the posteromedial papillary muscle was found to be ruptured. Histology of the papillary muscle revealed myocardial necrosis with no signs of infection. Cultures obtained from a mitral valve specimen were negative. The patient's recovery was uneventful and he was discharged on the 6th postoperative day.

  3. Mitral regurgitation in heart failure: insights from CPET combined with exercise echocardiography.

    Science.gov (United States)

    Bandera, Francesco; Generati, Greta; Pellegrino, Marta; Garatti, Andrea; Labate, Valentina; Alfonzetti, Eleonora; Gaeta, Maddalena; Castelvecchio, Serenella; Menicanti, Lorenzo; Guazzi, Marco

    2017-03-01

    In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO <20 mm2) MR (group A), exercise-induced severe (ERO ≥20 mm2) MR (group B), and rest severe MR (group C). Patients were tracked for the composite end point of death and heart failure hospitalization. Group B (ERO: rest= 14 ± 5 mm2, Ex= 28 ± 6 mm2; P = < 0.001) had a functional impairment (workload = 56 ± 21 vs. 50 ± 17 watts, P = 0.42; peak VO2 = 11.8 ± 3.2 vs. 11.5 ± 3.0 mL/Kg/min, P = 0.70) similar to Group C (ERO: rest = 29 ± 7 mm2, Ex = 42 ± 7 mm2, P = < 0.001), associated with comparable advanced left ventricle remodelling (end diastolic indexed volume = 107 ± 34 vs. 115 ± 30 mL/m2, P = 0.27), characterized by exercise-induced pulmonary hypertension (PH) (Ex systolic pulmonary pressures = 63 ± 16 mmHg). Group C showed the worse cardiac phenotype (right ventricle dilatation, dysfunction, and rest PH) with severe ventilatory impairment (VE/VCO2 = 41.2 ± 11) compared with Groups A and B. Moreover, Group C had the higher rate of death and HF hospitalization. In HFrEF patients, severe dynamic MR produces functional limitation similar to rest severe MR, characterized by dynamic PH. Rest severe MR reflects the most advanced bi-ventricular remodelling associated with rest PH, the most unfavourable ventilatory profile, and the worst mid-term outcome.

  4. EFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATE

    Directory of Open Access Journals (Sweden)

    V. N. Larina

    2016-01-01

    Full Text Available Aim. To evaluate chronic heart failure (CHF course, functional and structural heart changes in patients with functional mitral regurgitation (MR of various degrees.Material and methods. A total of 104 outpatients (60-85 y. o. with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV systolic dysfunction (p=0,029, severe CHF course (p=0,034, received furosemide (p=0.004 and digoxin (p=0,004. They had significant increase in end-diastolic dimension (p<0,001, end-systolic dimension (p<0,001, left atrium (p=0,004, end-diastolic volume (p<0,001, end-systolic volume (p<0,001, pulmonary artery pressure (p<0,001, decrease in LV relative wall thickness (p=0,021 and LV ejection fraction (p<0,001. Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045.Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

  5. EFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATE

    Directory of Open Access Journals (Sweden)

    V. N. Larina

    2009-01-01

    Full Text Available Aim. To evaluate chronic heart failure (CHF course, functional and structural heart changes in patients with functional mitral regurgitation (MR of various degrees.Material and methods. A total of 104 outpatients (60-85 y. o. with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV systolic dysfunction (p=0,029, severe CHF course (p=0,034, received furosemide (p=0.004 and digoxin (p=0,004. They had significant increase in end-diastolic dimension (p<0,001, end-systolic dimension (p<0,001, left atrium (p=0,004, end-diastolic volume (p<0,001, end-systolic volume (p<0,001, pulmonary artery pressure (p<0,001, decrease in LV relative wall thickness (p=0,021 and LV ejection fraction (p<0,001. Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045.Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

  6. Real-Time 3-Dimensional Echocardiographic Assessment of Effective Regurgitant Orifice Area in Dogs With Myxomatous Mitral Valve Disease.

    Science.gov (United States)

    Tidholm, A; Bodegård-Westling, A; Höglund, K; Häggström, J; Ljungvall, I

    2017-03-01

    Effective regurgitant orifice area (EROA), calculated from the vena contracta width (VCW) as the narrowest portion of the proximal regurgitant jet, might be used to estimate severity of mitral regurgitation. However, this simplified assumption only holds when the EROA is circular, which might not be true in dogs with myxomatous mitral valve disease (MMVD). Effective regurgitant orifice area in dogs with MMVD is noncircular, and using color Doppler real-time 3-dimensional (RT3D) echocardiography, measured EROA in the en face view will be significantly different from calculated EROA. Hundred and fifty-eight privately owned dogs with naturally occurring MMVD. Prospective observational study comparing en face view of EROA with calculated EROA using VCW in 4-chamber (4Ch) and 2-chamber (2Ch) view only or combined 4Ch and 2Ch views using RT3D echocardiography. The calculated EROA using the 2Ch view showed a systematic underestimation of 17% compared with the measured en face EROA corrected for body surface area. The calculated EROA using 4Ch and 4Ch + 2Ch views showed less agreement with the en face EROA, and the difference between methods increased with increasing EROA. The difference between calculated and measured EROA showed a systematic underestimation of the calculated EROA by 36% (4Ch) and 33% (4Ch + 2Ch), respectively, compared to measured en face EROA. When replacing measured EROA with calculated EROA using VCW measurements, the 2Ch view is preferred in dogs with MMVD. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  7. Coronary artery disease associated with severe mitral and tricuspid valve regurgitation after left pneumonectomy: report of a successful hybrid procedure.

    Science.gov (United States)

    Gennari, Marco; Kassem, Samer; Teruzzi, Giovanni; Agrifoglio, Marco

    2014-08-01

    The literature concerning heart surgery after pneumonectomy is still poor. Moreover, there is still a lack of a standardized approach to such a patient in the decision-making process. Here, we report a case of a patient who had previously had left pneumonectomy for malignancy and who had coronary artery disease and mitral and tricuspid regurgitation treated with a hybrid procedure. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Granulomatosis with Polyangiitis Presenting with Acute Aortic and Mitral Regurgitation: Case Report and Big-Data Analysis.

    Science.gov (United States)

    Al-Kindi, Sadeer G; Amer Al-Aiti, M; Yang, Michael; Josephson, Richard A

    2017-01-01

    Granulomatosis with polyangiitis (GPA) is a rare vasculitis that can have multisystem involvement, though cardiac involvement is very rare. The case is described of a 53-year-old woman who presented with acute aortic and mitral valve regurgitation requiring surgical intervention. Pathology from the excised aortic valve showed geographic necrosis concerning for GPA. Subsequent rheumatologic testing was positive for anti-serine proteinase 3 (PR3) antibody, consistent with GPA. A year after the valve surgery the patient was found to have a vegetation of the mitral valve and elevated PR3 antibody levels, and was successfully treated with an intensification of immunosuppression. The cardiac involvement of GPA is discussed and big data analyzed to identify the epidemiology of valvular involvement. In conclusion, GPA can have multiple different valvular manifestations with a high recurrence rate. GPA should be considered in patients who present with acute valvular disease without any clear precipitant.

  9. Echocardiographic assessment of left ventricular function in mitral regurgitation: is the dog a useful model of man?

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Pedersen, Henrik D; Häggström, Jens

    2014-01-01

    yxomatous mitral valve disease (MMVD) is the most common cause of primary mitral regurgitation in humans and the most common cardiac disease in dogs. Many similarities have been described and, therefore, the dog is considered to be a suitable natural model for MMVD in humans. Accurate...... identification of incipient myocardial deterioration is crucial to optimally time interventional surgery. Nonetheless, this issue is still an object of controversy. In this respect, studies of left ventricular (LV) function in dogs with MMVD could potentially be useful. The present review compares the results...... obtained in echocardiographic studies of LV function in humans and dogs with MMVD. Although different study designs pose a limitation and results within the two species are not entirely concordant, it appears that LV function is better preserved in small-sized and medium-sized dogs than in humans. This may...

  10. [Progressive moderate mitral regurgitation in a children with Axenfeld-Rieger syndrome. The importance of cardiologic follow up].

    Science.gov (United States)

    Sánchez Ferrer, Francisco; Grima Murcia, María D

    2016-12-01

    Axenfeld-Rieger syndrome is a congenital disease with an estimated prevalence of one in 200,000 individuals. This is an ophthalmic disorder related to anterior segment dysgenesis, which may be present from the neonatal period. It is associated with extraocular affectations such as cranial dimorphism, maxillofacial or dental anomalies. Cardiological or pituitary manifestations are less common. The congenital heart disease in Axenfeld-Rieger syndrome has been described in very few cases in the literature. We report a 7-year-old patient with Axenfeld-Rieger syndrome and mild mitral insufficiency since the age of 3 years, which is progressing to moderate mitral regurgitation at the present time. The cardiologic follow up may be indicated in patients with Axenfeld-Rieger syndrome. Sociedad Argentina de Pediatría.

  11. Quantification of mitral-valve regurgitation in a paediatric population by real-time three-dimensional echocardiography.

    Science.gov (United States)

    Gabriel Latcu, Decebal; Paranon, Soizic; Bongard, Vanina; Bassil-Eter, Rania; Grosjean-Guitton, Juliette; Dulac, Yves; Acar, Philippe

    2008-01-01

    Evaluation of mitral-regurgitation (MR) severity in infants is challenging. Real-time three-dimensional echocardiography (RT3DE) allows accurate left-ventricular volumetric measurements in adults. To validate RT3DE by measuring stroke volume in a normal paediatric population, then to use this new method to calculate regurgitant volume in paediatric patients with MR. Fifty-four patients, aged one week to 19 years, (29 without and 25 with MR) had two-dimensional echocardiography coupled with RT3DE left-ventricular volumetric acquisition. Stroke volume was calculated by the Doppler method at the aortic annulus (SV(D)). End-systolic and end-diastolic left-ventricular volumes were measured using the QLab semi-automated method; three-dimensional stroke volume (SV(3D)) was calculated as their difference. In the MR group, regurgitant volume was calculated by the PISA method (RV(PISA)) and as the difference between SV(3D) and SV(D) (RV(3D)). Regurgitant fraction was also evaluated by these methods (RF(PISA) and RF(3D)). Measurement feasibility was 88%. In the normal group, SV(3D) (27.9+/-18.1 ml) was highly correlated with SV(D) (30.7+/-19.6 ml; r=0.98; pPISA) (15.7+/-14.4 ml) and RV(3D) (11.0+/-10.2 ml) were well correlated (r=0.83; pPISA)=30.4+/-17.0%; RF(3D)=24.3+/-15.9%; r=0.79, p=0.006). RT3DE is a simple, rapid and reliable method for evaluating stroke volume in children and may, therefore, be useful for evaluating regurgitant volume and fraction in paediatric patients with MR.

  12. Quantification of mitral regurgitation orifice area by 3-dimensional echocardiography: comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter

    National Research Council Canada - National Science Library

    Lange, Aleksandra; Palka, Przemysław; Donnelly, J.Elisabeth; Burstow, Darryl J

    2002-01-01

    ... [5–7,10] . Geometric assumptions in quantitation of area, volume or spatial distribution of MR jets assessed by 2D echocardiography can be avoided with the use of 3-dimensional (3D) echocardiography. For this reason this technique is developing a role in the assessment of mitral valve morphology and function [12–17] . The evaluation of MR by...

  13. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse.

    Science.gov (United States)

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Massoni, Alberto; Natali, Benedetta Maria; Focardi, Marta; Tacchini, Damiana; Geyer, Alessia; Curci, Valeria; Di Tommaso, Cristina; Lisi, Gianfranco; Maccherini, Massimo; Chiavarelli, Mario; Massetti, Massimo; Tanganelli, Piero; Mondillo, Sergio

    2013-02-15

    In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Assessment of myocardial velocities and global function of the left ventricle in asymptomatic patients with moderate-to-severe chronic aortic regurgitation: a tissue Doppler echocardiographic study.

    Science.gov (United States)

    Sokmen, Gulizar; Sokmen, Abdullah; Duzenli, Akif; Soylu, Ahmet; Ozdemir, Kurtulus

    2007-07-01

    Asymptomatic patients with chronic aortic regurgitation (AR) have an excellent prognosis in the presence of preserved systolic function. It is a challenge to recognize patients with subclinical myocardial dysfunction in AR. Conventional parameters still have many drawbacks in predicting early left ventricular (LV) dysfunction. Pulsed-wave tissue Doppler imaging (PW-TDI) is a useful noninvasive technique for evaluating global and regional LV systolic function. In this study, we aimed to assess clinical usefulness of TDI in predicting early disturbance of myocardial contractility in asymptomatic patients with significant AR and preserved left ventricular systolic function. Echocardiograms were obtained in 32 AR patients and 33 healthy subjects. In addition to conventional parameters, regional myocardial velocities, isovolumetric contraction time (mICT), isovolumetric relaxation time (mIRT), and ejection time (mET) of left ventricle were obtained by TDI and modified LV myocardial performance index (MPI) was calculated. In AR, peak systolic velocity (Sm) of septal and anterior mitral annulus, and mean Sm was significantly lower, and LVMPI was significantly higher compared to control group. The data obtained by TDI show that LV MPI is lengthened, and systolic myocardial velocities are shortened in patients having chronic AR with normal LV systolic function according to conventional echocardiographic parameters. This suggests that LV long-axis contraction and global LV performance are preciously and noticeably decreased in patients with moderate-to-severe chronic AR despite normal LV ejection fraction.

  15. Three-Dimensional Field Optimization Method: Gold-Standard Validation of a Novel Color Doppler Method for Quantifying Mitral Regurgitation.

    Science.gov (United States)

    Pierce, Eric L; Rabbah, Jean Pierre M; Thiele, Karl; Wei, Qifeng; Vidakovic, Brani; Jensen, Morten O; Hung, Judy; Yoganathan, Ajit P

    2016-10-01

    Accurate diagnosis of mitral regurgitation (MR) severity is central to proper treatment. Although numerous approaches exist, an accurate, gold-standard clinical technique remains elusive. The authors previously reported on the initial development and demonstration of the automated three-dimensional (3D) field optimization method (FOM) algorithm, which exploits 3D color Doppler ultrasound imaging and builds on existing MR quantification techniques. The aim of the present study was to extensively validate 3D FOM in terms of accuracy, ease of use, and repeatability. Three-dimensional FOM was applied to five explanted ovine mitral valves in a left heart simulator, which were systematically perturbed to yield a total of 29 unique regurgitant geometries. Three-dimensional FOM was compared with a gold-standard flow probe, as well as the most clinically prevalent MR volume quantification technique, the two-dimensional (2D) proximal isovelocity surface area (PISA) method. Overall, 3D FOM overestimated and 2D PISA underestimated MR volume, but 3D FOM error had smaller magnitude (5.2 ± 9.9 mL) than 2D PISA error (-6.9 ± 7.7 mL). Two-dimensional PISA remained superior in diagnosis for round orifices and especially mild MR, as predicted by ultrasound physics theory. For slit-type orifices and severe MR, 3D FOM showed significant improvement over 2D PISA. Three-dimensional FOM processing was technically simpler and significantly faster than 2D PISA and required fewer ultrasound acquisitions. Three-dimensional FOM did not show significant interuser variability, whereas 2D PISA did. Three-dimensional FOM may provide increased clinical value compared with 2D PISA because of increased accuracy in the case of complex or severe regurgitant orifices as well as its greater repeatability and simpler work flow. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  16. The Impact of Transcatheter Aortic Valve Implantation on Mitral Regurgitation Regression in High-Risk Patients with Aortic Stenosis.

    Science.gov (United States)

    Perl, Leor; Vaturi, Mordehay; Assali, Abid; Sagie, Alexander; Weissler-Snir, Adaya; Codner, Pablo; Orvin, Katia; Vaknin-Assa, Hana; Shapira, Yaron; Kornowski, Ran

    2015-07-01

    In patients with aortic stenosis, mitral regurgitation (MR) is a common finding. Little is known regarding outcomes of MR in patients undergoing transcatheter aortic valve implantation (TAVI). The study aim was to characterize the short- and mid-term impact of the TAVI procedure on MR grade. A total of 261 patients (59% females; mean age 82.1 +/- 6.9 years) undergoing TAVI was assessed for rates of significant MR and the severity of MR at baseline, and at one month and six months after the procedure. In patients with moderate MR or above at baseline (n = 26, 10% of the cohort), there was a mean reduction in grade of 1.5 +/- 1.1 and 1.8 +/- 1.4 after one and six months, respectively (p < 0.01). Reduction in MR grade (1+) at six months was identified in 54.1% (40/74) of patients with mild-moderate MR or greater, and in 88.5% (23/26) of those with moderate MR or above, and was associated with an improved NYHA functional class (correlation coefficient r = -0.294, p < 0.001). Multivariate analysis identified low pulmonary pressure and tricuspid regurgitation as independent predictors of improvements in MR. Among the present cohort of patients undergoing TAVI, those with MR at baseline showed an improvement in the severity of their MR. Patients with moderate MR regurgitation or above demonstrated the greatest improvement.

  17. Double row of overlapping sutures for downsizing annuloplasty decreases the risk of residual regurgitation in ischaemic mitral valve repair.

    Science.gov (United States)

    Nappi, Francesco; Spadaccio, Cristiano; Chello, Massimo; Lusini, Mario; Acar, Christophe

    2016-04-01

    The aim of this study was to evaluate a novel insertion technique of the prosthetic ring that would further magnify the degree of annulus narrowing, thereby reducing the potential for a residual leak in ischaemic mitral valve repair. Thirty-six patients with ischaemic mitral regurgitation (MR) were randomly assigned into two groups. In 18 patients, the prosthetic ring was inserted in the conventional manner with a single row of sutures (control group). In the remaining 18 patients, the ring was attached using a double row of sutures tied both on the inner and on the outer part of the sewing cuff. Both groups had similar preoperative clinical and echocardiographic characteristics with severe leaflet tethering: mean tenting area >2.5 cm(2), mean anterior leaflet angle >25° and posterior leaflet angle >45°. The mean prosthetic ring sizes inserted in both groups were identical (mean: 27.3 mm). At 12 months, there was no clinical event except for 1 rehospitalization in the control group. The mean mitral regurgitation grade was higher in the control group than in the group with the double row of sutures at 1.6 ± 0.9 vs 0.7 ± 0.3 (P = 0.0003). Annulus diameter reduction was less pronounced in the control group when compared with the group with the double row of sutures, both in the parasternal long-axis: 29.3 ± 3 vs 26.3 ± 3 mm (P = 0.0003) and in apical four-chamber views: 31 ± 3 vs 28 ± 2 mm (P = 0.003). Leaflet tethering indices were greater in the control group than in the group with the double row of sutures: tenting area: 1.42 ± 0.3 vs 1.1 ± 0.5 cm(2) (P = 0.002), anterior leaflet angle: 33 ± 3° vs 28 ± 5° (P = 0.0009) and posterior leaflet angle: 110 ± 13° vs 80 ± 11° (P = 0.0001). Left ventricular function parameters were not statistically different among the two groups. A double row of overlapping sutures for attaching the prosthetic ring in downsizing annuloplasty is more efficient in narrowing the mitral annulus than the conventional technique

  18. Mitral valve surgery in emergency for severe acute regurgitation: analysis of postoperative results from a multicentre study.

    Science.gov (United States)

    Lorusso, Roberto; Gelsomino, Sandro; De Cicco, Giuseppe; Beghi, Cesare; Russo, Claudio; De Bonis, Michele; Colli, Andrea; Sala, Andrea

    2008-04-01

    To evaluate postoperative outcome of emergency surgery for acute severe mitral regurgitation (ASMR) from a multicentre experience. In six centres, 279 patients (mean age 62+/-14 years, 62% female) undergoing emergency surgery for ASMR from December 1986 to March 2007 were analysed and followed up. Aetiology included acute myocardial infarction (AMI) in 126 patients (group 1, 45%), degenerative mitral valve disease in 74 (group 2, 26%), and acute endocarditis (AE) in 79 (group 3, 28%). Preoperatively, all patients were in haemodynamic instability, with 185 patients in cardiogenic shock (66%), 184 (66%) intubated, and 61 (22%) on IABP, respectively. Valve repair was performed in 76 (27%), whereas 203 (73%) underwent valve replacement. Median follow-up (98% complete) was 70.8 months (inter-quartile range 59.8-86.66 months). Overall 30-day mortality was 22.5% (63/279). Early death was significantly lower in group 2 (pASMR remains a surgical challenge for high incidence of early and late cardiac-related events, particularly in patients with associated coronary artery disease and acute endocarditis. Apparently, type of mitral valve surgical approaches (repair or replacement) did not provide any influence on postoperative outcome.

  19. In vitro validation of real-time three-dimensional color Doppler echocardiography for direct measurement of proximal isovelocity surface area in mitral regurgitation.

    Science.gov (United States)

    Little, Stephen H; Igo, Stephen R; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J; Nosé, Yukihiko; Zoghbi, William A

    2007-05-15

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flow-meter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r(2) = 0.47, p PISA regurgitant volume underestimate was 19.1 +/- 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r(2) = 0.92, p PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions.

  20. Comparison of three-dimensional proximal isovelocity surface area to cardiac magnetic resonance imaging for quantifying mitral regurgitation.

    Science.gov (United States)

    Brugger, Nicolas; Wustmann, Kerstin; Hürzeler, Michael; Wahl, Andreas; de Marchi, Stefano F; Steck, Hélène; Zürcher, Fabian; Seiler, Christian

    2015-04-15

    The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surface area (PISA) as a tool for quantitative assessment of mitral regurgitation (MR) against in vitro and in vivo reference methods. A customized 3D PISA software was validated in vitro against a flowmeter MR phantom. Sixty consecutive patients, with ≥mild MR of any cause, were recruited and the regurgitant volume (RVol) was measured by 2D PISA, 3D peak PISA, and 3D integrated PISA, using transthoracic (TTE) and transesophageal echocardiography (TEE). Cardiac magnetic resonance imaging (CMR) was used as reference method. Flowmeter RVol was associated with 3D integrated PISA as follows: y = 0.64x + 4.7, r(2) = 0.97, p PISA was the most accurate method for MR quantification compared to CMR: r(2) = 0.76, y = 0.95x - 3.95, p PISA (r(2) = 0.67, y = 1.00x + 6.20, p PISA (r(2) = 0.54, y = 0.76x + 0.18, p echocardiography of the PISA permits a more accurate MR assessment than conventional techniques and, consequently, should enable an optimized management of patients suffering from MR. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Comparative effect of carperitide and furosemide on left atrial pressure in dogs with experimentally induced mitral valve regurgitation.

    Science.gov (United States)

    Suzuki, S; Fukushima, R; Yamamoto, Y; Ishikawa, T; Hamabe, L; Kim, S; Yoshiyuki, R; Fukayama, T; Machida, N; Tanaka, R

    2013-01-01

    The effects of carperitide on left atrial pressure (LAP) in dogs with mitral valve disease (mitral regurgitation, MR) have not been documented. The objective was to compare the short-term effects of carperitide versus furosemide on LAP and neurohumoral factors in MR dogs. Six healthy Beagle dogs weighing 9.8-12.6 kg (2 males and 4 females; aged 3 years) were used. Experimental, randomized, cross-over, and interventional study. Carperitide 0.1 μg/kg/min or furosemide 0.17 mg/kg/h (1 mg/kg/6 h) was administered to dogs with surgically induced MR for 6 hours, and after a 14 day wash-out period, the other drug was administered. LAP, plasma renin activity, plasma aldosterone, and echocardiographic variables were measured. Left atrial pressure was decreased similarly after the administration of carperitide 0.1 μg/kg/min and furosemide 0.17 mg/kg/h (1 mg/kg/6 h) compared with baseline in dogs with MR (Baseline 14.75 ± 3.74 mmHg, carperitide 10.24 ± 4.97 mmHg, P dogs with acute MR caused by experimental chordal rupture. Carperitide can have additional benefits from the viewpoint of minimal activation of neurohumoral factors in the treatment of dogs with MR. Additional studies in dogs with spontaneous disease are warranted. Copyright © 2013 by the American College of Veterinary Internal Medicine.

  2. Serotonin markers show altered transcription levels in an experimental pig model of mitral regurgitation

    DEFF Research Database (Denmark)

    Cremer, Signe Emilie; Zois, Nora Elisabeth; Moesgaard, S. G.

    2015-01-01

    Serotonin (5-hydroxytryptamine, 5-HT) signalling is implicated in the pathogenesis of myxomatous mitral valve disease (MMVD) through 5-HT1B receptor (R), 5-HT2AR and 5-HT2BR-induced myxomatous pathology. Based on increased tryptophan hydroxylase-1 (TPH-1) and decreased serotonin re-uptake transpo...

  3. Valvoplastia sem suporte para insuficiência mitral degenerativa: resultados a longo prazo Unsupported valvuloplasty for degenerative mitral regurgitation: long-term results

    Directory of Open Access Journals (Sweden)

    Alexsandra L. Balbinot

    2008-06-01

    êutica adequada para determinados casos.BACKGROUND: The advantages of valve repair for treatment of degenerative mitral regurgitation are well established. The procedure is associated with low mortality and morbidity rates, and low indices of reoperation, thromboembolic events and endocarditis have been reported. In most series, annuloplasty rings are implanted, but some institutions give preference to unsupported valvuloplasty. OBJECTIVE: To assess the clinical outcome of patients submitted to unsupported valvuloplasty for degenerative mitral regurgitation. METHODS: Between January 1980 and January 2003, 116 patients were submitted to the procedure. A total of 62 (53.4% were men, and mean age was 47.2 ± 16.5 years. The procedures included: Wooler annuloplasty (65.5%, unilateral annuloplasty (15.5%, quadrangular resection of the posterior leaflet (35.3%, anterior chordal shortening (20.7%, posterior chordal shortening (6.9%, and calcium debridement (0.9%. Mean follow-up was 6.5 ± 5.1 years, and the longest follow-up was 24 years. RESULTS: Mortality was 0.86% (1 pt early and 6.03% (7 pt late. Actuarial survival was 85.3% in 20 years. Most patients (55.2% presented preoperative NYHA functional class III, whereas class I was more frequent in the postoperative period (66.4%. Thromboembolic complications were observed in 4 patients (3.4%, and no correlation was seen with atrial fibrillation. Freedom from thromboembolic events was 94.8%, and similar results were observed for bacterial endocarditis. Survival free from reoperation was 79%, and 53% at 5 and 10 years, respectively. CONCLUSION: Unsupported valvuloplasty is effective and safe for treatment of degenerative mitral regurgitation, representing an adequate therapeutic alternative for selected cases.

  4. Mitral valve disease--current management and future challenges.

    Science.gov (United States)

    Nishimura, Rick A; Vahanian, Alec; Eleid, Mackram F; Mack, Michael J

    2016-03-26

    The field of mitral valve disease diagnosis and management is rapidly changing. New understanding of disease pathology and progression, with improvements in and increased use of sophisticated imaging modalities, have led to early diagnosis and complex treatment. In primary mitral regurgitation, surgical repair is the standard of care. Treatment of asymptomatic patients with severe mitral regurgitation in valve reference centres, in which successful repair is more than 95% and surgical mortality is less than 1%, should be the expectation for the next 5 years. Transcatheter mitral valve repair with a MitraClip device is also producing good outcomes in patients with primary mitral regurgitation who are at high surgical risk. Findings from clinical trials of MitraClip versus surgery in patients of intermediate surgical risk are expected to be initiated in the next few years. In patients with secondary mitral regurgitation, mainly a disease of the left ventricle, the vision for the next 5 years is not nearly as clear. Outcomes from ongoing clinical trials will greatly inform this field. Use of transcatheter techniques, both repair and replacement, is expected to substantially expand. Mitral annular calcification is an increasing problem in elderly people, causing both mitral stenosis and regurgitation which are difficult to treat. There is anecdotal experience with use of transcatheter valves by either a catheter-based approach or as a hybrid technique with open surgery, which is being studied in early feasibility trials. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. One Hundred Percent Reparability of Degenerative Mitral Regurgitation: Intermediate-Term Results of a Dynamic Engineered Approach.

    Science.gov (United States)

    Lawrie, Gerald M; Zoghbi, William; Little, Stephen; Shah, Dipan; Ben-Zekry, Zegit; Earle, Nan; Earle, Elizabeth

    2016-02-01

    Advances in understanding dynamic mitral valve function have led to a repair technique with no leaflet resection, accurate dynamic annular and chordal sizing, and preservation of left ventricular outflow tract dynamics. This approach uses inflation of the left ventricle and ascending aorta with pressurized saline to achieve diastolic mitral valve locking and early isovolumic systole. The left ventricle is maximally dilated, the aorta and root are distended, and the mitral leaflets are opposed. This is used to adjust the length of the artificial chordae and size the fully flexible annuloplasty ring in three dimensions for accurate apposition of the zones of leaflet coaptation. We monitored 752 consecutive patients after repairs performed between 2001 and 2013. There were 510 men (68.8%). Mean age was 61.3 ± 13.54 years. The leaflet repaired was anterior in 127 patients (17%), posterior in 451 (60%), both 55 (7.3%), and Barlow's in 119 (16%). Repair was isolated in 76% (573 of 752). Reparability was 100%. No prosthetic valve was implanted in patients with myxomatous or degenerative disease. Perioperative mortality was 2.3% (17 of 752) overall and was 1.6% (9 of 573) for isolated repair and 0.2% (1 of 451) for isolated posterior leaflet. Nonsignificant leaflet systolic anterior leaflet motion was observed in 0.2% (14 of 739) of patients. At 10 years, survival by Kaplan-Meier analysis was 66.4%, and freedom from reoperation was 91.8%. Freedom from significant mitral regurgitation at 5 years was 90.3%. Cox analysis showed male gender was a predictor of reoperation (p = 0.63). This dynamic approach enabled 100% reparability of myxomatous and degenerative valves with no occurrence of significant systolic anterior leaflet motion. Despite 100% of patients having been repaired, intermediate-term durability measured by reoperation rates, freedom from prosthetic valve, and intermediate echocardiographic follow-up have been good. Copyright © 2016 The Society of Thoracic

  6. Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

    Directory of Open Access Journals (Sweden)

    Nicole Marijanovich

    2018-01-01

    Full Text Available Systemic lupus erythematosus (SLE is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25% and severe (+4 mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation.

  7. In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

    OpenAIRE

    Little, Stephen H.; Igo, Stephen R.; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J.; Nosé, Yukihiko; Zoghbi, William A.

    2007-01-01

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two ...

  8. Three-dimensional characteristics of functional mitral regurgitation in patients with severe left ventricular dysfunction: a real-time three-dimensional colour Doppler echocardiography study.

    Science.gov (United States)

    Song, J-M; Kim, M-J; Kim, Y-J; Kang, S-H; Kim, J-J; Kang, D-H; Song, J-K

    2008-05-01

    We sought to evaluate the three-dimensional (3D) features of functional mitral regurgitation (FMR) and their geometric determinants by real-time 3D colour Doppler echocardiography. Real-time 3D colour Doppler echocardiography was performed in 52 patients with severe left ventricular dysfunction. With aliasing velocity set around 40 cm/s, proximal isovelocity surface area (PISA) radius was measured on medial, central and lateral antero-posterior planes at a mid-systole frame, and the largest (PISAmax) was determined. Geometric investigations of the left ventricle and mitral valve were performed. The distal length from the anterior leaflet angulation on the central plane was significantly longer in the 29 patients (56%) with eccentric PISA than in the 23 patients with central PISA (1.73 (0.44) vs 1.47 (0.33) cm, pPISA had a smaller anterior leaflet bending angle (141 degrees (8 degrees ) vs 147 degrees (8 degrees ), pPISAs had smaller PISAmax (0.33 (0.13) vs 0.45 (0.16) cm, pPISA. 3D features of FMR are quite diverse. The shape and site of anterior leaflet bending determine the shape of the regurgitant orifice, and small mitral valve tenting generates separate small regurgitant orifices of FMR in patients with severe left ventricular dysfunction.

  9. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography.

    Science.gov (United States)

    Zeng, Xin; Levine, Robert A; Hua, Lanqi; Morris, Eleanor L; Kang, Yuejian; Flaherty, Mary; Morgan, Nina V; Hung, Judy

    2011-09-01

    Accurate quantification of mitral regurgitation (MR) is important for patient treatment and prognosis. Three-dimensional echocardiography allows for the direct measure of the regurgitant orifice area (ROA) by 3D-guided planimetry of the vena contracta area (VCA). We aimed to (1) establish 3D VCA ranges and cutoff values for MR grading, using the American Society of Echocardiography-recommended 2D integrative method as a reference, and (2) compare 2D and 3D methods of ROA to establish a common calibration for MR grading. Eighty-three patients with at least mild MR underwent 2D and 3D echocardiography. Direct planimetry of VCA was performed by 3D echocardiography. Two-dimensional quantification of MR included 2D ROA by proximal isovelocity surface area (PISA) method, vena contracta width, and ratio of jet area to left atrial area. There were significant differences in 3D VCA among patients with different MR grades. As assessed by receiver operating characteristic analysis, 3D VCA at a best cutoff value of 0.41 cm(2) yielded 97% of sensitivity and 82% of specificity to differentiate moderate from severe MR. There was significant difference between 2D ROA and 3D VCA in patients with functional MR, resulting in an underestimation of ROA by 2D PISA method by 27% as compared with 3D VCA. Multivariable regression analysis showed functional MR as etiology was the only predictor of underestimation of ROA by the 2D PISA method. Three-dimensional VCA provides a single, directly visualized, and reliable measurement of ROA, which classifies MR severity comparable to current clinical practice using the American Society of Echocardiography-recommended 2D integrative method. The 3D VCA method improves accuracy of MR grading compared with the 2D PISA method by eliminating geometric and flow assumptions, allowing for uniform clinical grading cutoffs and ranges that apply regardless of etiology and orifice shape.

  10. The effect of depth of anesthesia on the severity of mitral regurgitation as measured by transesophageal echocardiography.

    Science.gov (United States)

    Chin, Ji-Hyun; Lee, Eun-Ho; Choi, Dae-Kee; Choi, In-Cheol

    2012-12-01

    The unloading effect of anesthesia on the left ventricle results in a downgrade of mitral regurgitation (MR) severity, which increases as anesthesia deepens. This study examined how the depth of anesthesia could affect the loading condition of the left ventricle and the severity of MR. A prospective study. Cardiac operating room at a single institution. Twenty patients with functional MR and 20 patients with organic MR. Different anesthetic depths determined by bispectral index (BIS) monitoring. In patients with functional MR, maximal regurgitant jet area (JA), the vena contracta (VC) width, and the proximal isovelocity surface area (PISA) radius were significantly smaller at a low BIS than at a high BIS (JA, 2.4 cm(2), 1.9-4.7, v 5.0 cm(2), 3.4-6.7, p PISA radius, 3.3 ± 2.3 v 5.6 ± 2.4 mm, p PISA radius were significantly smaller at a low BIS than at a high BIS (JA, 7.0 ± 2.4 v 9.7 ± 3.6 cm(2), p = 0.002; VC width, 5.7 mm, 4.1-6.6, v 7.1 mm, 5.4-8.4, p PISA radius, 9.0 ± 2.8 v 12.0 ± 3.3 mm, p < 0.001). It may be helpful to measure the severity of MR at a shallower anesthesia depth guided by BIS monitoring to avoid a downgrade of MR under general anesthesia. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Comparative effects of amlodipine and benazepril on Left Atrial Pressure in Dogs with experimentally-induced Mitral Valve Regurgitation

    Directory of Open Access Journals (Sweden)

    Suzuki Shuji

    2012-09-01

    Full Text Available Abstract Background One of the purposes of treatment for dogs with mitral regurgitation (MR is lowering left atrial pressure (LAP. There has been few study of the amlodipine in dogs with MR and amlodipine’s effect on LAP has not been fully evaluated in a quantitative manner because of difficulties in directly measuring LAP. The objective of our study was to compare the short-term effects of amlodipine (0.2 mg/kg PO q12h vs benazepril (0.5 mg/kg PO q12h, on LAP and echocardiographic parameters in five beagle dogs with experimentally-induced MR. LAP of eight dogs that has own control were measured using radiotelemetry system at baseline and again on days 1, 2, 3, 4, 5, 6, 7 of the drug administration. Results Mean LAP decreased significantly after amlodipine (11.20 ± 4.19 mmHg vs 14.61 ± 3.81 mmHg at baseline, p  .05. LAP was lower after 7 days of amlodipine treatment than after 7 days of benazepril treatment. Significant reduction was seen for the first time 4 days after the administration amlodipine. The rate of the maximal area of the regurgitant jet signals to the left atrium area (ARJ/LAA of the amlodipine treatment was significantly lower (p  Conclusions LAP was significantly decreased after amlodipine treatment in dogs with surgically-induced MR but not after benazepril treatment. Although this study did not focus on adverse effects, amlodipine may be an effective drug for helping the patients with acute onset of severe MR, such as rupture of chordae tendinae or end stage patients were the LAP is likely to be elevated. Additional studies in clinical patients with degenerative mitral valve disease and acute chordal rupture are warranted because the blood-pressure lowering effects of amlodipine can decrease renal perfusion and this can further activate the RAAS.

  12. Mitral Regurgitation Grading in the Operating Room: A Systematic Review and Meta-analysis Comparing Preoperative and Intraoperative Assessments During Cardiac Surgery.

    Science.gov (United States)

    Sanfilippo, Filippo; Johnson, Christopher; Bellavia, Diego; Morsolini, Marco; Romano, Giuseppe; Santonocito, Cristina; Centineo, Luigi; Pastore, Federico; Pilato, Michele; Arcadipane, Antonio

    2017-10-01

    To assess differences in mitral regurgitation (MR) grade between the preoperative and the intraoperative evaluations. Systematic review and meta-analysis of 6 observational studies found from MEDLINE and EMBASE. Cardiac surgery. One hundred thirty-seven patients. Comparison between the preoperative MR assessment and the intraoperative evaluation conducted under general anesthesia (GA), with or without "hemodynamic matching" (HM) (artificial increase of afterload). The primary outcome was the difference between the preoperative and intraoperative MR grade under "GA-only" or "after-HM." Secondary analyses addressed differences according to effective regurgitant orifice area (EROA), regurgitant volume (RVol), color-jet area, and vena contracta width. Risk of MR underestimation was found under "GA-only" (SMD: 0.55; 95% confidence interval [CI], 0.31-0.79, p strategy carries high risk of clinically significant overestimation. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation.

    Science.gov (United States)

    Mihos, Christos G; Xydas, Steve; Williams, Roy F; Pineda, Andrés M; Yucel, Evin; Davila, Hector; Beohar, Nirat; Santana, Orlando

    2017-06-01

    The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0-2] versus 3 units (IQR, 1-4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.

  14. Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation.

    Science.gov (United States)

    Iwakura, Katsuomi; Ito, Hiroshi; Kawano, Shigeo; Okamura, Atsushi; Kurotobi, Toshiya; Date, Motoo; Inoue, Koichi; Fujii, Kenshi

    2006-06-01

    Effective regurgitant orifice area is a useful index of the severity of mitral regurgitation (MR). The calculation of regurgitant orifice area using the proximal isovelocity surface area (PISA) method has some technical limitations. Three-dimensional reconstruction of the MR jet was performed using the Live 3D system on a Sonos 7500 to measure regurgitant orifice area directly in 109 cases of MR. Regurgitant orifice area was also measured by quantitative 2-dimensional echocardiography and by the PISA method. To analyze the shape of the regurgitant orifice, the ratio of the long axis to the short axis of the orifice (the L/S ratio) was calculated. Regurgitant orifice area on 3-dimensional echocardiography showed an almost identical correlation with that obtained by quantitative echocardiography (r = 0.91, p PISA method (r = 0.93, p echocardiography was significantly larger than that obtained using the PISA method in the whole study group and in the 62 cases of MR with L/S ratios >1.5, whereas the correlation was almost identical in cases of MR with L/S ratios PISA method also underestimated that obtained by quantitative echocardiography in cases of MR with L/S ratios >1.5. Three-dimensional echocardiography provided robust values independent of the eccentricity of the MR jet or of cardiac rhythm. In conclusion, the direct measurement of the regurgitant orifice area of MR with 3-dimensional Doppler echocardiography could be a promising method to overcome the limitations of the PISA method, especially in cases of MR with elliptic orifice shapes.

  15. Calculation of Mitral Valve Area in Mitral Stenosis: Comparison of Continuity Equation and Pressure Half Time With Two-Dimensional Planimetry in Patients With and Without Associated Aortic or Mitral Regurgitation or Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Roya Sattarzadeh

    2018-01-01

    Full Text Available Accurate measurement of Mitral Valve Area (MVA is essential to determining the Mitral Stenosis (MS severity and to achieving the best management strategies for this disease. The goal of the present study is to compare mitral valve area (MVA measurement by Continuity Equation (CE and Pressure Half-Time (PHT methods with that of 2D-Planimetry (PL in patients with moderate to severe mitral stenosis (MS. This comparison also was performed in subgroups of patients with significant Aortic Insufficiency (AI, Mitral Regurgitation (MR and Atrial Fibrillation (AF. We studied 70 patients with moderate to severe MS who were referred to echocardiography clinic. MVA was determined by PL, CE and PHT methods. The agreement and correlations between MVA’s obtained from various methods were determined by kappa index, Bland-Altman analysis, and linear regression analysis. The mean values for MVA calculated by CE was 0.81 cm (±0.27 and showed good correlation with those calculated by PL (0.95 cm, ±0.26 in whole population (r=0.771, P<0.001 and MR subgroup (r=0.763, P<0.001 and normal sinus rhythm and normal valve subgroups (r=0.858, P<0.001 and r=0.867, P<0.001, respectively. But CE methods didn’t show any correlation in AF and AI subgroups. MVA measured by PHT had a good correlation with that measured by PL in whole population (r=0.770, P<0.001 and also in NSR (r=0.814, P<0.001 and normal valve subgroup (r=0.781, P<0.001. Subgroup with significant AI and those with significant MR showed moderate correlation (r=0.625, P=0.017 and r=0.595, P=0.041, respectively. Bland Altman Analysis showed that CE would estimate MVA smaller in comparison with PL in the whole population and all subgroups and PHT would estimate MVA larger in comparison with PL in the whole population and all subgroups. The mean bias for CE and PHT are 0.14 cm and -0.06 cm respectively. In patients with moderate to severe mitral stenosis, in the absence of concomitant AF, AI or MR, the accuracy

  16. Does exercise and the stress of clinical examination influence endothelial function in dogs with mitral regurgitation?

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Pedersen, Henrik Duelund; Holte, Andreas

    2005-01-01

    subjects is regarded as being an important therapeutic target.An aim of this PhD project is to investigate the involvement of NO in mitral valve disease and explain possible reasons for the decrease in NOx seen in connection with MR.When dogs are examined under clinic conditions there is an inevitable...... the day, however, exercise significantly increased the plasma NOx (1.78±1.24 vs. 8.19±4.13 µM NOx before and after exercise, respectively, P

  17. Usefulness of a Z-score of E' versus raw E' velocities to detect left ventricular dysfunction in patients with mitral or aortic regurgitation or dilated cardiomyopathy.

    Science.gov (United States)

    Yadav, Hemang; Unsworth, Beth; Medlow, Katharine; Baruah, Resham; Wasan, Balvinder S; Mayet, Jamil; Francis, Darrel P

    2010-10-15

    Despite their potential as a sensitive measure of ventricular performance, tissue Doppler velocities vary with normal aging. This is inconvenient for nonspecialists to interpret and makes it difficult to use as an entry criterion for clinical studies. The age-adjusted tissue Doppler Z-scores might avoid these disadvantages and be more discriminant for myocardial impairment than the raw velocities. We conducted a meta-regression of studies reporting age-specific normal tissue Doppler velocities to determine a consensus formula for Z-scores (8 studies, 1,867 patients) that we then tested in an independent study at our institution. We next compared the Z-scores head-to-head with the raw velocities for their ability to distinguish a fresh set of 81 healthy subjects from groups in whom subtle ventricular dysfunction might be expected, including 50 patients with dilated cardiomyopathy, 50 with aortic regurgitation, and 50 with mitral regurgitation. The discriminant capacity, assessed by the area under the receiver operating characteristic curves, was higher for the Z-scores than for the raw velocities in each patient group. At the septal angle of the mitral annulus: dilated cardiomyopathy 0.95 versus 0.92 (p = 0.03), aortic regurgitation 0.83 versus 0.78 (p = 0.02), mitral regurgitation 0.85 versus 0.81 (p = 0.04). At the lateral angle: dilated cardiomyopathy 0.94 versus 0.88 (p = 0.005), aortic regurgitation 0.92 versus 0.83 (p = 0.001), mitral regurgitation 0.87 versus 0.85 (p = 0.31). In conclusion, the Z-scores of the tissue Doppler velocities were better than the raw velocities at detecting myocardial impairment in valvular or heart muscle disease. The calculation needs only the raw velocity and patient age. Tissue Doppler Z-scores could be used to create a novel, more sensitive, definition of ventricular dysfunction and might make it easier for nonspecialists to interpret the reports. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Prognostic implications of left ventricular dilation in patients with nonischemic heart failure: interactions with restrictive filling pattern and mitral regurgitation.

    Science.gov (United States)

    Ghio, Stefano; Temporelli, Pier L; Marsan, Nina A; Poppe, Katrina; Giannuzzi, Pantaleo; Dini, Frank L; Rossi, Andrea; Doughty, Robert N; Whalley, Gillian

    2012-01-01

    The aim of this study was to evaluate whether small left ventricular (LV) volumes increase the negative prognostic impact of a restrictive filling pattern (RFP) and that of mitral regurgitation (MR) in patients with nonischemic heart failure (HF). The Meta-analysis Research Group in Echocardiography (MeRGE) is a meta-analysis that collated individual patient data from several prospective echocardiography outcome studies. This analysis was restricted to 10 studies and 601 patients with nonischemic HF. The role of MR was tested in a subgroup of 252 patients. A total of 106 deaths occurred during a median follow-up of 32 months. At multivariate analysis, RFP (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.54-11.23; P=.005) and New York Heart Association class III or IV (HR, 2.15; 95% CI, 1.33-3.47; P=.001) were the independent predictors of poor prognosis, and there was no statistically significant interaction between LV dilation and RFP. Moderate/severe MR was associated with poorer outcome in the group of patients with normal volumes, whereas it was not a significant predictor of mortality in patients with any degree of LV dilation. In patients with nonischemic HF, RFP is the most important indicator of poor prognosis, irrespective of the degree of LV dilation. Normal LV volumes increase the negative prognostic impact of moderate to severe MR. © 2012 Wiley Periodicals, Inc.

  19. Mitral valve repair versus replacement in patients with ischaemic mitral regurgitation and depressed ejection fraction: risk factors for early and mid-term mortality†.

    Science.gov (United States)

    Lio, Antonio; Miceli, Antonio; Varone, Egidio; Canarutto, Daniele; Di Stefano, Gioia; Della Pina, Francesca; Gilmanov, Daniyar; Murzi, Michele; Solinas, Marco; Glauber, Mattia

    2014-07-01

    Mitral valve (MV) surgery for ischaemic mitral regurgitation (IMR) in patients with depressed left ventricular ejection fraction (LVEF) is associated with poor outcomes. The optimal surgical strategy for IMR in these patients remains controversial. The objective of this study was to compare the early mortality and mid-term survival of MV repair versus MV replacement in patients with IMR and depressed LVEF undergoing coronary artery bypass grafting (CABG). A retrospective, observational, cohort study was undertaken of prospectively collected data on 126 consecutive CABG patients with IMR and LVEF <40% undergoing either MV repair (n = 98, 78%) or MV replacement (n = 28, 22%) between July 2002 and February 2011. The overall mortality rate was 7.9% (n = 10). MV replacement was associated with a 4-fold increase in the risk of death compared with MV repair [17.9%, n = 5 vs 5.1%, n = 5; odds ratio (OR) 4.04, 95% confidence interval (CI) 1.08-15.1, P = 0.04]. However, after adjusting for preoperative risk factors, the type of surgical procedure was not an independent risk factor for early mortality (OR 0.1, 95% CI 0.01-31, P = 0.7). Multivariable analysis showed that preoperative LVEF (OR 0.8, 95% CI 0.6-0.9, P = 0.018), preoperative B-type natriuretic peptide (BNP) levels (OR 1.01, 95% CI 1-1.02, P = 0.025), preoperative left ventricle end-systolic diameter (OR 0.8, 95% CI 0.7-1.0, P = 0.05) and preoperative left atrial diameter (OR 1.3, 95% CI 1.0-1.6, P = 0.015) were independent risk factors of early mortality. At the median follow-up of 45 months (interquartile range 20-68 months), the mid-term survival rate was 74% in the MV repair group and 70% in the MV replacement group (P = 0.08). At follow-up, predictors of worse survival were BNP levels [hazard ratio (HR) 1.0, 95% CI 1.0-1.01, P = 0.047], preoperative renal failure (HR 4.6, 95% CI 1.1-20.3, P = 0.039) and preoperative atrial fibrillation (HR 3.3, 95% CI 1.1-10, P = 0.032). MV repair in CABG patients with IMR and

  20. Analysis of early effect of surgical treatment in patients with coronary heart disease complicated by moderate-to-severe ischemic mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Jin WANG

    2012-04-01

    Full Text Available Objective To probe into the early effect of surgical treatment in coronary atherosclerotic heart disease (CAD patients with moderate-to-severe ischemic mitral regurgitation (IMR. Methods A total of 175 CAD patients with moderateto- severe IMR undergoing coronary artery bypass grafting (CABG from December 1999 to December 2010 were analyzed retrospectively. Based on the method applied during surgery, 108 patients were assigned to CABG group, undergoing CABG alone, and 67 to CABG+MVP/R group, undergoing CABG plus concomitant mitral valvuloplasty/repair (MVP/R. Differences between groups were compared in age, gender, numbers of the conduits, application of intra-aortic balloon pump (IABP and ventricular assist device (VAD, perioperative mortality, and other concomitant procedures (i.e. aortic valve replacement, resection of the heart wall aneurysm, repair of the septal defect repair. Differences within the groups were looked for in terms of left atrial diameter (LA, left ventricular ending diastolic diameter (LVEDD, left ventricular ejection fraction (LVEF, mitral regurgitation degree, systolic pulmonary artery pressure (sPAP, and cardiac function (NYHA classification, pre-operatively and post-operatively. Results  The differences between the groups showed no statistical significance in terms of age, gender, numbers of conduits, application of IABP and VAD, peri-operative mortality, and concomitant procedures (P > 0.05. LA, LVEDD, mitral regurgitation, sPAP, and cardiac function (NYHA classification after operation were improved obviously in both groups compared with that before operation (P 0.05. Conclusions The comprehensive and aggressive surgery did not result in more ideal early effect to CAD patients with moderate-to-severe IMR. Based on the total revascularization, we can choose simpler, safer, and more effective surgical methods.

  1. Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics.

    Science.gov (United States)

    Choi, Jaehuk; Heo, Ran; Hong, Geu-Ru; Chang, Hyuk-Jae; Sung, Ji Min; Shin, Sang Hoon; Cho, In Jeong; Shim, Chi-Young; Chung, Namsik

    2014-05-01

    The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations. We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P15 mL) between 2D- and 3D-PISA methods. Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR. © 2014 American Heart Association, Inc.

  2. Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study.

    Science.gov (United States)

    Moraldo, Michela; Cecaro, Fabrizio; Shun-Shin, Matthew; Pabari, Punam A; Davies, Justin E; Xu, Xiao Y; Hughes, Alun D; Manisty, Charlotte; Francis, Darrel P

    2013-09-30

    Guidelines for quantifying mitral regurgitation (MR) using "proximal isovelocity surface area" (PISA) instruct operators to measure the PISA radius from valve orifice to Doppler flow convergence "hemisphere". Using clinical data and a physically-constructed MR model we (A) analyse the actually-observed colour Doppler PISA shape and (B) test whether instructions to measure a "hemisphere" are helpful. In part A, the true shape of PISA shells was investigated using three separate approaches. First, a systematic review of published examples consistently showed non-hemispherical, "urchinoid" shapes. Second, our clinical data confirmed that the Doppler-visualized surface is non-hemispherical. Third, in-vitro experiments showed that round orifices never produce a colour Doppler hemisphere. In part B, six observers were instructed to measure hemisphere radius rh and (on a second viewing) urchinoid distance (du) in 11 clinical PISA datasets; 6 established experts also measured PISA distance as the gold standard. rh measurements, generated using the hemisphere instruction significantly underestimated expert values (-28%, pPISA distance was found to have a coefficient of variation (CV) of 25% in patients and 9% in in-vitro data. Beat-to-beat variability had a CV of 15% in patients. Doppler-visualized PISA shells are not hemispherical: we should avoid advising observers to measure a hemispherical radius because it encourages underestimation of orifice area by approximately two-fold. If precision is needed (e.g. to detect changes reliably) multi-frame averaging is essential. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Deep sequencing of atrial fibrillation patients with mitral valve regurgitation shows no evidence of mosaicism but reveals novel rare germline variants

    DEFF Research Database (Denmark)

    Gregers, Emilie; Ahlberg, Gustav; Christensen, Thea

    2017-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Valvular heart disease is a strong predictor, yet the underlying molecular mechanisms are unknown. OBJECTIVE: The purpose of this study was to investigate the prevalence of somatic variants in AF candidate genes in an AF...... patient population undergoing surgery for mitral valve regurgitation (MVR) to determine whether these patients are genetically predisposed to AF. METHODS: DNA was extracted from blood and left atrial tissue from 44 AF patients with MVR. Using next-generation sequencing, we investigated 110 genes using...

  4. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan

    2012-01-01

    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  5. Automated Quantification of Mitral Regurgitation by Three Dimensional Real Time Full Volume Color Doppler Transthoracic Echocardiography: A Validation with Cardiac Magnetic Resonance Imaging and Comparison with Two Dimensional Quantitative Methods

    OpenAIRE

    Son, Jang-Won; Chang, Hyuk-Jae; Lee, Jin-Kyung; Chung, Hee-Jung; Song, Ran-Young; Kim, Young-Jin; Datta, Saurabh; Heo, Ran; Shin, Sang-Hoon; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Chung, Namsik

    2013-01-01

    Background Accurate assessment of mitral regurgitation (MR) severity is crucial for clinical decision-making and optimizing patient outcomes. Recent advances in real-time three dimensional (3D) echocardiography provide the option of real-time full volume color Doppler echocardiography (FVCD) measurements. This makes it practical to quantify MR by subtracting aortic stroke volume from the volume of mitral inflow in an automated manner. Methods Thirty-two patients with more than a moderate degr...

  6. Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study.

    Science.gov (United States)

    de Agustín, Jose Alberto; Marcos-Alberca, Pedro; Fernandez-Golfin, Covadonga; Gonçalves, Alexandra; Feltes, Gisela; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Perez de Isla, Leopoldo; Macaya, Carlos; Zamorano, Jose

    2012-08-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat, real-time three-dimensional (3D) color Doppler imaging allows direct measurement of PISA without geometric assumptions. The aim of this study was to validate this novel method in patients with chronic mitral regurgitation (MR). Thirty-three patients were included, 25 (75.7%) with degenerative MR and eight (24.2%) with functional MR. EROA and regurgitant volume were assessed using transthoracic 2D and 3D PISA methods. The quantitative Doppler method and 3D transesophageal echocardiographic planimetry of EROA were used as reference methods. Both EROA and regurgitant volume assessed using the 3D PISA method had better correlations with the reference methods than conventional 2D PISA. A consistent significant underestimation of EROA and regurgitant volume using 2D PISA was observed, particularly in the assessment of eccentric jets. On the basis of 3D transesophageal echocardiographic planimetry of EROA, 14 patients had severe MR (EROA ≥ 0.4 cm(2)). Of these 14 patients, 42.8% (6 of 14) were underestimated as having nonsevere MR (EROA ≤ 0.4 cm(2)) by the 2D PISA method. In contrast, the 3D PISA method had 92.9% (13 of 14) agreement with 3D transesophageal planimetry in classifying severe MR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.96 and 0.92, respectively. Direct measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method. Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  7. Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation.

    Directory of Open Access Journals (Sweden)

    Antonino Di Franco

    Full Text Available Ischemic mitral regurgitation (iMR predisposes to right ventricular (RV pressure and volume overload, providing a nidus for RV dysfunction (RVDYS and non-ischemic fibrosis (NIF. Echocardiography (echo is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown.iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S', fractional area change [FAC], and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS] and parasternal long axis orientation (transverse strain. CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI and septal NIF.73 iMR patients were studied; 36% had RVDYS (EF<50% on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05. CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73 and lowest for RV-S' (r = 0.43; all p<0.001. RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001. Whereas all RV indices were lower among NIF-affected patients (all p≤0.006, percent change was largest for transverse strain (48.3%. CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001 and transverse strain (r = 0.38, p = 0.002 (R = 0.78, p<0.001. Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87-0.99]|0.91[0.84-0.99], both p<0.001, and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively.Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR.

  8. Five-year real world outcomes of GeoForm ring implantation in patients with ischemic mitral regurgitation.

    Science.gov (United States)

    Timek, Tomasz A; Hooker, Robert L; Collingwood, Robin; Davis, Alan T; Alguire, Craig T; Willekes, Charles L; Murphy, Edward T; Heiser, John C; Patzelt, Lawrence H

    2014-11-01

    Reductive ring annuloplasty represents the current standard surgical therapy for ischemic mitral regurgitation (IMR); however, the clinical results have been suboptimal. Etiology-specific prostheses such as the GeoForm annuloplasty ring have been designed to better address the annular and subvalvular perturbations associated with IMR. However, clinical experience is limited, and mid-term results are lacking. We reviewed the clinical outcomes of 86 patients who had undergone implantation of a GeoForm ring at our center from 2005 to 2011. Perioperative mortality and clinical parameters were derived from The Society of Thoracic Surgeons database. Follow-up survival was assessed using the Social Security Death Index. Surviving patients were interviewed by telephone for valve-specific follow-up data and to complete the Medical Outcomes Study, short-form, 36-item, quality-of-life questionnaire. The mean grade of IMR preoperatively was 3.1±0.8 (range, 1-4+), 0.2±0.4 in the immediate postoperative period, and 0.7±0.7 at the last mean follow-up point of 41 months; only 2 patients developed ≥2+IMR during the follow-up period, for a 5-year freedom from recurrent 2+ IMR of 86%. The mean left ventricular end-diastolic and end-systolic diameters decreased from before to after surgery from 6.0±0.0 cm to 5.3±09 cm and 5.0±0.9 cm to 4.3±1.1 cm, respectively (P<.001). Perioperative mortality was 5.8% (5 of 86), and 1-, 3-, and 5-year survival was 87%, 81%, and 75%, respectively. At the last follow-up point, 80% of patients were in New York Heart Association class I and II, and their quality of life was equal to, or better than, age-matched controls from the general population. Implantation of the GeoForm ring offers very good control of IMR, with low rate of recurrent IMR at mid-term follow-up. The use of this prosthesis was associated with good perioperative mortality, mid-term survival, and quality of life. Copyright © 2014 The American Association for Thoracic Surgery

  9. Problem: Heart Valve Regurgitation

    Science.gov (United States)

    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... should be completely closed For example: Watch an animation of mitral valve regurgitation A leaking mitral valve ...

  10. Primary Mitral Valve Regurgitation Outcome in Patients With Severe Aortic Stenosis 1 Year After Transcatheter Aortic Valve Implantation: Echocardiographic Evaluation.

    Science.gov (United States)

    Florentino, Thiago Marinho; Bihan, David Le; Abizaid, Alexandre Antonio Cunha; Cedro, Alexandre Vianna; Corrêa, Amably Pessoa; Santos, Alexandre Roginski Mendes Dos; Souza, Alexandre Costa; Bignoto, Tiago Costa; Sousa, José Eduardo Moraes Rego; Sousa, Amanda Guerra de Moraes Rego

    2017-07-10

    Mitral valve regurgitation (MR), present in up to 74% of the patients with severe aortic stenosis (AS), can be a negative prognostic factor when moderate or severe. The outcome of MR after percutaneous transcatheter aortic valve implantation (TAVI) and predictors associated with that outcome have not been well established in the literature. To assess the outcome of primary MR in patients submitted to TAVI and to identify associated factors. Observational study of patients with symptomatic severe AS submitted to TAVI from January 2009 to April 2015 at two specialized centers. Echocardiographic outcome was assessed with data collected before and 1 year after TAVI. Of the 91 patients with MR submitted to TAVI and followed up for at least 12 months, 67 (73.6%) had minimum/mild MR before the procedure and 24 (26.4%) had moderate/severe MR. Of those with minimum/mild MR, 62 (92.5%) had no change in the MR grade (p literatura. Avaliar a evolução da IM primária em pacientes submetidos ao TAVI e identificar fatores associados a essa evolução. Realizou-se um estudo observacional em pacientes com EA grave sintomática, submetidos ao TAVI no período de janeiro de 2009 a abril de 2015 em dois centros especializados. Foram avaliados desfechos ecocardiográficos com dados antes e 1 ano após a intervenção. Dos 91 pacientes com IM que realizaram TAVI e tinham acompanhamento de pelo menos 12 meses, 67 (73,6%) apresentavam IM mínima ou discreta antes da realização do procedimento e 24 (26,4%), IM moderada ou grave. Entre os com IM mínima ou discreta, 62 (92,5%) não apresentaram mudança no grau de refluxo (p < 0,001) e 5 (7,5%) tiveram piora. Entre os com IM moderada ou grave, 8 (33,3%) permaneceram na mesma classe e 16 (66,7%) tiveram melhora (p = 0,076). Pacientes com IM moderada ou grave que melhoraram o grau de insuficiência apresentavam menores valores de EuroSCORE II (p = 0,023) e STS morbidade (p = 0,027), quando comparados aos que continuaram na mesma classe

  11. Off-pump myocardial revascularization safety aspects in combined operations on patients with ischemic heart disease complicated by ischemic mitral regurgitation

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    A. S. Zavologhin

    2017-11-01

    Full Text Available Aim. The issues of safety of off-pump myocardial revascularization in patients with severe ischemic mitral regurgitation remain insufficiently studied. Control of transport and oxygen consumption allows one to assess some of the safety aspects of this technique. The study was designed to evaluate the safety of myocardial revascularization without cardiopulmonary bypass in a combined operation for patients with ischemic mitral regurgitation and a similar operation under cardiopulmonary bypass and cardioplegia by assessment of the main parameters of transport and oxygen consumption.Methods. Forty-two adult patients scheduled for elective coronary artery bypass grafting in combination with mitral annuloplasty were randomized into two groups: off-pump (22 patients and on-pump (20 patients. In the off-pump group, coronary artery bypass grafting was performed on a beating heart without cardiopulmonary bypass, whereas in the on-pump group it was conventional coronary artery bypass grafting on a cardiopulmonary bypass with cardiac arrest. The coronary artery bypass grafting stage was performed before intervention on the mitral valve.Results. On completion of the coronary artery bypass grafting stage, the cardiac index, the oxygen delivery index and the blood lactate level in the off-pump group were lower than those in the on-pump group by 20%, 17% and 100% (p = 0.01, 0.02, 0.003, respectively, while the consumption index and oxygen extraction were higher by 17% and 94% (p = 0.016 and 0.0001, respectively. In the off-pump group, the oxygen consumption index remained stable at all stages of the operation and the C-reactive protein level tended to decrease between 10–14 days after surgery (p = 0.13.Conclusion. Implementation of off-pump coronary surgery in a combined operation for patients with ischemic mitral regurgitation does not lead to disruption of transport and oxygen consumption, does not exacerbate the systemic inflammatory response and can be

  12. Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis : a report of four cases and a systematic review of the literature

    NARCIS (Netherlands)

    Bouma, Wobbe; Klinkenberg, Theo J.; van der Horst, Iwan C. C.; Wijdh-den Hamer, Inez J.; Erasmus, Michiel E.; Bijl, Marc; Suurmeijer, Albert J. H.; Zijlstra, Felix; Mariani, Massimo A.

    2010-01-01

    Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome

  13. Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography.

    Science.gov (United States)

    Kahlert, Philipp; Plicht, Björn; Schenk, Ingmar M; Janosi, Rolf-Alexander; Erbel, Raimund; Buck, Thomas

    2008-08-01

    Vena contracta width (VCW) as an estimate of effective regurgitant orifice area (EROA) is an accepted parameter of mitral regurgitation (MR) severity. However, uncertainty exists in cases in which VCW at the same time appears narrow in 4-chamber (4CH) view and broad in 2-chamber (2CH) view as common in functional MR with noncircular or slit-like regurgitant orifices. We therefore hypothesized that new real-time 3-dimensional color Doppler echocardiography (RT3DE) can be used for direct assessment of the size and shape of vena contracta area (VCA) in an en face view and to determine the potential error of conventional VCW measurement on estimation of EROA. RT3DE was performed in 57 patients with relevant MR of different etiologies. Manual tracing of VCA in a cross-sectional plane through the vena contracta was compared with VCW in 4CH and 2CH views. As a comparative approach to VCA-3D, EROA was calculated using the hemispheric and hemielliptic proximal isovelocity surface (PISA) area method. Direct measurement of VCA-3D was feasible in all patients within 2.6 +/- 0.7 minutes. RT3DE revealed significant asymmetry of VCA in functional compared with organic MR (P PISA (r = .96, mean error: -0.09 +/- 0.14 cm(2)) compared with significant underestimation of hemispheric PISA in noncircular lesions. Direct assessment of VCA using RT3DE revealed significant asymmetry of VCA in functional MR compared with organic MR, resulting in poor estimation of EROA by single VCW measurements.

  14. Simultaneous multi-vessel coronary artery bypass grafting, ischemic mitral regurgitation repair and descending aortic aneurysm replacement: analysis of technical points.

    Science.gov (United States)

    Malyshev, Michael; Safuanov, Alexander; Borovikov, Dmitry; Malyshev, Anton

    2008-04-01

    The combination of coronary artery disease and its complications (ischemic mitral regurgitation etc.) with the aneurysm of the descending thoracic aorta is not a rare case. The single-stage correction of coronary/intracardiac/aortic lesions may be considered as a way of managing the combined patients. Simultaneous multi-vessel coronary artery bypass grafting, suture mitral annuloplasty and descending aortic aneurysm replacement with synthetic prosthesis is described. The operation was performed through the left thoracotomy with cardiopulmonary bypass established by the cannulation of the ascending aorta and of the right atrial appendage. Ventricular fibrillation and no clamping of the ascending aorta were used. The circulatory arrest was induced for the construction of the proximal anastomosis between the descending aorta and the synthetic prosthesis. No complications related to the operation were diagnosed for the 14-month follow-up. Several technical points seem optimal for the combined procedure: (1) Minimization of manipulations on the ascending aorta (using of pedicled left internal thoracic artery; construction of the proximal anastomoses with synthetic aortic prosthesis; unclamped ascending aorta). (2) Revascularization of all coronary areas and correction of intracardiac lesions through the left thoracotomy. Individual planning of the procedural technical points for every patient may provide a safe feasibility of the combined procedure.

  15. Mitral regurgitation recovery and atrial reverse remodeling following pulmonary vein isolation procedure in patients with atrial fibrillation: a clinical observation proof-of-concept cardiac MRI study.

    Science.gov (United States)

    Reddy, Sahadev T; Belden, William; Doyle, Mark; Thompson, Diane V; Williams, Ronald; Yamrozik, June; Shah, Moneal; Biederman, Robert W W

    2013-09-01

    Reverse remodeling of the left atrium (LA) following successful pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) has been well documented. However, mitral regurgitation (MR) recovery after successful PVI has never been demonstrated systematically. The objective of our study was to retrospectively analyze the effectiveness of PVI in patients with AF on recovery of MR using cardiac magnetic resonance (CMR) imaging. Prior to PVI, patients underwent a clinically indicated CMR imaging. Post-PVI (6 ± 2 months), patients underwent a follow-up MRI and were classified into two groups-responders (R) and non-responders (NR) to PVI-as assessed by cessation of AF at the end of the prespecified 6-month (14-day "P" sensitive event monitor defined) follow-up period. Furthermore, CMR was used to evaluate the severity of MR (0 to 4+) and to relate changes in MR to LA volumes as well as mitral apparatus geometry. Patients who had mild and higher MR (2+) on baseline CMR and had a post-PVI CMR were selected for final analysis. Out of the consecutive 122 patients with AF who underwent PVI, 74 patients that had mitral regurgitation on initial CMR were included in the study. Of these74 patients with AF with MR, 52 (70 %) were classified as R and 22 (30 %) were classified as NR. Baseline demographics were similar between the groups. In the subgroup with mild to severe MR, pre vs. post in the R group MR severity significantly improved (mean = 2.3, median = 2.0 vs. mean = 1.0, median = 1.0, p < 0.0001) and was matched by favorable reverse remodeling of the mitral apparatus geometry (annulus = 35 ± 4 vs. 33 ± 3 mm, p < 0.002; tenting area = 175 ± 56 vs.137 ± 37 mm(2), p < 0.003; tenting height = 8 ± 2 vs.7 ± 2 mm, p < 0.02; and tenting angle = 129 ± 10° vs. 131 ± 11°, p = 0.1). However, in the NR subgroup, MR failed to improve (mean = 2.2, median = 2.0 vs

  16. Double orifice mitral valve: A case report

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    Musić Ljilja

    2016-01-01

    Full Text Available Introduction. Double orifice mitrol valve (DOMV is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status. He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices were seen as a double mitral orifice through which we registered normal flow, without regurgitation and mitral stenosis. Transesophageal echocardiography (TEE examination from the transgastric view at the level of mitral valve, showed 2 single asymmetric mitral orifices separated by fibrous tissue, mitral leaflet with a separate insertion of hordes for each orifice. Conclusion. The presented patient with DOMV is the only one recognized in our country. The case is interesting because during 16-year a follow-up period there were no functional changes despite the fact that he performed very demanded sport activities. This is very important because there is no information in the literature about that.

  17. Edge-to-edge percutaneous repair of severe mitral regurgitation--state-of-the-art for Mitraclip® implantation

    DEFF Research Database (Denmark)

    Alegria-Barrero, Eduardo; Chan, Pak Hei; Paulo, Manuel

    2012-01-01

    MitraClip® therapy is a percutaneous edge-to-edge plication of the mitral leaflets, mimicking the Alfieri surgical technique. MitraClip® implantation is a safe procedure, and survival outcomes in high-surgical-risk patients are superior to historical controls. Despite these results, questions...

  18. Efeito da plástica mitral nas variáveis do teste cardiopulmonar em pacientes com insuficiência mitral crônica Effect of mitral valve repair on cardiopulmonary exercise testing variables in patients with chronic mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Dorival Julio Della Togna

    2013-04-01

    Full Text Available FUNDAMENTO: A plástica valvar mitral é o procedimento cirúrgico de escolha para pacientes com Insuficiência Mitral (IM crônica. Os bons resultados imediatos e tardios permitem a indicação cirúrgica antes do início dos sintomas. O teste cardiopulmonar de exercício (TCPE pode avaliar objetivamente a capacidade funcional, mas pouco se conhece o efeito da cirurgia em suas variáveis. OBJETIVOS: Avaliar os efeitos da plástica mitral nas variáveis do TCPE em pacientes com IM crônica. MÉTODOS: Foram selecionados 47 pacientes com IM grave e submetidos plástica da valva mitral, sendo nestes, realizado TCPE ± 30 dias antes da cirurgia, e de seis a 12 meses após a cirurgia. RESULTADOS: Houve predominância da classe funcional I ou II pela NYHA em 30 pacientes (63,8% e 34 pacientes (72,3%, respectivamente. Após a cirurgia foi observado uma diminuição significativa do consumo de oxigênio (VO2, de 1.719 ± 571 para 1.609 ± 428 mL.min-1, p = 0,036. Houve redução do Oxygen Uptake Efficiency Slope (OUES, de 1.857 ± 594 para 1.763 ± 514, p = 0,073 e o pulso de oxigênio (O2 aumentou após a cirurgia, de 11,1 ± 3,2 para 11,9 ± 3,2 mL.bat-1 (p = 0,003. CONCLUSÃO: A plástica da valva mitral, não determinou aumento do VO2 pico e do OUES apesar do remodelamento cardíaco positivo observado após sete meses de cirurgia. Entretanto, o pulso de O2 aumentou no pós-operatório, sugerindo melhora do desempenho sistólico do VE. O TCPE é uma ferramenta útil, podendo auxiliar na conduta médica em pacientes com IM.BACKGROUND: Mitral valve repair is the surgical procedure of choice for patients with chronic Mitral Regurgitation (MR. The good early and late results allow surgical indication before symptom onset. The cardiopulmonary exercise test (CPET can objectively assess functional capacity, but little is known about the effect of surgery on their variables. OBJECTIVE: Evaluate the effects of mitral repair on CPET variables in patients with

  19. Quantification of Multiple Mitral Regurgitant Jets: An In Vitro Validation Study Comparing Two- and Three-Dimensional Proximal Isovelocity Surface Area Methods.

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    Zürcher, Fabian; Brugger, Nicolas; Jahren, Silje Ekroll; de Marchi, Stefano Fausto; Seiler, Christian

    2017-05-01

    The accuracy of the proximal isovelocity surface area (PISA) method for the quantification of mitral regurgitation (MR), in the case of multiple jets, is unknown. The aim of this study was to evaluate different two-dimensional (2D) and three-dimensional (3D) PISA methods using 3D color Doppler data sets. Several regurgitant volumes (Rvols) were simulated using a pulsatile pump connected to a phantom equipped with single and double regurgitant orifices of different sizes and interspaces. A flowmeter served as the reference method. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were used to acquire the 3D data sets. Offline, Rvols were calculated by 2D PISA methods based on hemispheric and hemicylindric assumptions and by 3D integrated PISA. A fusion of the PISA was observed in the setting of narrow-spaced regurgitant orifices; compared with flowmeter, Rvol was underestimated using the single hemispheric PISA model (TTE: Bland-Altman bias ± limit of agreement, -17.5 ± 8.9 mL; TEE: -15.9 ± 7.3 mL) and overestimated using the double hemispheric PISA model (TTE: +7.1 ± 14.6 mL; TEE: +10.4 ± 11.9 mL). The combined approach (hemisphere for single orifice, hemicylinder with two bases for nonfused PISAs, and hemicylinder with one base for fused PISAs) was more precise (TTE: -3.4 ± 6.3 mL; TEE: -1.9 ± 5.6 mL). Three-dimensional integrated PISA was the most accurate method to quantify Rvol (TTE: -2.1 ± 6.5 mL; TEE -3.2 ± 4.8 mL). In the setting of double MR orifices, the 2D combined approach and integrated 3D PISA appear to be superior as compared with the conventional hemispheric method, thus providing tools for the challenging quantification of MR with multiple jets. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  20. Feasibility of Ultrasound-Based Computational Fluid Dynamics as a Mitral Valve Regurgitation Quantification Technique: Comparison with 2-D and 3-D Proximal Isovelocity Surface Area-Based Methods.

    Science.gov (United States)

    Jamil, Muhammad; Ahmad, Omar; Poh, Kian Keong; Yap, Choon Hwai

    2017-07-01

    Current Doppler echocardiography quantification of mitral regurgitation (MR) severity has shortcomings. Proximal isovelocity surface area (PISA)-based methods, for example, are unable to account for the fact that ultrasound Doppler can measure only one velocity component: toward or away from the transducer. In the present study, we used ultrasound-based computational fluid dynamics (Ub-CFD) to quantify mitral regurgitation and study its advantages and disadvantages compared with 2-D and 3-D PISA methods. For Ub-CFD, patient-specific mitral valve geometry and velocity data were obtained from clinical ultrasound followed by 3-D CFD simulations at an assumed flow rate. We then obtained the average ratio of the ultrasound Doppler velocities to CFD velocities in the flow convergence region, and scaled CFD flow rate with this ratio as the final measured flow rate. We evaluated Ub-CFD, 2-D PISA and 3-D PISA with an in vitro flow loop, which featured regurgitation flow through (i) a simplified flat plate with round orifice and (ii) a 3-D printed realistic mitral valve and regurgitation orifice. The Ub-CFD and 3-D PISA methods had higher precision than the 2-D PISA method. Ub-CFD had consistent accuracy under all conditions tested, whereas 2-D PISA had the lowest overall accuracy. In vitro investigations indicated that the accuracy of 2-D and 3-D PISA depended significantly on the choice of aliasing velocity. Evaluation of these techniques was also performed for two clinical cases, and the dependency of PISA on aliasing velocity was similarly observed. Ub-CFD was robustly accurate and precise and has promise for future translation to clinical practice. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  1. Severe Hypoplasia of Posterior Mitral Valve Leaflet Presented with Atypical Chest Pain: A Case Report

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    Afsoon Fazlinezhad

    2016-02-01

    Full Text Available Introduction Absence of the posterior mitral leaflet is usually fatal for fetus in utero. Although hypoplasia of the posterior mitral leaflet is usually present in children with symptomatic mitral regurgitation, it is usually evident in a few cases of asymptomatic adults. We decided to introduce a rare case with hypoplasia of the posterior mitral valve leaflet associated with aortic stenosis. Case Presentation A 24-year-old man was admitted with a history of atypical chest pain. The patient had a normal psychophysical growth. The physical examination showed 4/6 mid- systolic ejection murmurs over the left sternal border. Chest roentgenogram was normal and the electrocardiogram showed sinus rhythm with mild LVH. Meanwhile, the echocardiography revealed severe elongated sail- like anterior leaflet and hypoplasia of the posterior mitral leaflet with moderate valvular aortic stenosis. MR grade was mild due to the complete coverage of anterior mitral leaflet. Moreover, LV function and pulmonary arterial pressure were reported normal. Conclusions This abnormality was tolerated since adulthood and mitral regurgitation was gradually developed due to annulus dilation. Therefore, the posterior mitral leaflet did not have a significant impact on mitral valve performance.

  2. Chronic ischemic mitral regurgitation and papillary muscle infarction detected by late gadolinium-enhanced cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Bouma, Wobbe; Willemsen, Hendrik M; Lexis, Chris P H; Prakken, Niek H; Lipsic, Erik; van Veldhuisen, Dirk J; Mariani, Massimo A; van der Harst, Pim; van der Horst, Iwan C C

    2016-12-01

    Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction. The influence of PMI on CIMR and factors influencing both entities are incompletely understood. We sought to determine the influence of PMI on CIMR after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and to define independent predictors of PMI and CIMR. Between January 2011 and May 2013, 263 patients (mean age 57.8 ± 11.5 years) underwent late gadolinium-enhanced cardiac magnetic resonance imaging and transthoracic echocardiography 4 months after PCI for STEMI. Infarct size, PMI, and mitral valve and left ventricular geometric and functional parameters were assessed. Univariate and multivariate analyses were performed to identify predictors of PMI and CIMR (≥grade 2+). PMI was present in 61 patients (23 %) and CIMR was present in 86 patients (33 %). In patients with PMI, 52 % had CIMR, and in patients without PMI, 27 % had CIMR (P < 0.001). In multivariate analyses, infarct size [odds ratio (OR) 1.09 (95 % confidence interval 1.04-1.13), P < 0.001], inferior MI [OR 4.64 (1.04-20.62), P = 0.044], and circumflex infarct-related artery [OR 8.21 (3.80-17.74), P < 0.001] were independent predictors of PMI. Age [OR 1.08 (1.04-1.11), P < 0.001], infarct size [OR 1.09 (1.03-1.16), P = 0.003], tethering height [OR 19.30 (3.28-113.61), P = 0.001], and interpapillary muscle distance [OR 3.32 (1.31-8.42), P = 0.011] were independent predictors of CIMR. The risk of PMI is mainly associated with inferior infarction and infarction in the circumflex coronary artery. Although the prevalence of CIMR is almost doubled in the presence of PMI, PMI is not an independent predictor of CIMR. Tethering height and interpapillary muscle distance are the strongest independent predictors of CIMR.

  3. 3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information.

    Science.gov (United States)

    Dietl, Alexander; Prieschenk, Christine; Eckert, Franziska; Birner, Christoph; Luchner, Andreas; Maier, Lars S; Buchner, Stefan

    2018-01-09

    Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D-colour-Doppler datasets were available before, during and 4 weeks after PMVR. Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9% NYHA III/IV) and severe degenerative (34%) or functional (66%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm2 vs. 0.22 ± 0.15 cm2, p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR. VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients' physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.

  4. Mitral valve repair versus replacement

    Science.gov (United States)

    Keshavamurthy, Suresh; Gillinov, A. Marc

    2015-01-01

    Degenerative, ischemic, rheumatic and infectious (endocarditis) processes are responsible for mitral valve disease in adults. Mitral valve repair has been widely regarded as the optimal surgical procedure to treat mitral valve dysfunction of all etiologies. The supporting evidence for repair over replacement is strongest in degenerative mitral regurgitation. The aim of the present review is to summarize the data in each category of mitral insufficiency and to provide recommendations based upon this data. PMID:26309824

  5. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction.

    Science.gov (United States)

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Jeong, Myung Ho; Cho, Jae Yeong; Ahn, Youngkeun; Kim, Kye Hun; Park, Jong Chun; Seung, Ki Bae; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Han, Kyoo Rok; Kim, Hyo Soo

    2015-07-01

    The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

  6. Assessment of proximal isovelocity surface area (PISA) shape using three-dimensional echocardiography in a paediatric population with mitral regurgitation or ventricular shunt.

    Science.gov (United States)

    Ziani, Abdelkader Boutaleb; Latcu, Decebal Gabriel; Abadir, Sylvia; Paranon, Soizic; Dulac, Yves; Guerrero, Felipe; Acar, Philippe

    2009-03-01

    The proximal isovelocity surface area (PISA) method is validated to quantify mitral regurgitation (MR) and ventricular shunt (VS). However, the two-dimensional echocardiography (2DE) PISA method assumes a hemispherical distribution of velocity factors proximal to the MR or VS orifice. To assess the PISA shape by three-dimensional echocardiography (3DE) in a paediatric population with MR or VS. According to the true PISA shape, we suggest different models to calculate the MR or VS volume by the 3DE PISA method. Thirty-one paediatric patients (aged 1month to 20years, median 69months) were included: 17 had MR and 14 had VS. The orifice area and volume of MR and VS were evaluated by 2DE. 3DE acquired the entire PISA volume at orifice level. The PISA shape was estimated according to three diameters as being hemispherical, prolate hemispheroid, oblate hemispheroid and hemiellipsoid. Data from 28patients were analysed. The PISA shape was variable: hemispherical, 11%; prolate hemispheroid, 43%; oblate hemispheroid, 32%; hemiellipsoid, 14%. Oblate hemispheroids occurred more frequently in the MR group (47%), whereas prolate hemispheroids occurred more frequently in the VS group (62%); hemispheres were scarce in both groups (10%). The mean MR or VS orifices and volumes measured by 2DE and 3DE were significantly different (0.123cm(2) versus 0.094cm(2) and 13.2mL versus 10.1mL, respectively; p=0.019). 3DE describes the true surface of the PISA shape. In a paediatric population with MR or VS, the PISA is rarely hemispherical but is more often prolate or oblate hemispheroid.

  7. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction

    Science.gov (United States)

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Cho, Jae Yeong; Ahn, Youngkeun; Kim, Kye Hun; Park, Jong Chun; Seung, Ki Bae; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Han, Kyoo Rok; Kim, Hyo Soo

    2015-01-01

    The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR. PMID:26130953

  8. Quantification of chronic functional mitral regurgitation by automated 3-dimensional peak and integrated proximal isovelocity surface area and stroke volume techniques using real-time 3-dimensional volume color Doppler echocardiography: in vitro and clinical validation.

    Science.gov (United States)

    Thavendiranathan, Paaladinesh; Liu, Shizhen; Datta, Saurabh; Rajagopalan, Sanjay; Ryan, Thomas; Igo, Stephen R; Jackson, Matthew S; Little, Stephen H; De Michelis, Nathalie; Vannan, Mani A

    2013-01-01

    The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography. Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm(2)) was underestimated to a greater degree by the 2D (0.12±0.05 cm(2)) than the 3D method (0.25±0.10 cm(2); PPISA (20±19 mL) was underestimated (PPISA-based (38±14 mL) RVol were comparable (P>0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol r=0.84 and regurgitant fraction r=0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL; P=0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL; Pechocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL; P=0.33). Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity.

  9. Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic Echocardiography in Quantifying Mitral Regurgitation: A Comparison with Conventional Two-Dimensional Methods.

    Science.gov (United States)

    Heo, Ran; Son, Jang-Won; Ó Hartaigh, Briain; Chang, Hyuk-Jae; Kim, Young-Jin; Datta, Saurabh; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Ha, Jong-Won; Chung, Namsik

    2017-04-01

    Automatic quantification of real-time three-dimensional (3D) full-volume color Doppler transthoracic echocardiography (FVCD) has been proposed as a feasible and accurate method for quantifying MR. We aimed to explore the clinical implications of real-time 3D-FVCD for mitral regurgitation (MR) with various clinical manifestations, in comparison with the conventional two-dimensional (2D) proximal isovelocity surface area (PISA) and volumetric method and cardiac magnetic resonance imaging (CMR) methods. A total 186 patients with MR were enrolled prospectively. Based on exclusion criteria and image quality review, 152 patients were included in the final analysis for 3D-FVCD and 2D transthoracic echocardiography. Among them, 37 patients underwent subsequent CMR for the validation of 3D-FVCD. MR volume from 3D-FVCD demonstrated a better agreement (r = 0.94) with CMR than 2D-PISA or the 2D volumetric method (VM; r = 0.87 vs 0.56). Overall, 2D methods underestimated MR when compared with 3D-FVCD (35.4 ± 28.4 mL for 2D-VM vs 43.8 ± 24.6 mL for 2D-PISA vs 64.6 ± 35.1 mL for 3D-FVCD; P 30 mL for primary MR and >15 mL for secondary MR) between 2D-PISA and 3D-FVCD. In identifying surgical candidates, patients with multijet MR (OR, 4.53, 95% CI, 1.99-10.35) demonstrated a higher risk of discrepancy between 2D-PISA and 3D-FVCD, which were consistent in both primary and secondary MR, respectively. MR quantification with 3D-FVCD showed better correlation and agreement than conventional 2D methods. MR was underestimated by 2D methods, especially in multijet and dilated left ventricle. Multijet MR demonstrated higher risk of discrepancy for the identification of surgical candidate, regardless of MR etiology. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  10. Decreases in left atrial compliance during early-stage exercise are related to exercise intolerance in asymptomatic significant mitral stenosis.

    Science.gov (United States)

    Jung, Mi-Hyang; Jung, Hae Ok; Lee, Jung-Won; Youn, Ho-Joong

    2017-11-01

    Doppler-driven net atrioventricular compliance (C n ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). We hypothesized that decreases in C n during early-stage exercise underlie exercise intolerance in patients with MS. Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm 2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative C n decrease at 50 W (expressed as a percentage of the resting C n ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. Decreases in C n during early-stage exercise are an important mechanism underlying exercise intolerance in MS. © 2017, Wiley Periodicals, Inc.

  11. Hammock mitral valve: A rare case report

    Directory of Open Access Journals (Sweden)

    Veeresh F. Manvi

    2014-01-01

    Full Text Available Congenital mitral stenosis is a relatively rare disorder comprising 0.2% of all congenital heart defects. Hammock mitral valve producing severe mitral stenosis is a rare variant of congenital mitral stenosis. We report a 2-year-old boy who had hammock mitral valve producing severe mitral stenosis with severe pulmonary artery hypertension. He underwent successful surgical repair. Post-surgery, the mitral valve opening was adequate without residual stenosis or regurgitation. Pulmonary artery pressure had normalized. Follow-up data showed he had significant clinical and echocardiography improvement. This is the first reported case of successful surgical repair done for hammock mitral valve from our institute.

  12. Mitral Valve Disease: a Comprehensive Review.

    Science.gov (United States)

    Harb, Serge C; Griffin, Brian P

    2017-08-01

    This review aims to provide a comprehensive assessment of mitral valve disease, both mitral stenosis and mitral regurgitation, starting with an overview of the valve anatomy. The advent of three-dimensional imaging has allowed a better representation of the valve anatomy. Rheumatic disease is still the number one cause of mitral stenosis worldwide and percutaneous balloon mitral valvuloplasty remains the therapy of choice when indicated and in anatomically eligible patients. Mitral regurgitation (MR) is classified as primary (i.e., lesion in the mitral apparatus) or secondary (caused by left ventricular geometrical alterations). While surgery, preferably repair, is still the recommended therapy for severe primary MR, percutaneous approaches to repair and/or replace the mitral valve are being extensively investigated. Mitral valve disease is common. A careful understanding of mitral valve anatomy and the disease processes that affect the valve are crucial for providing optimal patient care.

  13. Spectrum of congenital mitral valve abnormalities associated with solitary undifferentiated papillary muscle in adults

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    Jagdish C. Mohan

    2016-09-01

    Conclusion: In adult patients, a high index of suspicion is required to detect congenital mitral stenosis/regurgitation with large solitary PM (resembling a parachute mitral valve which may masquerade as hypertrophic cardiomyopathy or rheumatic mitral valve disease.

  14. Automated quantification of mitral regurgitation by three dimensional real time full volume color Doppler transthoracic echocardiography: a validation with cardiac magnetic resonance imaging and comparison with two dimensional quantitative methods.

    Science.gov (United States)

    Son, Jang-Won; Chang, Hyuk-Jae; Lee, Jin-Kyung; Chung, Hee-Jung; Song, Ran-Young; Kim, Young-Jin; Datta, Saurabh; Heo, Ran; Shin, Sang-Hoon; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Chung, Namsik

    2013-06-01

    Accurate assessment of mitral regurgitation (MR) severity is crucial for clinical decision-making and optimizing patient outcomes. Recent advances in real-time three dimensional (3D) echocardiography provide the option of real-time full volume color Doppler echocardiography (FVCD) measurements. This makes it practical to quantify MR by subtracting aortic stroke volume from the volume of mitral inflow in an automated manner. Thirty-two patients with more than a moderate degree of MR assessed by transthoracic echocardiography (TTE) were consecutively enrolled during this study. MR volume was measured by 1) two dimensional (2D) Doppler TTE, using the proximal isovelocity surface area (PISA) and the volumetric quantification methods (VM). Then, 2) real time 3D-FVCD was subsequently obtained, and dedicated software was used to quantify the MR volume. MR volume was also measured using 3) phase contrast cardiac magnetic resonance imaging (PC-CMR). In each patient, all these measurements were obtained within the same day. Automated MR quantification was feasible in 30 of 32 patients. The mean regurgitant volume quantified by 2D-PISA, 2D-VM, 3D-FVCD, and PC-CMR was 72.1 ± 27.7, 79.9 ± 36.9, 69.9 ± 31.5, and 64.2 ± 30.7 mL, respectively (p = 0.304). There was an excellent correlation between the MR volume measured by PC-CMR and 3D-FVCD (r = 0.85, 95% CI 0.70-0.93, p PISA or 2D-VM (60.0 and 62.8 mL, respectively). Automated quantification of MR with 3D-FVCD is feasible and accurate. It is a promising tool for the real-time 3D echocardiographic assessment of patients with MR.

  15. Quantificação de insuficiência protética mitral por diferentes métodos de avaliação pela ecocardiografia transesofágica Quantification of mitral prosthesis regurgitation by transesophageal echocardiography. Evaluation of different methods

    Directory of Open Access Journals (Sweden)

    Cláudio Henrique Fischer

    1998-12-01

    Full Text Available OBJETIVO: Avaliar os diferentes métodos de quantificação de insuficiência mitral (IM ao ecocardiograma transesofágico (ETE em pacientes com suspeita clínica de disfunção de prótese mitral. MÉTODOS: Foram estudados 15 pacientes, divididos em dois grupos, conforme a presença ou não de IM expressiva (grau importante ao cateterismo cardíaco (Cate. A IM foi quantificada ao ETE pelos seguintes métodos, habitualmente empregados para IM de valvas nativas: avaliação subjetiva do jato regurgitante ao mapeamento de fluxo a cores, avaliação objetiva com base na área absoluta do jato regurgitante e na sua área relativa (área do jato/área do átrio esquerdo (AE, e avaliação baseada na presença de fluxo sistólico reverso em veia pulmonar. RESULTADOS: A IM foi predominantemente de origem transprotética (14 pacientes e de distribuição excêntrica (11 pacientes. Observou-se concordância estatisticamente significante (p7cm² e relativa (área de jato >35% da área do AE não mostraram concordância significante com o Cate, com nítida subestimação ao ETE pela área relativa. Houve, porém, concordância significante, quando considerado como IM expressiva, jato cuja área relativa foi >30% da área do AE. CONCLUSÃO: O ETE identificou adequadamente as IM protéticas angiograficamente expressivas, particularmente pelos métodos subjetivo e de fluxo sistólico reverso em veia pulmonar. É necessário cautela na utilização de critérios baseados na área do jato regurgitante, em virtude da subestimação da área na presença de jato excêntrico, freqüente em disfunção de prótese mitral.PURPOSE: To evaluate the different methods for grading mitral regurgitation (MR by transesophageal echocardiography (TEE in patients with clinical suspicion of mitral prosthesis dysfunction. METHODS: Cardiac catheterization (Cath was performed in 15 patients for grading the severity of prosthetic MR, divided in two groups based on the presence or

  16. Case Report: Giant Right Atrium in Rheumatic Mitral Disease

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    Deniz Demir

    2014-06-01

    Full Text Available Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. Dilatation of the atriums which occurs slowly in time, becomes evident with ritim disturbances and embolic events. We report a case of an unusual giant right atrium in context of rheumatic mitral stenosis, mitral regurgitation, pulmonar hypertansion and severe tricuspid regurgitation in a 40-year-old man who underwent succesfull operations as mitral valve replacement, Maze-IV radiofrequency ablation, right atrium atrioplasty and De Vega anuloplasty. [J Contemp Med 2014; 4(2.000: 98-102

  17. Evaluation of plasma and urinary levels of 6-keto-prostaglandin F1a as a marker for asymptomatic myxomatous mitral valve disease in dogs

    DEFF Research Database (Denmark)

    Rasmussen, Caroline Elisabeth; Sundqvist, Anna Vilhelmina; Kjempff, Christina Tirsdal

    2010-01-01

    Endothelial dysfunction might be involved in the pathogenesis of myxomatous mitral valve disease (MMVD). The aims of this study were (1) to validate an enzyme immunoassay (EIA) for canine 6-keto-prostaglandin (PG)F(1alpha) (prostacyclin metabolite and marker for endothelial function) and (2......) to compare plasma and urinary 6-keto-PGF(1alpha) in dogs with asymptomatic MMVD. The study included two breeds predisposed to MMVD and two control groups (Cairn terriers and dogs of different breeds). Echocardiography was used to estimate the severity of MMVD. The intra- and inter-assay coefficients...... of variation were between 3.1% and 24.5% in the assay range. No echocardiographic parameter was correlated with plasma or urinary 6-keto-PGF(1alpha) (P>0.05), but all control dogs had lower urinary 6-keto-PGF(1alpha) (Pketo-PGF(1alpha) (P

  18. The risk of worsening CHF is positively related to unitary increase in mitral regurgitation size: a case-cohort study derived from a II NYHA class CHF patient population.

    Science.gov (United States)

    De Vecchis, R; Cioppa, C; Giasi, A; Pucciarelli, A; Ariano, C; Pucciarelli, G; Cantatrione, S

    2010-06-01

    The passage from II to III New York Heart Association (NYHA) class is indicative of cardiopulmonary impairment and unfavourable prognosis. Among chronic heart failure(CHF) II NYHA class patients, the topic has been debated what criteria have be assumed for identifying the patients prone to accelerated progression towards III NYHA class. A case cohort study, including a number of CHF II NYHA class patients, was carried out, to evaluate the role as predictor of CHF worsening of some ultrasonographic parameters, listed as follows: left ventricular ejection fraction, as continuous and as a dichotomous variable, i.e. subdivided as follows: 1) LVEF larger than 40% and 2) LVEF ranged from 30% to 40%; mitral regurgitation (MR), as continuous and as a dichotomic variable (i.e. moderate-to-severe MR, defined by transmitralic jet planimetric area estimated as larger than 20% of left atrium area), restrictive LV filling pattern and pulmonary systolic arterial pressure >40 mmHg. The pts were subdivided in 3 categories, as follows:1) diastolic CHF, i.e. heart failure with normal or only mildly impaired left ventricular ejection fraction - 20 patients; 2) systolic CHF, i.e. heart failure with reduced left ventricular ejection fraction - 19 patients; and 3) CHF due to "organic" mitral insufficiency-19 patients. All patients were treated with pharmacologic therapy, according to their respective clinical features and typology of basal heart disease. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for the composite endpoint death and hospitalization due to worsening CHF were investigated, concerning each of the above-mentioned criteria. Moreover, the odds ratios (OR) were calculated, by not conditional logistic regression analysis, to achieve information about risk of death and/or worsening CHF, as well as the respective profiles of risk, assessed by relative risk (RR). From 173 followed-up patients, 58 patients,70+/-12 aged, whose 15

  19. The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population.

    Science.gov (United States)

    Chen, Chi; Chen, Yung-Tzi; Wang, Kuang-Te; Shih, Shou-Chuan; Liu, Chuan-Chuan; Kuo, Jen-Yuan; Hou, Charles Jia-Yin; Wu, Yih-Jer; Hung, Chung-Lieh; Yeh, Hung-I

    2015-09-01

    Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evaluation cohort (2004-2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EF slope (mm/s) and serum NT-proBNP level were obtained. The association between EF slope and the other clinical or echo-based parameters was investigated. Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: - 0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multivariate models (all p cardiac concentricity, abnormal E' and E/E' (AUROC: 0.74 and 0.77, respectively, both p parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E' and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.

  20. Midregional-proAtrial Natriuretic Peptide and High Sensitive Troponin T Strongly Predict Adverse Outcome in Patients Undergoing Percutaneous Repair of Mitral Valve Regurgitation.

    Directory of Open Access Journals (Sweden)

    Jochen Wöhrle

    Full Text Available It is not known whether biomarkers of hemodynamic stress, myocardial necrosis, and renal function might predict adverse outcome in patients undergoing percutaneous repair of severe mitral valve insufficiency. Thus, we aimed to assess the predictive value of various established and emerging biomarkers for major adverse cardiovascular events (MACE in these patients.Thirty-four patients with symptomatic severe mitral valve insufficiency with a mean STS-Score for mortality of 12.6% and a mean logistic EuroSCORE of 19.7% undergoing MitraClip therapy were prospectively included in this study. Plasma concentrations of mid regional-proatrial natriuretic peptide (MR-proANP, Cystatin C, high-sensitive C-reactive protein (hsCRP, high-sensitive troponin T (hsTnT, N-terminal B-type natriuretic peptide (NT-proBNP, galectin-3, and soluble ST-2 (interleukin 1 receptor-like 1 were measured directly before procedure. MACE was defined as cardiovascular death and hospitalization for heart failure (HF.During a median follow-up of 211 days (interquartile range 133 to 333 days, 9 patients (26.5% experienced MACE (death: 7 patients, rehospitalization for HF: 2 patients. Thirty day MACE-rate was 5.9% (death: 2 patients, no rehospitalization for HF. Baseline concentrations of hsTnT (Median 92.6 vs 25.2 ng/L, NT-proBNP (Median 11251 vs 1974 pg/mL and MR-proANP (Median 755.6 vs 318.3 pmol/L, all p<0.001 were clearly higher in those experiencing an event vs event-free patients, while other clinical variables including STS-Score and logistic EuroSCORE did not differ significantly. In Kaplan-Meier analyses, NT-proBNP and in particular hsTnT and MR-proANP above the median discriminated between those experiencing an event vs event-free patients. This was further corroborated by C-statistics where areas under the ROC curve for prediction of MACE using the respective median values were 0.960 for MR-proANP, 0.907 for NT-proBNP, and 0.822 for hsTnT.MR-proANP and hsTnT strongly

  1. Myocardial infarction with acute valvular regurgitation.

    Science.gov (United States)

    Murthy, Sandhya; Greenberg, Mark; Wharton, Ronald

    2012-08-01

    Left-sided valvular lesions are commonly associated with acute and chronic coronary syndromes. Ischemic mitral regurgitation is well described in the literature. We report a case of acute ischemic right-sided valvular disease in which the presenting symptom of an infarction was severe tricuspid regurgitation. This rare entity is usually caused by distortion of the valve apparatus due to underlying wall motion abnormalities. In conclusion, tricuspid regurgitation is an important yet uncommon presentation of acute ischemia that requires a high degree of suspicion for diagnosis.

  2. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function

    DEFF Research Database (Denmark)

    Amigoni, Maria; Meris, Alessandra; Thune, Jens Jakob

    2007-01-01

    post-MI month were substantially more likely to die or develop HF (adjusted HR per increased MR grade 3.0, 95% CI 1.8-4.9). Progression of MR over 20 months in survivors was associated with increased hospitalizations for HF (P ... baseline MR and progression of MR and cardiovascular (CV) outcomes. METHODS AND RESULTS: We studied 496 patients with heart failure (HF) and/or systolic dysfunction after MI who underwent echocardiography at a median of 5 days after MI. MR severity, quantified as the regurgitant jet area/left atrial area......-severe MR was an independent predictor of total mortality [adjusted hazard ratio (HR) 2.4 (1.1-5.3)], CV mortality [adjusted HR 2.7 (1.2-6.1)], hospitalization for HF [adjusted HR 2.5 (1.1-5.5)], or death or HF hospitalization [adjusted HR 2.5 (1.4-4.6)]. Patients with progression of MR during the first...

  3. Exercise Testing and Stress Imaging in Mitral Valve Disease.

    Science.gov (United States)

    Voilliot, Damien; Lancellotti, Patrizio

    2017-03-01

    Mitral valve disease represented by mitral stenosis and mitral regurgitation is the second most frequent valvulopathy. Mitral stenosis leads to an increased left atrial pressure whereas mitral regurgitation leads to an increased left atrial pressure associated with a volume overload. Secondary to an upstream transmission of this overpressure, both mitral stenosis and regurgitation lead to pulmonary hypertension and right heart failure. In addition, mitral regurgitation also leads to left ventricular dilatation and dysfunction with left heart failure. Depending on the anatomy of the valvular and subvalvular apparatus, valve repair (percutaneous mitral commissurotomy for mitral stenosis and valvuloplasty for mitral regurgitation) might be possible. If the anatomy is not favorable, valve replacement by mechanical or biological prosthesis is indicated. Most of the intervention indications are based on clinical symptoms and resting transthoracic echocardiography. Outcomes of patients operated based upon resting echo abnormalities might however not be optimal. Therefore early intervention might be beneficial based upon abnormal exercise testing, which has been demonstrated to more sensitive to identify high-risk patients. In this last decade, especially exercise echocardiography has been found to be a crucial tool in the management of patients with mitral valve disease.

  4. Balloon valvuloplasty for severe mitral valve stenosis in pregnancy ...

    African Journals Online (AJOL)

    Balloon valvuloplasties for severe mitral stenosis were performed on 11 pregnant patients with excellent resutts and no complications. The mitral valve area was increased from a mean of 0.9 cnr to 2.1 cnr. There was no clinically significant mitral regurgitation. The pregnancies proceeded normally to delivery at or near tenn, ...

  5. Transcatheter mitral valve implantation via transapical approach

    DEFF Research Database (Denmark)

    Sondergaard, Lars; Brooks, Matthew; Ihlemann, Nikolaj

    2015-01-01

    OBJECTIVES: As many as 50% of patients with severe symptomatic mitral valve regurgitation are denied surgical valve replacement or repair due to high operative risk. We describe an early series of cases of transcatheter implantation with a CardiAQ™ mitral valve via a transapical approach. METHODS...

  6. Promising results after percutaneous mitral valve repair

    DEFF Research Database (Denmark)

    Ihlemann, Nikolaj; Franzen, Olaf; Jørgensen, Erik

    2011-01-01

    Mitral valve regurgitation (MR) is the secondmost frequent valve disease in Europe. Untreated MR causes considerable morbidity and mortality. In the elderly, as many as half of these patients are denied surgery because of an estimated high surgical risk. Percutaneous mitral valve repair...... with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets....

  7. Immediate and 12-Month Outcomes of Ischemic Versus Nonischemic Functional Mitral Regurgitation in Patients Treated With MitraClip (from the 2011 to 2012 Pilot Sentinel Registry of Percutaneous Edge-To-Edge Mitral Valve Repair of the European Society of Cardiology).

    Science.gov (United States)

    Pighi, Michele; Estevez-Loureiro, Rodrigo; Maisano, Francesco; Ussia, Gian P; Dall'Ara, Gianni; Franzen, Olaf; Laroche, Cécile; Settergren, Magnus; Winter, Reidar; Nickenig, Georg; Gilard, Martine; Di Mario, Carlo

    2017-02-15

    In literature, there are limited data comparing ischemic mitral regurgitation (I-MR) versus nonischemic MR regarding outcomes after percutaneous "edge-to-edge" repair. We aimed to describe the early and 12-month results after MitraClip device implantation regarding the 2 etiologies. From January 2011 to December 2012, the Transcatheter Valve Treatment Sentinel Pilot Registry included 452 patients with MR who underwent MitraClip procedure in 25 centers across Europe. The prevalent etiology was I-MR (235 patients, 52.0%). I-MR group had a significantly higher proportion of men (74.9 vs 59.9%, p logistic EuroSCORE 24.8 ± 18.2 vs 18.8 ± 16.3, p reverse atrial remodeling after clip, there were no significant changes in left ventricular volumes. In conclusion, this large independent cohort showed that percutaneous "edge-to-edge" therapy was associated with early- and long-term improvement of MR severity and functional condition both in patients with I-MR and nonischemic MR. There were no significant differences between the 2 etiologies regarding survival and freedom from rehospitalization due to heart failure at the 1-year follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Timing of Dynamic NT-proBNP and hs-cTnT Response to Exercise Challenge in Asymptomatic Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis.

    Science.gov (United States)

    Mawad, Wadi; Abadir, Sylvia; Fournier, Anne; Bigras, Jean-Luc; Curnier, Daniel; Kadem, Lyes; Dahdah, Nagib

    2015-12-01

    Patients with congenital aortic valve stenosis (AVS) can remain asymptomatic but may develop progressive and often underestimated exercise intolerance. The risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated patients warrants earlier intervention. The timing for curative therapy for severe AVS is clear, but optimal timing for moderate stenosis (modAS) is unknown. AVS often coexists with aortic regurgitation, which adds a volume overload to an already pressure-overloaded LV, adding an additional challenge to the estimation of disease severity. We investigated the possible value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) upon treadmill exercise challenge in children with asymptomatic modAS versus moderate regurgitation (modAR). The aim was to determine optimal timing of peak biochemical response. Blood samples were obtained at rest, and then at 20, 40 and 60 min after peak exercise comparing modAS and modAR to healthy controls. Exercise performance was equivalent in all groups, with no difference for biomarker levels at rest. The increase in NT-proBNP was significant in modAR at 40 min (99.2 ± 48.6 ng/L; p = 0.04) and 60 min into recovery (100.0 ± 53.7 ng/L; p = 0.01), but not in modAS. The increase in hs-cTnT was significant only at 60 min into recovery for modAS and modAR. NT-proBNP and hs-cTnT following exercise challenge are possible discriminant biomarkers of modAR from modAS and controls at 60 min into recovery despite comparable exercise performance. This offers a promising avenue for future stratification of aortic valve disease and optimal timing of intervention.

  9. Management of acute regurgitation in left-sided cardiac valves.

    Science.gov (United States)

    Mokadam, Nahush A; Stout, Karen K; Verrier, Edward D

    2011-01-01

    The management of acute, severe cardiac valvular regurgitation requires expeditious multidisciplinary care. Although acute, severe valvular regurgitation can be a true surgical emergency, accurate diagnosis and subsequent treatment decisions require clinical acumen, appropriate imaging, and sound judgment. An accurate and timely diagnosis is essential for successful outcomes and requires appropriate expertise and a sufficiently high degree of suspicion in a variety of settings. Whereas cardiovascular collapse is the most obvious and common presentation of acute cardiac valvular regurgitation, findings may be subtle, and the clinical presentation can often be nonspecific. Consequently, other acute conditions such as sepsis, pneumonia, or nonvalvular heart failure may be mistaken for acute valvular regurgitation. In comparison with that of the right-sided valves, regurgitation of the left-sided valves is more common and has greater clinical impact. Therefore, this review focuses on acute regurgitation of the aortic and mitral valves.

  10. Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

    Science.gov (United States)

    Goldstone, Andrew B; Woo, Y Joseph

    2016-11-01

    The treatment of mitral valve disease remains dynamic; surgeons and patients must now choose between many different surgical options when addressing mitral regurgitation and mitral stenosis. Notably, advances in imaging and surgical instrumentation allow surgeons to perform less invasive mitral valve surgery that spares the sternum. With favorable long-term data now emerging, we compare the benefits and risks of thoracoscopic mitral valve surgery with that through conventional sternotomy or surgery that is robot-assisted.

  11. Anomalous pulmonary venous drainage associated with mitral valve disease

    NARCIS (Netherlands)

    Bruschke, A.V.G.; Bloch, Antoine

    1969-01-01

    Four cases of mitral stenosis associated with anomalous pulmonary venous return are described. In two of these cases there was severe mitral regurgitation as well. A pulmonary arteriovenous shunt was also found in one of these. A review of the records of patients admitted for cardiac

  12. Percutaneous Mitral Valve Technology: What Is on the Horizon?

    Science.gov (United States)

    Pant, Sadip; Grubb, Kendra J

    2017-11-27

    Mitral valve disease is common, with mitral regurgitation (MR) being the most frequent pathology. The etiology of MR is diverse, but, if left untreated, MR results in left ventricular (LV) volume overload, leading to remodeling, dilation of the LV, pulmonary hypertension, heart failure, and death. Mitral regurgitation is a high-risk diagnosis, yet a minority of symptomatic patients are referred for discussion of surgical treatment options. Percutaneous repair options are under development to address this clinical need and emphasize correction of the underlying anatomical pathology to restore mitral valve coaptation. Transcatheter mitral valve replacement is in the early stages of development and may prove safe and effective in certain patient populations. Investigational devices are challenging our current thinking about the management of mitral valve disease, and it will be the task of the multidisciplinary Heart Team to determine the right device for the right pathology. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Rupture of mitral valve chordae in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Boissier, Florence; Achkouty, Guy; Bruneval, Patrick; Fabiani, Jean-Noël; Nguyen, Anh Tuan; Riant, Elisabeth; Desnos, Michel; Hagège, Albert

    2015-04-01

    While occasional reports of mitral valve chordal rupture have been described in hypertrophic cardiomyopathy, the exact prevalence and characteristics of this event in a large medical cohort have not been reported. To assess the prevalence of mitral valve chordal rupture in hypertrophic cardiomyopathy and the clinical, echocardiographic, surgical and histological profiles of those patients. We searched for patients with mitral valve chordal rupture diagnosed by echocardiography among all electronic files of patients admitted to our centre for hypertrophic cardiomyopathy between 2000 and 2010. Among 580 patients admitted for hypertrophic cardiomyopathy, six patients (1%, 5 men, age 68-71 years) presented with mitral valve chordal rupture, symptomatic in five cases, always involving the posterior mitral leaflet. In all cases, echocardiography before rupture showed mitral valve systolic anterior motion, with anterior (and not posterior) leaflet elongation compared with a random sample of patients with non-obstructive hypertrophic cardiomyopathy (P=0.006) (and similar to that observed in obstructive hypertrophic cardiomyopathy). Significant resting left ventricular outflow tract obstruction was always present before rupture and disappeared after rupture in the five cases requiring mitral valve surgery for severe mitral regurgitation. Histological findings were consistent with extensive myxomatous degeneration in all cases. Mitral valve chordal rupture is: infrequent in hypertrophic cardiomyopathy; occurs in aged patients with obstructive disease; involves, essentially, the posterior mitral leaflet; and causes, in general, severe mitral regurgitation requiring surgery. Myxomatous degeneration may be the substrate for rupture in these patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Valve reconstruction for congenital mitral valve disease.

    Science.gov (United States)

    Quinonez, Luis G; Del Nido, Pedro J

    2015-01-01

    The surgical treatment of mitral valve disease in children is a challenging problem. Mitral stenosis and regurgitation may occur in isolation or together. Mitral valve repair is almost always preferable to replacement. Mitral valve replacement is not an ideal alternative to repair due to limitations of size, growth, structural valve degeneration, anticoagulation and poor survival. Surgical repair of congenital mitral stenosis must address the multiple levels of obstruction, including resection of the supramitral ring, thinning of leaflets and mobilization of the subvalvular apparatus. Sometimes leaflet augmentation is required. Repair of mitral regurgitation in children may involve simple cleft closures, edge-to-edge repairs, triangular resections and annuloplasties. Techniques used in adults, such as annuloplasty bands or artificial chords, may not be appropriate for children. Overall, an imperfect mitral valve repair may be more acceptable than the negative consequences of a replacement in a child. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Percutaneous transfemoral-transseptal implantation of a second-generation CardiAQ™ mitral valve bioprosthesis

    DEFF Research Database (Denmark)

    Ussia, Gian Paolo; Quadri, Arshad; Cammalleri, Valeria

    2016-01-01

    AIMS: Transcatheter mitral valve implantation for mitral valve regurgitation is in the very early phase of development because of challenging anatomy and device dimensions. We describe the procedure of a transfemoral-transseptal implantation of the second-generation CardiAQ mitral valve bioprosth....... CONCLUSIONS: This procedure shows that percutaneous transfemoral transcatheter mitral valve implantation is feasible, safe and successful. Further experience is needed to render this procedure clinically available....

  16. Mitral Valve Repair: The Chordae Tendineae

    Directory of Open Access Journals (Sweden)

    Carlos-A Mestres

    2015-10-01

    Full Text Available Repair of the mitral valve is the treatment of choice for mitral valve regurgitation when the anatomy is favorable. It is well known that mitral valve repair enjoys better clinical and functional results than any other type of valve substitute. This fact is beyond doubt regardless of the etiology of the valve lesion and is of particular importance in degenerative diseases.This review analyzes the most important advances in the knowledge of the anatomy, pathophysiology, and chordal function of the mitral valve as well as the different alternatives in the surgical repair and clinical results of the most prevalent diseases of the mitral valve. An attempt has been made to organize the acquired information available in a practical way.

  17. Preoperative assessment of mitral valve abnormalities in left atrial myxoma patients using cardiac CT

    Science.gov (United States)

    Chen, Jing; Yang, Zhi-Gang; Ma, En-Sen; Zhang, Qin; Liu, Xi; Guo, Ying-Kun

    2017-01-01

    Background To retrospectively evaluate mitral valve abnormality in left atrial myxoma patients by using cardiac computed tomography (CT). Material and methods Cardiac CT was performed in 56 patients with left atrial myxoma and 50 controls. Tumor and mitral valve characteristics were analyzed. The mitral valve parameters differences were compared between patients with myxoma and controls, myxoma with or without mitral valve obstruction, different obstruction degrees, respectively. Receiver operating characteristic analysis was performed to determine the cut-off values of abnormal mitral valve parameters for myxoma patients. Multiple linear regression, logistic regression models and cox regression analysis were used to determine factors associated with mitral valve abnormalities, mitral obstruction, mitral regurgitation and postoperative recovery, respectively. Results Myxoma induced the dilation of mitral valve, with different results among different degrees of obstruction (pmyxoma parameters. The cut-off values for discriminating mitral valve abnormalities in myxoma patients were found. Some significant predictors for mitral obstruction were tumor pedicle-tumor volume and patient age (HR, 0.886-30.811; p = 0.011-0.043). Moreover, the predictor for mitral regurgitation was mitral annulus diameter in diastolic phase (HR, 20.862; 95%CI,1.331-327.100; p = 0.031). Some predictors associated with postoperative recovery of mitral regurgitation were age, mitral annulus area, mitral annulus diameter and mitral valve diameter cutoff value for diastolic phase (HR, 0.001-119.160; p = 0.012-0.028). Conclusion Cardiac CT is capable of quantitatively assessing myxoma characteristic and mitral valve abnormality induced by myxoma, thus providing guidance of operative management and postoperative evaluation. PMID:28915697

  18. The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population

    Directory of Open Access Journals (Sweden)

    Chi Chen

    2015-09-01

    Conclusions: EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E′ and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.

  19. An isolated anterior mitral leaflet cleft: a case report

    Directory of Open Access Journals (Sweden)

    Boccardi Lidia

    2010-07-01

    Full Text Available Abstract Introduction The anterior mitral leaflet cleft is an unusual congenital lesion most often encountered in association with other congenital heart defects. The isolated anterior leaflet cleft is quite a rare anomaly and is usually cause of mitral valve regurgitation. The importance of the lesion is that it is often correctable. When feasible, cleft suture and, eventually, annuloplasty are preferable to valve replacement. Echocardiography is the first choice technique in the evaluation of mitral valve disease, providing useful information about valve anatomy and hemodynamic parameters. Case presentation We present a case of an isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation correctly identified by echocardiography and successfully surgically corrected. Conclusion Isolated cleft is a rare aberration, that has to be known in order to be diagnosed. Transthoracic and transesophageal echocardiography is the most useful non invasive technique for cleft diagnosis and to indicate the right surgical correction.

  20. Mitral Valve Repair: The French Correction Versus the American Correction.

    Science.gov (United States)

    Schubert, Sarah A; Mehaffey, James H; Charles, Eric J; Kron, Irving L

    2017-08-01

    Degenerative mitral valve disease causing mitral regurgitation is the most common organic valve pathology and is classified based on leaflet motion. The "French correction" mitral valve repair method restores normal valvular anatomy with extensive leaflet resection, chordal manipulation, and rigid annuloplasty. The American correction attempts to restore normal valve function through minimal leaflet resection, flexible annuloplasty, and use of artificial chordae. These differing methods of mitral valve repair reflect an evolution in principles, but both require understanding of the valve pathology and correction of leaflet prolapse and annular dilatation. Adhering to those unifying principles and ensuring that no patient leaves the operating room with significant persistent mitral regurgitation produces durable results and satisfactory patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Mitral valve disease--morphology and mechanisms.

    Science.gov (United States)

    Levine, Robert A; Hagége, Albert A; Judge, Daniel P; Padala, Muralidhar; Dal-Bianco, Jacob P; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H; Clusel, Catherine; Delling, Francesca N; Dietz, Harry C; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D; Jensen, Morten O; Jeunemaitre, Xavier P; Le Marec, Hervé; Le Tourneau, Thierry; Markwald, Roger R; Mérot, Jean; Messas, Emmanuel; Milan, David P; Neri, Tui; Norris, Russell A; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucéat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A; Song, Jae-Kwan; Yacoub, Magdi H

    2015-12-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but--even in adult life--remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular-ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease.

  2. Mitral valve disease—morphology and mechanisms

    Science.gov (United States)

    Levine, Robert A.; Hagége, Albert A.; Judge, Daniel P.; Padala, Muralidhar; Dal-Bianco, Jacob P.; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T.; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H.; Clusel, Catherine; Delling, Francesca N.; Dietz, Harry C.; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D.; Jensen, Morten O.; Jeunemaitre, Xavier P.; Le Marec, Hervé; Le Tourneau, Thierry; Markwald, Roger R.; Mérot, Jean; Messas, Emmanuel; Milan, David P.; Neri, Tui; Norris, Russell A.; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucéat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A.; Song, Jae-Kwan; Yacoub, Magdi H.

    2016-01-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but—even in adult life—remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular–ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease. PMID:26483167

  3. Percutaneous mitral valve edge-to-edge repair

    DEFF Research Database (Denmark)

    Nickenig, Georg; Estevez-Loureiro, Rodrigo; Franzen, Olaf

    2014-01-01

    a real-world overview of TMVR use in Europe. METHODS: The Transcatheter Valve Treatment Sentinel Pilot Registry is a prospective, independent, consecutive collection of individual patient data. RESULTS: A total of 628 patients (mean age 74.2 ± 9.7 years, 63.1% men) underwent TMVR between January 2011....... The estimated 1-year mortality was 15.3%, which was similar for FMR and degenerative mitral regurgitation. The estimated 1-year rate of rehospitalization because of heart failure was 22.8%, significantly higher in the FMR group (25.8% vs. 12.0%, p[log-rank] = 0.009). Paired echocardiographic data from the 1......-year follow-up, available for 368 consecutive patients in 15 centers, showed a persistent reduction in the degree of mitral regurgitation at 1 year (6.0% of patients with severe mitral regurgitation). CONCLUSIONS: This independent, contemporary registry shows that TMVR is associated with high immediate...

  4. Mitral stenosis (image)

    Science.gov (United States)

    Mitral stenosis is a heart valve disorder that narrows or obstructs the mitral valve opening. Narrowing of the mitral ... the body. The main risk factor for mitral stenosis is a history of rheumatic fever but it ...

  5. Emergency mitral valve replacement and cesarean section in parturients: Two case reports

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2016-01-01

    Full Text Available Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR after percutaneous transluminal mitral commissurotomy (PTMC due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

  6. Left-sided approach for mitral valve replacement in a case of dextrocardia with situs solitus.

    Science.gov (United States)

    Kikon, Mhonchan; Kazmi, Aamir; Gupta, Anubhav; Grover, Vijay

    2013-11-01

    Mitral valve surgery in dextrocardia is technically challenging due to its anatomical malposition. Minor modifications are required in the surgical technique to counteract the problems during cannulation and exposure of the mitral valve. We report a case of a patient with dextrocardia, situs solitus, rheumatic heart disease, severe mitral regurgitation, moderate pulmonary artery hypertension, and severe left ventricular dysfunction who underwent mitral valve replacement using a two-stage right atrial cannulation with left-sided left atrial atriotomy, with the surgeon standing on the left side of the patient. Our approach for mitral valve surgery in this clinical setting is simple.

  7. Aortic and Mitral Valve Disease and Left Ventricular Dysfunction in Children.

    Science.gov (United States)

    Maher, Kevin O; Tweddell, James S

    2016-08-01

    In this review, we will discuss aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis. We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. Age and lesion specific treatments are outlined based on the severity of valve disease with an aim at long-term preservation of left ventricular function. MEDLINE and PubMed. Mitral and aortic valve disease leads to unique hemodynamic burdens that can impact left ventricular function, quality of life, and longevity. The primary challenge in the management of mitral and aortic valve disease is to apply appropriate medical management and identify that point in time at which the surgery is necessary. Although guidelines have been established for the management of aortic and mitral valve disease in adults, the challenges of early presentation, maintenance of growth potential, and apparent increased tolerance of hemodynamic burden in children makes decision making challenging.

  8. Treatment of delayed rupture of the left ventricle after mitral valve replacement

    Directory of Open Access Journals (Sweden)

    Gomes Walter J.

    2002-01-01

    Full Text Available Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

  9. Phonocardiography-based mitral valve prolapse detection using an artificial neural network

    OpenAIRE

    Bogdanović, Vesna; Božić, Ivan; Gavrovska, Ana; Stojić, Vladislava; Jakovljević, Vladimir

    2013-01-01

    Mitral valve prolapse (MVP) is the most common valve anomaly and the most frequent cause of isolated mitral insufficiency. MVP has a mostly benign course and prognosis in childhood; however, complications, such as severe mitral regurgitation, infectious endocarditis, pulmonary embolism, arrhythmia and sudden death, occur more often in elderly people, demonstrating the need for prompt diagnostics and prevention. Due to its frequent occurrence, failures in diagnosing MVP and the clinical import...

  10. Mitral stenosis before, during and after pregnancy

    Directory of Open Access Journals (Sweden)

    JW Roos-Hesselink

    2007-07-01

    Full Text Available Mitral stenosis is the most common cardiac valvular problem in pregnant women with rheumatic heart disease being the most important cause. As a result of hemodynamic changes associated with pregnancy, previously asymptomatic patients develop symptoms or complications during pregnancy. Pregnancy in women with mitral stenosis is associated with a marked increase in maternal morbidity and adverse fetal outcome. Treatment of symptomatic mitral stenosis during pregnancy consists of bedrest, beta-blockers and diuretics. If symptoms persist despite optimal medical treatment, percutaneous mitral valvulotomy should be considered. If possible, surgery should be postponed until after delivery. It is recommended to treat women with symptomatic mitral stenosis in a tertiary centre with interventional possibilities.

  11. Radial and longitudinal strain and strain rate assessed by speckle-tracking echocardiography in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Tidholm, A.; Nägga, K.M.

    2012-01-01

    Assessment of left ventricular (LV) function using conventional echocardiographic methods is difficult in mitral regurgitation (MR) owing to altered hemodynamic loading conditions. Newer methods such as speckle-tracking echocardiography (STE) provide assessment of LV strain (St) and strain rates ...

  12. Quantitation of valve regurgitation severity by three-dimensional vena contracta area is superior to flow convergence method of quantitation on transesophageal echocardiography.

    Science.gov (United States)

    Abudiab, Muaz M; Chao, Chieh-Ju; Liu, Shuang; Naqvi, Tasneem Z

    2017-07-01

    Quantitation of regurgitation severity using the proximal isovelocity acceleration (PISA) method to calculate effective regurgitant orifice (ERO) area has limitations. Measurement of three-dimensional (3D) vena contracta area (VCA) accurately grades mitral regurgitation (MR) severity on transthoracic echocardiography (TTE). We evaluated 3D VCA quantitation of regurgitant jet severity using 3D transesophageal echocardiography (TEE) in 110 native mitral, aortic, and tricuspid valves and six prosthetic valves in patients with at least mild valvular regurgitation. The ASE-recommended integrative method comprising semiquantitative and quantitative assessment of valvular regurgitation was used as a reference method, including ERO area by 2D PISA for assigning severity of regurgitation grade. Mean age was 62.2±14.4 years; 3D VCA quantitation was feasible in 91% regurgitant valves compared to 78% by the PISA method. When both methods were feasible and in the presence of a single regurgitant jet, 3D VCA and 2D PISA were similar in differentiating assigned severity (ANOVAPPISA and 3D VCA with the integrative method was 47% and 58% for moderate and 65% and 88% for severe regurgitation, respectively. Measurement of 3D VCA by TEE is superior to the 2D PISA method in determination of regurgitation severity in multiple native and prosthetic valves. © 2017, Wiley Periodicals, Inc.

  13. Mitral valve perforation appearing years after radiofrequency ablation

    DEFF Research Database (Denmark)

    Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik

    2011-01-01

    The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...

  14. [Clinical analysis of robotic mitral valve repair].

    Science.gov (United States)

    Gao, Chang-Qing; Yang, Ming; Xiao, Cang-Song; Wang, Gang; Wang, Jia-Li; Wu, Yang; Wang, Yao

    2011-07-01

    To determine the safety and efficacy of robotic mitral valve repair using da Vinci S Surgical system. Method From January 2007 to April 2011, over 400 cases of robotic cardiac surgery have been performed, in which 60 patients with isolated mitral valve insufficiency underwent robotic mitral valve repair, including 42 male and 18 female patients with a mean age of (44 ± 13) years (ranging from 14 to 70 years). Forty-eight patients were in NYHA class I-II and 12 patients in class III. Fourteen patients were concomitant with atrial fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results. All patients had successful valve repair including quadrangular resections, sliding plasties and chordal replacement. There was no conversion to median sternotomy. The mean cardiopulmonary bypass and arrested heart time were (132 ± 30) min and (88 ± 22) min. One patient had hemolysis after operation, and required mitral valve replacement. Echocardiographic follow-up revealed trace to mild regurgitation in 2 patients with a mean of (16 ± 9) months. Robotic mitral valve repair is safe and efficacious in the patients with isolated mitral valve insufficiency.

  15. Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes.

    Science.gov (United States)

    Coutinho, Gonçalo F; Antunes, Manuel J

    2017-11-01

    Mitral valve repair (MVRepair) has become the procedure of choice to correct severe degenerative mitral regurgitation (MR), due to its documented superiority to valve replacement regarding long-term survival, freedom from valve-related adverse events and preservation of left ventricular (LV) function. The refinement of MVRepair techniques has rendered almost all valves (more than 95%) amenable to repair with a 15-year freedom from reoperation of 90%. The concept of 'centres of excellence for MVRepair' has emerged, encouraging referring doctors to select the most experienced institutions or individual surgeons to deal with the most complex cases, based on repair volume, appropriate peri-procedural imaging and data regarding expected outcomes (repair, mortality and durability of repair). Based on the good results, operating on asymptomatic patients with severe MR is now widely accepted, prophylactically avoiding the dire consequences of chronic MR, such as LV function deterioration/enlargement, and development of atrial fibrillation and pulmonary hypertension. In reference centres, where the repair rate is over 95% for all types of disease with <1% mortality, it has become standard practice in nearly 50%-60% of all patients submitted to MVRepair. Finally, recent advances in the surgical treatment with the purpose of reducing invasiveness and surgical trauma, through partial sternotomy or mini-thoracotomy (video-assisted with or without robotics), are now being increasingly performed in 20%-30% of centres, claiming comparable results to conventional surgery. In addition, transcatheter technology, particularly the MitraClip, is evolving and treading its way in the treatment of high-risk patients with severe MR, but the results are still short of ideal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. [Totally robotic mitral valve surgery in 60 cases].

    Science.gov (United States)

    Yang, Ming; Gao, Chang-qing; Wang, Gang; Wang, Jia-li; Xiao, Cang-song; Wu, Yang

    2011-10-01

    To evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system. We conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results. None of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group. In selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

  17. Dynamic phenotypes of degenerative myxomatous mitral valve disease: quantitative 3-dimensional echocardiographic study.

    Science.gov (United States)

    Clavel, Marie-Annick; Mantovani, Francesca; Malouf, Joseph; Michelena, Hector I; Vatury, Ori; Jain, Mothilal Sonia; Mankad, Sunil V; Suri, Rakesh M; Enriquez-Sarano, Maurice

    2015-05-01

    Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown. We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31) and DMD (n=18) by surgical observation showed no difference in age (65±10 versus 59±13; P=0.5), body surface area (2.0±0.2 versus 2.0±0.2 m(2); P=0.5), left ventricular and atrial dimensions (all P>0.55), and mitral regurgitation regurgitant orifice (P=0.62). On average, annular dimensions were larger in DMD versus FED, but height was similar resulting in lower saddle shape. Dynamically, annular DMD versus FED display poorer contraction and saddle-shape accentuation in early systole and abnormal enlargement, particularly intercommissural, in late-systole (all Pmitral regurgitation, despite larger prolapse and valve redundancy, underscoring potential compensatory role of tissue redundancy of DMD (or aggravating role of tissue paucity of FED) on mitral regurgitation severity. © 2015 American Heart Association, Inc.

  18. Three-dimensional echocardiography in the assessment of congenital mitral valve disease.

    Science.gov (United States)

    Kutty, Shelby; Colen, Timothy M; Smallhorn, Jeffrey F

    2014-02-01

    Congenital mitral valve abnormalities are rare and cause mitral stenosis, regurgitation, or a combination of the two. Three-dimensional echocardiography has provided new insight into the structure and function of both normal and abnormal mitral valves. Three-dimensional imaging permits accurate anatomic diagnosis and enhances two-dimensional echocardiographic data. Moreover, it enables echocardiographers to communicate effectively with cardiothoracic surgeons when displaying, analyzing, and describing pathology. The purpose of this report is to review congenital mitral valve disease, focusing on the benefits of three-dimensional echocardiography in its evaluation. Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  19. Management of the Congenital Aneurysm of the Left Ventricle Associated with Mitral Insufficiency in a Child: A Case Report

    Directory of Open Access Journals (Sweden)

    Mitsomoy Michel Francklyn

    2013-03-01

    Full Text Available The combination of congenital left ventricular aneurysm associated with mitral insufficiency is rare. We describe the case of a girl aged 11 years, bearing these two entities simultaneously. Aneurysmal resection of the left ventricle was performed with Dor technic to allow remodelation of the anatomy of the left ventricle. Mitral annuloplasty was performed through a transseptal approach. Three months after surgery, the child presents a good myocardial contractility without mitral regurgitation and normal ejection fraction.

  20. Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

    Science.gov (United States)

    Abdi, Seyfollah; salehi, Negar; Ghodsi, Babak; Basiri, Hossein Ali; Momtahen, Mahmoud; Firouzi, Ata; Sanati, Hamid Reza; Shakerian, Farshad; Maadani, Mohsen; Bakhshandeh, Homan; Chamanian, Soheila; Chitsazan, Mitra; Vakili-Zarch, Anoushiravan

    2012-01-01

    Background Valvular heart diseases and mainly rheumatic heart diseases complicate about 1% of pregnancies. During pregnancy physiological hemodynamic changes of the circulation are the main cause of mitral stenosis (MS) decompensation. Prior to introduction of percutaneous mitral balloon commissuroplasty (PTMC), surgical comissurotomy was the preferred method of treatment in patients with refractory symptoms. PTMC is an established non-surgical treatment of rheumatic mitral stenosis. The study aimed to assess the safety and efficacy of PTMC in pregnant women with severs mitral stenosis. Material and Method Thirty three consecutive patients undergoing PTMC during pregnancy enrolled in this prospective study. Mitral valve area (MVA), transmitral valve gradient (MVG), and severity of mitral regurgitation (MR) were assessed before and 24 hour after the procedure by transthoracic and transesophageal echocardiography. Mitral valve morphology was evaluated before the procedure using Wilkin’s criteria. Patient followed for one month and neonates monitored for weight and height and adverse effect of radiation. Result Mitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 (P = 0.007). Mean gradient of mitral valve decreased from 15.5 ± 7.4 mmHg to 2.3 ± 2.3 mmHg (P = <0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, abortion, intrauterine growth restriction was observed and only one stillbirth occurred. Conclusion PTMC in pregnant women has favorable outcome and no harmful effect on children noted. PMID:22442639

  1. Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system.

    Science.gov (United States)

    Patzelt, Johannes; Zhang, Yingying; Magunia, Harry; Ulrich, Miriam; Jorbenadze, Rezo; Droppa, Michal; Zhang, Wenzhong; Lausberg, Henning; Walker, Tobias; Rosenberger, Peter; Seizer, Peter; Gawaz, Meinrad; Langer, Harald F

    2017-08-01

    Improved mitral valve leaflet coaptation with consecutive reduction of mitral regurgitation (MR) is a central goal of percutaneous mitral valve repair (PMVR) with the MitraClip® system. As influences of PMVR on mitral valve geometry have been suggested before, we examined the effect of the procedure on mitral annular size in relation to procedural outcome. Geometry of the mitral valve annulus was evaluated in 183 patients undergoing PMVR using echocardiography before and after the procedure and at follow-up. Mitral valve annular anterior-posterior (ap) diameter decreased from 34.0 ± 4.3 to 31.3 ± 4.9 mm (P < 0.001), and medio-lateral (ml) diameter from 33.2 ± 4.8 to 32.4 ± 4.9 mm (P < 0.001). Accordingly, we observed an increase in MV leaflet coaptation after PMVR. The reduction of mitral valve ap diameter showed a significant inverse correlation with residual MR. Importantly, the reduction of mitral valve ap diameter persisted at follow-up (31.3 ± 4.9 mm post PMVR, 28.4 ± 5.3 mm at follow-up). This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.

  2. The prevalence and impact of deep clefts in the mitral leaflets in mitral valve prolapse.

    Science.gov (United States)

    Ring, Liam; Rana, Bushra S; Ho, Siew Yen; Wells, Francis C

    2013-06-01

    Deep clefts are a cause of early failure of mitral valve repair, but it is not known whether clefts represent normal morphology, or whether they occur more frequently in mitral valve prolapse (MVP). Deep clefts were defined as indentations extending ≥ 50% of the depth of the mitral valve leaflet. Using trans-oesophageal echo (TOE), 3D zoom images were acquired of the mitral valve in 176 patients: 76 patients with MVP, 43 patients with alternative causes of mitral regurgitation (MR), and 57 controls. Three-dimensional TOE results were corroborated with findings made at surgery for a subset of patients who subsequently underwent mitral valve surgery. An assessment of the proportion of the valve that was prolapsing was documented, and correlated to the number of clefts. The relationship of clefts to the region of prolapse or flail was recorded. Three-dimensional TOE was 93% sensitive and 92% specific for detecting clefts. Clefts were documented in 84% of patients with MVP, but significantly less frequently in patients with alternative MR (16%; P framing them, and the number of clefts increased in patients with more extensive prolapse. Clefts are frequently seen in MVP, but are uncommon in patients without this diagnosis. They occur in greater numbers as a larger proportion of the valve prolapses. They may play an important role in the development of MVP.

  3. Mechanics of mitral valve edge-to-edge-repair and MitraClip procedure.

    Science.gov (United States)

    Bhattacharya, Shamik; He, Zhaoming

    2015-01-01

    The edge-to-edge repair (ETER) technique has been used as a stand-alone procedure, or as a secondary procedure with ring annuloplasty for degenerative, functional mitral regurgitation, or for mitral regurgitation of other kinds of valvular etiologies. The percutaneous MitraClip technique based on ETER has been used in patients who are inoperable or at high surgical risk. However, adverse events such as residual mitral regurgitation, and clip detachment or fracture indicate that the mechanics underlying these procedures is not well understood. Therefore, current studies on mitral valve functionality and mechanics related to the ETER and MitraClip procedures are reviewed to improve the efficacy and safety of both procedures. Extensive in vivo, in vitro, and in silico studies related to ETER and MitraClip procedures along with MitraClip clinical trial results are presented and discussed herein. The ETER suture force and the mitral valve tissue mechanics and hemodynamics of each procedure are discussed. A quantitative understanding of the interplay of mitral valve components and as to biological response to the procedures remains challenging. Based on mitral valve mechanics, ETER or MitraClip therapy can be optimized to enhance repair efficacy and durability.

  4. Mid-term results of mitral valve repair using flexible bands versus complete rings in patients with degenerative mitral valve disease: a prospective, randomized study.

    Science.gov (United States)

    Bogachev-Prokophiev, Alexandr V; Afanasyev, Alexandr V; Zheleznev, Sergei I; Nazarov, Vladimir M; Sharifulin, Ravil M; Karaskov, Alexandr M

    2017-12-13

    We aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients. From September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline. There were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6-98.7%) and 94.3 ± 2.8% (95% CI, 85.5-97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9-17] vs. 6 [2.1-18] mmHg, p mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044). Patients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence. ClinicalTrials.gov NCT03278574 , retrospectively registered on 06.09.2017.

  5. [Mitral valve replacement in dextrocardia and situs inversus].

    Science.gov (United States)

    Uchimuro, Tomoya; Fukui, Toshihiro; Matsuyama, Shigefumi; Tabata, Minoru; Takanashi, Shuichirou

    2012-09-01

    Cardiac surgery for acquired valvular diseases in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve replacement and tricuspid annuloplasty in a patient with dextrocardia and situs inversus. A 74-year-old man with dextrocardia and situs inversus, who had undergone patch closure of atrial septal defect 25 years before, was referred for surgical treatment of severe mitral and tricuspid valve regurgitation. Preoperative computed tomography( CT) showed dextrocardia, situs inversus, interruption of the inferior vena cava with an azygos vein continuation, and drainage of the hepatic vein into the right atrium. Under redo-median sternotomoy, cardiopulmonary bypass was established by cannulating the ascending aorta, the superior vena cava, the right femoral and the hepatic veins. The surgeon operated from the left side of the operating table, and had an excellent exposure to the mitral and tricuspid valves during the operation. Mitral valve replacement and tricuspid annuloplasty were performed successfully. The postoperative course was uneventful.

  6. Echocardiographic evaluation of mitral durability following valve repair in rheumatic mitral valve disease: impact of Maze procedure.

    Science.gov (United States)

    Kim, Gwan Sic; Lee, Chee Hoon; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2014-01-01

    The data on echocardiographic evaluation of mitral durability after rheumatic mitral repair is scarce. A total of 193 patients (mean age, 39.4 ± 12.8 years; 154 females) who underwent mitral valve repair for rheumatic valve disease from 1997 to 2010 were included in the study. A Maze operation was performed in 90.3% (n = 102) of the patients with atrial fibrillation (n = 113). Survival, valve-related complications, and echocardiographic data were evaluated. Mitral regurgitation was the predominant disease in 75.6% of patients (n = 146). There was one early death (0.5%) . During the mean follow-up period of 76.7 ± 45.6 months, there were 9 late deaths and 5 mitral reoperations. Valve-related, event-free survival at 10 years was 85.5% ± 3.3%. In serial postoperative echocardiographic evaluations (mean follow-up duration, 53.7 ± 43.5 months), 40 patients showed either mitral regurgitation (>mild; n = 31) or mitral stenosis (mitral valve area ≤1.5 cm(2); n = 9). At 10 years, 66.4% ± 5.4% of the patients did not have moderate to severe mitral dysfunction. By multivariate analysis, no Maze operation for atrial fibrillation was an independent predictor of mitral dysfunctions (hazard ratio, 3.72; 95% confidence interval, 1.47-9.42; P = .005), whereas the presence of hypertension had borderline significance (hazard ratio, 3.15; 95% confidence interval, 0.96-10.38; P = .059). Although rheumatic mitral repair showed excellent long-term clinical outcomes, a significant proportion of patients experienced moderate to severe mitral dysfunctions postoperatively. Atrial fibrillation without a Maze procedure increased significantly the risks of mitral dysfunctions and adverse outcomes. Therefore, routine performance of a Maze procedure is warranted in the presence of atrial fibrillation whenever possible. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves.

    Science.gov (United States)

    van Rensburg, Annari; Herbst, Philip; Doubell, Anton

    2017-06-01

    The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P = 0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P mitral regurgitation (P Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect. © 2017 The authors.

  8. The challenges of managing rheumatic disease of the mitral valve in Jamaica.

    Science.gov (United States)

    Little, Sherard G

    2014-12-01

    Between January, 2009 and December, 2013, 84 patients were identified who underwent isolated mitral valve surgery in Jamaica at The University Hospital of the West Indies and The Bustamante Hospital for Children. The most common pathology requiring surgery was rheumatic heart disease, accounting for 84% of the procedures performed. The majority of patients had regurgitation of the mitral valve (67%), stenosis of the mitral valve (22%), and mixed mitral valve disease (11%). The most common procedure performed was replacement of the mitral valve (69%), followed by mitral valve repair (29%). Among the patients, one underwent closed mitral commissurotomy. The choice of procedure differed between age groups. In the paediatric population (mitral valve (89%). In the adult population (18 years and above), the majority of patients underwent mitral valve replacement (93%). Overall, of all the patients undergoing replacement of the mitral valve, 89% received a mechanical valve prosthesis, whereas 11% received a bioprosthetic valve prosthesis. Of the group of patients who underwent mitral valve repair for rheumatic heart disease, 19% required re-operation. The average time between initial surgery and re-operation was 1.2 years. Rheumatic fever and rheumatic heart disease remain significant public health challenges in Jamaica and other developing countries. Focus must remain on primary and secondary prevention strategies in order to limit the burden of rheumatic valvulopathies. Attention should also be directed towards improving access to surgical treatment for young adults.

  9. Valvular regurgitation and surgery associated with fenfluramine use: an analysis of 5743 individuals

    Directory of Open Access Journals (Sweden)

    Allen Marvin R

    2008-11-01

    Full Text Available Abstract Background Use of fenfluramines for weight loss has been associated with the development of characteristic plaques on cardiac valves causing regurgitation. However, previously published studies of exposure to fenfluramines have been limited by relatively small sample size, short duration of follow-up, and the lack of any estimate of the frequency of subsequent valvular surgery. We performed an observational study of 5743 users of fenfluramines examined by echocardiography between July 1997 and February 2004 in a single large cardiology clinic. Results The prevalence of at least mild aortic regurgitation (AR or moderate mitral regurgitation (MR was 19.6% in women and 11.8% in men (p p p = 0.002, and tricuspid regurgitation (TR (p p p Conclusion Regurgitant valvulopathy was common in individuals exposed to fenfluramines, more frequent in females, and associated with duration of use in all valves assessed. Valve surgery was performed as frequently for aortic as mitral valves and some tricuspid valve surgeries were also performed. The incidence of surgery appeared to be substantially increased compared with limited general population data.

  10. [Results of percutaneous mitral balloon commissurotomy in pregnant women about 12 cases].

    Science.gov (United States)

    Zairi, I; Mzoughi, K; Mroua, F; Ben Moussa, F; Amri, I; Kammoun, S; Fennira, S; Kraiem, S

    2018-02-01

    Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable. The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment. It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years. Mean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cm 2  averaged to 2±0.35cm 2 . Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58±64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy. The effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Mitral valve surgery in a patient with dextrocardia and 180° counter-clockwise rotated heart due to congenital agenesis of the right lung.

    Science.gov (United States)

    Atsumi, Yosuke; Tokunaga, Shigehiko; Yasuda, Shota; Fushimi, Kenichi; Masuda, Munetaka

    2013-11-01

    We report a case of severe mitral regurgitation (MR) with dextrocardia and 180° counterclockwise rotated situs solitus heart. We describe the technique for mitral valve surgery in a patient with dextrocardia and agenesis of the right lung. © 2013 Wiley Periodicals, Inc.

  12. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  13. Two melodies in concert: mitral and pulmonary valve replacement late in repaired tetralogy of Fallot.

    Science.gov (United States)

    Fang, Zhi; Hu, Jia; Zhu, Xianglan; Lin, Ke

    2015-04-17

    Disruption of pulmonary valve integrity after Tetralogy of Fallot repair often results in a cascade of hemodynamic and electrophysiological abnormalities. Here we report an uncommon case of severe pulmonary regurgitation with concomitant rheumatic mitral stenosis diagnosed 25 years after primary Tetralogy of Fallot repair. A 33-year-old man presented with symptomatic palpitation and exercise intolerance and was treated successfully with pulmonary and mitral valve replacement, after which his symptoms improved dramatically.

  14. Cabergoline-induced tricuspid regurgitation: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Mohammad Hayat Bhat

    2011-01-01

    Full Text Available The increased risk of cardiac valve disease in patients treated for Parkinson′s disease with cabergoline has raised concerns about the safety of treatment with ergot-derived dopamine agonists in patients with endocrine diseases, especially prolactinoma. Concern is raised because the use of cabergoline was associated in one study with an increased prevalence of moderate tricuspid regurgitation, and in two other studies with mild tricuspid regurgitation. Furthermore, the use of cabergoline was associated with increased frequencies of valvular thickening, calcifications, and increased mitral tenting area.

  15. Ultrasound based mitral valve annulus tracking for off-pump beating heart mitral valve repair

    Science.gov (United States)

    Li, Feng P.; Rajchl, Martin; Moore, John; Peters, Terry M.

    2014-03-01

    Mitral regurgitation (MR) occurs when the mitral valve cannot close properly during systole. The NeoChordtool aims to repair MR by implanting artificial chordae tendineae on flail leaflets inside the beating heart, without a cardiopulmonary bypass. Image guidance is crucial for such a procedure due to the lack of direct vision of the targets or instruments. While this procedure is currently guided solely by transesophageal echocardiography (TEE), our previous work has demonstrated that guidance safety and efficiency can be significantly improved by employing augmented virtuality to provide virtual presentation of mitral valve annulus (MVA) and tools integrated with real time ultrasound image data. However, real-time mitral annulus tracking remains a challenge. In this paper, we describe an image-based approach to rapidly track MVA points on 2D/biplane TEE images. This approach is composed of two components: an image-based phasing component identifying images at optimal cardiac phases for tracking, and a registration component updating the coordinates of MVA points. Preliminary validation has been performed on porcine data with an average difference between manually and automatically identified MVA points of 2.5mm. Using a parallelized implementation, this approach is able to track the mitral valve at up to 10 images per second.

  16. Mitral valve disease in pregnancy: outcomes and management

    OpenAIRE

    Tsiaras, Sarah; Poppas, Athena

    2009-01-01

    Young women may have asymptomatic mitral valve disease which becomes unmasked during the haemodynamic stress of pregnancy. Rheumatic mitral stenosis is the most common cardiac disease found in women during pregnancy. The typical increased volume and heart rate of pregnancy are not well tolerated in patients with more than mild stenosis. Maternal complications of atrial fibrillation and congestive heart failure can occur, and are increased in patients with poor functional class and severe pulm...

  17. [Long-term results of surgical treatment of patients with aortic valve disease and functional mitral insufficiency].

    Science.gov (United States)

    Salagaev, G I; Belov, Yu V; Charchyan, E R; Katkov, A I; Vinokurov, I A

    2016-01-01

    To analyze long-term surgical results in patients with aortic valve disease and concomitant mitral regurgitation (MR) depending on volume of valve surgery. It was studied 5-year results in 71 patients with aortic valve disease and different degree of mitral regurgitation. Patients were divided into 3 groups. Control group included 40 patients after aortic valve replacement (AVR) and no mitral insufficiency. The 2nd group consisted of 16 patients after AVR and concomitant mitral regurgitation degree 2-3. The 3rd group - 15 patients after aortic and mitral valve replacement. Mortality in long-term postoperative period, quality of life, incidence of complications and echocardiography data were analyzed. There was no significant improvement of mitral regurgitation after AVR. It was showed that persistent MR decreases remote survival and quality of life as well as deteriorates echocardiography data. Herewith these data in the 3rd group did not differ from the control group. Double-valve replacement may be advisable in patients with aortic valve disease and concomitant moderate MR because persistent MR deteriorates long-term However prolonged time of cardiopulmonary bypass, aortic cross-clamping, greater blood loss require comprehensive approach to advanced cardiac surgery.

  18. Transcatheter mitral valve implantation for inoperable severely calcified native mitral valve disease: A systematic review.

    Science.gov (United States)

    Puri, Rishi; Abdul-Jawad Altisent, Omar; del Trigo, Maria; Campelo-Parada, Francesco; Regueiro, Ander; Barbosa Ribeiro, Henrique; DeLarochellière, Robert; Paradis, Jean-Michel; Dumont, Eric; Rodés-Cabau, Josep

    2016-02-15

    Transcatheter mitral valve implantation (TMVI) for severely calcified native mitral valve disease recently emerged as a treatment option in patients deemed inoperable by conventional techniques. Yet no systematic appraisal currently exists characterizing this novel treatment paradigm. A systematic literature review summarizing the clinical, anatomical, peri- and post-procedural characteristics underscoring the technical feasibility of this procedure was performed. Nine publications describing 11 patients [mean age 68 ± 10 years, 82% female, 82% severe mitral stenosis (MS), 18% severe mitral regurgitation (MR)] were identified. Mean STS score, trans-mitral gradient and effective orifice area were 10.5 ± 4.6%, 12 ± 2.4 mm Hg and 0.93 ± 0.06 cm(2) respectively. All patients had severe, circumferential mitral annular calcification on imaging. Dedicated balloon-expanding transcatheter aortic valves were used in 10/11 cases, with 8/11 cases involving a true percutaneous approach with peri-procedural 3D trans-esophageal echocardiographic guidance; 3/11 cases involved an open left atrial approach. Following initial balloon inflation and valve deployment, procedural success rate was 73%, without residual paravalvular leaks (PVL). Successful immediate re-deployment of a 2nd valve was needed in 2 instances following significant PVL detection. Residual trans-valvular gradients ranged from 3 to 7 mm Hg, with no patient demonstrating >grade 2 MR. All patients survived the procedure, with 2 reported deaths on days 10- and 41 post-TMVI being non-cardiac-related. Mid-term clinical follow-up, reported in 8 patients, revealed 6 patients to be alive at 3-months with much improved functional status. TMVI for native severely calcified mitral valve disease appears technically feasible with acceptable initial acute and mid-term hemodynamic and clinical outcomes. The outcomes of an ongoing, dedicated global Sapien TMVI registry will shed further light on this evolving treatment

  19. Three hundred robotic-assisted mitral valve repairs: the Cedars-Sinai experience.

    Science.gov (United States)

    Ramzy, Danny; Trento, Alfredo; Cheng, Wen; De Robertis, Michele A; Mirocha, James; Ruzza, Andrea; Kass, Robert M

    2014-01-01

    The study objective was to review our first 300 consecutive robotic-assisted mitral repairs performed from June 2005 to October 2012 and to compare the surgical outcomes of our previously reported initial 120 cases with the subsequent 180 procedures. Our initial 120 robotic-assisted mitral repairs were previously reported, and we now compare our early experience with the recent 180 consecutive procedures for a total of 300 robotic-assisted mitral repairs. There was no patient selection. Every patient in need of isolated mitral valve repair underwent this procedure. All patients received an annuloplasty band and 1 or more of the following: leaflet resection, secondary chordal transposition, or polytetrafluoroethylene neochordal replacement and edge-to-edge repair. All 300 patients had preoperative echocardiographic findings of severe mitral regurgitation. There were no differences (P = not significant) between the initial and the recent cohorts for preoperative characteristics, including age (58.4 ± 10.5 years vs 59.9 years), female gender (35.8% vs 36.1%), ejection fraction (61.9% vs 60.6%), congestive heart failure (35.0% vs 36.7%), creatinine (0.94 mg/dL vs 0.98 mg/dL), and New York Heart Association class. The incidence of anterior and posterior leaflet prolapse was similar in both groups, whereas Barlow syndrome was higher in group 2 (5.8% vs 27.8%). There was 1 (0.33%) hospital mortality and no deaths in the last 180 cases. Overall, 8 patients (2.7%) required subsequent mitral valve replacement via a median sternotomy, 6 (5.0%) in the first group and 2 (1.1%) in the second group (P = .06). One patient in each group had mitral valve re-repair through a right mini-thoracotomy, and 1 patient in the first group required a mitral valve replacement via a mini-thoracotomy during the original procedure. Two of the 180 patients had documented cerebrovascular accident, but both fully recovered clinically. There was no cerebrovascular accident in the last 120

  20. Clinical outcomes and economic impact of transcatheter mitral leaflet repair in heart failure patients.

    Science.gov (United States)

    Asgar, Anita W; Khairy, Paul; Guertin, Marie-Claude; Cournoyer, Daniel; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsene; Tardif, Jean-Claude; Cohen, David J

    2017-01-01

    Mitral regurgitation (MR) is a common valvular heart disorder requiring intervention once it becomes severe. Transcatheter mitral repair with the MitraClip device is a safe and effective therapy for selected patients denied surgery. The authors sought to evaluate the clinical outcomes and economic impact of this therapy compared to medical management in heart-failure patients with symptomatic mitral regurgitation. The study was comprised of two phases; an observational study of patients with heart failure and mitral regurgitation treated with either medical therapy or the MitraClip, and an economic model. Results of the observational study were used to estimate parameters for the decision model, which estimated costs, and benefits in a hypothetical cohort of patients with heart failure and moderate-to-severe mitral regurgitation treated with either standard medical therapy or MitraClip. The cohort of patients treated with the MitraClip was propensity matched to a population of heart failure patients, and their outcomes compared. At a mean follow-up of 22 months, all-cause mortality was 21% in the MitraClip cohort and 42% in the medical management cohort (p = .007). The decision model demonstrated that MitraClip increased life expectancy from 1.87-3.60 years and quality-adjusted life years (QALY) from 1.13-2.76 years. The incremental cost was $52,500 Canadian dollars, corresponding to an incremental cost-effectiveness ratio (ICER) of $32,300.00 per QALY gained. Results were sensitive to the survival benefit. In heart failure patients with symptomatic moderate-severe mitral regurgitation, therapy with the MitraClip is associated with superior survival and is cost-effective compared to medical therapy.

  1. Mitral valve prolapse

    Science.gov (United States)

    ... mitral valve prolapse is called "mitral valve prolapse syndrome," and includes: Chest pain (not caused by coronary artery disease or a heart attack) Dizziness Fatigue Panic attacks Sensation of feeling the heart beat ( palpitations ) ...

  2. Mitral valve repair in Barlow's disease with bileaflet prolapse: the effect of annular stabilization on functional mitral valve leaflet prolapse.

    Science.gov (United States)

    Tomšic, Anton; Hiemstra, Yasmine L; Bissessar, Daniella D; van Brakel, Thomas J; Versteegh, Michel I M; Ajmone Marsan, Nina; Klautz, Robert J M; Palmen, Meindert

    2017-11-27

    Barlow's disease is the most severe form of degenerative mitral valve disease, commonly characterized by bileaflet prolapse. Abnormal mitral annular dynamics is typically present and results in functional prolapse of the mitral leaflets that may be addressed with annular stabilization alone. Between January 2001 and December 2015, 128 patients with Barlow's disease and bileaflet prolapse underwent valve repair. This included anterior mitral valve leaflet (AMVL) repair in 70 patients, whereas 58 patients were identified as having functional prolapse and underwent no specific AMVL repair. During the course of the study, the proportion of patients undergoing specific AMVL repair decreased (77% in the first and 33% in the second 64 patients). Semirigid ring annuloplasty was performed in all cases. The median clinical and echocardiographic follow-up duration was 6.5 years [interquartile range (IQR) 2.9-10.5 years; 93.9% complete] and 4.7 years (IQR 2.2-10.2 years; 94.4% complete), respectively. Early mortality was 1.6%. Postoperative echocardiogram demonstrated no residual mitral regurgitation in all but 1 patient (AMVL repair group). There was no significant difference in the overall survival rate at 6 years after operation between both groups. At 6 years, the freedom from recurrent ≥Grade 2+ mitral regurgitation rate was 90.7% (IQR 82.9-98.5%) and 89.1% (IQR 75.8-100%) for patients with and patients with no AMVL repair, respectively (P = 0.43). Three patients required late mitral valve reintervention, all from the AMVL repair group. Annular stabilization can effectively resolve the functional prolapse of the AMVL. Careful discrimination between functional and true AMVL prolapse allows for a technically less challenging operation that provides excellent repair durability.

  3. Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed

    2016-05-01

    Full Text Available The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR. It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk.

  4. Robotic mitral valve surgery: a United States multicenter trial.

    Science.gov (United States)

    Nifong, L Wiley; Chitwood, W R; Pappas, P S; Smith, C R; Argenziano, M; Starnes, V A; Shah, P M

    2005-06-01

    In a prospective phase II Food and Drug Administration trial, robotic mitral valve repairs were performed in 112 patients at 10 centers by using the da Vinci surgical system. The safety of performing valve repairs with computerized telemanipulation was studied. After institutional review board approval, informed consent was obtained. Patients had moderate to severe mitral regurgitation. Operative technique included peripheral cardiopulmonary bypass, a 4- to 5-cm right minithoracotomy, a transthoracic aortic crossclamp, and antegrade cardioplegia. The successful study end point was grade 0 or 1 mitral regurgitation by transthoracic echocardiography at 1 month after surgery. Valve repairs included quadrangular resections, sliding plasties, edge-to-edge approximations, and both chordal transfers and replacements. The average age was 56.4 +/- 0.09 years (mean +/- SEM). There were 77 (68.8%) men and 35 (31.2%) women. Valve pathology was myxomatous degeneration in 105 (91.1%), and 103 (92.0%) had type II leaflet prolapse. Leaflet repair times averaged 36.7 +/- 0.2 minutes, with annuloplasty times of 39.6 +/- 0.1 minutes. Total robot, aortic crossclamp, and cardiopulmonary bypass times were 77.9 +/- 0.3 minutes, 2.1 +/- 0.1 hours, and 2.8 +/- 0.1 hours, respectively. On 1-month transthoracic echocardiography, 9 (8.0%) had grade 2 mitral regurgitation, and 6 (5.4%) of these had reoperations (5 replacements and 1 repair). There were no deaths, strokes, or device-related complications. Multiple surgical teams performed robotic mitral valve repairs safely early in development of this procedure, with a reoperation rate of 5.4%. Advancements in robotic design and adjunctive technologies may help in the evolution of this minimally invasive technique by decreasing operative times.

  5. Percutaneous transvenous mitral commissurotomy in juvenile mitral ...

    African Journals Online (AJOL)

    Objective: To determine the efficacy and safety of percutaneous transvenous mitral commissurotomy(PTMC), using multi-track double balloon technique in juvenile mitral stenosis. Design: Open non-randomised intervention. Setting: Cardiac catheterisation laboratories of The Mater Hospital, The Nairobi Hospital and ...

  6. Arterial distensibility as a possible compensatory mechanism in chronic aortic regurgitation

    Directory of Open Access Journals (Sweden)

    Kopel Liliane

    2001-01-01

    Full Text Available OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30±1 years (control group and 14 asymptomatic patients with severe aortic regurgitation aged 29±2 years and left ventricular ejection fraction of 0.61±0.02 (radioisotope ventriculography were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78±3 versus 48±1mmHg, P<0.01. Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0±0.8 versus 8.1±0.7 10-10 N-1 m4, P=0.01 e and 39.3±2.6 versus 31.1±2.0 10-6 N-1 m², P=0.02, respectively. CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.

  7. Towards patient-specific finite-element simulation of MitralClip procedure.

    Science.gov (United States)

    Mansi, T; Voigt, I; Assoumou Mengue, E; Ionasec, R; Georgescu, B; Noack, T; Seeburger, J; Comaniciu, D

    2011-01-01

    MitralClip is a novel minimally invasive procedure to treat mitral valve (MV) regurgitation. It consists in clipping the mitral leaflets together to close the regurgitant hole. A careful preoperative planning is necessary to select respondent patients and to determine the clipping sites. Although preliminary indications criteria are established, they lack prediction power with respect to complications and effectiveness of the therapy in specific patients. We propose an integrated framework for personalized simulation of MV function and apply it to simulate MitralClip procedure. A patient-specific dynamic model of the MV apparatus is computed automatically from 4D TEE images. A biomechanical model of the MV, constrained by the observed motion of the mitral annulus and papillary muscles, is employed to simulate valve closure and MitralClip intervention. The proposed integrated framework enables, for the first time, to quantitatively evaluate an MV finite-element model in-vivo, on eleven patients, and to predict the outcome of MitralClip intervention in one of these patients. The simulations are compared to ground truth and to postoperative images, resulting in promising accuracy (average point-to-mesh distance: 1.47 +/- 0.24 mm). Our framework may constitute a tool for MV therapy planning and patient management.

  8. Radiotherapy-induced concomitant coronary artery stenosis and mitral valve disease.

    Science.gov (United States)

    Akboga, Mehmet Kadri; Akyel, Ahmet; Sahinarslan, Asife; Cengel, Atiye

    2014-04-01

    Radiotherapy is extensively used in the treatment of Hodgkin's disease. One of its untoward effects is on heart. Coronary arteries and heart valves can be adversely affected from radiotherapy. However, co-existence of both conditions is very rare. In this report, we present a patient with Hodgkin's disease who developed both coronary artery stenosis and severe mitral valve regurgitation after radiotherapy.

  9. Mitral valve disease with rheumatic appearance in the presence of left ventricular endomyocardial fibrosis

    Directory of Open Access Journals (Sweden)

    Lurildo R. Saraiva

    1999-03-01

    Full Text Available This is a report of a nine-year-old boy with both mitral stenosis and regurgitation and extensive endomyocardial fibrosis of the left ventricle. Focus is given to the singularity of the fibrotic process, with an emphasis on the etiopathogenic aspects.

  10. A novel mechanical mitral valve replacement using Sapien XT.

    Science.gov (United States)

    Koehle, Megan; Strote, Justin A; Guadagnoli, Mark; Oldemeyer, J Bradley

    2017-06-09

    We report the case of a 66 year old female who presented to our institution fourteen years after receiving a St. Jude Mechanical Mitral Valve Replacement. She presented in refractory NYHA class IV congestive heart failure with comorbidities of acute renal failure, liver failure, and mental status changes. She was found to have immobility of one of the mitral valve disks with resultant severe mitral stenosis with a mean pressure gradient of 12 mmHg. The patient was found to have an STS predicted mortality of 39% with redo surgical MVR, and evaluation by the valve team led to a recommendation of a hybrid surgical and transcatheter procedure. The patient underwent femoral bypass and hypothermia with a sternotomy and left atrial approach. The mechanical discs were removed utilizing needle drivers without removal of the St. Jude ring. Subsequently, a 26 mm Edwards Sapien XT valve was deployed under direct and fluoroscopic visualization. The patient had an event free post-operative course, and one year following the procedure has had an outstanding clinical response with NYHA class II congestive heart failure. Her echocardiogram reveals normal valve function with a MPG of 4 mmHg without mitral regurgitation. Transatrial hybrid TMVR within the ring of a St. Jude mechanical mitral valve appears to be a feasible procedure which may be used in the future to decrease morbidity and mortality associated with high-risk redo-MVR in patients with mechanical mitral valve prostheses. © 2017 Wiley Periodicals, Inc.

  11. Mitral valve prolapse, atrial flutter, and syncope in a young female patient.

    Science.gov (United States)

    Ismajli, Jehona; Shabani, Xhevahire; Manaj, Rexhep; Emini, Merita; Bajraktari, Gani

    2006-11-01

    The syndrome of mitral valve prolapse (MVP) is the most common form of valvular heart disease. The case of a 16-year-old girl with mitral valve prolapse, atrial flutter and syncope is presented. The patient was admitted to the clinic complaining of atypical chest pain, palpitations, breathlessness at physical efforts, fatigue, and a feeling of fogginess. Electrocardiogram showed the presence of the common-type atrial flutter with 3:1 ventricular responses. Echocardiography showed mitral valve prolapse with mild mitral regurgitation. The patient reported to have had these symptoms for about nine months. She was not aware of heart disease before. A young female patient with combined mitral valve prolapse, atrial flutter, and syncope is presented.

  12. Mitral valve mechanics following posterior leaflet patch augmentation

    DEFF Research Database (Denmark)

    Rahmani, Azadeh; Rasmussen, Ann Qvist; Hønge, Jesper Langhoff

    2013-01-01

    Background and aim of the study: Attention towards the optimization of mitral valve repair methods is increasing. Patch augmentation is one strategy used to treat functional ischemic mitral regurgitation (FIMR). The study aim was to investigate the force balance changes in specific chordae...... tendineae emanating from the posterior papillary muscle in a FIMR-simulated valve, following posterior leaflet patch augmentation. Methods: Mitral valves were obtained from 12 pigs (body weight 80 kg). An in vitro test set-up simulating the left ventricle was used to hold the valves. The left ventricular...... pressure was regulated with water to simulate different static pressures during valve closure. A standardized oval pericardial patch (17 × 29 mm) was introduced into the posterior leaflet from mid P2 to the end of the P3 scallop. Dedicated miniature transducers were used to record the forces exerted...

  13. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions.

    Science.gov (United States)

    Ando, Tomo; Takagi, Hisato; Briasoulis, Alexandros; Telila, Tesfaye; Slovut, David P; Afonso, Luis; Grines, Cindy L; Schreiber, Theodore

    2018-01-01

    To summarize the published data of combined transcatheter aortic and mitral valve intervention (CTAMVI). CTAMVI, a combination of either transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring (TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive alternative in high-surgical risk patients with combined aortic and mitral valve disease. However, its procedural details and clinical outcomes have not been well described. We performed a systematic review of all the published articles from PUBMED and EMBASE. A total of 37 studies with 60 patients were included. The indication for CTAMVI was high or inoperable surgical risk and symptomatic severe aortic stenosis (92%) or severe aortic regurgitation (8%) combined with moderate to severe/severe mitral stenosis (30%) or moderate/severe mitral regurgitation (65%) or both (5%). In majority of the cases, aortic valve intervention was performed prior to the mitral valve. Mortality rate were 25% for TAVR + TMVR (range 42 days to 10 months), 17% for TAVR + TMViV/ViR (range 13 days to 6 months), 0% for TAViV + TMViV/ViR (range 6-365 days), and 15% for TAVR/ViV + PMVR (range 17 days to 419 days). Significant (more than moderate) paravalvular regurgitation post-procedure was rare. CTAMVI appears to confer reasonable clinical outcome. Further large study is warranted to clarify the optimal strategy, procedural details and clinical outcomes in the future. © 2017 Wiley Periodicals, Inc.

  14. Schistosome feeding and regurgitation.

    Directory of Open Access Journals (Sweden)

    Patrick J Skelly

    2014-08-01

    Full Text Available Schistosomes are parasitic flatworms that infect >200 million people worldwide, causing the chronic, debilitating disease schistosomiasis. Unusual among parasitic helminths, the long-lived adult worms, continuously bathed in blood, take up nutrients directly across the body surface and also by ingestion of blood into the gut. Recent proteomic analyses of the body surface revealed the presence of hydrolytic enzymes, solute, and ion transporters, thus emphasising its metabolic credentials. Furthermore, definition of the molecular mechanisms for the uptake of selected metabolites (glucose, certain amino acids, and water establishes it as a vital site of nutrient acquisition. Nevertheless, the amount of blood ingested into the gut per day is considerable: for males ∼100 nl; for the more actively feeding females ∼900 nl, >4 times body volume. Ingested erythrocytes are lysed as they pass through the specialized esophagus, while leucocytes become tethered and disabled there. Proteomics and transcriptomics have revealed, in addition to gut proteases, an amino acid transporter in gut tissue and other hydrolases, ion, and lipid transporters in the lumen, implicating the gut as the site for acquisition of essential lipids and inorganic ions. The surface is the principal entry route for glucose, whereas the gut dominates amino acid acquisition, especially in females. Heme, a potentially toxic hemoglobin degradation product, accumulates in the gut and, since schistosomes lack an anus, must be expelled by the poorly understood process of regurgitation. Here we place the new observations on the proteome of body surface and gut, and the entry of different nutrient classes into schistosomes, into the context of older studies on worm composition and metabolism. We suggest that the balance between surface and gut in nutrition is determined by the constraints of solute diffusion imposed by differences in male and female worm morphology. Our conclusions have

  15. Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair.

    Science.gov (United States)

    Jorbenadze, Rezo; Patzelt, Johannes; Gawaz, Meinrad; Seizer, Peter; Langer, Harald F

    2017-01-01

    Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR.

  16. Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair

    Directory of Open Access Journals (Sweden)

    Rezo Jorbenadze

    2017-01-01

    Full Text Available Percutaneous edge-to-edge mitral valve repair (PMVR is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR. This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR caused by a flail of the posterior mitral valve leaflet (PML. PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2 resulted in a significant reduction of MR.

  17. Intraoperative application of geometric three-dimensional mitral valve assessment package: a feasibility study.

    Science.gov (United States)

    Mahmood, Feroze; Karthik, Swaminathan; Subramaniam, Balachundhar; Panzica, Peter J; Mitchell, John; Lerner, Adam B; Jervis, Karinne; Maslow, Andrew D

    2008-04-01

    To study the feasibility of using 3-dimensional (3D) echocardiography in the operating room for mitral valve repair or replacement surgery. To perform geometric analysis of the mitral valve before and after repair. Prospective observational study. Academic, tertiary care hospital. Consecutive patients scheduled for mitral valve surgery. Intraoperative reconstruction of 3D images of the mitral valve. One hundred and two patients had 3D analysis of their mitral valve. Successful image reconstruction was performed in 93 patients-8 patients had arrhythmias or a dilated mitral valve annulus resulting in significant artifacts. Time from acquisition to reconstruction and analysis was less than 5 minutes. Surgeon identification of mitral valve anatomy was 100% accurate. The study confirms the feasibility of performing intraoperative 3D reconstruction of the mitral valve. This data can be used for confirmation and communication of 2-dimensional data to the surgeons by obtaining a surgical view of the mitral valve. The incorporation of color-flow Doppler into these 3D images helps in identification of the commissural or perivalvular location of regurgitant orifice. With improvements in the processing power of the current generation of echocardiography equipment, it is possible to quickly acquire, reconstruct, and manipulate images to help with timely diagnosis and surgical planning.

  18. Advanced electrocardiography can predict mitral regurgitation in cavalier king charles spaniels with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Spiljak, Maja; Petric, Alexandra; Olsen, Lisbeth Høier

    2011-01-01

    . Clinic for Surgery and Small Animal Medicine, Veterinary Faculty, University of Ljubljana, Slovenia. 3. Department of Basic Animal and Veterinary Sciences, Faculty of Life Sciences, University of Copenhagen, Denmark. 4. Quality Control Department, Metallurgical and Chemical Industry Cinkarna Celje, INC...

  19. Preoperative left ventricular function in degenerative mitral valve disease.

    Science.gov (United States)

    Malev, Eduard; Kim, Gleb; Mitrofanova, Lubov; Zemtsovsky, Eduard

    2014-03-01

    The aim of the study is to determine the impact of the underlying etiology (Barlow's disease or fibroelastic deficiency) on left ventricular function in patients with degenerative mitral valve disease and severe mitral regurgitation. We studied 233 patients (mean age: 53.8 ± 12.9) undergoing surgery for severe mitral regurgitation due to degenerative mitral valve disease at Almazov Federal Heart Centre between 2009 and 2011. Pathologic diagnoses for valvular tissue specimens were provided by an experienced pathologist. Preoperative strain and strain rate were determined using speckle tracking (Vivid 7 Dimension, EchoPAC'08). Barlow's disease was identified by the pathologist in 60 patients (25.8%), and fibroelastic deficiency in 173 patients (74.2%). There were no significant differences between groups in preoperative mitral regurgitation volume (70.5 ± 9.6 vs. 71.6 ± 8.5 ml, P = 0.40), and in global systolic (ejection fraction: 52.7 ± 6.6 vs. 52.0 ± 7.4%, P = 0.53) and diastolic (E/e': 12.2 ± 3.9 vs. 12.8 ± 4.2, P = 0.35) left ventricular function. Despite the lack of difference in ejection fraction and diastolic tissue Doppler parameters, in patients with Barlow's disease in comparison with fibroelastic deficiency a significant decrease of the left ventricular longitudinal systolic strain (-13.5 ± 2.2 vs. -15.6 ± 2.3%, P = 0.00001) and early diastolic strain rate (1.04 ± 0.20 vs. 1.14 ± 0.18 s, P = 0.0004) were detected. Patients with severe mitral regurgitation due to Barlow's disease have a lower preoperative left ventricular systolic function than those with fibroelastic deficiency, which may affect their postoperative prognosis.

  20. Left ventricular twist and circumferential strain in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Olsen, N. T.; Moesgaard, S. G.

    2013-01-01

    During the cardiac cycle, the ventricle undergoes a twisting motion because of the oblique orientation of the left ventricular (LV) myofibers. This can be quantified by speckle-tracking echocardiography (STE). In mitral regurgitation (MR) in humans, the short axis deformation has been suggested a...... as being pivotal to LV function. Decreased and delayed LV twist has been described in experimental MR, but has not been studied in myxomatous mitral valve disease (MMVD).......During the cardiac cycle, the ventricle undergoes a twisting motion because of the oblique orientation of the left ventricular (LV) myofibers. This can be quantified by speckle-tracking echocardiography (STE). In mitral regurgitation (MR) in humans, the short axis deformation has been suggested...

  1. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2013-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

  2. Minimally invasive septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy and intrinsic mitral valve disease.

    Science.gov (United States)

    Gilmanov, Daniyar Sh; Bevilacqua, Stefano; Solinas, Marco; Ferrarini, Matteo; Kallushi, Enkel; Santarelli, Philippo; Farneti, Pier Andrea; Glauber, Mattia

    2015-01-01

    Transaortic left ventricular septal myectomy described by Morrow is a classical procedure for the treatment of systolic anterior motion of the mitral apparatus associated with hypertrophic obstructive cardiomyopathy (HOCM). We aimed to review our results of transmitral septal myectomy and mitral valve repair/replacement in patients with intrinsic mitral valve disease associated with HOCM, operated on through a minimally invasive approach. Between 2005 and 2014, 19 patients [7 men (37%); mean (SD) age, 69.4 (14.5) years] were treated with minimally invasive approach for degenerative mitral regurgitation and HOCM. Preoperative peak left ventricular outflow tract (LVOT) gradient was 66 (24) mm Hg. Severe mitral regurgitation was diagnosed in 16 cases (84%). New York Heart Association functional class III to IV heart failure was present in 13 patients (68%). Fifteen patients (79%) underwent mitral valve replacement, and four patients (21%) underwent mitral valve repair. Left ventricular outflow tract obstruction was corrected directly in all patients via the mitral valve with septal myectomy/myotomy, avoiding aortotomy in majority of the patients. No significant prolongation of extracorporeal circulation/aortic cross-clamping times was observed (P = 0.41 and P = 0.67, respectively) when compared with a similar population without HOCM. No iatrogenic ventricular septal defect developed in treated patients. No hospital mortality occurred. Resting LVOT gradient reduced at discharge to 13 (22) mm Hg (P = 0.025). Transmitral left ventricular septal myectomy in patients with degenerative mitral valve disease is quite a simple, feasible, and effective technique and does not require aortotomy in most cases. It can be performed with low early mortality and satisfactory resolution of LVOT obstruction in a minimally invasive setting.

  3. Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis.

    Science.gov (United States)

    Tomšic, Anton; Versteegh, Michel I M; Ajmone Marsan, Nina; van Brakel, Thomas J; Klautz, Robert J M; Palmen, Meindert

    2017-12-18

    Native mitral valve infective endocarditis (IE) is a complicated disease with high mortality and morbidity rates. Mitral valve repair (MVRep) is feasible when limited valve destruction is present. However, recurrent valve dysfunction and reintervention are common. Between January 2000 and March 2016, 83 patients underwent surgery for isolated active native mitral valve IE. We applied an early surgery, MVRep-oriented approach with progressive utilization of patch techniques to secure a durable repair; MVRep was attempted in 67% of patients. Fifty-one (61%) patients underwent MVRep (including full-ring annuloplasty in 94%) and 32 (39%) patients underwent mitral valve replacement. Early mortality was 13%. No cases of early recurrent IE occurred. Predischarge echocardiography demonstrated good MVRep function in all, except 1 patient with residual (Grade 2+) regurgitation. The mean duration of follow-up was 3.7 years (interquartile range 1.5-8.4). For hospital survivors, 8-year overall survival rates were 92.4% (95% confidence interval 84.0-100%) and 74.2% (95% confidence interval 53.8-94.6%) for the MVRep and mitral valve replacement groups, respectively. Propensity score-adjusted Cox regression analysis revealed no significant difference in survival between the 2 groups (hazard ratio 0.359, 95% confidence interval 0.107-1.200; P = 0.096). Four reinterventions occurred, 2 in each group. Echocardiographic follow-up demonstrated excellent MVRep durability; no cases of mitral regurgitation and 1 case of mitral valve stenosis were seen. Native mitral valve IE is linked to high mortality and morbidity rates. A durable MVRep is feasible in most patients and provides excellent mid-term durability. Mitral valve replacement is a reasonable alternative when a durable repair is not likely.

  4. Intermittent mechanical and clinical intravalvar regurgitation aortic ...

    African Journals Online (AJOL)

    Mechanical prosthetic valve regurgitation may be either peri- prosthetic or intraprosthetic. The la"er is usually mild, occur- ring in the majority of normally functioning valves and is due to the 'regurgitant flow' closing the valve. An unusual case is reported of intermi"ent intraprosthetic regurgitation through a normally ...

  5. Minimally invasive mitral valve repair in Barlow's disease: early and long-term results.

    Science.gov (United States)

    Borger, Michael A; Kaeding, Anna F; Seeburger, Joerg; Melnitchouk, Serguei; Hoebartner, Michael; Winkfein, Michael; Misfeld, Martin; Mohr, Friedrich W

    2014-10-01

    Barlow's disease remains a challenging surgical pathology in patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients with Barlow's disease who underwent minimally invasive mitral valve surgery. Between 1999 and 2010, 145 patients with Barlow's disease underwent minimally invasive mitral valve repair at Leipzig Heart Center. Preoperative echocardiography and intraoperative valve analysis confirmed annular dilatation, bileaflet prolapse, and excessive leaflet tissue in all cases. We retrospectively reviewed mitral valve repair techniques, early and late postoperative clinical outcomes, and follow-up echocardiographic data. Successful mitral valve repair was performed in 94.5% of patients (n=137), initial mitral valve replacement was performed in 2.8% of patients (n=4), and mitral valve replacement after unsuccessful mitral valve repair was performed in 2.8% of patients (n=4). Mean aortic crossclamp time was 99±33 minutes, cardiopulmonary bypass time was 153±47 minutes, and total duration of surgery was 200±44 minutes. Mitral valve repair techniques consisted of ring annuloplasty and a variety of other methods (not mutually exclusive): "loop" neochordae (72% of patients), posterior mitral leaflet resection (28%), Alfieri stitch (17%), commissural plication (9%), chordal transfer (9%), and anterior mitral leaflet resection (7%). Concomitant procedures consisted of cryoablation for atrial fibrillation (28%), tricuspid valve repair (6%), and closure of an atrial septal defect/patent foramen ovale (12%). Thirty-day mortality was 1.4% (n=2), rethoracotomy for bleeding was required in 4.1% of patients (n=6), and conversion to sternotomy was required in 1 patient (0.7%). Long-term clinical follow-up was obtained in 100% of patients, and long-term echocardiographic data were obtained in 93.3% of surviving patients. Long-term survival was 94.7%±2.2% at 5 years and 88.3%±4.9% at 10 years. Freedom from mitral valve reoperation

  6. Acute effect of static exercise in patients with aortic regurgitation assessed by cardiovascular magnetic resonance: role of left ventricular remodelling.

    Science.gov (United States)

    Alegret, Josep M; Martinez-Micaelo, Neus; La Gerche, Andre; Franco-Bonafonte, Luis; Rubio-Pérez, Francisco; Calvo, Nahum; Montero, Manuel

    2017-04-01

    In patients with aortic regurgitation (AR), the effect of static exercise (SE) on global ventricular function and AR severity has not been previously studied. Resting and SE cardiovascular magnetic resonance (CMR) were prospectively performed in 23 asymptomatic patients with AR. During SE, we observed a decrease in regurgitant volume in both end-diastolic (EDV) and end-systolic (ESV) volume in both ventricles, as well as a slight decrease in LV ejection fraction (EF). Interestingly, responses varied depending on the degree of LV remodelling. Among patients with a greater degree of LV remodelling, we observed a decrease in LVEF (56 ± 4 % at rest vs 48 ± 7 % during SE, p = 0.001) as a result of a lower decrease in LVESV (with respect to LVEDV. Among patients with a lower degree of LV remodelling, LVEF remained unchanged. RVEF remained unchanged in both groups. In patients with AR, SE provoked a reduction in preload, LV stroke volume, and regurgitant volume. In those patients with higher LV remodelling, we observed a decrease in LVEF, suggesting a lower LV contractile reserve. • In patients with aortic regurgitation, static exercise reduced preload volume. • In patients with aortic regurgitation, static exercise reduced stroke volume. • In patients with aortic regurgitation, static exercise reduced regurgitant volume. • In patients with greater remodelling, static exercise unmasked a lower contractile reserve. • Effect of static exercise on aortic regurgitation was assessed by cardiac MR.

  7. Robotic mitral valve repair for anterior leaflet and bileaflet prolapse.

    Science.gov (United States)

    Rodriguez, Evelio; Nifong, L Wiley; Chu, Michael W A; Wood, William; Vos, Paul W; Chitwood, W Randolph

    2008-02-01

    Centers have expanded indications for robotic mitral valve repairs to include complex pathologic features. We studied our results after robotic mitral valve repair for anterior leaflet or bileaflet prolapse. Data were collected contemporaneously on 289 patients operated on from May 2000 to September 2006. Every patient underwent preoperative transesophageal echocardiography. Follow-up consisted of serial echocardiograms, clinic visits, and phone conversations with patients and their physicians. A total of 66 patients (anterior leaflet, n = 14; and bileaflet, n = 52) were identified. Mean age was 52.6 +/- 7.1 years, and 57 (86%) patients had New York Heart Association functional class II or III symptoms. Cardiopulmonary bypass and cross-clamp times were 171 +/- 52 and 132 +/- 39 minutes, respectively. The 30-day and late mortality rates were 3% (n = 2) for each time point. There were no device-related or perfusion-related complications or sternotomy conversions. Complications included 2 strokes (3%), 2 bleeding reexplorations (3%), and 10 pleural effusions requiring intervention (15%). The length of hospital stay for surviving patients was 5 +/- 3 days, and time to extubation averaged 9.5 +/- 13 hours. A total of 6 (9%) patients required valve reoperation. Mean follow-up was 795 +/- 495 days, and echocardiographic mitral regurgitation (n = 60) was none or trace (n = 35, 58.3%), mild (n = 19, 31.6%), moderate (n = 2, 3.3%), and severe (n = 4, 6.7%). Robotic mitral valve repair for anterior leaflet and bileaflet prolapse is feasible and safe. Outcomes and degree of late mitral regurgitation are similar to series using conventional techniques. Long-term follow-up is required to formally address the efficacy of robotic repair techniques.

  8. Valvular regurgitation and surgery associated with fenfluramine use: an analysis of 5743 individuals

    Science.gov (United States)

    Dahl, Charles F; Allen, Marvin R; Urie, Paul M; Hopkins, Paul N

    2008-01-01

    Background Use of fenfluramines for weight loss has been associated with the development of characteristic plaques on cardiac valves causing regurgitation. However, previously published studies of exposure to fenfluramines have been limited by relatively small sample size, short duration of follow-up, and the lack of any estimate of the frequency of subsequent valvular surgery. We performed an observational study of 5743 users of fenfluramines examined by echocardiography between July 1997 and February 2004 in a single large cardiology clinic. Results The prevalence of at least mild aortic regurgitation (AR) or moderate mitral regurgitation (MR) was 19.6% in women and 11.8% in men (p valvulopathy was common in individuals exposed to fenfluramines, more frequent in females, and associated with duration of use in all valves assessed. Valve surgery was performed as frequently for aortic as mitral valves and some tricuspid valve surgeries were also performed. The incidence of surgery appeared to be substantially increased compared with limited general population data. PMID:18990200

  9. Japan's first robot-assisted totally endoscopic mitral valve repair with a novel atrial retractor.

    Science.gov (United States)

    Ishikawa, Norihiko; Watanabe, Go; Tomita, Shigeyuki; Nagamine, Hiroshi; Yamaguchi, Shojiro

    2009-10-01

    This case report presents the first robot-assisted totally endoscopic mitral valve plasty in Japan. A 54-year-old woman was found by echocardiography to have grade III mitral valve regurgitation because of prolapse of the posterior leaflet. Surgical repair was performed using the da Vinci Surgical System. For the totally endoscopic mitral valve repair, a right-sided approach was used through four ports. A transthoracic aortic cross-clamp and novel flexible port access retractor were inserted through a 5-mm skin incision. Quadrangular resection of the posterior leaflet was performed, and an annuloplasty band was placed into the atrium. Resection of the valve segment took 13 min, and band implementation, 45 min. The total pump time was 197 min and the aortic cross-clamp time, 117 min. Postoperative echocardiography confirmed the absence of mitral insufficiency.

  10. Isolated parachute mitral valve in a 29 years old female; a case report

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2016-03-01

    Full Text Available A 29-year old female patient was referred to our hospital for evaluation of dyspnea NYHA class I which begun from several months ago. The only abnormal sign found on physical examination was a grade 2/6 systolic murmur at the apex position without radiation. Echocardiography revealed normal left and right ventricular sizes and systolic function, and only one papillary muscle in left ventricular (LV cavity which all chordae tendineae inserted into that muscle. The mitral valve orifice was eccentrically located at the lateral side with mild to moderate mitral regurgitation but without significant mitral stenosis. No other congenital heart anomalies were identified. Thus, the final diagnosis was isolated parachute mitral valve (IPMV. She was one of the very rare IPMV cases have ever been reported in adults

  11. Subacute Staphylococcus epidermidis Bacterial Endocarditis Complicated by Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Diane Elegino-Steffens

    2012-01-01

    Full Text Available The patient is a 75-year-old man with a history significant for hypertension and congestive heart failure who underwent a bioprosthetic aortic valve replacement secondary to acute onset of aortic insufficiency. Cultures of the native valve were positive for Staphylococcus epidermidis sensitive to nafcillin and intravenous cefazolin was initiated. On postoperative day 24, he developed acute decompensated heart failure. A transesophageal echocardiogram demonstrated a structurally abnormal mitral valve with severe regurgitation, anterior and posterior leaflet vegetations, and scallop prolapse. There was also evidence of a mitral-aortic intervalvular fibrosa pseudoaneurysm (P-MAIF with systolic expansion and flow within the aneurysm. Antibiotic treatment was changed from cefazolin to vancomycin for presumed development of methicillin-resistant Staphylococcus. He subsequently underwent a bioprosthetic mitral valve replacement and has restoration of health without sequella. This case highlights the development of a P-MAIF as a rare complication of both aortic or mitral valve replacement and infective endocarditis.

  12. Right ventricular function in patients with mitral valve disease; Evaluation by radionuclide blood pool scan

    Energy Technology Data Exchange (ETDEWEB)

    Hiraki, Yoshio; Shimizu, Mitsuharu; Noriyasu, Toshiaki; Nakagawa, Tomio; Aono, Kaname; Yanagi, Hidekiyo; Seno, Yoshimasa; Teramoto, Shigeru; Nagaya, Isao (Okayama Univ. (Japan). School of Medicine)

    1989-10-01

    Right ventricular function was studied in 13 patients with mitral valve stenosis (MS), 10 patients with mitral valve regurgitation (MR) and 10 patients after mitral valve replacement (MVR) with radionuclide blood pool scan. In MS, right ventricular end-diastolic and end-systolic volumes were larger than MVR. In MR, right ventricular ejection fraction (RVEF) was smaller and right ventricular end-systolic volume was larger than MVR. In both MS and MR, there was no significant linear correlation between RVEF and mean pulmonary arterial pressure (mPAP) at rest, but during exercise RVEF of patients with elevated mPAP decreased more than that of patients with normal mPAP. RVEF in patients with MS and MR was significantly decreased during exercise, while that in patients after MVR showed no significant change. Radionuclide blood pool scan seems to be useful for the evaluation of right ventricular function in mitral valve disease. (author).

  13. Heart Rate Variability in Cavalier King Charles Spaniels with Different Degree of Myxomatous Mitral Valve Disease

    DEFF Research Database (Denmark)

    Rasmussen, Caroline Elisabeth; Falk, Bo Torkel; Zois, Nora Elisabeth

    2010-01-01

    Heart Rate Variability in Cavalier King Charles Spaniels with Different Degree of Myxomatous Mitral Valve Disease Rasmussen, C.E. 1, Falk, T. 1, Zois, N.E. 1, Moesgaard, S.G. 1, Häggström, J. 2, Pedersen, H.D. 3 and Olsen, L.H1. 1Department of Basic Animal and Veterinary Sciences, Faculty of Life...... variability (HRV). Reduced HRV is seen in dogs with heart failure secondary to myxomatous mitral valve disease (MMVD). However, HRV is suggested to increase with disease progression in dogs with early stages of MMVD. Comparable results are found in people with primary mitral valve prolapse, a disease...... into 4 groups: 1) no or minimal mitral regurgitation (MR) (MR jet=15% of the left atrial area) and no murmur, 2) mild MR (20%50%) and no clinical signs of heart failure, 4) left atrium to aortic root ratio >1.5, clinical signs of heart failure and furosemide...

  14. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement

    Directory of Open Access Journals (Sweden)

    Shio Priye

    2015-01-01

    Full Text Available Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5 th post-operative day.

  15. Frequency of mitral valve dysfunction from mitral anular calcium as detected by Doppler echocardiography.

    Science.gov (United States)

    Labovitz, A J; Nelson, J G; Windhorst, D M; Kennedy, H L; Williams, G A

    1985-01-01

    Doppler echocardiography is useful for detecting and quantifying mitral regurgitation (MR) and mitral stenosis (MS). To determine the prevalence of these abnormalities in patients with mitral anular calcium (MAC), 51 consecutive patients who had an echocardiographic diagnosis of MAC were examined by Doppler ultrasound. Transmitral flow was evaluated to determine the presence of MR or left ventricular inflow obstruction (MS) by continuous and pulsed-wave Doppler echocardiography. The severity of these hemodynamic abnormalities was quantitated by previously described techniques. Eleven patients (22%) had mild MR, 17 (33%) had moderate to severe MR and 4 (8%) had significant MS. Clinical findings such as a systolic murmur, evidence of congestive heart failure, and dyspnea on exertion were not helpful in distinguishing patients with no or mild MR from those who had moderate to severe MR. M-mode measured left atrial size was significantly larger (p less than 0.05) in patients with moderate to severe MR. This study suggests that MR is often associated with MAC, that MS is not a rare finding with MAC, and that Doppler echocardiography can quantitate these lesions in the elderly when symptoms are not specific and physical findings are inconclusive or absent.

  16. Intraoperative echocardiographic detection of regurgitant jets after valve replacement

    Science.gov (United States)

    Morehead, A. J.; Firstenberg, M. S.; Shiota, T.; Qin, J.; Armstrong, G.; Cosgrove, D. M. 3rd; Thomas, J. D.

    2000-01-01

    BACKGROUND: Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. METHODS: Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. RESULTS: Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. CONCLUSIONS: Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.

  17. FBN1 gene mutation characteristics and clinical features for the prediction of mitral valve disease progression.

    Science.gov (United States)

    Kühne, Kristin; Keyser, Britta; Groene, Eike F; Sheikhzadeh, Sara; Detter, Christian; Lorenzen, Viktoria; Hillebrand, Mathias; Bernhardt, Alexander M J; Hoffmann, Boris; Mir, Thomas S; Robinson, Peter N; Berger, Jürgen; Reichenspurner, Hermann; von Kodolitsch, Yskert; Rybczynski, Meike

    2013-09-30

    Until today, FBN1 gene mutation characteristics were not compared with clinical features for the prediction of mitral valve disease progression. Therefore, we conducted a study of 116 patients (53 men, 63 women aged 33 ± 15 years) with a causative FBN1 gene mutation and ≤ moderate mitral valve regurgitation at baseline. During 7.4 ± 6.8 years 30 patients developed progression of mitral valve regurgitation ≥ 1 grade (primary endpoint), and 26 patients required mitral valve surgery (secondary endpoint). Cox regression analysis identified an association of atrial fibrillation (hazard ratio (HR)=2.703; 95% confidence interval (CI) 1.013-7.211; P=.047), left ventricular ejection fraction (HR=.970; 95%CI .944-.997; P=.032), indexed end-diastolic left ventricular diameter (HR=15.165; 95%CI 4.498-51.128; Pvalve prolapse (HR=2.599; 95%CI 1.243-5.437; P=.011), posterior leaflet prolapse (HR=1.075; 95%CI 1.023-1.130; P=.009), and posterior leaflet thickening (HR=3.368; 95%CI 1.265-8.968; P=.015) with progression of mitral valve disease, whereas none of the FBN1 gene mutation characteristics were associated with progression of mitral valve disease. However, Cox regression analysis identified a marginal relationship of FBN1 gene mutations located both in a transforming-growth-factor beta-binding protein-like (TGFb-BP) domain (HR=3.453; 95%CI .982-12.143; P=.053), and in the calcium-binding epidermal growth factor-like (cbEGF) domain (HR=2.909; 95%CI .957-8.848; P=.060) with mitral valve surgery, a finding that was corroborated by Kaplan-Meier analysis (P=.014; and P=.041, respectively). Clinical features were better predictors of mitral valve disease progression than FBN1 gene mutation characteristics. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Breeding Restrictions Decrease the Prevalence of Myxomatous Mitral Valve Disease in Cavalier King Charles Spaniels over an 8-to 10-Year Period

    DEFF Research Database (Denmark)

    Birkegård, Anna Camilla; Reimann, M. J.; Martinussen, T.

    2016-01-01

    Background: Cavalier King Charles Spaniels (CKCS) are predisposed to myxomatous mitral valve disease (MMVD). Studies have indicated a strong genetic background. Objective: The aim of this study was to evaluate the effect of a breeding scheme involving auscultation and echocardiography. Animals...... valve prolapse (MVP). The odds of having mitral regurgitation murmur or MVP > grade 1 in 2010-2011 compared to 2002-2003 were estimated using logistic regression analysis including age and sex as covariates. Odds were estimated for dogs that were products of the breeding scheme (defined as dogs......: In the Danish Kennel Club mandatory breeding scheme, 997 purebred CKCS were examined during the period 2002-2011. Each dog was evaluated 1-4 times with a total of 1,380 examinations. Methods: Auscultation and echocardiography were performed to evaluate mitral regurgitation murmur severity and degree of mitral...

  19. Minimally invasive mitral valve repair in osteogenesis imperfecta.

    Science.gov (United States)

    Tagliasacchi, Isabella; Martinelli, Luigi; Bardaro, Leopoldo; Chierchia, Sergio

    2017-10-01

    Osteogenesis imperfecta is a disorder of the connective tissue that affects several structures including heart valves. However, cardiac surgery is associated with high mortality and morbidity rates. In a 48-year-old man with osteogenesis imperfecta and mitral valve prolapse, we performed the first successful mitral valve repair by right anterior mini-thoracotomy. At the 1-year follow-up, he was asymptomatic and echocardiography confirmed the initial success. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. [Surgical outcome of mitral valve repair in Iceland 2001-2012].

    Science.gov (United States)

    Gudmundsdottir, Johanna Frida; Ragnarsson, Sigurdur; Geirsson, Arnar; Danielsen, Ragnar; Gudbjartsson, Tomas

    2014-11-01

    To review, for the first time, the outcome of mitral valve repair operations in Iceland. A retrospective study of all mitral valve repair patients (average age 64 yrs, 74% males) operated in Iceland 2001-2012. All 125 patients had mitral regurgitation; either due to degenerative disease (56%) or functional regurgitation (44%). Survival was estimated using the Kaplan-Meier method. The median follow-up time was 3.9 years The number repair-procedures increased from 39 during the first half of the study period to 86 during the latter period. The mean EuroSCORE was 12.9% and 2/3 of the patients were in NYHA class III/IV. Half of them had severe mitral regurgitation, 12% had a recent myocardial infarction, and 10% a history of previous cardiac surgery. A ring annuloplasty was performed in 98% of cases, a posterior leaflet resection was done in 51 patients (41%), 28 received artificial chordae (Goretex(®)) and 7 an Alfieri-stitch. Concomitant cardiac surgery was performed in 83% of cases, where coronary artery bypass (53%), Maze-procedure (31%) or aortic valve replacement (19%) were most common. Major complications occurred in 56% of the cases and minor complications were noted in 71% of cases. Two patients later required mitral valve replacement. Eight patients died within 30 days (6%) and 5-year overall survival was 79%; or 84% and 74% for the degenerative and functional groups, respectively. The number of mitral valve repairs in Iceland increased significantly over the study period. Complications are common but operative mortality and long-term survival is similar to that reported in studies from other countries.

  1. Causes of repair failure for degenerative mitral valve disease and reoperation outcomes.

    Science.gov (United States)

    Nishida, Hidefumi; Fukui, Toshihiro; Kasegawa, Hitoshi; Kin, Hajime; Yamazaki, Masataka; Takanashi, Shuichiro

    2018-01-03

    This study aimed to evaluate the causes of initial mitral valve (MV) repair failure, the details of reoperation and the long-term outcomes of mitral valve re-repair (Re-MVP). We retrospectively reviewed 86 patients who underwent reoperation after MV repair for MR due to degenerative disease from October 1991 to December 2015. First, we analysed the initial MV repair data, causes of MV repair failure, reoperation data and long-term outcomes including survival. Second, the patients were classified into 2 groups based on valve related failure or procedure related failure , and the differences between the groups were analysed. Leaflet prolapse at the initial operation affected the bilateral leaflets in 37 (43%) patients, the anterior leaflet in 30 (35%) patients and the posterior leaftlet in 19 (22%) patients. Median duration from first operation to reoperation was 47.5 (interquartile range 4.8-85.8) months. Reoperation indication included recurrent mitral regurgitation alone in 59 patients, haemolysis combined with recurrent mitral regurgitation in 15 patients, infectious endocarditis combined with recurrent mitral regurgitation in 8 patients, mitral stenosis in 2 patients and left ventricular pseudoaneurysm in 2 patients. The cause of MV repair failure was valve-related in 61 (71%) patients, procedure-related in 20 (23%) patients and both in 5 (6%) patients. Re-MVP was successful in 23 (27%) patients. Re-MVP was more common in patients with procedure-related failure, which occurred earlier than valve-related failure. Freedom from all-cause death was significantly better after Re-MVP. The 5-year freedom from reoperation after Re-MVP was 95.7%. Re-MVP was more common in patients with procedure-related failure, which occurred earlier than valve-related failure. Durability of re-repaired MVs and survival of re-repaired patients were acceptable.

  2. Transvalvular pressure gradients for different methods of mitral valve repair: only neochordoplasty achieves native valve gradients.

    Science.gov (United States)

    Jahren, Silje Ekroll; Hurni, Samuel; Heinisch, Paul Philipp; Winkler, Bernhard; Obrist, Dominik; Carrel, Thierry; Weber, Alberto

    2018-02-01

    Many surgical and interventional methods are available to restore patency for patients with degenerative severe mitral valve regurgitation. Leaflet resection and neochordoplasty, which both include ring annuloplasty, are the most frequently performed techniques for the repair of posterior mitral leaflet flail. It is unclear which technique results in the best haemodynamics. In this study, we investigated the effect of different mitral valve reconstruction techniques on mitral valve haemodynamics and diastolic transvalvular pressure gradient in an ex vivo porcine model. Eight porcine mitral valves were tested under pulsatile flow conditions in an in vitro pulsatile flow loop for haemodynamic quantification. Severe acute posterior mitral leaflet flail was created by resecting the posterior marginal chorda. The acute mitral valve regurgitation was corrected using 4 different repair techniques, in each valve, in a strictly successive order: (i) neochordoplasty with polytetrafluoroethylene sutures alone and (ii) with ring annuloplasty, (iii) edge-to-edge repair and (iv) triangular leaflet resection, both with ring annuloplasty. Valve haemodynamics were measured and quantified for all valve configurations (native, rupture and each surgical reconstruction). The results were analysed using a validated statistical linear mixed model, and the P-values were calculated using a 2-sided Wald test. All surgical reconstruction techniques were able to sufficiently correct the acute mitral valve regurgitation. Neochordoplasty without ring annuloplasty was the only reconstruction technique that resulted in haemodynamic properties similar to the native mitral valve (P-values from 0.071 to 0.901). The diastolic transvalvular gradient remained within the physiological range for all reconstructions but was significantly higher than in the native valve for neochordoplasty with ring annuloplasty (P < 0.000), edge-to-edge repair (P < 0.000) and leaflet resection (P < 0

  3. Radionuclide ventriculography for non-invasive diagnosis and quantification of tricuspid regurgitation

    Energy Technology Data Exchange (ETDEWEB)

    Kress, P.; Seibold, H.; Wieshammer, S.; Richter, P.; Stauch, M.; Waitzinger, J.; Bitter, F.; Adam, W.E.

    1987-08-01

    A series of 33 patients with TR on physical examination and cardiac catheterization underwent RNV and was compared with 48 patients with right ventricular enlargement or pressure load on the right ventricle. In addition, the specificity of the method was evaluated in 470 consecutive patients with various forms of heart disease. In 18 out of 20 subjects with isolated TR a regurgitant index below the lower normal limit was found. The remaining 2 cases with minor TR had a regurgitant index within the normal range, which is 0.89 to 1.97 in this laboratory. In patients with additional volume load on the left ventricle, the sensitivity of the method was found to be low, as could be expected from the principle of the method. The time-activity curve over the liver was usually in phase with that recorded over the atria in subjects with TR. Therefore, the additional examination of a region of interest over the liver was particularly useful in these patients with concomitant aortic or mitral valve regurgitation. None of the 48 patients with right ventricular enlargement or pressure load on the right ventricle had a falsely positive result. A total of 17 out of 470 consecutive patients had a regurgitant index below the normal range; left ventricular function was severely impaired in 9 of these patients. The remaining subjects had a regurgitant index slightly below the lower normal limit. In conclusion, RNV has a high sensitivity in the diagnosis of TR in patients without left heart valvular regurgitation and a high specificity in patients without severely impaired left ventricular function and without left-to-right shunt through an atrial septal defect. As in patients with right ventricular volume load from an atrial septal defect, RNV appears to allow the quantification of TR. This, however, cannot be proven directly since a golden standard for quantification of TR is not available. (orig./TRV).

  4. Mitral valve replacement in a patient with situs inversus and dextrocardia.

    Science.gov (United States)

    Sahin, M A; Guler, A; Kaya, E

    2011-08-01

    Dextrocardia is a rarely seen cardiac malposition, often associated with multiple and complex congenital cardiac anomalies. Valve surgery for acquired valvular lesions in dextrocardia with situs inversus is rare. A 65-year-old man was admitted to our department with palpitation and dyspnea. Chest X-ray showed dextrocardia, and echocardiography revealed severe mitral regurgitation due to rheumatic valve degeneration. Prosthetic mitral valve replacement using a transseptal approach via a median sternotomy was successfully performed in the patient. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Mitral Valve Stenosis

    Science.gov (United States)

    ... valve stenosis include: Rheumatic fever. A complication of strep throat, rheumatic fever can damage the mitral valve. Rheumatic ... children see your doctor for sore throats. Untreated strep throat infections can develop into rheumatic fever. Fortunately, strep ...

  6. Three-dimensional echocardiographic assessment of the repaired mitral valve.

    Science.gov (United States)

    Maslow, Andrew; Mahmood, Feroze; Poppas, Athena; Singh, Arun

    2014-02-01

    This study examined the geometric changes of the mitral valve (MV) after repair using conventional and three-dimensional echocardiography. Prospective evaluation of consecutive patients undergoing mitral valve repair. Tertiary care university hospital. Fifty consecutive patients scheduled for elective repair of the mitral valve for regurgitant disease. Intraoperative transesophageal echocardiography. Assessments of valve area (MVA) were performed using two-dimensional planimetry (2D-Plan), pressure half-time (PHT), and three-dimensional planimetry (3D-Plan). In addition, the direction of ventricular inflow was assessed from the three-dimensional imaging. Good correlations (r = 0.83) and agreement (-0.08 +/- 0.43 cm(2)) were seen between the MVA measured with 3D-Plan and PHT, and were better than either compared to 2D-Plan. MVAs were smaller after repair of functional disease repaired with an annuloplasty ring. After repair, ventricular inflow was directed toward the lateral ventricular wall. Subgroup analysis showed that the change in inflow angle was not different after repair of functional disease (168 to 171 degrees) as compared to those presenting with degenerative disease (168 to 148 degrees; p<0.0001). Three-dimensional imaging provides caregivers with a unique ability to assess changes in valve function after mitral valve repair. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Asymptomatic dystrophinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Morrone, A. [Univ. of Pittsburgh School of Medicine, PA (United States)]|[Univ. of Florence (Italy); Hoffman, E.P.; Hoop, R.C. [Univ. of Pittsburgh School of Medicine, PA (United States)] [and others

    1997-03-31

    A 4-year-old girl was referred for evaluation for a mild but persistent serum aspartate aminotransferase (AST) elevation detected incidentally during routine blood screening for a skin infection. Serum creatine kinase activity was found to be increased. Immuno-histochemical study for dystrophin in her muscle biopsy showed results consistent with a carrier state for muscular dystrophy. Molecular work-up showed the proposita to be a carrier of a deletion mutation of exon 48 of the dystrophin gene. Four male relatives also had the deletion mutation, yet showed no clinical symptoms of muscular dystrophy (age range 8-58 yrs). Linkage analysis of the dystrophin gene in the family showed a spontaneous change of an STR45 allele, which could be due to either an intragenic double recombination event, or CA repeat length mutation leading to identical size alleles. To our knowledge, this is the first documentation of an asymptomatic dystrophinopathy in multiple males of advanced age. Based on molecular findings, this family would be given a diagnosis of Becker muscular dystrophy. This diagnosis implies the development of clinical symptoms, even though this family is clearly asymptomatic. This report underscores the caution which must be exercised when giving presymptomatic diagnoses based on molecular studies. 28 refs., 4 figs., 1 tab.

  8. Left atrial volume in patients with asymptomatic aortic valve stenosis (the Simvastatin and Ezetimibe in Aortic Stenosis study)

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, K.; Wachtell, K.

    2008-01-01

    = -0.1, p = 0.0002). Multivariate analysis showed that LAVI was significantly related to AVA indexed (beta = -4.1, p = 0.007) in a model that also included mitral regurgitation (beta = 2.8, p history of hypertension (beta = 2.2, p = 0.002), LV end-diastolic volume (beta = 0.05, p

  9. Mitral Valve Modelling in Ischemic Patients: Finite Element Analysis from Cardiac Magnetic Resonance Imaging

    OpenAIRE

    Conti, C. A.; Stevanella, M.; Maffessanti, F.; Trunfio, S.; Votta, E; Roghi, A; Parodi, O; Caiani, E. G.; Redaelli, A

    2010-01-01

    The goal of the present work was to develop a framework for the analysis of time-varying mitral valve (MV) geometry from cardiac magnetic resonance (CMR) imaging, and to integrate these data in a patient-specific simulation of MV closure. CMR imaging of 18 long-axis planes was performed on a healthy subject and on two ischemic patients with MV regurgitation. MV annulus geometry, leaflets surface and papillary muscles position were obtained using custom software. Hyperelastic anisotropic mecha...

  10. Regurgitative food transfer among wild wolves

    Science.gov (United States)

    L. David Mech; Paul C. Wolf; Jane M. Packard

    1999-01-01

    Few studies of monogamous canids have addressed regurgitation in the context of extended parental care and alloparental care within family groups. We studied food transfer by regurgitation in a pack of wolves on Ellesmere Island, North West Territories, Canada, during 6 summers from 1988 through 1996. All adult wolves, including yearlings and a post-reproductive female...

  11. Echocardiography of the mitral valve

    OpenAIRE

    Omran, A.S.; Arifi, A.A.; Mohamed, A.A.

    2010-01-01

    Mitral valve disease is the second most common valvular heart disease after the aortic valve worldwide. Mitral valve has historically been a structure of interest by pioneers in echocardiography. One of the earliest applications of echocardiography was in the diagnosis of valvular heart disease, particularly mitral stenosis. In this review we wish to take the reader through the structural and hemodynamic evaluation of the normal mitral valve.

  12. Plástica mitral Mitral repair

    Directory of Open Access Journals (Sweden)

    Domingo M Braile

    1990-08-01

    Full Text Available Foram estudados 101 pacientes submetidos a plástica da valva mitral em seis anos, com seguimento de 100%. Entre eles, 36 eram do sexo masculino e 65 do sexo feminino, com idade variando de dois a 62 anos (M = 28 ± 16,4. Desses, 57 (56,4% foram submetidos apenas a abordagem valvar mitral. Os demais foram submetidos a procedimentos associados, como plástica tricúspide (9,9%, revascularização do miocárdio (4,0%, entre outros. Não foi registrado óbito imediato. O índice de mortalidade tardia foi de 2% (AVC hemorrágico após cinco anos e septicemia, no primeiro ano. As complicações não fatais foram representadas pela endocardite evidenciada em dois pacientes (2%, sendo tratados e curados, e um paciente com reestenose mitral pós-plástica por reagudização da doença reumática. O estudo atuarial revelou um índice de 79,0 ± 17,7% de sobrevida, um total de 76,3 ± 17,8% de pacientes livres de complicações, 80,0 ± 17,9% de reoperações, 100,0% livres de tromboembolismo. Os resultados ecodoplercardiográficos registraram que 89% dos pacientes evoluíram com ausência de insuficiência. Dos 11% restantes, 7,4% apresentram insuficiência mitral discreta, 2,4% moderada e 2% importante. De acordo com a classificação da NYHA, os pacientes das classes III (83,8% e IV (16,2% passaram para as classes I (33,3%, II (60,6%, III (4,1% e IV (2%. Os autores concluem que o anel de pericárdio flexível conforma-se perfeitamente com o anel valvar, não produz hemólise e se endoteliza completamente a médio prazo.A hundred-and-one patients were studied in six years, with 100% of follow-up. Among them, 36 were male and 65 female, with an age range of two to 62 years (mean 28 ± 16.4%. Fifty seven of them (56.4% underwent just a mitral surgery, the others and other associated procedures, as tricuspid plastic (9.9%, coronary artery revascularization (4.0%, among others. Hospital mortality was not registered. The late mortality rate was 2% for AVC

  13. Manejo médico-quirúrgico del fibroelastoma papilar de la válvula mitral, diagnosticado durante la gestación

    Directory of Open Access Journals (Sweden)

    Nestor Pereira

    2012-07-01

    , with defined morphology. Female, 27 years, pregnant women with a history of premature ventricular contractions since 2002 and referred to the Cardiology Department for presenting stroke. The transesophageal echocardiogram showing a mass with settings or “anemone” in mitral valve attached to the atrial surface of the anterior leaflet or 7 x 7mm, and trivial mitral regurgitation by color Doppler. Surgical resection was decided. Histopathological examination of the specimen ends as fibroelastoma papillary biopsychosocial. Papillary fibroelastoma is the clinical presentation varies from asymptomatic to fatal valvular obstruction or peripheral embolism. The choice along with valve if necessary and, in some cases, resection of cardiac endothelium and subsequent repair of the area. We report the clinical and surgical management of the first case of papillary fibroelastoma reported in IAHULA.

  14. Mid-term outcomes of congenital mitral valve surgery: Shone's syndrome is a risk factor for death and reintervention.

    Science.gov (United States)

    Sughimoto, Koichi; Konstantinov, Igor E; d'Udekem, Yves; Brink, Johann; Zannino, Diana; Brizard, Christian P

    2017-11-01

    To study the recent trends and outcomes of congenital mitral valve surgery in children. From 2008 to 2014, 84 procedures in 66 consecutive patients (41 procedures in 31 patients with mitral stenosis and 43 procedures in 35 patients with mitral regurgitation) were retrospectively evaluated. The mean age at surgery was 4.3 ± 5.4 years, and 27 patients (41%) were neonates or infants. Seven (11%) patients died during the follow-up period of 3.2 ± 2.3 years and 5 (71%) were mitral valve replacements were performed in 8 patients, including 1 pulmonary valve homograft, 3 Contegra conduits of 12 mm thickness in the intra-annular position and 6 mechanical valves. Shone's syndrome, dysplastic valve, a need for valve replacement and age valve replacement and age mitral valve dysplasia was a significant risk factor for reoperation or death. The 5-year rate of freedom from death or reoperation in neonates or infants was 55% and that in patients aged >1 year was 88% (P = 0.003). An age of mitral valve dysplasia and a need for mitral valve replacement were associated with a higher incidence of death or reoperation. Primary mitral valve replacement or univentricular strategy may have to be considered for symptomatic neonates with Shone's syndrome.

  15. Outcome reporting for surgical treatment of degenerative mitral valve disease: a systematic review and critical appraisal.

    Science.gov (United States)

    Tomšic, Anton; Arabkhani, Bardia; Schoones, Jan W; van Brakel, Thomas J; Takkenberg, Johanna J M; Palmen, Meindert; Klautz, Robert J M

    2017-12-08

    Standardized outcome reporting is of critical importance for performance monitoring, improvement of existing techniques and introduction of novel technologies. Whether outcome reporting for surgical treatment of degenerative mitral valve disease complies with the guidelines has not been assessed to date. A systematic review of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted for articles published between 1 January 2009 and 7 March 2016. Inclusion criteria were adult patient population (n ≥ 200) and surgical intervention for degenerative mitral valve disease. The quality of reported outcome was compared with the standard recommended by the guidelines on reporting morbidity and mortality after cardiac valve interventions. Forty-two non-randomized clinical studies were included: 4 provided early and 38 provided early and late outcome data. Early echocardiographic outcome was reported in 49% of studies. Freedom from reintervention, the indication for reintervention and the follow-up echocardiographic outcome were reported in 97%, 59% and 79% of studies providing late outcome data, respectively. The Kaplan-Meier method was used to assess the freedom from recurrent mitral regurgitation in 60% (18/30) of studies, whereas 7% (2/30) of studies applied a longitudinal data analysis. Recurrent mitral regurgitation was most commonly defined as moderate (Grade 2+; 60%) or severe (Grade 4+; 37%) regurgitation. There is a significant discordance between the guidelines-based recommendations and actual reporting of outcome for surgical treatment of degenerative mitral valve disease. Better adherence to the guidelines would raise the quality and generalizability of clinical data reporting.

  16. Identification of 2 loci associated with development of myxomatous mitral valve disease in Cavalier King Charles Spaniels

    DEFF Research Database (Denmark)

    Madsen, Majbritt Busk; Olsen, Lisbeth Høier; Häggström, Jens

    2011-01-01

    Myxomatous mitral valve disease (MMVD) is the most common heart disease in dogs. It is characterized by chronic progressive degenerative lesions of the mitral valve. The valve leaflets become thickened and prolapse into the left atrium resulting in mitral regurgitation (MR). MMVD is most prevalent...... in small to medium sized dog breeds, Cavalier King Charles Spaniels (CKCS) in particular. The onset of MMVD is highly age dependent, and at the age of 10 years, nearly all CKCS are affected. The incidence of a similar disease in humans-mitral valve prolapse-is 1-5%. By defining CKCSs with an early onset......(-4)) associated with development of MMVD. This confirms the power of using the dog as a model to uncover potential candidate regions involved in the molecular mechanisms behind complex traits....

  17. Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

    Directory of Open Access Journals (Sweden)

    Seong Lee

    2015-10-01

    Full Text Available Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, 47.7±9.7 years; 11 female and 4 male who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5±7 years. The mean preoperative Wilkins score was 9.4±2.6. Results: The mean mitral valve area obtained using planimetry increased from 1.16±0.16 cm2 to 1.62±0.34 cm2 (p=0.0001. The mean pressure half time obtained using Doppler ultrasound decreased from 202.4±58.6 ms to 152±50.2 ms (p=0.0001. The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4±4.0 mmHg to 5.8±1.5 mmHg (p=0.0021. There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39±16 months. The 5-year event-free survival was 56.16% (95% confidence interval, 47.467–64.866. Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

  18. Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification: Results From the First Multicenter Global Registry.

    Science.gov (United States)

    Guerrero, Mayra; Dvir, Danny; Himbert, Dominique; Urena, Marina; Eleid, Mackram; Wang, Dee Dee; Greenbaum, Adam; Mahadevan, Vaikom S; Holzhey, David; O'Hair, Daniel; Dumonteil, Nicolas; Rodés-Cabau, Josep; Piazza, Nicolo; Palma, Jose H; DeLago, Augustin; Ferrari, Enrico; Witkowski, Adam; Wendler, Olaf; Kornowski, Ran; Martinez-Clark, Pedro; Ciaburri, Daniel; Shemin, Richard; Alnasser, Sami; McAllister, David; Bena, Martin; Kerendi, Faraz; Pavlides, Gregory; Sobrinho, Jose J; Attizzani, Guilherme F; George, Isaac; Nickenig, George; Fassa, Amir-Ali; Cribier, Alain; Bapat, Vinnie; Feldman, Ted; Rihal, Charanjit; Vahanian, Alec; Webb, John; O'Neill, William

    2016-07-11

    This study sought to evaluate the outcomes of the early experience of transcatheter mitral valve replacement (TMVR) with balloon-expandable valves in patients with severe mitral annular calcification (MAC) and reports the first large series from a multicenter global registry. The risk of surgical mitral valve replacement in patients with severe MAC is high. There are isolated reports of successful TMVR with balloon-expandable valves in this patient population. We performed a multicenter retrospective review of clinical outcomes of patients with severe MAC undergoing TMVR. From September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR with compassionate use of balloon-expandable valves. Mean age was 73 ± 13 years, 66% were female, and mean Society of Thoracic Surgeons score was 14.4 ± 9.5%. The mean mitral gradient was 11.45 ± 4.4 mm Hg and the mean mitral area was 1.18 ± 0.5 cm(2). SAPIEN valves (Edwards Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%, SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%. Technical success according to Mitral Valve Academic Research Consortium criteria was achieved in 46 (72%) patients, primarily limited by the need for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract obstruction with hemodynamic compromise. Mean mitral gradient post-procedure was 4 ± 2.2 mm Hg, paravalvular regurgitation was mild or absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular = 12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data available were in New York Heart Association functional class I or II at 30 days (n = 25). TMVR with balloon-expandable valves in patients with severe MAC is feasible but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options. Copyright

  19. Association of altered collagen content and lysyl oxidase expression in degenerative mitral valve disease.

    Science.gov (United States)

    Purushothaman, K-Raman; Purushothaman, Meerarani; Turnbull, Irene C; Adams, David H; Anyanwu, Anelechi; Krishnan, Prakash; Kini, Annapoorna; Sharma, Samin K; O'Connor, William N; Moreno, Pedro R

    Collagen cross-linking is mediated by lysyl oxidase (LOX) enzyme in the extracellular matrix (ECM) of mitral valve leaflets. Alterations in collagen content and LOX protein expression in the ECM of degenerative mitral valve may enhance leaflet expansion and disease severity. Twenty posterior degenerative mitral valve leaflets from patients with severe mitral regurgitation were obtained at surgery. Five normal posterior mitral valve leaflets procured during autopsy served as controls. Valvular interstitial cells (VICs) density was quantified by immunohistochemistry, collagen Types I and III by picro-sirius red staining and immunohistochemistry, and proteoglycans by alcian blue staining. Protein expression of LOX and its mediator TGFβ1 were quantified by immunofluorescence and gene expression by PCR. VIC density was increased, structural Type I collagen density was reduced, while reparative Type III collagen and proteoglycan densities were increased (Pvalves. These changes were associated with a reduction in LOX (Pmitral valve leaflets. Observed changes in Type I and III collagen densities in Degenerative Mitral Valve Disease may be secondary to alterations in LOX protein expression, contributing to disorganization of ECM and disease severity. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Mitral valve prolapse in Cavalier King Charles spaniel: a review and case study.

    Science.gov (United States)

    Hyun, Changbaig

    2005-03-01

    A 5 year-old spayed female Cavalier King Charles Spaniel was presented after a 3- to 5-day onset of severe respiratory distress. The dog also had a history of several episodes of syncope prior to presentation. A comprehensive diagnostic investigation revealed a midsystolic click sound on cardiac auscultation, signs of left sided cardiac enlargement in ECG and thoracic radiography, mitral valvular leaflet protrusion into left the atrium, decreased E-point-to septal separation (EPSS) and mitral regurgitated flow in echocardiography, all of which are characteristic signs of mitral valvular prolapse. After intensive care with diuretics [corrected] and a vasodilator with oxygen supplement, the condition of the dog was stabilized. The dog was then released and is being medicated with angiotensin converting enzyme (ACE) inhibitor with regular follow-up.

  1. Total Chordal Sparing Mitral Valve Replacement in Rheumatic Disease: A Word of Caution.

    Science.gov (United States)

    Kessel, Samuel M; Hawkins, Robert B; Yarboro, Leora T; Ailawadi, Gorav

    2017-07-01

    Total chordal preservation is the standard for mitral valve replacement to maintain long-term left ventricular geometry. Whereas it is appropriate for functional and degenerative mitral regurgitation, the role of chordal sparing in rheumatic valve disease is less well understood, with limited evidence supporting total chordal sparing. Inasmuch as this autoimmune disease affects the subvalvular apparatus in addition to the leaflets, it can be expected to continue after surgical repair. Here we present 2 patients who experienced adverse events associated with total chordal sparing mitral replacement as a result of disease progression with rapid fibrous growth causing inflow obstruction and early prosthetic valve failure. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Mitral Valve Prolapse

    Science.gov (United States)

    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... valve syndrome . What happens during MVP? Watch an animation of mitral valve prolapse When the heart pumps ( ...

  3. PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY ...

    African Journals Online (AJOL)

    Kateee

    2003-04-04

    Apr 4, 2003 ... G.O. Yonga, MBChB, MMed, Consultant Cardiologist, Hurlingham Heart Clinic, P.O. Box 76555, Nairobi and P. Bonhoeffer, Consultant Cardiologist and Director. Paediatric ... Standard left and right heart catheterisation for mitral valve disease. ... to severe rheumatic fever and also carries poorer prognosis.

  4. Homoenxerto mitral: uma realidade

    Directory of Open Access Journals (Sweden)

    Francisco Diniz Affonso da COSTA

    1998-07-01

    Full Text Available Fundamentos: A utilização de homoenxertos valvares aórticos criopreservados está associada a excelente qualidade de vida, com baixa morbidade e durabilidade satisfatória. Espera-se obter resultados semelhantes em posição mitral com o emprego de homoenxertos mitrais criopreservados. Objetivo: Avaliar os resultados imediatos e a curto prazo da substituição da valva mitral por homoenxerto mitral criopreservado. Casuística e Métodos: De julho/97 a fevereiro/98, 8 pacientes com média de idades de 40,3 ± 6,2 anos foram submetidos a substituição da valva mitral por homoenxerto mitral criopreservado. A técnica de implante consistiu de fixação látero-lateral dos músculos papilares, sutura anular contínua e anuloplastia com anel de Carpentier. Antes da alta, todos os pacientes realizaram ecocardiografia bidimensional com Doppler para análise da função valvar e ventricular. Os pacientes foram solicitados a retornar no primeiro mês e, subseqüentemente, a cada três meses de pós-operatório, para controles clínico e ecocardiográfico tardio. Resultados: Houve um óbito hospitalar de causa não relacionada ao enxerto. A avaliação ecocardiográfica antes da alta hospitalar demonstrou média das áreas valvares de 3,1 ± 0,6 cm2 e média dos gradientes médios de 3,5 ± 1,6 mmHg. A insuficiência valvar foi quantificada como inexistente ou trivial em 4 casos e leve em 3. A fração de ejeção de 57 ± 7% no pré-operatório foi adequadamente preservada no pós-operatório (62 ± 6%. Os níveis de hipertensão pulmonar regrediram significativamente de 87 ± 15 mmHg no pré-operatório para 48 ± 12 mmHg no pós-operatório. Houve também redução do tamanho da cavidade atrial esquerda de 61 ± 10 mm para 53 ± 7 mm. Nenhum paciente foi perdido do acompanhamento tardio. Após um tempo médio de seguimento de 4,1 ± 2,5 meses, os pacientes encontram-se funcionalmente bem e sem complicações pós-operatórias. O estudo ecocardiogr

  5. Mitral Valve Disease

    Science.gov (United States)

    ... clots, but they also are less durable than mechanical valves and may need to be replaced in the future. Like mitral valve repair, replacement can be done minimally invasively or with traditional open heart surgery. Your medical team will discuss the advantages ...

  6. Outcomes after mitral valve repair: A single-center 16-year experience.

    Science.gov (United States)

    Tatum, James M; Bowdish, Michael E; Mack, Wendy J; Quinn, Adrienne M; Cohen, Robbin G; Hackmann, Amy E; Barr, Mark L; Starnes, Vaughn A

    2017-09-01

    To evaluate outcomes after mitral valve repair. Between May 1999 and June 2015, 446 patients underwent mitral valve repair. Isolated mitral valve annuloplasty was excluded. A total of 398 (89%) had degenerative valve disease. Mean follow-up was 5.5 ± 3.8 years. Postoperative echocardiograms were obtained in 334 patients (75%) at a mean of 24.3 ± 13.7 months. Survival was 97%, 96%, 95%, and 94% at 1, 3, 5, and 10 years. Risk factor analysis showed age >60 years and nondegenerative etiology predict death (hazard ratio, 2.91; 95% confidence interval, 1.06-8.02, P = .038; and hazard ratio, 1.87; 95% confidence interval, 1.16-3.02, P = .010, respectively). Considering competing risks due to mortality, the cumulative incidence of reoperation was 2.8%, 4.2%, 5.1%, and 9.6% at 1, 3, 5, and 10 years. Competing risk proportional hazard survival regression identified nondegenerative etiology and previous cardiac surgery as predictors of reoperation, and posterior repair was protective (all P mitral regurgitation (2 or more grades) with mortality as a competing risk was 4.7%, 10.5%, 21.0%, and 35.8% at 1, 3, 5, and 10 years. Patients with previous sternotomy, repair or coronary artery bypass grafting, and concurrent tricuspid valve procedure or isolated anterior leaflet repair were more likely to develop progression of mitral regurgitation (all P valve intervention predicted MR progression. Mitral valve repair has excellent outcomes. Our results demonstrate failures appear to occur less in those who undergo posterior leaflet repair. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  7. Quantification of aortic regurgitation by magnetic resonance velocity mapping

    DEFF Research Database (Denmark)

    Søndergaard, Lise; Lindvig, K; Hildebrandt, P

    1993-01-01

    The use of magnetic resonance (MR) velocity mapping in the quantification of aortic valvular blood flow was examined in 10 patients with angiographically verified aortic regurgitation. MR velocity mapping succeeded in identifying and quantifying the regurgitation in all patients, and the regurgit......The use of magnetic resonance (MR) velocity mapping in the quantification of aortic valvular blood flow was examined in 10 patients with angiographically verified aortic regurgitation. MR velocity mapping succeeded in identifying and quantifying the regurgitation in all patients...

  8. Surgical Repair of Post-Infarct True Posterobasal Ventricular Aneurysm with Mitral Valve Replacement and Coronary Revascularization: a Case Report

    Directory of Open Access Journals (Sweden)

    Dasarathan Charumathi

    2012-03-01

    Full Text Available Post-infarction ventricular aneurysm is a complication of myocardial infarction. While the involvement of the anterior wall is quite common, posterobasal left ventricular aneurysm is a rare clinical complication in this setting. In this case report, we report a post-infarction posterobasal left ventricular aneurysm combined with ischemic mitral regurgitation due to coronary artery disease, for which we successfully performed triple coronary artery bypass and ventricular geometry restitution via a modified Dor’s procedure with mitral valve replacement through an extracardiac approach.1

  9. Mitral valve replacement with preservation of subvalvular apparatus in a patient with familial dextrocardia and situs solitus.

    Science.gov (United States)

    Khan, Junaid Fayyaz; Khan, Imran; Khan, Kamran

    2014-11-01

    Familial dextrocardia with situs solitus is extremely rare entity. Dextrocardia offers a difficult situation to surgeon. A different strategy for cannulation and approach to the left atrium has to be followed. Surgery in such settings has rarely been reported. We present the case of a patient with dextrocardia and situs solitus wherein a left sided approach was adopted for a better exposure of the valve. The patient had a rheumatic regurgitant mitral valve with ruptured chordae to anterior mitral leaflet. Since the valve was severely thickened, it was replaced rather than repaired. The left sided approach provided good exposure of the valve.

  10. Spectrum of congenital mitral valve abnormalities associated with solitary undifferentiated papillary muscle in adults.

    Science.gov (United States)

    Mohan, Jagdish C; Shukla, Madhu; Mohan, Vishwas; Sethi, Arvind

    Congenital anomaly wherein the mitral valve leaflets are directly attached to the papillary muscle(s) (PM) with or without short under-developed chords is rarely reported in adults. Patients with two PMs with an intervening fibrous bridge have also been included under this head in previous studies. Echocardiography enables accurate evaluation of the morphology and function of valve leaflets, chordae tendineae, and PM. This report describes a series of six patients aged 56-84 years who had abnormal mitral valve with a large solitary and anomalously inserted PM seen over a period of 3 years. Only those patients who had a single pillar or bridge-like PM and either absent tendinous chords or small under-developed chords were included in the analysis. Among 9600 consecutive echocardiograms performed, six patients met the criteria of an abnormal mitral valve with solitary large PM. Two patients underwent mitral valve replacement with partial excision of the PM wherein echocardiographic observations were confirmed. The patients were previously followed with the diagnosis of hypertrophic cardiomyopathy (3) and rheumatic mitral valve disease (3). Multi-planar reconstruction of 3D echocardiographic images provided incremental value in assessing the detailed patho-anatomy of PMs in these cases. In adult patients, a high index of suspicion is required to detect congenital mitral stenosis/regurgitation with large solitary PM (resembling a parachute mitral valve) which may masquerade as hypertrophic cardiomyopathy or rheumatic mitral valve disease. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  11. Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty.

    Science.gov (United States)

    Bernal, José M; Pontón, Alejandro; Diaz, Begoña; Llorca, Javier; García, Iván; Sarralde, J Aurelio; Gutiérrez-Morlote, Jesús; Pérez-Negueruela, Carolina; Revuelta, José M

    2010-05-04

    We examined predictors of early and very long-term outcome after combined mitral and tricuspid valve repair for rheumatic disease. Between 1974 and 2002, 153 consecutive patients (mean age, 46.0+/-13.2 years) underwent combined mitral and tricuspid valve repair for rheumatic disease. Mitral disease was predominantly stenosis (82.3%); 100% of patients had organic tricuspid valve disease, predominantly with regurgitation (53.6%) or some degree of tricuspid stenosis (46.4%). Mitral repair included commissurotomy in 132 patients (86.3%) associated with a flexible annuloplasty in 108. Tricuspid valve repair included flexible annuloplasty in 68 patients (44.4%) and suture annuloplasty in 20 patients (13.1%) combined with tricuspid commissurotomy in 62 patients (42.5%). Thirty-day mortality was 5.9%. Late mortality was 60.1%. The median follow-up was 15.8 years (interquartile range, 6 to 19 years). Follow-up was 97.9% complete. Age>65 years was the only predictor of late mortality. Kaplan-Meier survival probability was 74.4% at 10 years and 57.0% at 15 years. Sixty-three patients required valve reoperation (mitral valve, 59; tricuspid valve, 38). Predictors of valve reoperations were either mitral or tricuspid commissurotomy without associated prosthetic ring annuloplasty. At 20 years, Kaplan-Meier freedom from reoperation was 48.5+/-5.1%. Combined mitral and tricuspid valve repair in rheumatic disease showed satisfactory early results. Long-term results were poor because of high mortality and a high number of valve-related reoperations. The use of prosthetic ring annuloplasty was significantly associated with a reduced incidence of both mitral and tricuspid valve reoperations.

  12. Surgical treatment of congenital mitral stenosis: medium-term results

    Directory of Open Access Journals (Sweden)

    Atik Fernando A.

    2003-01-01

    Full Text Available OBJECTIVE: For a cohort of patients with congenital mitral stenosis (CMS, to determine: patient outcomes, predictors of valve repairability and predictors of durability of valve repair. METHODS: From 1989 and 2002, 23 patients underwent surgical treatment of CMS, excluding those with common atrioventricular canal, and univentricular forms. The median age at operation was 15.5 months (range 2-204, and the median body weight was 11 Kg (range 4.5-51.6. Seventeen patients (73.9% had associated anomalies, including Shone's complex in nine (39.1% and pulmonary hypertension in 14 (60.9%. Mitral stenosis was severe in 14 patients (60.9% and moderate in the remaining (median trans-mitral gradient of 16 mmHg, range 8.5-32. Mitral valve repair was performed in 18 patients (78.3%, and valve replacement in five (21.7%. Repair techniques included papillary muscle splitting (n=10, excision of supravalvular ring (n=9 and commissurotomy (n=8. Twelve patients (52.2% required associated procedures. RESULTS: There were no early and late deaths at a mean follow-up of 58.5 ± 46.7 months (range 1-156. Mean hospital stay was 12.7 ± 8.2 days. There were no significant factors associated with unsuccessful valve repair. Actuarial freedom from reoperation at five years was 67.1% (CI 95%: 56.8% to 77.4%. The mitral valve repair group required reoperation in eight patients (44.4% (two early and six late, as opposed to one (20% in the replacement group. The presence of preoperative pulmonary hypertension was significantly related (p<0.005 to higher reoperation rates. All but two the followed patients are presently in functional class I and the echocardiography has shown less than 2+ mitral stenosis and/or regurgitation. CONCLUSION: Reoperations were the most important cause of morbidity at the medium-term follow-up of CMS. Preoperative pulmonary hypertension may predict the need for reoperation after mitral valve repair, which is the procedure of choice in CMS.

  13. MITRAL VALVE PROLAPSE SYNDROME AND ITS ASSOCIATION WITH ANXIETY AND PANIC STATES

    OpenAIRE

    Chatterjee, S.B.; John, M.J.

    1982-01-01

    SUMMARY Mitral Valve Prolapse Syndrome is one of the most frequent cardiac valvular abnormalities in general population. Mostly the patients remain asymptomatic but a few may suffer from hyperadrenergic panic states, similar to anxiety attacks. In psychiatric practice, a number of physicians have come across this finding during the recent past. Present article deals with two such case illustrations.

  14. Valva mitral heteróloga sem suporte: resultados clínicos a médio prazo Heterologous mitral stentless valve: mid-term clinical results

    Directory of Open Access Journals (Sweden)

    Mario O Vrandecic

    1996-09-01

    sistólico e diastólico final, em avaliações ecocardiográficas seriadas CONCLUSÃO: As valvas mitrais porcinas sem suporte têm mostrado melhor performance hemodinâmica, com maior possibilidade de manutenção da função e do tamanho do ventrículo esquerdo. Embora este estudo tenha demonstrado uma curva de aprendizado bem definida relacionada a um novo substituto valvar e à técnica cirúrgica, estes fatores são superados com treino e aderência à técnica atualmente em uso.The concept of replacing diseased mitral valve with porcine mitral stentless valve allowed to address the "idiosyncrasy" of the left ventricular flow and contractility. From March 92 to December 95, 108 patients had their mitral valves replaced by stentless mitral valves. Their age varied from 11 to 65 years (mean 35.22 ± 14.98. There were 67 (62% females and 41 (38% males. The predominant ethiology was rheumatic heart disease 94 (87% cases, followed by a prosthetic dysfunction 6 (5.6% cases, myxomatous disease 5 (4.6% cases, infective endocarditis 2 (1.9% cases and ischemic lesion 1 (0.9% case, 26 (24.1% patients had mitral stenosis, 24 (22.2% mitral regurgitation and the remaining 58 (53.7% mixed lesions; 21.3% of the patients had previous open heart operations. The great majority of the operated patients (97.2% were in functional class III and IV (NYHA. Associated procedures were performed in 9.3% (10 of the cases. RESULTS: Hospital mortality occurred in 7 (6.5% patients non valved related with exception of one whom developed early endocarditis. Of the 101 remaining 3 required reoperations, in two due to valved size mismatch and 1 due to papillary muscle tear. Of the 98 remaining patients, 2 were lost to follow-up, 96 patients have been followed for 3.2 to 45 months. During the late follow-up there were six (6.25% deaths, of the 3 patients with late prosthetic endocarditis, 2 had their valves replaced with standard bioprosthesis, with one death. The third patient expired before

  15. Modeling the Mitral Valve

    Science.gov (United States)

    Kaiser, Alexander

    2016-11-01

    The mitral valve is one of four valves in the human heart. The valve opens to allow oxygenated blood from the lungs to fill the left ventricle, and closes when the ventricle contracts to prevent backflow. The valve is composed of two fibrous leaflets which hang from a ring. These leaflets are supported like a parachute by a system of strings called chordae tendineae. In this talk, I will describe a new computational model of the mitral valve. To generate geometry, general information comes from classical anatomy texts and the author's dissection of porcine hearts. An MRI image of a human heart is used to locate the tips of the papillary muscles, which anchor the chordae tendineae, in relation to the mitral ring. The initial configurations of the valve leaflets and chordae tendineae are found by solving solving an equilibrium elasticity problem. The valve is then simulated in fluid (blood) using the immersed boundary method over multiple heart cycles in a model valve tester. We aim to identify features and mechanisms that influence or control valve function. Support from National Science Foundation, Graduate Research Fellowship Program, Grant DGE 1342536.

  16. Asymptomatic HIV infection

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000682.htm Asymptomatic HIV infection To use the sharing features on this page, please enable JavaScript. Asymptomatic HIV infection is a phase of HIV/AIDS during which ...

  17. Early and long-term outcomes of mitral valve repair for Barlow's disease: a single-centre 16-year experience.

    Science.gov (United States)

    Tomšic, Anton; Hiemstra, Yasmine L; van der Pas, Stephanie L; Putter, Hein; Versteegh, Michel I M; van Brakel, Thomas J; Ajmone Marsan, Nina; Klautz, Robert J M; Palmen, Meindert

    2018-01-10

    Following mitral valve repair for Barlow's disease, recurrent mitral regurgitation (MR) is believed to occur frequently and is mainly attributed to disease progression. Between January 2000 and December 2015, 180 patients (40% women, mean age 58.7 ± 13.5 years) with Barlow's disease underwent mitral valve repair. To provide a longitudinal assessment of mitral valve repair durability, a multistate model for interval-censored observations (4 states: 1, Grade 0/1+ MR; 2, Grade 2+ MR; 3, Grade 3+/4+ MR; 4, reintervention/death) was developed. The mechanism of recurrent MR was assessed echocardiographically. Early mortality was 1.7%. After hospital discharge, 6 late reinterventions were performed. With death as a competing risk, the 10-year overall reintervention-free survival and reintervention rates were 79.8% (95% confidence interval 72.7-87.6%) and 4.5% (95% confidence interval 2.0-10.2%), respectively. Echocardiographic follow-up was available for 165 (93%) of hospital survivors with a total of 480 examinations. The incidence of both recurrent Grade 2+ and Grade 3+/4+ MR was relatively low up to 10 years after surgery. Grade 2+ MR did not always progress to higher regurgitation grade during the follow-up period. Grade 3+/4+ regurgitation was highly associated with valve-related morbidity and mortality. Recurrent MR (≥Grade 2+) was predominantly related to the technical aspects of valve repair. Despite the complex valve abnormalities observed in patients with Barlow's disease, mitral valve repair can be performed with good early and late outcomes and low rates of recurrence of MR up to 10 years after surgery. Early and late valve repair durability is good and remains stable over time, suggesting that underlying disease progression has limited clinical significance.

  18. Atrial fibrillation in pure rheumatic mitral valvular disease is expression of an atrial histological change.

    Science.gov (United States)

    Alessandri, N; Tufano, F; Petrassi, M; Alessandri, C; Di Cristofano, C; Della Rocca, C; Gallo, P

    2009-01-01

    Some of theories try to explain the insurgence of atrial fibrillation (AF) in patients with acute articular rheumatism (AAR). These theories remind the close relation between AF and left atrium, or with valvular vitium degree, or monophasic action potential and histological cardiac structure. In 15 years of work in the academic Department of Heart and Big Vessels in Rome, the Authors studied 243 patients with mitral valvular disease post AAR before and after surgical manoeuvres. Patients were divided in order to monitor atrium and ventricle morphological and functional modifications of the valve according to cardiac rhythm. Patients classification was based on surgical therapy adopted, kind of mitral disease and cardiac rhythm. An histological examination was performed, only in patients treated with valvular replacement. During the operation an histological examination in an atrial tissue fragment was performed. 243 patients with mitral valvular disease post AAR with indication in valvular adjustment were studied. The whole population was treated with mitral transcutaneous valvuloplasty (Group B--130 patients) or with mitral valve replacement surgery (Group A--113 patients). These two groups were divided: in Gr.A in Gr.A1 and Gr.A2, and Gr.B in Gr.B1 and Gr.B2, according to cardiac rhythm (sinus rhythm iSR, AF). These subgroups were also divided in Gr.A1SR, Gr.A1AF; Gr.A2SR, Gr.A2AF; Gr.A3SR, Gr.A3AF, according to mitralic disease's kind (stenosis, stenosis/regurgitation, regurgitation). A complex screening were exerted to all patients using echocardio-doppler technology. Morphological parameters of atrium and ventricle, and functional parameters of mitral valve, aorta and tricuspid were evaluated. In Gr.A group patients during the operation were execute a bioptic sampling from left atrium and a consecutive histological valuation. In Gr.A1 mitral valve area (MtVA) arises smaller (p0.05). Left atrium volume arises elder in patients in AF than in patients in SR

  19. Valve Repair Is Superior to Replacement in Most Patients With Coexisting Degenerative Mitral Valve and Coronary Artery Diseases.

    Science.gov (United States)

    Javadikasgari, Hoda; Gillinov, A Marc; Idrees, Jay J; Mihaljevic, Tomislav; Suri, Rakesh M; Raza, Sajjad; Houghtaling, Penny L; Svensson, Lars G; Navia, José L; Mick, Stephanie L; Desai, Milind Y; Sabik, Joseph F; Blackstone, Eugene H

    2017-06-01

    For mitral regurgitation (MR) from degenerative mitral disease in patients with coexisting coronary artery disease, the appropriate surgical strategy remains controversial. From 1985 to 2011, 1,071 adults (age 70 ± 9.3 years, 77% men) underwent combined coronary artery bypass grafting and either mitral valve repair (n = 872, 81%) or replacement (n=199, 19%) for degenerative MR. Propensity matching (177 patient pairs, 89% of possible matches) was used to compare early outcomes and time-related recurrence of MR after mitral valve repair, mitral valve reoperation, and mortality. Risk factors for death were identified with multivariable, multiphase hazard-function analysis. Patients undergoing valve replacement were older, with more valve calcification and a higher prevalence of preoperative atrial fibrillation and heart failure (all p < .0001). Among matched pairs, mitral replacement versus repair was associated with higher hospital mortality (5.0% vs 1.0%, p = .0001) and more postoperative renal failure (7.0% vs 3.2%, p = .01), reexplorations for bleeding (6.0% vs 3.1%, p = .05), and respiratory failure (14% vs 4.7%, p < .0001). Of matched patients undergoing repair, 18% had MR above 3+ by 5 years. Mitral valve durability was similar between matched groups, but survival at 15 years was 18% after replacement versus 52% after repair. Nomograms from the multivariable equation revealed that in 94% of cases, 10-year survival was calculated to be higher after repair than after replacement. In patients with coexisting degenerative mitral valve and coronary artery diseases, mitral valve repair is expected to confer a long-term survival advantage over replacement despite some recurrence of MR. When feasible, it is the procedure of choice for these patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Three-Dimensional Echocardiographic Assessment of Changes in Mitral Valve Geometry After Valve Repair

    Science.gov (United States)

    Mahmood, Feroze; Subramaniam, Balachundhar; Gorman, Joseph H.; Levine, Robert M.; Gorman, Robert C.; Maslow, Andrew; Panzica, Peter J.; Hagberg, Robert M.; Karthik, Swaminathan; Khabbaz, Kamal R.

    2011-01-01

    Background Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair. Methods We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared. Results Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 ±14 versus 146 ± 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings. Conclusions Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity. PMID:19932245

  1. Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach.

    Science.gov (United States)

    Mihos, Christos G; Pineda, Andrés M; Davila, Hector; Larrauri-Reyes, Maiteder C; Santana, Orlando

    2015-01-01

    Combined mitral and tricuspid valve surgery is associated with an increased perioperative morbidity and mortality. We evaluated the outcomes of a less invasive right minithoracotomy approach in patients undergoing primary or reoperative double-valve surgery. We retrospectively evaluated 132 consecutive patients with mitral and tricuspid valve disease who underwent double-valve surgery via a right minithoracotomy at our institution between January 2009 and April 2014. The cohort included 81 female (61%) and 51 male (39%) patients, with a mean ± SD age of 67 ± 13 years. The mean ± SD preoperative left ventricular ejection fraction, mitral regurgitation grade, and creatinine were 53% ± 12%, 3.8 ± 0.6, and 1.26 ± 1.17, respectively. The patients underwent primary (88%) or reoperative (12%) mitral and tricuspid valve surgery, which consisted of 88 mitral repairs (67%), 44 mitral replacements (33%), 131 tricuspid repairs (99%), and 1 tricuspid replacement (1%). Postoperatively, there were 6 cases of acute kidney injury (5%), 6 reoperations for bleeding (5%), 4 cerebrovascular accidents (3%), and 12 cases of atrial fibrillation (9%). The median intensive care unit length of stay and total hospital lengths of stay were 61 hours (interquartile range, 43-112 hours) and 8 days (interquartile range, 6-13 days), respectively. The in-hospital mortality was 4%. Actuarial survival at 1 and 5 years was 93% and 88%, respectively. In patients undergoing primary or reoperative mitral and tricuspid valve surgery, a right minithoracotomy approach is associated with a low perioperative morbidity and good midterm survival.

  2. Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Alexandre Visconti Brick

    Full Text Available Abstract Objective To evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods: We studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results: 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%, congestive heart failure (70%, and previous episodes of acute pulmonary edema (27%. Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion: Surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8% after 60 months of follow-up.

  3. R-R interval variations influence the degree of mitral regurgitation in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Reimann, M. J.; Moller, J. E.; Haggstrom, J.

    2014-01-01

    of the RR interval immediately influences the degree of MR assessed by echocardiography in dogs. Clinical examination including echocardiography was performed in 103 privately-owned dogs: 16 control Beagles, 70 CKCSs with different degree of MR and 17 dogs of different breeds with clinical signs...... of congestive heart failure due to MMVD. The severity of MR was evaluated in apical four-chamber view using colour Doppler flow mapping (maximum % of the left atrium area) and colour Doppler M-mode (duration in ms). The influence of the ratio between present and preceding R-R interval on MR severity...

  4. Quality of life after early mitral valve repair using conventional and robotic approaches.

    Science.gov (United States)

    Suri, Rakesh M; Antiel, Ryan M; Burkhart, Harold M; Huebner, Marianne; Li, Zhuo; Eton, David T; Topilsky, Tali; Sarano, Maurice E; Schaff, Hartzell V

    2012-03-01

    Early mitral valve (MV) repair of degenerative mitral regurgitation is associated with superior clinical outcomes compared with prosthetic replacement and restores normal life expectancy, even in those without symptoms. Although current guidelines recommend prompt referral for effective MV repair in those with severe mitral regurgitation, some are reluctant to pursue early correction due to the perception that short-term quality of life (QOL) may be adversely affected by the operation. Between January 2008 and November 2009, 202 patients underwent conventional transsternotomy or minimally invasive port-access robot-assisted MV repair, with or without patent foramen ovale closure or left Maze, and were mailed a postsurgical QOL survey. Unadjusted QOL scores for patients undergoing MV repair were excellent early after the operation using both approaches. Robotic repair was associated with slightly improved scores on the Duke Activity Status Index, the Short Form-12 Item Health Survey Physical domain, and the Linear Analogue Self-Assessment frequency of chest pain and fatigue indices during the first postoperative year; however, differences between treatment groups became indistinguishable after 1 year. Robotic repair patients returned to work slightly quicker (median, 33 vs 54 days, probotic platforms. A robotic approach may be associated with slightly improved early QOL and return to employment-based activities. These results may have implications regarding future evolution of clinical guidelines and economic health care policy. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Association Between Mitral Annular Calcium and Flail Mitral Leaflet in Degenerative Mitral Valve Disease.

    Science.gov (United States)

    Zemer Wassercug, Noa; Shapira, Yaron; Weisenberg, Daniel; Monakier, Daniel; Bental, Tamir; Sagie, Alik; Vaturi, Mordehay

    2015-07-01

    The aim of this study was to assess the association between mitral annular calcium (MAC) and flail mitral leaflets in a cohort of patients with degenerative mitral valve disease. A retrospective study was conducted of consecutive patients with degenerative mitral valve disease who underwent echocardiography at Rabin Medical Center from 2003 to 2012. Special focus was attended to the presence and grade of MAC and characterization of valve pathology (myxomatous vs nonmyxomatous, prolapse vs flail). Patients were excluded if they had undergone previous mitral valve surgery and/or had infective endocarditis. Multivariate logistic regressions were used to control for confounders. The study included 1,912 patients (60.8% men, mean age 63.8 ± 17.4 years) divided into 3 groups: 1,627 (86%) without MAC, 183 (10%) with either mild or moderate MAC, and 94 (5%) with severe MAC. The presence of flail leaflet was 27%, 30%, and 46% in these groups, respectively (p mitral leaflet with severe MAC versus no MAC was 1.76 (95% confidence interval 1.10 to 2.83, p = 0.019). In conclusion, this study demonstrates that degenerative mitral valve disease with severe MAC is significantly associated with flail mitral leaflet. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Deletion of Fstl1 (Follistatin-Like 1) From the Endocardial/Endothelial Lineage Causes Mitral Valve Disease.

    Science.gov (United States)

    Prakash, Stuti; Borreguero, Luis J J; Sylva, Marc; Flores Ruiz, Lorena; Rezai, Fereshte; Gunst, Quinn D; de la Pompa, José-Luis; Ruijter, Jan M; van den Hoff, Maurice J B

    2017-09-01

    Fstl1 (Follistatin-like 1) is a secreted protein that is expressed in the atrioventricular valves throughout embryonic development, postnatal maturation, and adulthood. In this study, we investigated the loss of Fstl1 in the endocardium/endothelium and their derived cells. We conditionally ablated Fstl1 from the endocardial lineage using a transgenic Tie2-Cre mouse model. These mice showed a sustained Bmp and Tgfβ signaling after birth. This resulted in ongoing proliferation and endocardial-to-mesenchymal transition and ultimately in deformed nonfunctional mitral valves and a hypertrophic dilated heart. Echocardiographic and electrocardiographic analyses revealed that loss of Fstl1 leads to mitral regurgitation and left ventricular diastolic dysfunction. Cardiac function gradually deteriorated resulting in heart failure with preserved ejection fraction and death of the mice between 2 and 4 weeks after birth. We report on a mouse model in which deletion of Fstl1 from the endocardial/endothelial lineage results in deformed mitral valves, which cause regurgitation, heart failure, and early cardiac death. The findings provide a potential molecular target for the clinical research into myxomatous mitral valve disease. © 2017 American Heart Association, Inc.

  7. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    Science.gov (United States)

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

    2014-01-01

    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  8. Insuficiencia mitral grave posvalvuloplastia mitral percutánea

    Directory of Open Access Journals (Sweden)

    Julio C. Echarte Martínez

    2010-01-01

    Full Text Available RESUMENIntroducciónLa valvuloplastia mitral percutánea es en la actualidad el tratamiento de elección en pacientesportadores de estenosis mitral de etiología reumática si la anatomía es apropiada.La insuficiencia mitral grave posvalvuloplastia continúa siendo un desafío.ObjetivoDeterminar las causas de insuficiencia mitral grave posvalvuloplastia mitral.Material y métodosSe realizaron 110 valvuloplastias mitrales percutáneas en forma consecutiva en 107 pacientes(3 repetidas por reestenosis en el Instituto de Cardiología y Cirugía Cardiovascular deCuba, entre el 17 de junio de 1998 y el 30 de junio de 2004 (106 por el método de Inoue y 4por Multitrack; el tiempo de evolución promedio fue de 24,6 meses (máximo 72 y mínimo1,93 meses. La insuficiencia mitral se clasificó por ecocardiografía Doppler en leve si elárea regurgitante era menor de 4 cm2, moderada si era de 4-8 cm2. y grave si era > 8 cm2 ypor ventriculografía izquierda según los criterios de Sellers. Para lograr correlación entre laclasificación por ecocardiografía Doppler color de tres grados y la de Sellers (cuatro gradosla insuficiencia mitral 1+ se consideró leve, 2+ y 3+ moderada y 4+, grave.ResultadosSe produjeron cinco insuficiencias mitrales graves posprocedimiento (4,54% del total. Tresde ellas necesitaron reemplazo valvular mitral por rotura de la valva anterior. Las dos restantesse encuentran bajo tratamiento médico.ConclusiónLos mecanismos de producción de la insuficiencia mitral posvalvuloplastia mitral percutáneason multifactoriales. Puede ocurrir en manos expertas.REV ARGENT CARDIOL 2010;78:222-227.

  9. Intermittent intravalvar regurgitation of a mechanical aortic valve ...

    African Journals Online (AJOL)

    Mechanical prosthetic valve regurgitation may be either periprosthetic or intraprosthetic. The later is usually mild, occurring in the majority of normally functioning valves and is due to the 'regurgitant flow' closing the valve. An unusual case is reported of intermitent intraprosthetic regurgitation through a normally functioning ...

  10. Plastia mitral cirúrgica em crianças com febre reumática Plastia mitral quirúrgica en niños con fiebre reumática Surgical mitral valve repair in children with rheumatic fever

    Directory of Open Access Journals (Sweden)

    Andréa Rocha e Silva

    2009-06-01

    pacientes (80% y moderada en ocho (20%. Ocurrieron tres óbitos inmediatos (7,5%. Después de tres meses de cirugía, el ecocardiograma mostró que en 35/37 (94,6% no había regurgitación valvular o era leve, y en dos pacientes (5,2% era grave. La clase funcional en el preoperatorio era III y IV en 33 casos (82,5%, y tres meses después de la cirugía los 37 casos (100% estaban en clase funcional I y II. La diferencia entre los datos del grados de regurgitación mitral y clase funcional en el pre y post operatorio fueron estadísticamente significativos (pBACKGROUND: Mitral repair is well accepted in children with rheumatic fever. OBJECTIVE: To analyze the outcomes of surgical mitral repair in children with rheumatic lesions after four years of follow-up. METHODS: Retrospective study of 40 patients younger than 18 years, who underwent surgery in the National Institute of Cardiology (Rio de Janeiro between January 1998 and January 2003. The echocardiographic degree of mitral regurgitation; surgical technique used; pre and postoperative functional class; patient outcome; need for valve replacement; and deaths were analyzed. RESULTS: Twenty one patients (52.5% were females. Severe mitral regurgitation was observed in 32 patients (80% and moderate in eight (20%. Three immediate deaths occurred (7.5%. Three months after surgery, echocardiography showed no valve regurgitation or mild regurgitation in 35 of 37 cases (94.6% patients, and severe regurgitation in two (5.2%. Thirty three cases (82.5% were in functional class III or IV in the preoperative period, and three months after surgery all the 37 cases (100% were in functional class I or II. The differences between the degree of mitral regurgitation and functional class in pre and postoperative periods were statistically significant (p<0.01. Seven (19% patients underwent heart valve replacement before four years of follow-up. CONCLUSION: Mitral valve repair showed favorable results in most of the cases as regards the degree of

  11. Midterm Outcome of Mitral Valve Repair with Artificial Chordae for Only Posterior Leaflet Disease-Comparison with the Resectional Technique in a Single Institute.

    Science.gov (United States)

    Takai, Hideaki; Tanabe, Hiroaki; Yamabe, Tsuyoshi; Sasaki, Kenichi; Suma, Hisayoshi

    2016-01-01

    We compared the midterm results of mitral valve repair with and without leaflet resection, and revealed the effectiveness of this technique, even for in the posterior leaflet alone. From August 2002 to March 2014, a total of 306 mitral valve repairs were carried out at our hospital. Of these patients, 50 cases did not undergo leaflet resection (Artificial Chordae; Group A) and 56 cases underwent leaflet resection (Resectional; Group R). There were no significant differences in the preoperative profiles. The follow up rate was 98% and 100% respectively. The mean cardiopulmonary bypass time and aortic cross clamp time were not significantly different. The average ring size was significantly larger (p mitral regurgitation at 3 years was 97.1% and at 8 years was 91.7% in Group A and 97.4% and 94.6% in Group R respectively. There were no cases of mortality, re-operation for recurrent mitral regurgitation, hemolytic anemia and infectious endocarditis. We demonstrated good midterm results in mitral valve repair without leaflet resection. However, further follow-up was needed.

  12. Lyme Carditis: A Case Involving the Conduction System and Mitral Valve.

    Science.gov (United States)

    Patel, Lakir D; Schachne, Jay S

    2017-02-01

    Lyme disease is the most common tick-borne infection in the Northern hemisphere. Cardiac manifestations of Lyme disease typically include variable atrioventricular nodal block and rarely structural heart pathology. The incidence of Lyme carditis may be underestimated based on current reporting practices of confirmed cases. This case of a 59-year-old man with Lyme carditis demonstrates the unique presentation of widespread conduction system disease, mitral regurgitation, and suspected ischemic disease. Through clinical data, electrocardiograms, and cardiac imaging, we show the progression, and resolution, of a variety of cardiac symptoms attributable to infection with Lyme. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].

  13. Predictive value of natriuretic peptides in dogs with mitral valve disease

    DEFF Research Database (Denmark)

    Tarnow, Inge; Olsen, Lisbeth Høier; Kvart, Clarence

    2009-01-01

    Natriuretic peptides are useful in diagnosing heart failure in dogs. However, their usefulness in detecting early stages of myxomatous mitral valve disease (MMVD) has been debated. This study evaluated N-terminal (NT) fragment pro-atrial natriuretic peptide (NT-proANP) and NT-pro-brain natriuretic...... peptide (NT-proBNP) in 39 Cavalier King Charles Spaniels (CKCS) with pre-clinical mitral valve regurgitation (MR), sixteen dogs with clinical signs of heart failure (HF) and thirteen healthy control dogs. Twenty seven CKCS and ten control dogs were re-examined 4 years after the initial examination...... and the status of the dogs 5 years after the initial examination was determined by telephone calls to the owner. All dogs were evaluated by clinical examination and echocardiography. CKCS with severe MR had higher NT-proANP and NT-proBNP compared to controls and CKCS with less severe MR. Dogs with clinical signs...

  14. Value of Robotically Assisted Surgery for Mitral Valve Disease

    Science.gov (United States)

    Mihaljevic, Tomislav; Koprivanac, Marijan; Kelava, Marta; Goodman, Avi; Jarrett, Craig; Williams, Sarah J.; Gillinov, A. Marc; Bajwa, Gurjyot; Mick, Stephanie L.; Bonatti, Johannes; Blackstone, Eugene H.

    2014-01-01

    Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotic surgery mitigate high technology costs. Design Clinical cohort study comparing costs of robotic vs. three contemporaneous conventional surgical approaches for degenerative mitral disease. Surgery was performed from 2006–2011, and comparisons were based on intent-to-treat, with propensity-matching used to reduce selection bias. Setting Large multi-specialty academic medical center. Participants 1,290 patients aged 57±11 years, 27% women, underwent mitral repair for regurgitation from posterior leaflet prolapse. Robotic surgery was used in 473, complete sternotomy in 227, partial sternotomy in 349, and anterolateral thoracotomy in 241. Three propensity-matched groups were formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiology, and echocardiographic measurements: robotic vs. sternotomy (n=198 pairs) vs. partial sternotomy (n=293 pairs) vs. thoracotomy (n=224 pairs). Interventions Mitral valve repair. Main Outcome Measures Cost of care, expressed as robotic capital investment, maintenance, and direct technical hospital cost, and benefit of care, based on differences in recovery time. Results Median cost of care for robotically assisted surgery exceeded the cost of alternative approaches by 27% (−5%, 68%), 32% (−6%, 70%), and 21% (−2%, 54%) (median [15th, 85th percentiles]) for complete sternotomy, partial sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: median 35 days for robotic surgery, 49 for complete sternotomy, 56 for partial sternotomy, and 42 for anterolateral thoracotomy. Resulting net differences in cost of robotic surgery vs. the three

  15. In-vivo mitral annuloplasty ring transducer: implications for implantation and annular downsizing.

    Science.gov (United States)

    Siefert, Andrew W; Touchton, Steven A; McGarvey, Jeremy R; Takebayashi, Satoshi; Rabbah, Jean Pierre M; Jimenez, Jorge H; Saikrishnan, Neelakantan; Gorman, Robert C; Gorman, Joseph H; Yoganathan, Ajit P

    2013-09-27

    Mitral annuloplasty has been a keystone to the success of mitral valve repair in functional mitral regurgitation. Understanding the complex interplay between annular-ring stresses and left ventricular function has significant implications for patient-ring selection, repair failure, and patient safety. A step towards assessing these challenges is developing a transducer that can be implanted in the exact method as commercially available rings and can quantify multidirectional ring loading. An annuloplasty ring transducer was developed to measure stresses at eight locations on both the in-plane and out-of-plane surfaces of an annuloplasty ring's titanium core. The transducer was implanted in an ovine subject using 10 sutures at near symmetric locations. At implantation, the ring was observed to undersize the mitral annulus. The flaccid annulus exerted both compressive (-) and tensile stresses (+) on the ring ranging from -3.17 to 5.34 MPa. At baseline hemodynamics, stresses cyclically changed and peaked near mid-systole. Mean changes in cyclic stress from ventricular diastole to mid-systole ranged from -0.61 to 0.46 MPa (in-plane direction) and from -0.49 to 1.13 MPa (out-of-plane direction). Results demonstrate the variability in ring stresses that can be introduced during implantation and the cyclic contraction of the mitral annulus. Ring stresses at implantation were approximately 4 magnitudes larger than the cyclic changes in stress throughout the cardiac cycle. These methods will be extended to ring transducers of differing size and geometry. Upon additional investigation, these data will contribute to improved knowledge of annulus-ring stresses, LV function, and the safer development of mitral repair techniques. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Changes in Mitral Valve Annular Geometry After Repair: Saddle-Shaped Versus Flat Annuloplasty Rings

    Science.gov (United States)

    Mahmood, Feroze; Gorman, Joseph H.; Subramaniam, Balachundhar; Gorman, Robert C.; Panzica, Peter J.; Hagberg, Robert C.; Lerner, Adam B.; Hess, Philip E.; Maslow, Andrew; Khabbaz, Kamal R.

    2011-01-01

    Background Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. Methods Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the “Image Arena” software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. Results Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. Conclusions Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings. PMID:20868816

  17. Pulmonary blood volume measured by RI angiocardiography. Comparison between mitral valve disease and other diseases

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Kazuo (Fukushima Medical Coll. (Japan))

    1982-08-01

    RI angiocardiography (RACG) was performed in 81 patients with heart disease without congestive heart failure at the time, and the results were compared between the groups with mitral valve disease and other diseases. Cardiac output (CO) and pulmonary mean transit time (PMTT) were compared with the results from the dye dilution method in the same patients. PMTT directly measured by RACG was also compared with the peak to peak time (P-PT). P-PT was expressed as the distance from the right to the left peak time in radiocardiography (RCG). There were good correlations between the CO and PMTT obtained from the RI method and those of the dye dilution method (r = 0.90, r = 0.84). The relationship between PMTT and P-PT in mitral valve disease was different from that of other diseases. The average value of PMTT was 5.2 +- 1.0 seconds, and pulmonary blood volume (PBV) was 315 +- 57 ml/m/sup 2/ in the control group. The PBV values were markedly increased in patients with mitral stenosis (558 +- 132 ml/m/sup 2/) and mitral regurgitation (444 +- 119 ml/m/sup 2/), and were slightly increased in aortic valve disease, congenital shunt disease and cardiomyopathy. The patients with ischemic heart disease had normal PBV. In mitral valve disease, the direct method using PMTT of RACG is more accurate than the presumption method using P-PT of RCG. The determination of PBV by this method is very important to observe hemodynamic states in mitral valve disease.

  18. Anuloplastia sem suporte para tratamento da insuficiência mitral reumática Non-supported mitral annuloplasty technique for treatment of rheumatic mitral insufficiency

    Directory of Open Access Journals (Sweden)

    Renato A. K Kalil

    1992-09-01

    sem suporte anular profético, com resultados tardios comparáveis àqueles obtidos por técnicas mais complexas. Isto tem importância no tratamento de crianças e adultos jovens, especialmente no sexo feminino, quando se deseja evitar implante de próteses mecânicas.Since 1974 a non-supported mitral annuloplasty technique has been employed for treatment of pure mitral regurgitation (PMR, in a population that was predominantly young and of rheumatic ethnology. An evaluation of late results forms the basis of this report. There were 154 patients operated on for PMR, 55 (36% male and 99 (64% female. Mean age was 36 ± 16 (5 to 73 years. Associated lesions were: 47 aortic, 21 tricuspid and 2 ASDs (atrial aptal defects. Cases with concomitant mitral stenosis were not included. Properative functional class was I-II in 19% and III-IV in 81%. The cardiothoracic ratio was 0.61 ± 0.10. All patients were submitted to an unsupported mitral annuloplastic procedure, similar to that described by WOOLER, that consisted in reduction of the mural portion of the annulus obtained with the application of two buttressed mattress sutures at the comissures without compromisse to the width of the septal leaflet. When necessary, additional chordal procedures were performed. No patients received ring or posterior annular support. Residual late systolic murmur was present in 48%. Late complications were: systemic thromboembolism 5.8% (1/3 with aortic prosthesis, infective endocardites 1.3% and pulmonary thromboembolism 0.7%. Postoperative functional class was I-II in 84% and III-IV in 16%. Cardiothoracic ratio was 0.58 ± 0.10. Actuarial probability of late survival was 79.5 ± 5.3% at 10 years and 71.0 ± 7.4% at 14 years. Event free survival was 67.9 ± 8.9% at 10 years and 56.1 ± 11.7% at 14 years. Rheumatic mitral regurgitation can be effectively treated by annuloplasty without prosthetic annular support with late results comparable to those obtained with more complicated procedures

  19. Impact of interventional edge-to-edge repair on mitral valve geometry.

    Science.gov (United States)

    Schueler, Robert; Kaplan, Sarah; Melzer, Charlotte; Öztürk, Can; Weber, Marcel; Sinning, Jan-Malte; Welz, Armin; Werner, Nikos; Nickenig, Georg; Hammerstingl, Christoph

    2017-03-01

    The acute and long-term effects of interventional edge-to-edge repair on the mitral valve (MV) geometry are unclear. We sought to assess MV-annular geometry and the association of changes in MV-diameters with functional response one year after MitraClip implantation. Consecutive patients (n=84; age 81.2±8.3years, logistic EuroSCORE 21.7±17.9%) with symptomatic moderate-to-severe mitral regurgitation (MR) underwent MitraClip-procedure. MV-annular geometry was assessed with 3D TOE before, immediately and one year after clip implantation. 96.7% of secondary mitral regurgitation (SMR) patients presented with moderate-to-severe MR, 3.3% with severe SMR, respectively. 66.7% of primary MR (PMR) patients had moderate-to-severe MR, and 33.3% severe PMR respectively. When analyzing immediate effects of MitraClipC on mitral geometry, only patients with SMR (n=60, 71.4%) experienced significant reductions of the diastolic MV anterior-posterior diameters (AP: 3.9±0.5cm, 3.5±0.7cm; pgeometry were not significantly altered in patients with PMR (p>0.05). After one year of follow-up, MV annular parameters remained significantly reduced in SMR patients (p0.05). Only SMR patients experienced significant increase in 6min walking distances (p=0.004), decrease in pulmonary pressures (p=0.007) and functional NYHA-class (pgeometry in patients with SMR with stable results after 12months. Reduction of MV-annular dimensions was associated with higher rates of persisting MR reduction and better functional status in patients with SMR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Clinical significance of markers of collagen metabolism in rheumatic mitral valve disease.

    Science.gov (United States)

    Banerjee, Tanima; Mukherjee, Somaditya; Ghosh, Sudip; Biswas, Monodeep; Dutta, Santanu; Pattari, Sanjib; Chatterjee, Shelly; Bandyopadhyay, Arun

    2014-01-01

    Rheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value marker (AUC = 0.95; 95% CI = 0.91-0.99; p459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.

  1. Anterior mitral valve aneurysm: a rare sequelae of aortic valve endocarditis

    Directory of Open Access Journals (Sweden)

    Rajesh Janardhanan

    2016-05-01

    Full Text Available In intravenous drug abusers, infective endocarditis usually involves right-sided valves, with Staphylococcus aureus being the most common etiologic agent. We present a patient who is an intravenous drug abuser with left-sided (aortic valve endocarditis caused by Enterococcus faecalis who subsequently developed an anterior mitral valve aneurysm, which is an exceedingly rare complication. A systematic literature search was conducted which identified only five reported cases in the literature of mitral valve aneurysmal rupture in the setting of E. faecalis endocarditis. Real-time 3D-transesophageal echocardiography was critical in making an accurate diagnosis leading to timely intervention. Learning objectives: • Early recognition of a mitral valve aneurysm (MVA is important because it may rupture and produce catastrophic mitral regurgitation (MR in an already seriously ill patient requiring emergency surgery, or it may be overlooked at the time of aortic valve replacement (AVR. • Real-time 3D-transesophageal echocardiography (RT-3DTEE is much more advanced and accurate than transthoracic echocardiography for the diagnosis and management of MVA.

  2. Infective endocarditis causing mitral valve stenosis - a rare but deadly complication: a case report.

    Science.gov (United States)

    Hart, Michael A; Shroff, Gautam R

    2017-02-17

    Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred. We report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness. The discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.

  3. Echocardiographic assessment of cardiac valvular regurgitation with lorcaserin from analysis of 3 phase 3 clinical trials.

    Science.gov (United States)

    Weissman, Neil J; Sanchez, Matilde; Koch, Gary G; Smith, Steven R; Shanahan, William R; Anderson, Christen M

    2013-07-01

    Lorcaserin is a selective 5-HT2C agonist evaluated for weight management in clinical trials. Echocardiographic monitoring was conducted to test the hypothesis that selective 5-HT2C agonism would avoid valvular heart disease. Echocardiographic and weight change data from 5249 obese and overweight patients in 3 phase 3 trials were integrated. Treatment duration with 10 mg lorcaserin twice daily or placebo was 52 weeks. The proportions of patients who developed Food and Drug Administration-defined valvulopathy (≥ mild aortic or ≥ moderate mitral regurgitation) and changes in regurgitant grade at each heart valve were evaluated. Possible associations between weight or body mass index change and valvulopathy were explored. New valvulopathy was present in 2.04% of placebo and 2.37% of lorcaserin recipients at 52 weeks (risk difference, 0.33%; 95% confidence interval, -0.46 to 1.13; risk ratio, 1.16 [all patients with sufficient echocardiographic data, last-observation-carried-forward imputation] or 1.03 [patients who completed 52 weeks]). Changes in weight and body mass index were negatively associated with presence of valvulopathy at week 52 (P=0.02 and P=0.04, respectively); a 5% decrease in weight was associated with an odds ratio of 1.15 for Food and Drug Administration-defined valvulopathy. Most changes in regurgitation were ±1 grade in both treatment groups at all heart valves. In 3 prospective placebo-controlled trials with integrated data for 5249 patients, the rate of echocardiographic valvulopathy was similar with lorcaserin and placebo. Point estimates for risk ratios ranged from 1.03 to 1.16 and may be at least partially influenced by greater weight loss in the lorcaserin group than in the placebo group. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00395135, NCT00603291, NCT00603902.

  4. Mitral valve annular downsizing forces: implications for annuloplasty device development.

    Science.gov (United States)

    Jensen, Morten O; Honge, Jesper L; Benediktsson, Jon A; Siefert, Andrew W; Jensen, Henrik; Yoganathan, Ajit P; Snow, Teresa K; Hasenkam, J Michael; Nygaard, Hans; Nielsen, Sten L

    2014-07-01

    Mitral valve repair with annulus downsizing is a popular surgical procedure for functional mitral regurgitation. We investigated the effects of externally applied downsizing on the observed in-plane forces and valvular dimensions. Five animals were included in an acute porcine study. Three traction sutures were anchored at the right fibrous trigone (T) and suspended across the annulus for externalization at the P1, P2, and P3 annular segments. The annulus was downsized with the sutures in controlled increments while measuring the tension force in the sutures. Downsizing percentages ranged from a 2% to 32% reduction of the T-P distances. Sonomicrometry was used to measure the resulting valvular dimensions. No difference in force was found between the P1, P2, and P3 segments across all levels of downsizing. The peak forces at 32% downsizing were 1.2 ± 0.9 N, 1.5 ± 1.0 N, and 0.8 ± 0.2 N for the T-P1, T-P2, and T-P3 segments, respectively. The maximum total suture forces in the mitral plane during downsizing increased from 0.12 ± 0.03 N to 3.5 ± 1.3 N (P downsizing (0%-32%) from 5 ± 3 mm to 1 ± 1 mm (P downsizing increased in-plane traction suture forces and has a significant influence on the in-plane biomechanics. These results have implications for device design in terms of mechanical strength requirements and can be used to supplement boundary conditions for computational left heart models. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  5. Decellularized mitral valve in a long-term sheep model.

    Science.gov (United States)

    Iablonskii, Pavel; Cebotari, Serghei; Ciubotaru, Anatol; Sarikouch, Samir; Hoeffler, Klaus; Hilfiker, Andres; Haverich, Axel; Tudorache, Igor

    2018-01-29

    The objective of this study was to evaluate surgical handling, in vivo hemodynamic performance and morphological characteristics of decellularized mitral valves (DMVs) in a long-term sheep model. Ovine mitral valves were decellularized using detergents and β-mercaptoethanol. Orthotopic implantations were performed in 6-month-old sheep (41.3 ± 1.2 kg, n = 11) without annulus reinforcement. Commercially available stented porcine aortic valves [biological mitral valve (BMV), n = 3] were implanted conventionally and used as controls. Valve function was evaluated by transoesophageal echocardiography and explants were investigated by a routine bright field microscopy and immunofluorescent histology. During implantation, 2 DMVs required cleft closure of the anterior leaflet. All valves were competent on water test and early postoperative transoesophageal echocardiography. Six animals (DMV, n = 4; BMV, n = 2) survived 12 months. Six animals died within the first 4 months due to valve-related complications. At 12 months, transoesophageal echocardiography revealed severe degeneration in all BMVs. Macroscopically, BMV revealed calcification at the commissures and leaflet insertion area. Histological examination showed sporadic cells negative for endothelial nitric oxide synthase, von Willebrand factor and CD45 on their surface. In contrast, DMV showed no calcification or stenosis, and the regurgitation was trivial to moderate in all animals. Fibrotic hardening occurred only along the suture line of the valve annulus, immunostaining revealed collagen IV covering the entire leaflet surface and a repopulation with endothelial cells. Surgical implantation of DMV is feasible and results in good early graft function. Additional in vivo investigations are required to minimize the procedure-related complications and to increase the reproducibility of surgical implantation. Degenerative profile of allogeneic DMV is superior to commercially available

  6. Mitral Regurgitation Severity and Left Ventricular Systolic Dimension Predict Survival in Young Cavalier King Charles Spaniels

    DEFF Research Database (Denmark)

    Reimann, M. J.; Moller, J. E.; Haggstrom, J.

    2017-01-01

    and echocardiographic characteristics associated with MMVD obtained at a young age for prediction of long-term cardiac and all-cause mortality in Cavalier King Charles Spaniels (CKCS). Animals 1125 privately owned CKCS. Methods A retrospective study including CKCS examined at the age of 1–3 years. Long-term outcome...

  7. Stroke Volume during Mueller Maneuver Measured by Impedance Cardiography in Patients with Mitral Regurgitation

    Czech Academy of Sciences Publication Activity Database

    Viščor, Ivo; Jurák, Pavel; Vondra, Vlastimil; Halámek, Josef; Leinveber, Pavel

    2009-01-01

    Roč. 36, - (2009), s. 749-751 ISSN 0276-6574 R&D Projects: GA AV ČR IAA200650801; GA ČR GP102/07/P425 Institutional research plan: CEZ:AV0Z20650511 Keywords : Mueller maneuver * impedance cardiography * congestive heart failure Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering http://cinc.mit.edu/archives/2009/pdf/0749.pdf

  8. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation

    Directory of Open Access Journals (Sweden)

    M. Cameli

    2017-12-01

    This review aims to summarize current knowledge on the role of atrial strain identifying early structural alterations of the atrial tissue in the rising stages of MR considering that Left Atrial Peak Longitudinal Strain (PALS considered useful parameter for a more extensive evaluation of MR patients.

  9. Development of left ventricular hypertrophy in a novel porcine model of mitral regurgitation

    DEFF Research Database (Denmark)

    Ravn, Nathja; Zois, Nora Elisabeth; Moesgaard, Sophia Gry

    2014-01-01

    traction sutures that where applied in transmyocardial fashion. A sham operated control group (n = 13) was included. Echocardiographic LV size and heart weight assessed at euthanasia were used to evaluate the development of LV enlargement and eccentric hypertrophy after 8 weeks follow-up. RESULTS: Eight...

  10. Circulating concentrations of insulin-like growth factor-1 in dogs with naturally occurring mitral regurgitation

    DEFF Research Database (Denmark)

    Pedersen, Henrik Duelund; Falk, Bo Torkel; Häggström, Jens

    2005-01-01

    Insulin-like growth factor-1 (IGF-1), which mediates most effects of growth hormone, has effects on cardiac mass and function, and plays an important role in the regulation of vascular tone. In humans, an inverse relationship between degree of heart failure (HF) and circulating IGF-1 concentratio...

  11. Intense Microbubbles Mimicking Mobile Thrombus in a Patient with Prosthetic Mitral Valve

    Directory of Open Access Journals (Sweden)

    Fatma Yılmaz Coşkun

    2017-06-01

    Full Text Available Microbubbles have been presumed as gaseous emboli, which originate during mechanical heart valve closure, but are not seen in bioprosthetic valves. In this report, we presented a cluster of microbubbles mimicking mobile thrombus in a patient with mechanical mitral valve prosthesis. A 30-year-old female with a history of implanted mechanical valve at the mitral position underwent a routine examination. She was asymptomatic and her physical examination was unremarkable. Transthoracic echocardiography showed a mobile thrombus-like mass on the ventricular side of the prosthetic mitral valve moving into the left ventricular outflow tract. However, close examination of images indicated that the mass was in fact intense microbubbles mimicking thrombus. Intense mobile microbubbles can be misdiagnosed as a mobile thrombus. We recommend and underscore the importance of detailed echocardiographic examination in case of mobile mass to avoid misdiagnosis in patients with mechanical heart valves.

  12. A systematic review on the safety and efficacy of percutaneous edge-to-edge mitral valve repair with the MitraClip system for high surgical risk candidates

    DEFF Research Database (Denmark)

    Munkholm-Larsen, Stine; Wan, Benjamin; Tian, David H

    2014-01-01

    BACKGROUND: MitraClip implantation has emerged as a viable option in high surgical risk patients with severe mitral regurgitation (MR). We performed the present systematic review to assess the safety and efficacy of the MitraClip system for high surgical risk candidates with severe organic and...... be implanted with reproducible safety and feasibility profile in this subgroup of patients. Further prospective trials with mid- to long-term follow-up are required....

  13. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification.

    Science.gov (United States)

    Lio, Antonio; Scafuri, Antonio; Nicolò, Francesca; Chiariello, Luigi

    2016-04-01

    Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

  14. Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

    2011-01-01

    in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...... LASF in the total study population was 21 ± 14 kdynes/cm(2) . The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R(2) = 0.37, P ....01). High LASF (78 patients) was characterized by abnormal LV relaxation in 90% of the cases. Low LASF (82 patients) was associated with restrictive LV filling pattern, absence of abnormal relaxation pattern, smaller maximal LA volume, and lower body mass index. In 40% of the patients with low LASF...

  15. Computational prediction of the effects of the intra-aortic balloon pump on heart failure with valvular regurgitation using a 3D cardiac electromechanical model.

    Science.gov (United States)

    Kim, Chang-Hyun; Song, Kwang-Soup; Trayanova, Natalia A; Lim, Ki Moo

    2017-10-23

    Intra-aortic balloon pump (IABP) is normally contraindicated in significant aortic regurgitation (AR). It causes and aggravates pre-existing AR while performing well in the event of mitral regurgitation (MR). Indirect parameters, such as the mean systolic pressure, product of heart rate and peak systolic pressure, and pressure-volume are used to quantify the effect of IABP on ventricular workload. However, to date, no studies have directly quantified the reduction in workload with IABP. The goal of this study is to examine the effect of IABP therapy on ventricular mechanics under valvular insufficiency by using a computational model of the heart. For this purpose, the 3D electromechanical model of the failing ventricles used in previous studies was coupled with a lumped parameter model of valvular regurgitation and the IABP-treated vascular system. The IABP therapy was disturbed in terms of reducing the myocardial tension generation and contractile ATP consumption by valvular regurgitation, particularly in the AR condition. The IABP worsened the problem of ventricular expansion induced as a result of the regurgitated blood volume during the diastole under the AR condition. The IABP reduced the LV stroke work in the AR, MR, and no regurgitation conditions. Therefore, the IABP helped the ventricle to pump blood and reduced the ventricular workload. In conclusion, the IABP partially performed its role in the MR condition. However, it was disturbed by the AR and worsened the cardiovascular responses that followed the AR. Therefore, this study computationally proved the reason for the clinical contraindication of IABP in AR patients.

  16. Modified Surgical Intervention for Extensive Mitral Valve Endocarditis and Posterior Mitral Annular Calcification

    Directory of Open Access Journals (Sweden)

    Gwan Sic Kim

    2016-02-01

    Full Text Available The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.

  17. Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography.

    Science.gov (United States)

    Altiok, Ertunc; Becker, Michael; Hamada, Sandra; Reith, Sebastian; Marx, Nikolaus; Hoffmann, Rainer

    2011-08-01

    Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation. It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has not been evaluated. In 28 high-surgical risk patients with moderate or severe mitral regurgitation (mean age 67 ± 10 years; 15 male), 2-D and RT 3-D TEE were used for the guidance of percutaneous edge-to-edge mitral valve repair using the MitraClip device. We performed a structured analysis to compare information and guidance capacity provided by RT 3-D TEE compared to 2-D TEE. RT 3-D TEE was found to provide advantages in 9 of 11 steps of the percutaneous mitral repair procedure. The advantages related to optimized definition of the transseptal puncture site, improved guidance of the clip delivery system towards the mitral valve, precise positioning of the clip delivery system simultaneously in anterior-posterior and lateral-medial direction above the mitral valve considering mitral valve scallops A2 and P2 and valvular regurgitation jet position, adjustment of the opened clip-arms perpendicular to the commissural line, visualization of the clip position relative to the valvular orifice and of the remaining regurgitant jet after clip closure from atrial as well as ventricular views providing double orifice images and thereby allowing confirmation or rejection of clip position in medial-lateral direction. RT 3-D TEE was inferior to 2-D TEE for leaflet grasping and analysis of leaflet insertion. In complex interventional edge-to-edge repair with the MitraClip device requiring optimal spatial information RT 3-D TEE allows improved guidance of the procedure. RT 3-D TEE guidance compared with 2-D TEE guidance alone resulted in greater operator confidence to adequately perform the procedure.

  18. Real-world echocardiography in patients referred for mitral valve surgery: the gap between guidelines and clinical practice.

    Science.gov (United States)

    De Groot-de Laat, Lotte E; Ren, Ben; McGhie, Jackie; Oei, Frans B S; Raap, Goris Bol; Bogers, J J C; Geleijnse, Marcel L

    2014-11-01

    Mitral regurgitation (MR) is a common disorder for which mitral valve surgery is an established therapy. Although surgical indications are clearly defined for the management of valvular heart disease, a gap exists between current guidelines and their effective application. The study aim was to provide an insight into the diagnostic information provided for cardiac surgeons before performing mitral valve surgery. The source documents and echocardiographic studies of 100 patients, referred by nine hospitals, were screened for arguments for MR severity justifying referral for surgery. Details of the documented MR mechanism, mitral annulus (MA) size, tricuspid regurgitation (TR) severity and annulus size were also noted. According to the referring physician, MR was severe in 83% and moderate-to-severe in 17%. In the great majority of patients (98%) the MR mechanism was mentioned, although specific information on the prolapsing scallops was available in only 17% of cases. The recommended primary determinants of MR severity, vena contracta and proximal isovelocity surface area (PISA) were measured in only 22% and 31% of patients, respectively. In 94% of patients with available PISA information this was described only qualitatively. Correct image expansion using the zoom mode was performed in only 25% of these patients, and a correct adaptation of the Nyquist limit in only 6%. Tricuspid annulus measurements guiding the need for concomitant tricuspid valvuloplasty in patients with less than severe TR were reported in only 6% of patients. These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the echocardiographic diagnostic information provided to the surgeon before performing mitral valve surgery.

  19. Reverse remodeling of left heart following mitral valve repair in case of mesenchimal dysplasia

    Directory of Open Access Journals (Sweden)

    А. М. Караськов

    2015-10-01

    Full Text Available Objectives. Volume overload in mitral regurgitation leads to compensatory dilation of the left heart chambers. Surgical correction promotes reverse remodeling of the heart. In this study, focus was placed on the changes in the left heart resulted from mitral regurgitation correction by using two different surgical techniques for mitral valve repair. Methods. 94 patients with posterior mitral valve prolapse were randomized in two groups. The first group patients underwent artificial chordal replacement, while a leaflet resection technique was used for the patients of the second group. Preoperative transthoracic and intraoperative transesophageal echocardiography was performed for all patients and data were obtained at 10-12 days after surgery and during long-term follow up. Results. In the early postoperative period, significant reverse remodeling of the left heart chambers was observed (LA 5.4-4.6, p <0.05; LVEDD 5.8-4.9 p <0.05; LVESD 3.6 - 3.1 p <0.05 - LA 5.2 - 4.5 p <0.05; LVEDD 5.8 - 4.8 p <0.05; LVESD 3.5 - 3.2 p <0.05. The mitral valve orifice area in the groups was 3.3 - 3.3 - 3.2 when replacing chords and 3.5 - 3.4 - 3.2 when doing resection, with p being equal to 0.32, 0.36 and 0.51 respectively. The mean diastolic gradient in the first group was 2.0 - 3.0 - 3.0 mm Hg, while in the second one it amounted to 2.3 - 3.2 - 3.3 mmHg, with p <0.05. Conclusion. The authors conclude that significant remodeling of the left heart occurs in the early postoperative period. In the immediate postoperative period, the mitral valve area tends to decrease and the gradient has a tendency to increase in both groups, with no significant changes observed in the late postoperative period.

  20. Anatomical challenges for transcatheter mitral valve intervention

    DEFF Research Database (Denmark)

    De Backer, Ole; Luk, Ngai H V; Søndergaard, Lars

    2016-01-01

    , most of these transcatheter mitral valve interventions are still in their early clinical or preclinical development phase. Challenges arising from the complex anatomy of the mitral valve and the interplay of the mitral apparatus with the left ventricle (LV) have contributed to a more difficult...

  1. Anatomical challenges for transcatheter mitral valve intervention

    DEFF Research Database (Denmark)

    De Backer, Ole; Luk, Ngai H V; Søndergaard, Lars

    2016-01-01

    system, most of these transcatheter mitral valve interventions are still in their early clinical or preclinical development phase. Challenges arising from the complex anatomy of the mitral valve and the interplay of the mitral apparatus with the left ventricle (LV) have contributed to a more difficult...

  2. Breeding Restrictions Decrease the Prevalence of Myxomatous Mitral Valve Disease in Cavalier King Charles Spaniels over an 8- to 10-Year Period.

    Science.gov (United States)

    Birkegård, A C; Reimann, M J; Martinussen, T; Häggström, J; Pedersen, H D; Olsen, L H

    2016-01-01

    Cavalier King Charles Spaniels (CKCS) are predisposed to myxomatous mitral valve disease (MMVD). Studies have indicated a strong genetic background. The aim of this study was to evaluate the effect of a breeding scheme involving auscultation and echocardiography. In the Danish Kennel Club mandatory breeding scheme, 997 purebred CKCS were examined during the period 2002-2011. Each dog was evaluated 1-4 times with a total of 1,380 examinations. Auscultation and echocardiography were performed to evaluate mitral regurgitation murmur severity and degree of mitral valve prolapse (MVP). The odds of having mitral regurgitation murmur or MVP > grade 1 in 2010-2011 compared to 2002-2003 were estimated using logistic regression analysis including age and sex as covariates. Odds were estimated for dogs that were products of the breeding scheme (defined as dogs with both parents approved by the breeding scheme before breeding) and non-products of the breeding scheme (defined as dogs with at least 1 parent with unknown cardiac status). In 2010-2011, the odds of having mitral regurgitation murmur were 0.27 if dogs were a product of the breeding scheme compared with dogs in 2002-2003, reflecting a 73% decreased risk (P < .0001). If non-products of the breeding scheme examined in 2010-2011 were compared with dogs in 2002-2003, no difference in odds was found (P = .49). A mandatory breeding scheme based on auscultation and echocardiography findings significantly decreased the prevalence of MMVD over the 8- to 10-year period. Such a breeding scheme therefore is recommended for CKCS. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  3. Use of equilibrium (gated) radionuclide ventriculography to quantitate left ventricular output in patients with and without left-sided valvular regurgitation

    Energy Technology Data Exchange (ETDEWEB)

    Konstam, M.A.; Wynne, J.; Holman, B.L.; Brown, E.J.; Neill, J.M.; Kozlowski, J.

    1981-09-01

    We examined the accuracy with which left ventricular output can be estimated by equilibrium radionuclide ventriculography. After red blood cells were labeled in vivo, we measured left ventricular end-diastolic and end-systolic count rates and the count rate in 5 ml of the patient's blood. After estimating the average ratio of counting efficiency for the left ventricle to counting efficiency for the blood sample (Elv/Es) in six patients, we calculated left ventricular output in 26 other patients as (left ventricular activity ejected per minute divided by activity per liter of blood) divided by the previously estimated Elv/Es. Radionuclide left ventricular output closely approximated Fick cardiac output (r . 0.94) in patients without mitral or aortic regurgitation and exceeded Fick cardiac output in all patients with valvular regurgitation. Regurgitant fraction, calculated as the difference between the radionuclide and Fick outputs divided by the radionuclide output, correlated with the severity of of regurgitation as assessed angiographically. The equilibrium radionuclide ventriculogram is an excellent means for noninvasive estimation of left ventricular output.

  4. Effects of Mechanical Ventilation on Heart Geometry and Mitral Valve Leaflet Coaptation During Percutaneous Edge-to-Edge Mitral Valve Repair.

    Science.gov (United States)

    Patzelt, Johannes; Zhang, Yingying; Seizer, Peter; Magunia, Harry; Henning, Andreas; Riemlova, Veronika; Patzelt, Tara A E; Hansen, Marc; Haap, Michael; Riessen, Reimer; Lausberg, Henning; Walker, Tobias; Reutershan, Joerg; Schlensak, Christian; Grasshoff, Christian; Simon, Dan I; Rosenberger, Peter; Schreieck, Juergen; Gawaz, Meinrad; Langer, Harald F

    2016-01-25

    This study sought to evaluate a ventilation maneuver to facilitate percutaneous edge-to-edge mitral valve repair (PMVR) and its effects on heart geometry. In patients with challenging anatomy, the application of PMVR is limited, potentially resulting in insufficient reduction of mitral regurgitation (MR) or clip detachment. Under general anesthesia, however, ventilation maneuvers can be used to facilitate PMVR. A total of 50 consecutive patients undergoing PMVR were included. During mechanical ventilation, different levels of positive end-expiratory pressure (PEEP) were applied, and parameters of heart geometry were assessed using transesophageal echocardiography. We found that increased PEEP results in elevated central venous pressure. Specifically, central venous pressure increased from 14.0 ± 6.5 mm Hg (PEEP 3 mm Hg) to 19.3 ± 5.9 mm Hg (PEEP 20 mm Hg; p 4.9 mm at PEEP of 10 mm Hg resulted in a significant reduction of PMVR procedure time (152 ± 49 min to 116 ± 26 min; p = 0.05). In this study, we describe a novel ventilation maneuver improving mitral valve coaptation length during the PMVR procedure, which facilitates clip positioning. Our observations could help to improve PMVR therapy and could make nonsurgical candidates accessible to PMVR therapy, particularly in challenging cases with functional MR. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification.

    Science.gov (United States)

    de Agustin, Jose Alberto; Viliani, Dafne; Vieira, Catarina; Islas, Fabian; Marcos-Alberca, Pedro; Gomez de Diego, Jose Juan; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; Perez de Isla, Leopoldo

    2013-09-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has known technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions and has already been validated for mitral regurgitation assessment. The aim of this study was to apply this novel method in patients with chronic tricuspid regurgitation (TR). Ninety patients with chronic TR were enrolled. EROA and regurgitant volume (Rvol) were assessed using transthoracic 2D and 3D PISA methods. Quantitative Doppler and 3D transthoracic planimetry of EROA were used as reference methods. Both EROA and Rvol assessed using the 3D PISA method had better correlations with the reference methods than using conventional 2D PISA, particularly in the assessment of eccentric jets. On the basis of 3D planimetry-derived EROA, 35 patients had severe TR (EROA ≥ 0.4 cm(2)). Among these 35 patients, 25.7% (n = 9) were underestimated as having nonsevere TR (EROA ≤ 0.4 cm(2)) using the 2D PISA method. In contrast, the 3D PISA method had 94.3% agreement (33 of 35) with 3D planimetry in classifying severe TR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.92 and 0.88 respectively. TR quantification using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  6. Asymptomatic Primary Hyperparathyroidism

    Science.gov (United States)

    Silverberg, Shonni J.; Walker, Marcella D.; Bilezikian, John P.

    2014-01-01

    The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term “asymptomatic primary hyperparathyroidism” was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease. PMID:23374736

  7. Patient-specific indirectly 3D printed mitral valves for pre-operative surgical modelling

    Science.gov (United States)

    Ginty, Olivia; Moore, John; Xia, Wenyao; Bainbridge, Dan; Peters, Terry

    2017-03-01

    Significant mitral valve regurgitation affects over 2% of the population. Over the past few decades, mitral valve (MV) repair has become the preferred treatment option, producing better patient outcomes than MV replacement, but requiring more expertise. Recently, 3D printing has been used to assist surgeons in planning optimal treatments for complex surgery, thus increasing the experience of surgeons and the success of MV repairs. However, while commercially available 3D printers are capable of printing soft, tissue-like material, they cannot replicate the demanding combination of echogenicity, physical flexibility and strength of the mitral valve. In this work, we propose the use of trans-esophageal echocardiography (TEE) 3D image data and inexpensive 3D printing technology to create patient specific mitral valve models. Patient specific 3D TEE images were segmented and used to generate a profile of the mitral valve leaflets. This profile was 3D printed and integrated into a mold to generate a silicone valve model that was placed in a dynamic heart phantom. Our primary goal is to use silicone models to assess different repair options prior to surgery, in the hope of optimizing patient outcomes. As a corollary, a database of patient specific models can then be used as a trainer for new surgeons, using a beating heart simulator to assess success. The current work reports preliminary results, quantifying basic morphological properties. The models were assessed using 3D TEE images, as well as 2D and 3D Doppler images for comparison to the original patient TEE data.

  8. Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Midterm Clinical and Echocardiographic Quality Outcomes.

    Science.gov (United States)

    Suri, Rakesh M; Taggarse, Amit; Burkhart, Harold M; Daly, Richard C; Mauermann, William; Nishimura, Rick A; Li, Zhuo; Dearani, Joseph A; Michelena, Hector I; Enriquez-Sarano, Maurice

    2015-11-24

    Severe primary (degenerative) mitral regurgitation (MR) is repaired with durable results when simple single-scallop disease is addressed. The midterm quality outcomes of minimally invasive repair for complex disease are unknown, however. From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe nonischemic degenerative MR. Simple pathology was addressed in 289 of 487 (59%) patients, and complex repair (all others) was performed in 198 of 487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex; hazard ratio, 0.48; 95% confidence interval, 0.05-4.59); and New York Heart Association functional class I/II was documented in 97.9% (477/487). Eight patients had recurrence of moderate-to-severe MR (4 simple, 4 complex), with a 5-year freedom from MR of 94.6% (96.2% simple; 92.7%, complex; P=0.67; hazard ratio, 1.36; 95% confidence interval, 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.1% simple; 95.7% complex; P=0.13; hazard ratio, 3.35; 95% confidence interval, 0.65-17.32). At a large tertiary care referral center, midterm quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence, regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair. © 2015 American Heart Association, Inc.

  9. Contemporary outcomes in reoperative mitral valve surgery.

    Science.gov (United States)

    Mehaffey, Hunter J; Hawkins, Robert B; Schubert, Sarah; Fonner, Clifford; Yarboro, Leora T; Quader, Mohammed; Speir, Alan; Rich, Jeff; Kron, Irving L; Ailawadi, Gorav

    2017-10-05

    Data suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes. All (11 973) open mitral valve cases were evaluated (2002-2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery. Of all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, pmitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era. Redo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Use of a Minimally Invasive Cardiac Output Monitor to Optimise Haemodynamics in a Patient with Mitral Valve Disease Undergoing Cerebrovascular Surgery

    Directory of Open Access Journals (Sweden)

    Ali M. Al-Mashani

    2017-10-01

    Full Text Available Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-yearold female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the VolumeView EV1000™ (Edwards Lifesciences, Irvine, California, USA system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients.

  11. Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia.

    Science.gov (United States)

    Bui, An H; Roujol, Sébastien; Foppa, Murilo; Kissinger, Kraig V; Goddu, Beth; Hauser, Thomas H; Zimetbaum, Peter J; Ngo, Long H; Manning, Warren J; Nezafat, Reza; Delling, Francesca N

    2017-02-01

    We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP). A retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T1 times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects. Patients with MVP had significantly shorter postcontrast T1 times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T1 times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R2=0.30). Patients with MVP with ComVA had significantly shorter postcontrast T1 times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE. MVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T1 times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Robotically assisted mitral valve replacement.

    Science.gov (United States)

    Gao, Changqing; Yang, Ming; Xiao, Cangsong; Wang, Gang; Wu, Yang; Wang, Jiali; Li, Jiachun

    2012-04-01

    In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 ± 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 ± 21.9 minutes (range, 105-168) and 99.3 ± 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  13. Perforated giant mycotic aneurysm of mitral valve in a drug-addicted young man: Rare complication of infective endocarditis.

    Science.gov (United States)

    Lavanco, Vincenzo; Curzi, Mirko; Giustiniano, Enrico; Raspante, Donatella; Di Lisi, Daniela; Bragato, Renato Maria

    2018-01-01

    Infective endocarditis (IE) affects patients at high clinical risk and may present as an acute and rapidly progressive, subacute or chronic infection. Transthoracic and transesophageal echocardiography represent the key diagnostic method in IE diagnosis. In particular, three-dimensional transesophageal echocardiography represents the imaging technique that allows to establish with adequate accuracy dimensions, shape, and localization of endocarditis vegetations. In our case, we show a huge vermiform mycotic aneurysm in an immunodeficient young drug-addicted man with severe mitral valve regurgitation and the additive value of three-dimensional transesophageal echocardiography in this specific clinical setting. © 2017 Wiley Periodicals, Inc.

  14. Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Huang Jiapeng

    2011-01-01

    Full Text Available Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

  15. Asymptomatic inhaled foreign body

    Science.gov (United States)

    Salim, Muhammad U.; Asghar, Asif; Tareen, Irum; Azhar, Muhammad

    2016-01-01

    It is very rare to have a big foreign body in the lungs without any complications or symptoms for 2 years. A 14-year-old male with episodes of minor hemoptysis for 4 weeks had a history of inhalation of a bullet 2 years earlier. He had asymptomatic for lung complications for 2 years. The bullet was removed by right thoracotomy and non-anatomical wedge stapled resection, and he followed an uneventful recovery. An aspirated foreign body although big can remain asymptomatic for a long time, especially if it has migrated to the periphery. PMID:27652366

  16. Effect of Losartan on Mitral Valve Changes After Myocardial Infarction.

    Science.gov (United States)

    Bartko, Philipp E; Dal-Bianco, Jacob P; Guerrero, J Luis; Beaudoin, Jonathan; Szymanski, Catherine; Kim, Dae-Hee; Seybolt, Margo M; Handschumacher, Mark D; Sullivan, Suzanne; Garcia, Michael L; Titus, James S; Wylie-Sears, Jill; Irvin, Whitney S; Messas, Emmanuel; Hagège, Albert A; Carpentier, Alain; Aikawa, Elena; Bischoff, Joyce; Levine, Robert A

    2017-09-05

    After myocardial infarction (MI), mitral valve (MV) tethering stimulates adaptive leaflet growth, but counterproductive leaflet thickening and fibrosis augment mitral regurgitation (MR), doubling heart failure and mortality. MV fibrosis post-MI is associated with excessive endothelial-to-mesenchymal transition (EMT), driven by transforming growth factor (TGF)-β overexpression. In vitro, losartan-mediated TGF-β inhibition reduces EMT of MV endothelial cells. This study tested the hypothesis that profibrotic MV changes post-MI are therapeutically accessible, specifically by losartan-mediated TGF-β inhibition. The study assessed 17 sheep, including 6 sham-operated control animals and 11 with apical MI and papillary muscle retraction short of producing MR; 6 of the 11 were treated with daily losartan, and 5 were untreated, with flexible epicardial mesh comparably limiting left ventricular (LV) remodeling. LV volumes, tethering, and MV area were quantified by using three-dimensional echocardiography at baseline and at 60 ± 6 days, and excised leaflets were analyzed by histopathology and flow cytometry. Post-MI LV dilation and tethering were comparable in the losartan-treated and untreated LV constraint sheep. Telemetered sensors (n = 6) showed no significant losartan-induced changes in arterial pressure. Losartan strongly reduced leaflet thickness (0.9 ± 0.2 mm vs. 1.6 ± 0.2 mm; p losartan-treated sheep. Profibrotic changes of tethered MV leaflets post-MI can be modulated by losartan without eliminating adaptive growth. Understanding the cellular and molecular mechanisms could provide new opportunities to reduce ischemic MR. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Robotic mitral valve repair for degenerative posterior leaflet prolapse.

    Science.gov (United States)

    Javadikasgari, Hoda; Suri, Rakesh M; Tappuni, Bassman; Lowry, Ashley M; Mihaljevic, Tomislav; Mick, Stephanie; Gillinov, A Marc

    2017-01-01

    Robotic mitral valve (MV) repair is the least invasive surgical approach to the MV and provides unparalleled access to the valve. We sought to assess technical aspects and clinical outcomes of robotic MV repair for isolated posterior leaflet prolapse by examining the first 623 such cases performed in a tertiary care center. We reviewed the first 623 patients (mean age 56±9.7 years) with isolated posterior leaflet prolapse who underwent robotic primary MV repair from 01/2006 to 11/2013. All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. MV repair was attempted in all patients; 622 (99.8%) underwent MV repair and only 1 (0.2%) converted to replacement. After an initial attempt at robotic MV repair, 8 (1.3%) patients were converted to sternotomy as a result of management of residual mitral regurgitation (n=3), bleeding (n=1), difficulties with surgical exposure (n=2), aortic valve injury (n=1), and aortic dissection (n=1). Intraoperative post-repair echocardiography confirmed that all patients left the operating room with MR graded as mild or less, and pre-discharge echocardiography confirmed mild or less MR in 573 (99.1%). There was no hospital death, sternal wound infection, or renal failure. Seven (1.1%) patients suffered a stroke, 11 (1.8%) patients underwent re-exploration for bleeding, and 111 (19%) experienced new-onset atrial fibrillation. The mean intensive care unit length of stay and hospital length of stay were 29±17 hours and 4.6±1.6 days, respectively. At a large tertiary care referral center, robotic MV repair for posterior prolapse is associated with zero mortality, infrequent operative morbidity, and near 100% successful repair. The combination of a patient selection algorithm and increased experience improved clinical outcomes and procedural efficiency.

  18. Dynamic heart phantom with functional mitral and aortic valves

    Science.gov (United States)

    Vannelli, Claire; Moore, John; McLeod, Jonathan; Ceh, Dennis; Peters, Terry

    2015-03-01

    Cardiac valvular stenosis, prolapse and regurgitation are increasingly common conditions, particularly in an elderly population with limited potential for on-pump cardiac surgery. NeoChord©, MitraClipand numerous stent-based transcatheter aortic valve implantation (TAVI) devices provide an alternative to intrusive cardiac operations; performed while the heart is beating, these procedures require surgeons and cardiologists to learn new image-guidance based techniques. Developing these visual aids and protocols is a challenging task that benefits from sophisticated simulators. Existing models lack features needed to simulate off-pump valvular procedures: functional, dynamic valves, apical and vascular access, and user flexibility for different activation patterns such as variable heart rates and rapid pacing. We present a left ventricle phantom with these characteristics. The phantom can be used to simulate valvular repair and replacement procedures with magnetic tracking, augmented reality, fluoroscopy and ultrasound guidance. This tool serves as a platform to develop image-guidance and image processing techniques required for a range of minimally invasive cardiac interventions. The phantom mimics in vivo mitral and aortic valve motion, permitting realistic ultrasound images of these components to be acquired. It also has a physiological realistic left ventricular ejection fraction of 50%. Given its realistic imaging properties and non-biodegradable composition—silicone for tissue, water for blood—the system promises to reduce the number of animal trials required to develop image guidance applications for valvular repair and replacement. The phantom has been used in validation studies for both TAVI image-guidance techniques1, and image-based mitral valve tracking algorithms2.

  19. Proximal flow convergence method by three-dimensional color Doppler echocardiography for mitral valve area assessment in rheumatic mitral stenosis.

    Science.gov (United States)

    de Agustin, Jose Alberto; Mejia, Hernan; Viliani, Dafne; Marcos-Alberca, Pedro; Gomez de Diego, Jose Juan; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; Perez de Isla, Leopoldo

    2014-08-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has important technical limitations for mitral valve orifice area (MVA) assessment in mitral stenosis (MS), mainly the geometric assumptions of PISA shape and the requirement of an angle correction factor. Single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions or the requirement of an angle correction factor. The aim of this study was to validate this method in patients with rheumatic MS. Sixty-three consecutive patients with rheumatic MS were included. MVA was assessed using the transthoracic 2D and 3D PISA methods. Planimetry of MVA (2D and 3D) and the pressure half-time method were used as reference methods. The 3D PISA method had better correlations with the reference methods (with 2D planimetry, r = 0.85, P PISA method (with 2D planimetry, r = 0.63, P PISA method was observed. A high percentage (30%) of patients with nonsevere MS by 3D planimetry were misclassified by the 2D PISA method as having severe MS (effective regurgitant orifice area PISA method had 94% agreement with 3D planimetry. Good intra- and interobserver agreement for 3D PISA measurements were observed, with intraclass correlation coefficients of 0.95 and 0.90, respectively. MVA assessment using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method. Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  20. Folding mitral valvuloplasty without posterior leaflet resection for calcified mitral annulus

    Science.gov (United States)

    Smith, Craig R.; Stamou, Sotiris C.; Boeve, Theodore J.; Patzelt, Lawrence H.

    2012-01-01

    Mitral valve annular calcification has long been a challenge in repairing posterior mitral valve prolapse. Folding valvuloplasty of the posterior leaflet without resection provides a means of circumventing common procedural complications. This report demonstrates the success of folding valvuloplasty without resection in the treatment of mitral valve prolapse and severe annular calcification. PMID:22159235

  1. Asymptomatic ocular sarcoidosis

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Azevedo de Freitas

    2013-04-01

    Full Text Available Sarcoidosis is an idiopathic systemic granulomatous disease. It commonly affects the skin, lungs, kidneys, and central nervous system. In the eyes it primarily affects the uveal tract, conjunctiva, lacrimal glands and optic nerve. Here in we describe the case of a patient with systemic sarcoidosis and asymptomatic eye inflammation.

  2. Endurance Training on Congenital Valvular Regurgitation: An Athlete Case Series.

    Science.gov (United States)

    Hoyt, Walter Jordan; Dean, Peter N; John, Anitha S; Gimple, Lawrence W; Mistry, Dilaawar J; Battle, Robert W

    2016-01-01

    Both intense endurance training and valvular regurgitation place a volume load on the right and left ventricles, potentially leading to dilation, but their effects in combination are not well-known. The purpose of this case series is to describe the combined volume load of intense endurance athletic training and regurgitant valvular disease as well as the challenging assessment of each component's cardiovascular effect. In this article, the clinical course of three elite endurance athletes with congenital valvular disease were reviewed. A swimmer with aortic regurgitation, a cyclist with aortic regurgitation, and a cyclist with pulmonary regurgitation were found to have severe dilation of the associated ventricles despite continuing to train at an elite level without symptoms. Because of the cumulative effects of endurance training and valvular regurgitation, each athlete manifested ventricular dilation out of proportion to their valvular disease and symptoms. Although the effects of congenital valvular disease and athletic remodeling on ventricular dilation have been thoroughly studied individually, their cumulative effect is not well understood. This complicates the assessment of athletes with valvular regurgitation and underscores the need for athlete-specific recommendations for valve replacement.

  3. Long-axis fractional shortening and mitral annulus motion in dogs

    Directory of Open Access Journals (Sweden)

    Marlos Gonçalves Sousa

    2016-10-01

    Full Text Available Ventricular systolic dynamics involves the contraction of transverse and longitudinal myocardial fibers. Unfortunately, only the activity of the transverse myocardial fibers is foreseen by the standard systolic echocardiographic parameters. Although strain and strain rate have been used to assess the radial, circumferential and longitudinal planes of cardiac contraction, such analysis requires advanced equipment which is not always available in veterinary medicine. On the contrary, some unusual parameters may be recorded via standard methodology, allowing for the specific evaluation of left ventricular longitudinal contractility. In this study, the longitudinal contractile activity was evaluated using the long-axis fractional shortening and the mitral annulus motion, which were compared with several standard echocardiographic parameters in 14 beagles, including seven with asymptomatic mitral valve disease. The long-axis fractional shortening was positively correlated with both the mitral annulus motion and the end-diastolic left-ventricular diameter. Also, a significant correlation was found to exist between the mitral annulus motion and the left-ventricular end-diastolic diameter, which is likely supportive of its preload dependency. Even though no difference was documented in either mitral annulus motion or long-axis fractional shortening between healthy dogs and dogs with mitral valve disease, the latter only included animals with minimal cardiac remodeling, with no overt compromise of systolic function. Since it is possible to obtain these two parameters with any echocardiographic equipment, their inclusion in the routine exam would probably add information regarding the activity of the longitudinal myocardial fibers, whose functional deterioration supposedly occurs prior to the impairment of transverse fibers.

  4. Percutaneous approaches to mitral valve disease

    National Research Council Canada - National Science Library

    Fassa, A-A; Himbert, D; Brochet, E; Bouleti, C; Vahanian, A

    2015-01-01

    Percutaneous approaches to mitral valve disease consist in modifications of existing surgical techniques, aiming to replicate the favourable outcomes of surgery, with less procedure-related risk, due...

  5. The Burden of Pulmonary Hypertension in Patients with Degenerative Mitral Valve Disease in Enugu South-East Nigeria: An Echocardiographic Based Study.

    Science.gov (United States)

    Ejim, E C; Oguanobi, N I

    2016-01-01

    Pulmonary hypertension is a common complication of degenerative mitral valve disease, and contributes significantly to both morbidity and mortality. The use of medications for reduction of pulmonary pressure in patients is not a common practice by most physicians in this part of the world because of the absence of data on pulmonary hypertension. The authors set out to find the prevalence of pulmonary hypertension in patients with degenerative mitral valve disease and to determine if there are gender differences in affectation. This will form a basis for future research on the management of pulmonary hypertension in sub-Saharan Africa. The echocardiographic records of 1390 patients carried out over a period of 4 years were retrospectively reviewed. The examinations were done with a Logic 500 MD echocardiographic machine. Tricuspid valve regurgitation velocity above 250 cm/s defined pulmonary hypertension. Data obtained included presence of degenerative mitral valve disease, pulmonary hypertension, age, and gender. A total of 1390 echocardiogram reports done at Conquest Medical Imaging, Enugu, from July 2009 to August 2013 were retrospectively reviewed. Degenerative mitral valve disease was noted in 18.7% of the patients, (259/1390) made up of 149 males and 110 females with a mean age of 68.3 (14.4) years. Pulmonary hypertension was present in 30% of the patients (78/259) and affected males more than females. Pulmonary hypertension is common in patients with degenerative mitral valve disease in Enugu, and affects males more than females.

  6. Correção da origem anômala de artéria coronária esquerda com insuficiência mitral e hemólise mecânica Correction of anomalous origin of left coronary artery with mitral insufficiency and mechanical hemolisys

    Directory of Open Access Journals (Sweden)

    José Alberto Caliani

    2004-12-01

    Full Text Available Criança do sexo feminino, 2 meses de idade, apresentando quadro clínico de insuficiência cardíaca e sopro. Durante a investigação, foi realizado ecocardiograma e estudo cineangiocardiográfico que evidenciaram origem anômala da artéria coronária esquerda do tronco pulmonar e insuficiência mitral importante demonstrada ao doppler. A paciente foi submetida a tratamento cirúrgico com auxílio de circulação extracorpórea, que consistiu no reimplante da artéria coronária esquerda na aorta, associado à anuloplastia da valva mitral. No pós-operatório tardio, houve importante hemólise mecânica ocasionada pela plastia mitral. A paciente foi reoperada para remoção de retalho de pericárdio bovino. O ecocardiograma pós-operatório mostra insuficiência mitral leve e o paciente apresenta-se em classe funcional I (NYHA.A 2 months-old girl, presenting with heart failure and murmur was investigated using echocardiography and cardiac cathetherization revealing an anomalous left coronary artery origin from the pulmonary trunk and massive mitral regurgitation. The patient was submitted to surgery under cardiopulmonary bypass: the anomalous coronary was implanted in the aorta and the mitral valve repaired by annuloplasty. In the postoperative period the patient had important mechanical hemolysis caused by mitral annuloplasty. The patient underwent a second intervention to remove a piece of bovin pericardium. A postoperative echocardiogram revealed mild mitral insufficiency and the patient is free of symptoms.

  7. Mitral valve repair [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Alberto Pozzoli

    2016-06-01

    Full Text Available Mitral regurgitation (MR is the most common valvular heart disease in the Western world. The MR can be either organic (mainly degenerative in Western countries or functional (secondary to left ventricular remodeling in the context of ischemic or idiopathic dilated cardiomyopathy. Degenerative and functional MR are completely different disease entities that pose specific decision-making problems and require different management. The natural history of severe degenerative MR is clearly unfavorable. However, timely and effective correction of degenerative MR is associated with a normalization of life expectancy. By contrast, the prognostic impact of the correction of functional MR is still debated and controversial. In this review, we discuss the optimal treatment of both degenerative and functional MR, taking into account current surgical and percutaneous options. In addition, since a clear understanding of the etiology and mechanisms of valvular dysfunction is important to guide the timing and choice of treatment, the role of the heart team and of echo imaging in the management of MR is addressed as well.

  8. Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.

    Science.gov (United States)

    Commeau, P; Grollier, G; Huret, B; Foucault, J P; Potier, J C

    1987-01-01

    Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:3620253

  9. Double orifice mitral valve; a coincidental finding

    NARCIS (Netherlands)

    Westendorp, Iris C. D.; de Bruin-Bon, H. A. C. M.; Hrudova, Jana

    2006-01-01

    A double orifice mitral valve (DOMV) represents a rare congenital malformation characterised by two valve orifices with two separate subvalvular apparatus. This case demonstrates the necessity of careful imaging of the mitral valve apparatus, not only in patients with atrioventricular septal

  10. Mitral valve repair in acquired dextrocardia.

    Science.gov (United States)

    Elmistekawy, Elsayed; Chan, Vincent; Hynes, Mark; Mesana, Thierry

    2015-10-01

    Surgical correction of valvular heart disease in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve repair in a patient with acquired dextrocardia. Successful mitral valve repair was performed through a right lateral thoracotomy. We describe our surgical strategy and summarize the literature. © The Author(s) 2014.

  11. The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review.

    Science.gov (United States)

    Badar, Athar A; Brunton, Alan P T; Mahmood, Ammad H; Dobbin, Stephen; Pozzi, Andrea; McMinn, Jenna F; Sinclair, Andrew J E; Gardner, Roy S; Petrie, Mark C; Curry, Phil A; Al-Attar, Nawwar H K; Pettit, Stephen J

    2015-01-01

    A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5-14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation.

  12. Effects of undersized mitral annuloplasty on regional transmural left ventricular wall strains and wall thickening mechanisms.

    Science.gov (United States)

    Cheng, Allen; Nguyen, Tom C; Malinowski, Marcin; Liang, David; Daughters, George T; Ingels, Neil B; Miller, D Craig

    2006-07-04

    Undersized mitral annuloplasty, widely used for ischemic and functional mitral regurgitation (MR), has been proposed as an "annular solution to a ventricular problem." Beyond relief of MR, it is thought to improve global left ventricular (LV) shape, hence potentially reducing myocardial stress and promoting beneficial reverse LV remodeling. We previously observed that undersized annuloplasty inhibited systolic wall thickening at the LV base near the mitral annulus. In this study, we measured the effects of undersized annuloplasty on regional transmural LV wall fiber and sheet strains and wall thickening mechanisms. Nine sheep had transmural radiopaque beadsets surgically inserted into anterobasal and lateral equatorial LV regions, with additional markers silhouetting the LV and mitral annulus. 4-Dimensional marker dynamics were studied with biplane videofluoroscopy before and after tightening an adjustable Paneth-type mitral annuloplasty suture. Transmural circumferential, longitudinal, and radial systolic and remodeling strains in the subepicardium (20% depth), midwall (50%), and subendocardium (80%) in both regions were computed. Fiber and sheet angles from quantitative regional histology allowed transformation of these strains into local fiber (f), sheet (s), and sheet-normal (n) coordinates. Further analysis calculated the transmural contributions of sheet extension (E(ssc)), sheet thickening (E(nnc)), and sheet shear (E(snc)) to systolic wall thickening (E(33)). In the anterobasal region, undersized annuloplasty reduced systolic wall thickening (E33) by &50% at all transmural depths by inhibiting: (1) subendocardial systolic fiber shortening (-0.10+/-0.05 versus -0.04+/-0.05; Pextension (0.22+/-0.12 versus 0.11+/-0.06; Ptransmural sheet shear (subepicardium, -0.14+/-0.07 versus -0.08+/-0.07; midwall, 0.21+/-0.12 versus 0.10+/-0.11; subendocardium, -0.19+/-0.23 versus -0.11+/-0.16; P<0.05). In the remote lateral equatorial region, fiber-sheet strains and E33

  13. Defeito do anel fibroso mitral posterior com aneurisma de átrio esquerdo e insuficiência mitral: tratamento cirúrgico com sucesso Defect of the posterior mitral fibrous ring with left atrial aneurysm and mitral insufficiency: successful surgical treatment

    Directory of Open Access Journals (Sweden)

    Ronaldo Machado BUENO

    1999-10-01

    Full Text Available Aneurismas em átrio esquerdo são pouco comuns, podendo ocorrer na aurícula ou na parede do átrio esquerdo. Freqüentemente, são assintomáticos, podendo ocorrer arritmias, fenômenos tromboembólicos ou insuficiência cardíaca como complicação da sua evolução. Apresentamos paciente de 39 anos, do sexo feminino, com defeito do anel posterior da valva mitral levando a grande dilatação aneurismática da parede posterior do átrio esquerdo com insuficiência mitral. O diagnóstico foi feito pela radiografia de tórax (abaulamento de silhueta cardíaca esquerda e ecocardiograma (grande aneurisma do átrio esquerdo posteriormente à parede posterior do ventrículo esquerdo com insuficiência mitral. O estudo hemodinâmico sugeriu pseudo-aneurisma de ventrículo esquerdo. Submetida a tratamento cirúrgico com auxílio da circulação extracorpórea, realizou-se anuloplastia mitral e exclusão do aneurisma com reconstrução do assoalho do átrio esquerdo com retalho de pericárdio bovino. A paciente apresentou boa evolução pós-operatória, recebendo alta hospitalar no oitavo dia em boas condições clínicas.Atrial aneurysm is a rare condition and can be found on the atrial appendage or on the atrial wall. Most patients are asymptomatic, but arrhythmias, thromboembolism, and heart failure are common complications. We present a 39 years old female patient with posterior mitral ring defect causing a great aneurysm of the left posterior atrial wall with mitral insufficiency. The diagnosis was achieved by chest roentgenogram (marked prominence of the upper left heart border and echocardiography (great left atrial aneurysm behind the left posterior ventricular wall with mitral insufficiency. Left ventricular cineangiogram suggested the presence of a false aneurysm of the left ventricle. The patient subsequently underwent surgical treatment with cardiopulmonary bypass. Posterior mitral valve annuloplasty was performed with aneurysm exclusion

  14. Mitral valve replacement with the preservation of the entire valve apparatus Substituição da valva mitral com preservação do aparato completo da valva

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    Ahmed A. Alsaddique

    2007-06-01

    Full Text Available OBJECTIVE: The papillary muscles and the chordae tendineae of both mitral leaflets contribute to the preservation of the left ventricular function. Most surgeons, however, routinely excise the anterior mitral leaflet. METHODS: In a group of nine patients, six of them underwent mitral valve replacement alone and three underwent both aortic and mitral valve replacements, all the mitral apparatus was preserved. All of these patients had mechanical valves using CarboMedics cardiac prosthesis (CarboMedics, Inc. Austin, Texas. RESULTS: There was no mortality. Postoperative echocardiographic assessment revealed maintained left ventricular function with no interference with the prosthetic leaflet mobility and no left ventricular outflow tract gradient. CONCLUSION: We believe that in most patients with long-standing mitral valve regurgitation, thinned out papillary muscles and elongated chordae tendineae that are not amenable to repair, valve replacement with the preservation of the entire native valve is possible and should be encouraged. This is especially valuable for those with depressed left ventricular function, who might otherwise suffer from left ventricular dysfunction in the long-term if the entire mitral valve apparatus were to be excised.OBJETIVO: Os músculos papilares e as cordas tendíneas de ambos folhetos mitral contribuem para a preservação da função ventricular esquerda. Muitos cirurgiões, entretanto, rotineiramente extirpar o folheto mitral anterior. MÉTODOS: Em um grupo de nove pacientes, seis deles foram submetidos à substituição da válvula mitral e três foram submetidos a substituições das válvulas mitral e aórtica, todos os aparatos mitrais foram preservados. Todos os pacientes tinham válvulas mecânicas implantadas usando próteses cardíacas CarboMedics (CarboMedics, Inc. Austin, Texas. RESULTADOS: Não houve mortalidade. A avaliação ecocardiográfica pós-operatória revelou a conservação da fun

  15. Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures.

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    Gaia, Diego Felipe; Braz, Ademir Massarico; Simonato, Matheus; Dvir, Danny; Breda, João Roberto; Ribeiro, Gustavo Calado; Ferreira, Carolina Baeta; Souza, José Augusto Marcondes; Buffolo, Enio; Palma, José Honório

    2017-04-01

    Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 ± 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%; 64.8%; P  = 0.3). The mitral gradient showed a significant reduction (11 mmHg; 6 mmHg; P  < 0.001). Residual mitral regurgitation was not present. There was no left ventricular outflow tract obstruction. The mitral ViV implant in a failed bioprosthesis is an effective procedure. This possibility might alter prosthesis selection in the future initial surgical prosthesis selection, favouring bioprostheses. Further large trials should explore its safety.

  16. Mitral supravalvular ring: a case report

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    Testa Paola

    2005-08-01

    Full Text Available Abstract Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative diagnosis is difficult with transtoracic echo (TTE, angiography and magnetic resonance imaging (MRI. In this case, a 36-year-old male, was admitted to our Heart department: He experienced progressive dyspnea on effort and at rest. Diagnosis was made by transesophageal echocardiography which showed, on apical 4-chamber section, an anulare structure attached since a membrane to the atrial wall anterior mitral valve leaflet and just proximal to the posterior mitral leaflet. Pre-operative identification of the supravalvular mitral ring is the target for obtaining good surgical results. Cineangiography and MRI both failed in reaching this objective, whereas, transesophageal echocardiography is the best method to identify this congenital heart disease. Using TEE the identification is not only possible but also easier.

  17. [Interventional catheter treatment of tricuspid valve regurgitation].

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    Wißt, T; Kreidel, F; Schlüter, M; Kuck, K-H; Frerker, C

    2017-11-01

    The tricuspid valve can be considered the "forgotten" valve because in the past hardly any research has been conducted in this field and as a result only few therapeutic options existed. The prognosis of untreated tricuspid regurgitation (TR) is poor and mortality is high for patients with severe TR. Patients frequently return to medical practices and hospitals because of cardiac decompensation, with shortness of breath and leg edema. Recent years have seen more development in catheter-based treatment options. Currently, several devices are in clinical evaluation, which are presented in this article. A web-based literature search was carried out and information was gathered at international cardiology meetings (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris). There are various options for interventional catheter procedures for TR, which are being investigated within the scope of clinical studies. Most aim at reducing the tricuspid annular diameter and optimizing leaflet coaptation. Because of these new therapy options patients can now be treated who were considered untreatable in the past because of the high perioperative mortality.

  18. Long-term results of suture annuloplasty for degenerative mitral valve disease: a propensity-matched analysis.

    Science.gov (United States)

    Garatti, Andrea; Canziani, Alberto; Parolari, Alessandro; Castelvecchio, Serenella; Guazzi, Marco; Daprati, Andrea; Farah, Ali Abu; Grimaldi, Francesco; Tripepi, Sonia; Menicanti, Lorenzo

    2018-01-01

    Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n = 147 (37%)] or with flexible posterior annuloplasty band [n = 253 (63%)]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P = 0.20). In-hospital mortality was comparable between the two study groups (P = 0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P = 0.71). At a mean follow-up of 11 ± 3 years, all-cause mortality (P = 0.12), need for mitral valve replacement (P = 0.49), and cardiac re-hospitalization rate (P = 0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71%, P = 0.51) and freedom from MVF (92 vs. 84%, P = 0.39) were similar between posterior annuloplasty band and DSA groups. Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in

  19. Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery?

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    Di Gioia, Giuseppe; Mega, Simona; Nenna, Antonio; Campanale, Cosimo Marco; Colaiori, Iginio; Scordino, Domenico; Ragni, Laura; Miglionico, Marco; Di Sciascio, Germano

    2017-01-15

    Severe primary mitral regurgitation (MR) carries a significant incidence of mortality and morbidity. Though a number of prognostic factors have been identified, the best timing for mitral valve repair is still debated. We assessed the role of Left Atrial Volume Indexed (LAVI) as predictor of adverse events after mitral valve surgery. 134 patients with severe MR were studied with a follow-up of 42±16months. Endpoints were Post-Operative Atrial Fibrillation (POAF), atrial and ventricular remodeling (LARR/LVRR) and correlation with outcome. POAF was defined as AF occurring within 2weeks and late AF (LAF) more than 2weeks after surgery. LARR was defined as LAVI reduction ≥15% and LVRR as any reduction of ventricular mass after surgery. Forty-one patients experienced POAF, 26 had LAF. Pre-operative LAVI was an independent risk factor for POAF (OR 1.03, CI [1.00-1.06], p=0.01), LAF (OR 1.03, CI [1.00-1.06], p=0.02), LARR and LVRR (OR 1.04, CI [1.01-1.07], p=0.002, respectively). LARR was found in 75 patients, while LVRR in 111. Patients with heart remodeling had less incidence of LAF and cardiac adverse events, better diastolic function and improved their NYHA class after surgery. LAVI should be given more weight into decision making for patients with MR as it predicts POAF and LAF and reverse atrial and ventricular remodeling, both associated to long-term outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Risk of Cerebral Embolization with Caseous Calcification of the Mitral Annulus: Review Article.

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    Dietl, Charles A; Hawthorn, Christopher M; Raizada, Veena

    2016-01-01

    Caseous calcification of the mitral annulus (CCMA) is believed to have a benign prognosis. Several authors have recommended conservative management in asymptomatic patients. However, the prevalence of cerebrovascular events (CVE) in patients with CCMA has never been evaluated before. The aims of this study are to investigate whether patients with CCMA are at increased risk of cerebral embolization, and to determine whether elective surgical resection of CCMA should be considered to prevent a cardioembolic stroke. A comprehensive literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar using the following search queries: caseous calcification of the mitral annulus, intracardiac pseudotumor, mitral annular calcification, and cardioembolic stroke. From our initial search that yielded 1,502 articles, we identified a total of 130 patients with CCMA reported in 86 publications. Literature review revealed that the prevalence of CVE associated with CCMA is 19.2% (25 of 130) which is significantly higher than the prevalence of CVE reported with mitral annular calcification (MAC), 11.8% (214 of 1818) (range 4.8% to 24.1%) (P = 0.01796) (odds ratio = 1.78; 0.95 confidence interval = 1.1278 - 2.8239). Only four of 25 (16.0%) patients with CCMA who suffered a CVE had history of atrial fibrillation (AF). Based on our review, it would be reasonable to consider elective surgical resection of CCMA in asymptomatic patients who are good surgical candidates, because patients with CCMA may be at increased risk of embolic strokes, which are unrelated to AF.

  1. Non-Invasive Assessment of Left Ventricular End-Diastolic Pressure in Patients with Chronic Aortic Regurgitation, Comparison of the Sensitivity and Specificity of CW Doppler Echocardiography with Angiography

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    M Esmaeilzadeh

    2009-06-01

    Full Text Available Background: Left ventricular end diastolic pressure could be estimated collectively using various measures of mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient ratio.Patients and Methods: Fifty three patients with at least moderate aortic regurgitation were enrolled in this study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac catheterization. The severity of AR was graded according to the recommendations of American society for echocardiography. The pressure half time, aortic regurgitation early diastolic velocity , aortic regurgitation early diastolic pressure gradient , aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and recorded. The results from cardiac catheterization and echocardiography were compared.Result: The early diastolic to end diastolic pressure gradient ratio was very accurate (80% for determining the left ventricular end diastolic pressure (P =0.01. An early diastolic to end diastolic pressure gradient ratio of 1.5 has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure ≤12 mmHg. The best cutoff value of early diastolic to end diastolic pressure gradient ratio for the prediction of left ventricular end diastolic pressure >12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection fraction or aortic regurgitation severity in cardiac catheterization (P

  2. Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results.

    Science.gov (United States)

    Chiappini, Bruno; Sanchez, Alvaro; Noirhomme, Philippe; Verhelst, Robert; Rubay, Jean; Poncelet, Alain; Funken, Jean Christophe; El Khoury, Gebrine

    2006-09-01

    A variety of reliable techniques are now available for chordal disease management and repair of the anterior mitral valve leaflet prolapse. The study aim was to review the authors' experience with polytetrafluoroethylene (PTFE), using a standardized technique for length adjustment, and to analyze the long-term results in patients who underwent mitral valve repair. A total of 111 patients (mean age 56.2 +/- 16.1 years) underwent mitral valve repair with PTFE neochordae, in addition to a variety of other surgical procedures. Etiologies were degenerative in 82 patients (73.9%), Barlow disease in 13 (11.7%), rheumatic in 10 (9%), and infection in six (5.4%). Prolapse of the anterior leaflet was present in 78 patients (70.3%), of the posterior leaflet in 15 (13.5%), a bileaflet prolapse was present in 12 (10.8%), and a commissural prolapse in six (5.4%). In all cases the anterior annulus was used as the reference level in order to assess the appropriate length of the PTFE neochordae. The mean number of PTFE neochordae used was 6 +/- 4 per patient. In-hospital mortality was 1.8% (n = 2); mean follow up was 36.8 +/- 25.6 months (range: 12-94 months). There were no late deaths. At five years postoperatively the patient overall survival was 98.2 +/- 1.8%, freedom from reoperation rate 100%, and freedom from grade 1+ mitral regurgitation rate 97.2 +/- 2.8%. There were no documented thromboembolism or hemorrhagic events. In degenerative and myxomatous mitral valve disease, leaflet prolapse can be successfully repaired by implantation of PTFE neochordae. Both immediate and long-term results proved the versatility, efficiency and durability of this technique.

  3. Efficiency of energy-rich therapy for cellular energy metabolic disturbances in children with mitral valve prolapse

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    M. T. Baedilova

    2017-01-01

    Full Text Available Objective: to determine impairments in cell energy metabolism (the levels of amino acids and carnitine in children with connective tissue dysplasia, such as mitral valve prolapse, and to evaluate the efficiency of energy-rich therapy.Subjects and methods. High-performance liquid chromatography- mass spectrometry was used to determine the levels of carnitines and amino acids in dried blood spots from 57 children with mitral valve prolapse (1–2 variants without regurgitation and in 38 children having Health Groups 1 and 2. The clinical efficiency of prolonged (12-month combined use of energy-rich medications (L-carnitine, coenzyme Q10 was evaluated.Results. As compared with the controls, the children with mitral valve prolapse showed a significant change, although not beyond the normal range, in the values of free and bound carnitine and amino acids (primarily methionine. There was a significant increase of these indicators in the blood during 12-month combined energy-rich therapy.Conclusion. The findings suggest that that there are moderate, but significant tissue metabolic changes in children with mitral valve prolapse. The found changes are a rationale for the use of energy-rich therapy in this category of children. Analysis of dried blood spots by liquid chromatography tandem mass spectrometry is recommended for the early diagnosis of cellular energy metabolic disturbances in children with signs of connective tissue dysplasia, such as mitral valve prolapse.

  4. First in human implantation of the mechanical expanding Lotus® valve in degenerated surgical valves in mitral position.

    Science.gov (United States)

    Schaefer, Ulrich; Conradi, Lenard; Lubos, Edith; Deuschl, Florian; Schofer, Niklas; Seiffert, Moritz; Treede, Hendrik; Schirmer, Johannes; Reichenspurner, Hermann; Blankenberg, Stefan

    2015-12-01

    Implantation of transcatheter heart valves (THV) into degenerated surgical valves is an emerging therapy for selected high-risk patients. Although, CE mark of most THV is limited for native aortic valvular stenosis, transcatheter valve implantation into degenerated bioprostheses, even in mitral position is very intriguing. After placement of a cerebral protection device (Claret Sentinel®), three consecutive patients (age, 79.0 ± 6.1; log EuroSCORE I: 33.3 ± 9.2%) with a degenerated mitral bioprosthesis were treated by transapical implantation of the Lotus® valve (Boston Scientific Inc.). In addition, a SwanGanz catheter was introduced in the pulmonary artery for hemodynamic assessments all patients. Procedural success was 100%. Valve implantation was performed without rapid ventricular pacing. Resheating was performed in two patients due to suboptimal initial positioning. Invasive online hemodynamics revealed stable blood pressure in all patients. After Lotus® valve implantation, valvular mitral regurgitation was completely eliminated in all patients. One patient had a mild paravalvular leak of the surgical bioprosthesis, which was present before implantation. Invasive right and left heart hemodynamics showed an immediate improvement after Lotus® valve implantation. Mean mitral surface area (2.1 ± 0.2 cm(2) ) and mean gradient (3.7 ± 2.1 mm Hg) demonstrated satisfactory results. All patients were immediately extubated and discharged from the hospital without any adverse event. This study demonstrates for the first time the feasibility of transapical Lotus® Valve implantation in degenerated mitral bioprostheses. The controlled mechanical Lotus® valve expansion with remarkably stable hemodynamics throughout the procedure offers a new and valuable treatment option. © 2015 Wiley Periodicals, Inc.

  5. Acute aortic regurgitation due to infective endocarditis

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    Claudia M Cortés

    2017-10-01

    Full Text Available Acute aortic regurgitation (AAR due to infective endocarditis (IE is a serious disease and usually requires surgical treatment. Our study aims to compare the clinical, echocardiographic, and microbiological characteristics as well as in-hospital outcome of patients with AAR according to the severity of heart failure (HF and to evaluate predictors of in-hospital mortality in a tertiary centre. In a prospective analysis, we compared patients with NYHA functional class I-II HF (G1 vs. functional class III-IV HF (G2. From 06/92 to 07/16, 439 patients with IE were hospitalized; 86 presented AAR: (G1, 39: 45.4% y G2, 47: 54.7%. The G1 had higher prosthetic IE (43.6% vs. 17%, p 0.01. All G2 patients had dyspnoea vs. 30.8% of the G1 (p < 0.0001. There were no differences in clinical, echocardiographic and microbiological characteristics. Surgical treatment was indicated mainly due to infection extension or valvular dysfunction in G1 and HF in G2. In-hospital mortality was 15.4% vs. 27.7% (G1 and G2 respectively p NS. In multivariate analysis, health care-associated acquisition (p 0.001, negative blood cultures (p 0.004, and functional class III-IV HF (p 0.039 were in-hospital mortality predictors. One-fifth of the patients with EI had AAR. Half of them had severe HF which needed emergency surgery and the remaining needed surgery for extension of the infection and / or valvular dysfunction. Both groups remain to have high surgical and in-hospital mortality. Health care-associated acquisition, negative blood cultures and advanced HF were predictors of in-hospital mortality

  6. Traumatic Mitral Valve and Pericardial Injury

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    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  7. Clinical applicability for the assessment of the valvular mitral stenosis severity with Doppler echocardiography and the proximal isovelocity surface area (PISA) method.

    Science.gov (United States)

    Lee, Tao Yu; Tseng, Chi-Jen; Chiao, Chia-Ding; Chiou, Chuen-Wang; Mar, Guang-Yuan; Liu, Chun-Peng; Lin, Shao Lin; Chiang, Hung-Tin

    2004-01-01

    Evaluation of the severity of valvular mitral stenosis and measurements of the effective rheumatic mitral valve area by noninvasive echocardiography has been well accepted. The area is measured by the two-dimensional planimetry (PLM) method and the Doppler pressure half-time (PHT) method. Recently, the proximal isovelocity surface area (PISA) by color Doppler technique has been used as a quantitative measurement for valvular heart disease. However, this method needs more validation. The aim of this study was therefore to investigate the clinical applicability of the PISA method in the measurements of effective mitral valve area in patients with rheumatic valvular heart disease. Forty-seven patients aged from 23 to 71 years, with a mean age of 53 +/- 13 (25 male and 22 female, 15 with sinus rhythm, mean heart rate of 83 +/- 14 beats per minute, with rheumatic valvular mitral stenosis without hemodynamically significant mitral regurgitation) were included in the study. Effective mitral valve area (MVA) derived by the PISA method was calculated as follows: 2 x Pi x (proximal aliasing color zone radius)2x aliasing velocity/peak velocity across mitral orifice. Effective mitral valve areas measured by three different methods (PLM, PHT, and PISA) were compared and correlated with those calculated by the "gold standard" invasive Gorlin's formula. The MVA derived from PHT, PLM, PISA and Gorlin's formula were 1.00 +/- 0.31cm2, 0.99 +/- 0.30 cm2, 0.95 +/- 0.30 cm2 and 0.91 +/- 0.29 cm2, respectively. The correlation coefficients (r value) between PHT, PLM, PISA, and Gorlin's formula, respectively, were 0.66 (P = 0.032, SEE = 0.64), 0.67 (P = 0.25, SEE = 0.72) and 0.80 (P = 0.002, SEE = 0.53). In conclusion, the PISA method is useful clinically in the measurement of effective mitral valve area in patients with rheumatic mitral valve stenosis. The technique is relatively simple, highly feasible and accurate when compared with the PHT, PLM, and Gorlin's formula. Therefore, this

  8. [An asymptomatic chronic hypokalaemia].

    Science.gov (United States)

    Otto, Marie-Pierre; Cheminel, Valérie; Crevon, Lionel; Dubourg, Laurence; Hadj-Aissa, Aoumeur; Mounier, Chantal; Prevosto, Jean-Michel

    2011-01-01

    We report the case of an asymptomatic patient presenting a severe chronic renal hypokalaemia. Once being sure of no diuretics use, two hypothesis can be mentioned for a normotensive patient presenting an hypokalaemia associated with a metabolic alcalosis: Bartter syndrome or Gitelman syndrome. The highlighting of low magnesaemia and hypocalciuria strongly concentrates the diagnosis on Gitelman syndrome. First, this has been strengthened by the results of renal function tests and later it has confirmed by molecular diagnosis with the identification of a known homozygous mutation on SLC12A3 gene. In the patient family, the same chromosomal abnormality has been found in the young sister. For these two patients the treatment ordered is an antikaliuretic diuretic, magnesium and potassium supplements. This case shows the difficulty to diagnose Gitelman syndrome: it is frequently mistaken for Bartter syndrome. The main differences between these two syndromes are magnesaemia and calciuria. Furthemore , patients with Gitelman syndrome are often asymptomatic, this explains why prevalence of this illness is probably underestimated.

  9. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for "burnt-out" rheumatic disease still inferior to repair for degenerative disease in the current era?

    Science.gov (United States)

    Dillon, Jeswant; Yakub, Mohd Azhari; Kong, Pau Kiew; Ramli, Mohd Faizal; Jaffar, Norfazlina; Gaffar, Intan Fariza

    2015-03-01

    Mitral valve repair is perceived to be of limited durability for advanced rheumatic disease in adults. We aim to examine the long-term outcomes of repair for rheumatic disease, identify predictors of durability, and compare with repair for degenerative disease. Rheumatic and degenerative mitral valve repairs in patients aged 40 years or more were prospectively analyzed. The primary outcomes investigated were mortality, freedom from reoperation, and valve failure. Logistic regression analysis was performed to define predictors of poor outcome. Between 1997 and 2011, 253 rheumatic and 148 degenerative mitral valves were repaired. The age of patients in both groups was similar, with a mean of 54.1 ± 8.4 years versus 55.6 ± 7.3 years (P = .49). Freedom from reoperation for rheumatic valves at 5 and 10 years was 98.4%, comparable to 95.3% (P = .12) for degenerative valves. Freedom from valve failure at 5 and 10 years was 91.4% and 81.5% for rheumatic repairs and 82.5% and 75.4% for degenerative repairs, respectively (P = .15). The presence of residual mitral regurgitation greater than 2+ before discharge was the only significant independent predictor of reoperation, whereas residual mitral regurgitation greater than 2+ and leaflet procedures were significant risk factors for valve failure. The durability of rheumatic mitral valve repair in the current era has improved and is comparable to the outstanding durability of repairs for degenerative disease, even in the adult rheumatic population. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation, and strict quality control with stringent use of intraoperative transesophageal echocardiography have all contributed to the improved long-term results. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  10. Computer tomographic findings in mitral valve disease

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    Heuser, L.; Neufang, K.F.R.; Jansen, W.

    1984-04-01

    In 38 patients suffering from mitral valve disease the findings of cardiac CT scans were compared to the results of echocardiographic, standard roentgenographic, and cineangiocardiographic studies as well as to intraoperative and histological findings. CT proved to be superior to the other imaging modalities in detecting mitral calcifications and in demonstrating the morphological changes, but cannot replace cardiac catheterization as it does not yield haemodynamic data. The indication for CT in mitral valve disease therefore is restricted to cases with extremely enlarged left atria in which the other methods do not provide satisfactory visualization, and to patients with suspected intracavitary thrombus or tumor. 8 figs.

  11. Regurgitation quantification using 3D PISA in volume echocardiography.

    Science.gov (United States)

    Grady, Leo; Datta, Saurabh; Kutter, Oliver; Duong, Christophe; Wein, Wolfgang; Little, Stephen H; Igo, Stephen R; Liu, Shizhen; Vannan, Mani

    2011-01-01

    We present the first system for measurement of proximal isovelocity surface area (PISA) on a 3D ultrasound acquisition using modified ultrasound hardware, volumetric image segmentation and a simple efficient workflow. Accurate measurement of the PISA in 3D flow through a valve is an emerging method for quantitatively assessing cardiac valve regurgitation and function. Current state of the art protocols for assessing regurgitant flow require laborious and time consuming user interaction with the data, where a precise execution is crucial for an accurate diagnosis. We propose a new improved 3D PISA workflow that is initialized interactively with two points, followed by fully automatic segmentation of the valve annulus and isovelocity surface area computation. Our system is first validated against several in vitro phantoms to verify the calculations of surface area, orifice area and regurgitant flow. Finally, we use our system to compare orifice area calculations obtained from in vivo patient imaging measurements to an independent measurement and then use our system to successfully classify patients into mild-moderate regurgitation and moderate-severe regurgitation categories.

  12. The Effect of Tricuspid Regurgitation and the Right Heart on Survival after Transcatheter Aortic Valve Replacement: Insights from the PARTNER II Inoperable Cohort

    Science.gov (United States)

    Lindman, Brian R.; Maniar, Hersh S.; Jaber, Wael A.; Lerakis, Stamatios; Mack, Michael J.; Suri, Rakesh M.; Thourani, Vinod H.; Babaliaros, Vasilis; Kereiakes, Dean J.; Whisenant, Brian; Miller, D. Craig; Tuzcu, E. Murat; Svensson, Lars G.; Xu, Ke; Doshi, Darshan; Leon, Martin B.; Zajarias, Alan

    2015-01-01

    Background Tricuspid regurgitation (TR) and right ventricular (RV) dysfunction adversely affect outcomes in patients with heart failure or mitral valve disease, but their impact on outcomes in patients with aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) has not been well characterized. Methods and Results Among 542 patients with symptomatic AS treated in the PARTNER II trial (inoperable cohort) with a SAPIEN or SAPIEN XT valve via a transfemoral approach, baseline TR severity, right atrial (RA) and RV size, and RV function were evaluated by echocardiography according to established guidelines. One-year mortality was 16.9%, 17.2%, 32.6%, and 61.1% for patients with no/trace (n=167), mild (n=205), moderate (n=117), and severe (n=18) TR, respectively (p<0.001). Increasing severity of RV dysfunction as well as RA and RV enlargement were also associated with increased mortality (p<0.001). After multivariable adjustment, severe TR (HR 3.20, 95% CI 1.50–6.82, p=0.003) and moderate TR (HR 1.60, 95% CI 1.02–2.52, p=0.042) remained associated with increased mortality as did RA and RV enlargement, but not RV dysfunction. There was an interaction between TR and mitral regurgitation severity (p=0.04); the increased hazard of death associated with moderate/severe TR only occurred in those with no/trace/mild mitral regurgitation. Conclusions In inoperable patients treated with TAVR, moderate or severe TR and right heart enlargement are independently associated with increased 1-year mortality, however the association between moderate or severe TR and an increased hazard of death was only found in those with minimal MR at baseline. These findings may improve our assessment of anticipated benefit from TAVR and support the need for future studies on TR and the right heart, including whether concomitant treatment of TR in operable but high risk patients with AS is warranted. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique

  13. Maximal oxygen uptake in severe aortic regurgitation: a different view of left ventricular function.

    Science.gov (United States)

    Scriven, A J; Lipkin, D P; Fox, K M; Poole-Wilson, P A

    1990-10-01

    Respiratory gas exchange was used to assess left ventricular (LV) function in 22 patients with severe aortic regurgitation (19 men and three women, aged 18 and 70 years, mean 49 years). Anaerobic threshold and symptom-limited maximal oxygen consumption (VO2 max) were measured during treadmill exercise, and the results were compared with conventional echocardiographic and radionuclide indices of LV systolic function. The results were considered with respect to the patients' New York Heart Association functional class. Both rest and exercise LV ejection fractions were variable, but the mean results were similar in all classes. The echocardiographic indices of LV cavity dimensions, fractional shortening, radius/thickness ratio, and systolic wall stress also showed a wide range but with similar mean results in each class. In contrast, VO2 max and anaerobic threshold showed a relationship to functional class. VO2 max was 32.4 +/- 3.4 ml/kg/min in age-matched control subjects; in the patients it was 27.9 +/- 4.7 in class I, 24.7 +/- 5.7 in class II, and 14.2 +/- 2 in the combined class III/IV. Results in patients in classes I and II were similar, but both groups were significantly different from control subjects (p less than 0.05) and from patients in class III/IV (p less than 0.01). About half of the patients with moderate LV dysfunction (judged by reduced VO2 max) were asymptomatic, and LV function was impaired in 4 of 10 patients in class I. Thus, unlike conventional indices of LV function, VO2 max appeared capable of distinguishing patients with moderate-to-severe LV dysfunction from those with little or no LV dysfunction. Measurement of respiratory gas exchange appears to be a valid and useful supplementary means of assessing LV function in severe aortic regurgitation. Further long-term evaluation is required.

  14. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease: Implications for Transcatheter Interventions.

    Science.gov (United States)

    Naoum, Christopher; Blanke, Philipp; Cavalcante, João L; Leipsic, Jonathon

    2017-03-01

    Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions. © 2017 American Heart Association, Inc.

  15. The role of intraoperative transesophageal echocardiography in robotic mitral valve repair.

    Science.gov (United States)

    Wang, Yao; Gao, Chang-Qing; Wang, Jia-Li; Yang, Ming

    2011-01-01

    Robotic mitral valve (MV) repair is a new surgical technique that uses small incisions. Previous studies have demonstrated the importance of intraoperative transesophageal echocardiography (TEE) for conventional MV surgery with the use of a median sternotomy incision. The aim of the present study was to delineate the utility of intraoperative TEE in robotic MV repair. Intraoperative TEE was performed in 22 consecutive patients undergoing robotic MV repair for severe degenerative mitral regurgitation (MR) over a period of 2 years. Before cardiopulmonary bypass (CPB), TEE was used to define the lesions of degenerative MR and the localization of the prolapsed leaflets, and to evaluate the severity of MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was used to assess immediately the competency of the surgical repair. Agreement between TEE and surgical findings was excellent: 92.3% (kappa, 0.873) for the lesions of degenerative MR, and 98.5% (kappa, 0.943) for the localization of the prolapsed leaflets. Under TEE guidance, all the cannulae (100%) in the SVC, IVC, and AAO were placed correctly. TEE demonstrated all the patients (100%) had successful robotic MV repairs. Intraoperative TEE is a valuable adjunct in the assessment of robotic MV repair. (Echocardiography 2011;28:85-91). © 2010, Wiley Periodicals, Inc.

  16. Robotic mitral valve annuloplasty with double-arm nitinol U-clips.

    Science.gov (United States)

    Reade, Clifton C; Bower, Curtis E; Bailey, B Marcus; Maziarz, David M; Masroor, Saqib; Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2005-04-01

    Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times. A 67-year-old female was approached through a right mini-thoracotomy with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Using 12 nitinol U-clips (Coalescent Surgical, Sunnyvale, CA) an annuloplasty band was placed under robotic guidance. Clip placement and deployment times were recorded and statistical comparisons were assessed to prior suture annuloplasties. Clip placement time was 1.3 +/- 0.9 (minutes +/- standard deviation), statistical comparison with first, most recent, and all prior suture annuloplasties proving no significance. Clip deployment time was 0.5 +/- 0.2, whereas knot-tying times and respective statistical comparison for first, most recent, and all prior suture annuloplasties were 2.0 +/- 0.7 (p = 0.003), 1.2 +/- 0.4 (p = 0.0004), and 1.6 +/- 0.6 (p echocardiography performed postoperatively, at 3 months, and at 9 months revealed valvular structural integrity with only minimal mitral regurgitation. U-clips considerably reduce time for annuloplasty over conventional suture and may help reduce operative times as well.

  17. Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Leonetti Stefania

    2010-01-01

    Full Text Available Abstract Background This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR. Methods Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR, including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed. Results Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%, 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity. Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p Conclusions 2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2, which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases.

  18. [Mitral valve repair in the course of active infectious endocarditis. Study of four patients].

    Science.gov (United States)

    García-Alonso, Carlos J; Ferrer, Elena; Vallejo, Nuria; Delgado, Luis; Pedro-Botet, María Luisa; Ruyra, Xavier; Bayés-Genis, Antoni

    2013-06-04

    Mitral valve (MV) repair is the preferred surgical treatment for degenerative mitral regurgitation (MR). However, questions remain about the efficacy of MV repair when performed for MR caused by infective endocarditis (IE), particularly during its active phase. Although several observational studies have suggested the superiority of MV repair over replacement in patients undergoing surgery for IE, many centres are still opting for valve replacement because of its technical feasibility and reproducibility. In the following document we expose the experience of our hospital. We present a series of 4 patients who recently underwent surgery for IE during its active phase. Epidemiological and clinical characteristics are discussed. All patients underwent different MV repair techniques. No relapse or reinfection has been reported. All patients present MR grades 0 or iI/ivIV at follow up. Even during the active phase of IE, MV repair is a feasible technique with good postoperatory results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  19. Should high risk patients with concomitant severe aortic stenosis and mitral valve disease undergo double valve surgery in the TAVR era?

    Science.gov (United States)

    Yu, Pey-Jen; Mattia, Allan; Cassiere, Hugh A; Esposito, Rick; Manetta, Frank; Kohn, Nina; Hartman, Alan R

    2017-12-29

    Significant mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The aim of this study is to determine if surgical correction of both aortic and mitral valves in high risk patients with concomitant valvular disease would offer patients better outcomes than TAVR alone. A retrospective analysis of 43 high-risk patients who underwent concomitant surgical aortic valve replacement and mitral valve surgery from 2008 to 2012 was performed. Immediate and long term survival were assessed. There were 43 high-risk patients with severe aortic stenosis undergoing concomitant surgical aortic valve replacement and mitral valve surgery. The average age was 80 ± 6 years old. Nineteen (44%) patients had prior cardiac surgery, 15 (34.9%) patients had chronic obstructive lung disease, and 39 (91%) patients were in congestive heart failure. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for isolated surgical aortic valve replacement for the cohort was 10.1% ± 6.4%. Five patients (11.6%) died during the index admission and/or within thirty days of surgery. Mortality rate was 25% at six months, 35% at 1 year and 45% at 2 years. There was no correlation between individual preoperative risk factors and mortality. High-risk patients with severe aortic stenosis and mitral valve disease undergoing concomitant surgical aortic valve replacement and mitral valve surgery may have similar long term survival as that described for such patients undergoing TAVR. Surgical correction of double valvular disease in this patient population may not confer mortality benefit compared to TAVR alone.

  20. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: A consensus document from the Mitral Valve Academic Research Consortium.

    Science.gov (United States)

    Stone, Gregg W; Adams, David H; Abraham, William T; Kappetein, Arie Pieter; Généreux, Philippe; Vranckx, Pascal; Mehran, Roxana; Kuck, Karl-Heinz; Leon, Martin B; Piazza, Nicolo; Head, Stuart J; Filippatos, Gerasimos; Vahanian, Alec S

    2015-08-01

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of trans- catheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. Published on behalf of the European Society of Cardiology. All rights reserved. © American College of Cardiology

  1. The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures.

    Science.gov (United States)

    Murphy, Douglas A; Moss, Emmanuel; Binongo, Jose; Miller, Jeffrey S; Macheers, Steven K; Sarin, Eric L; Herzog, Alexander M; Thourani, Vinod H; Guyton, Robert A; Halkos, Michael E

    2015-11-01

    The role of robotic instruments in mitral valve (MV) surgery continues to evolve. The purpose of this study was to assess the safety, efficacy, and scope of MV surgery using a lateral endoscopic approach with robotics (LEAR) technique. From 2006 to 2013, a dedicated LEAR team performed 1,257 consecutive isolated MV procedures with or without tricuspid valve repair or atrial ablation. The procedures were performed robotically through five right-side chest ports with femoral artery or ascending aortic perfusion and balloon occlusion. Operative videos and data were recorded on all procedures and reviewed retrospectively. The mean age of all patients was 59.3 ± 20.5 years, and 8.4% (n = 105) had previous cardiac surgery. The MV repair was performed in 1,167 patients (93%). The MV replacement was performed in 88 patients (7%), and paravalvular leak repair in 2 patients. Concomitant atrial ablation was performed in 226 patients (18%), and tricuspid valve repair in 138 patients (11%). Operative mortality occurred in 11 patients (0.9%) and stroke in 9 patients (0.7%). Predischarge echocardiograms demonstrated mild or less mitral regurgitation in 98.3% of MV repair patients. At mean follow-up of 50 ± 26 months, 44 patients (3.8%) required MV reoperation. Application of the LEAR technique to all institutional isolated MV procedures increased from 46% in the first year to more than 90% in the last 3 years. Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. The hemodynamic basis of exercise intolerance in tricuspid regurgitation

    DEFF Research Database (Denmark)

    Andersen, Mads Jønsson; Nishimura, Rick a; Borlaug, Barry A

    2014-01-01

    BACKGROUND:Patients with severe tricuspid regurgitation (TR) frequently present with exertional fatigue and dyspnea, but the hemodynamic basis for exercise limitation in people with TR remains unclear. METHODS AND RESULTS:Twelve subjects with normal left ventricular (LV) ejection fraction and gra...

  3. Plasma proANP and SDMA and microRNAs are associated with chronic mitral regurgitation in a pig model

    DEFF Research Database (Denmark)

    Cirera Salicio, Susanna; Moesgaard, Sophia Gry; Zois, Nora Elisabeth

    2013-01-01

    was subdivided into mild MR (mMR, MR=20-50%, n=10) and moderate/severe MR (sMR, MR >50%, n=6) and compared with controls (CON, MR ≤10%, n=12). Eight weeks postoperatively, follow-up examinations were performed followed by killing. Circulating concentrations of pro-atrial natriuretic peptide (proANP), l......-arginine, asymmetric dimethylarginine, and symmetric dimethylarginine (SDMA) were measured. MV, anterior papillary muscle, and left ventricular free wall tissues were collected to quantify mRNA expression of eNOS (NOS3), iNOS (NOS2), MMP9, MMP14, ANP (NPPA), BNP (NPPB), and TGFB1, 2, and 3 and five micro......RNAs by quantitative real-time PCR. Pigs with sMR displayed markedly increased plasma proANP and SDMA concentrations compared with both controls and mMR (P...

  4. Advanced electrocardiographic parameters change with severity of mitral regurgitation in Cavalier King Charles Spaniels in sinus rhythm

    DEFF Research Database (Denmark)

    Pakkanen, M. Spiljak; Petric, A. Domanjko; Olsen, Lisbeth Høier

    2012-01-01

    Multiple advanced resting ECG (A-ECG) techniques have improved the diagnostic or prognostic value of ECG in detecting human cardiac diseases even before onset of clinical signs or changes in conventional ECG....

  5. Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Cosmo Godino

    2016-06-01

    Conclusions: This study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.

  6. Functional (ischemic mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

    Directory of Open Access Journals (Sweden)

    Živilė Valuckienė

    2015-01-01

    Conclusions: Moderate and severe MR in acute MI is related to age, atrial fibrillation, increased left ventricular diastolic dimensions and decreased ejection fraction. Moderate and severe, but not mild MR is an important clinical contributor to in-hospital cardiac death.

  7. A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation

    DEFF Research Database (Denmark)

    Wan, Benjamin; Rahnavardi, Mohammad; Tian, David H

    2013-01-01

    . The purpose of this meta-analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. METHODS: Six electronic databases were searched for original published studies from January 2000 to August 2013. Two reviewers independently...... to the surgical group (17.2% vs. 0.4%; PClass III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7...

  8. Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up

    Directory of Open Access Journals (Sweden)

    Widgren Veronica

    2012-10-01

    Full Text Available Abstract Background There is limited information about any association between the onset of atrial fibrillation (AF and the presence of valvular disease. Methods We retrospectively examined 940 patients in sinus rhythm, examined by echocardiography in 1996. During 11 years of follow-up, we assessed the incidence of AF and outcome defined as valvular surgery or death, in relation to baseline valvular function. AS (aortic stenosis severity at baseline examination was assessed using peak transaortic valve pressure gradient. Results In univariate analysis, the risk of developing AF was related to AS (significant AS versus no significant AS; hazard ratio (HR 3.73, 95% confidence interval (CI 2.39-5.61, p Conclusions AS, but not MR, was independently predictive of development of AF and combined valvular surgery or death. In patients with combined AS and MR, the grade of AS, more than the grade of MR, determined the risk of AF and combination of valvular surgery or death. Further studies using contemporary echocardiographic quantification of aortic stenosis are warranted to confirm these retrospective data based on peak transaortic valve pressure gradient.

  9. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis.

    Science.gov (United States)

    Refatllari, Ali; Likaj, Ermal; Dumani, Selman; Hasimi, Endri; Goda, Artan

    2016-03-15

    An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient's perioperative course was without complications and patient was discharged on the seventh postoperative day. Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes.

  10. Asymptomatic bacteriuria among pregnant women

    OpenAIRE

    Sudha Biradar Kerure; Rajeshwari Surpur; Sheela S. Sagarad; Sneha Hegadi

    2013-01-01

    Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB) is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB) in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens....

  11. Ocularhaemodynamics parameters of asymptomatic HAART ...

    African Journals Online (AJOL)

    Results: Vmax of blood flow in central retinal artery (CRA) of asymptomatic HAART - experienced HIV infected children was 12.2cm/s while that of seronegative children was 13.4 cm/s. The PI and RI of blood flow in CRA of asymptomatic HAARTexperienced HIV-infected children were 0.8 and 0.5 respectively while those of ...

  12. Repair of Concomitant Double Orifice Mitral and Tricuspid Valves.

    Science.gov (United States)

    Saxena, Rachit; Talwar, Sachin; Gharde, Parag; Kumar, Manikala Vinod; Choudhary, Shiv Kumar

    2016-01-01

    The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old boy with double orifice mitral and tricuspid valves requiring surgical correction of hemodynamically significant mitral and tricuspid stenosis. © The Author(s) 2015.

  13. Echocardiographic anatomy of the mitral valve in healthy dogs and dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Wesselowski, S; Borgarelli, M; Menciotti, G; Abbott, J

    2015-06-01

    To further characterize the echocardiographic anatomy of the canine mitral valve apparatus in normal dogs and in dogs affected by myxomatous mitral valve disease (MMVD). Twenty-two normal dogs and 60 dogs with MMVD were prospectively studied. The length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet were measured in the control group and the affected group, as were the diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs). The dogs with MMVD were staged based on American College of Veterinary Internal Medicine (ACVIM) guidelines and separated into groups B1 and B2/C. All measurements were indexed to body weight based on empirically defined allometric relationships. There was a statistically significant relationship between all log10 transformed mitral valve dimensions and body weight. The AMVL, AMVW, AMVA, MVAd and MVAs were all significantly greater in the B2/C group compared to the B1 and control groups. The AMVW was also significantly greater in the B1 group compared to the control group. Interobserver % coefficient of variation (% CV) was mitral valve leaflet and the mitral valve annulus in the dog can be indexed to body weight based on allometric relationships. Preliminary reference intervals have been proposed over a range of body sizes. Relative to normal dogs, AMVL, AMVW, AMVA, MVAd and MVAs are greater in patients with advanced MMVD. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry.

    Science.gov (United States)

    Schwencke, Carsten; Bijuklic, Klaudija; Ouarrak, Taoufik; Lubos, Edith; Schillinger, Wolfgang; Plicht, Björn; Eggebrecht, Holger; Baldus, Stephan; Schymik, Gerhard; Boekstegers, Peter; Hoffmann, Rainer; Senges, Jochen; Schofer, Joachim

    2017-04-01

    The use of the MitraClip system has gained widespread acceptance for the treatment of patients with mitral regurgitation (MR) who are not suitable for the conventional surgery. This study sought to investigate the early and 1-year outcome after MitraClip therapy of patients with MR and cardiac comorbidities. Outcomes through 12-month follow-up of patients (n = 528) who underwent MitraClip implantation were obtained from the German transcatheter mitral valve interventions (TRAMI) registry. The majority of these patients (n = 409, 77.5 %) also suffered from coronary artery disease (CAD). Patients with a dilated cardiomyopathy (DCM, n = 65, 12.3 %) or concomitant valvular aortic disease (AV, n = 54, 10.2 %) were less frequent. Although the prevalent pathogenesis was functional MR, patients with DCM had significantly more frequent a functional MR (96.9 %) compared to patients with CAD (74.9 %) or AV (62.5 %, p < 0.001). Technical success was achieved in 97.5 % of patients. Procedural echocardiograms demonstrated in the vast majority of patients a reduction from severe MR III to mild MR I with no difference between the groups (p = 0.83). The peri-procedural complication rate was very low. At 30-day and 12-month follow-up, the majority of patients were in NYHA functional class II or lower. The rate of death, stroke, and myocardial infarction (MACCE) was comparable in the three patient groups during 12-month follow-up (DCM 26.9 %, CAD 30.3 % and AV 27.5 %, p = 0.85). The MitraClip implantation is feasible and safe even in high-risk patients with MR and cardiac comorbidities.

  15. In vitro balloon dilatation of mitral valve stenosis: the importance of subvalvar involvement as a cause of mitral valve insufficiency

    NARCIS (Netherlands)

    Sadee, A. S.; Becker, A. E.

    1991-01-01

    To investigate the mechanism that increases the orifice area of the mitral valve during balloon dilatation 43 surgically excised intact rheumatic mitral valves were studied. The main pathological features were (a) fibrosis of mitral valve leaflets and commissures (10 valves); (b) fibrosis with

  16. Piezogenic pedal papules with mitral valve prolapse

    Directory of Open Access Journals (Sweden)

    Cihan Altin

    2016-01-01

    Full Text Available Piezogenic pedal papules (PPP are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases.

  17. The serpentine mitral valve and cerebral embolism

    Directory of Open Access Journals (Sweden)

    Ker James

    2011-02-01

    Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

  18. Balloon expandable transcatheter heart valves for native mitral valve disease with severe mitral annular calcification.

    Science.gov (United States)

    Guerrero, Mayra; Urena, Marina; Pursnani, Amit; Wang, Dee D; Vahanian, Alec; O'Neill, William; Feldman, Ted; Himbert, Dominique

    2016-06-01

    Patients with mitral annular calcification (MAC) have high surgical risk for mitral valve replacement due to associated comorbidities and technical challenges related to calcium burden, precluding surgery in many patients. Transcatheter mitral valve replacement (TMVR) with the compassionate use of balloon expandable aortic transcatheter heart valves has been used in this clinical scenario. The purpose of this review was to summarize the early experience including successes and failures reported. TMVR might evolve into an acceptable alternative for selected patients with severe MAC who are not candidates for conventional mitral valve surgery. However, this field is at a very early stage and the progress will be significantly slower than the development of transcatheter aortic valve replacement due to the complexity of the mitral valve anatomy and its pathology. Optimizing patient selection process by using multimodality imaging tools to accurately measure the mitral valve annulus and evaluate the risk of left ventricular outflow tract obstruction is essential to minimize complications. Strategies for treating and preventing left ventricular outflow tract obstruction are being tested. Similarly, carefully selecting candidates avoiding patients at the end of their disease process, might improve the overall outcomes.

  19. The future of transcatheter mitral valve interventions

    DEFF Research Database (Denmark)

    Maisano, Francesco; Alfieri, Ottavio; Banai, Shmuel

    2015-01-01

    Transcatheter mitral interventions has been developed to address an unmet clinical need and may be an alternative therapeutic option to surgery with the intent to provide symptomatic and prognostic benefit. Beyond MitraClip therapy, alternative repair technologies are being developed to expand...

  20. Minimally Invasive Mitral Valve Surgery III

    Science.gov (United States)

    Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

    2016-01-01

    Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

  1. Planimetric Measurement of the Regurgitant Orifice Area Using Multidetector CT for Aortic Regurgitation: a Comparison with the Use of Echocardiography

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    Jeon, Min Hee; Choe, Yeon Hyeon; Cho, Soo Jin; Park, Seung Woo; Park, Pyo Won; Oh, Jae K. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    This study compared the area of the regurgitant orifice, as measured by the use of multidetector-row CT (MDCT), with the severity of aortic regurgitation (AR) as determined by the use of echocardiography for AR. In this study, 45 AR patients underwent electrocardiography- gated 40-slice or 64-slice MDCT and transthoracic or transesophageal echocardiography. We reconstructed CT data sets during mid-systolic to enddiastolic phases in 10% steps (20% and 35-95% of the R-R interval), planimetrically measuring the abnormally opened aortic valve area during diastole on CT reformatted images and comparing the area of the aortic regurgitant orifice (ARO) so measured with the severity of AR, as determined by echocardiography. In the 14 patients found to have mild AR, the ARO area was 0.18{+-} 0.13 cm{sup 2} (range, 0.04-0.54 cm{sup 2}). In the 15 moderate AR patients, the ARO area was 0.36 {+-} 0.23 cm{sup 2} (range, 0.09-0.81 cm{sup 2}). In the 16 severe AR patients, the ARO area was 1.00 {+-} 0.51 cm{sup 2} (range, 0.23-1.84 cm{sup 2}). Receiver-operator characteristic curve analysis determined a sensitivity of 85% and a specificity of 82%, for a cutoff of 0.47 cm{sup 2}, to distinguish severe AR from less than severe AR with the use of CT (area under the curve = 0.91; 95% confidence interval, 0.84-1.00; p < 0.001). Planimetric measurement of the ARO area using MDCT is useful for the quantitative evaluation of the severity of aortic regurgitation.

  2. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons.

    Science.gov (United States)

    Silverman, Norman H

    2014-12-01

    I surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

  3. TRAUMA VALVULAR MITRAL EN UN LACTANTE DURANTE LA VALVULOPLASTIA AÓRTICA Y SU TRATAMIENTO QUIRÚRGICO / Mitral valve trauma in an infant during aortic valvuloplasty and its surgical treatment

    Directory of Open Access Journals (Sweden)

    Francisco Díaz Ramírez

    2013-04-01

    Full Text Available Resumen: La valvuloplastia con globo es ampliamente aceptada como tratamiento de elección de la estenosis aórtica congénita en recién nacidos y lactantes. Las complicaciones por el procedimiento son bien conocidas pero el daño valvular mitral es infrecuente. Se presenta un paciente masculino, de siete meses de edad, con el diagnóstico de coartación de la aorta y estenosis valvular aórtica a quién se le realizó dilatación de ambas lesiones por cateterismo intervencionista. A las 20 horas del procedimiento se diagnosticó insuficiencia cardíaca grave secundaria a lesión de la valva anterior mitral. Se intervino quirúrgicamente de urgencia y se observó un desgarro en forma de hendidura desde el borde libre hasta el anillo, el cual se reparó y se realizó anuloplastia en la comisura lateral. En el postoperatorio inmediato evolucionó sin complicaciones y al año de seguimiento presenta insuficiencia valvular mitral leve sin signos de recoartación ni de estenosis valvular aórticas. / Abstract: Balloon valvuloplasty is widely accepted as the treatment of choice for congenital aortic stenosis in newborns and infants. Complications from the procedure are well known but mitral valve damage is rare. This is the case of a 7-month-old male patient with the diagnosis of coarctation of the aorta and aortic valve stenosis who underwent dilation of both lesions via catheterization. At 20 hours of the procedure a severe heart failure secondary to an injury of the anterior mitral valve was diagnosed. The patient underwent emergency surgery and a slit-like tear from the free edge to the annulus was observed, which was repaired and annuloplasty in the lateral commissure was performed. In the immediate postoperative period the patient progressed without complications and at one year follow up he shows mild valve regurgitation without evidence of recoarctation or aortic valve stenosis.

  4. A novel echocardiography formula for calculating predicted pulmonary vascular resistance in patients with mitral stenosis

    Directory of Open Access Journals (Sweden)

    Amiliana M. Soesanto

    2016-07-01

    Full Text Available Background: Pulmonary vascular resistance (PVR plays an important role in the natural history, prognosis, and outcome after valve intervention in patients with mitral stenosis (MS. The existing formula to estimate PVR by means of echocardiography is not readily applicable in the MS patient subset because it does not specifically calculate the risk of PVR in MS. The aim of this study was to find a new echocardiography formula to estimate PVR in MS.Methods: This diagnostic study was conducted in 2 stages. In the first stage, 58 consecutive subjects with MS were studied to find some model formulas for estimating PVR by multiple regression. Eight echo parameters were analyzed to seek their correlation with the invasive PVR value as a gold standard. The formula that had the best correlation and was easiest to use would be selected. In the second stage, those model formulas were validated by applying them to a further 34 consecutive MS subjects.Results: Four formulas which gave a discriminator coefficient of r2 0.62–0.68 were derived.  The best model formula was proposed for further application.  The new selected formula PVR=-7.465+3.566 TRvmax –(0.23 TVs’+6.799 (RV-MPI showed good correlation (r=0.71, p<0.001 to the invasive PVR value, with good reliability. TRvmax is maximal velocity of tricuspid regurgitation, TVs’ is systolic velocity of tricuspid annulus, and RV-MPI is right ventricle index myocardial performance. ROC curve showed that the cut off point 7.2 has good sensitivity and specificity (90% and 88%, respectively to predict PVR 7 WU.Conclusion: This study has shown that a novel echocardiography formula can estimate PVR with good correlation and reliability in subjects with mitral stenosis.

  5. Clinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease.

    Science.gov (United States)

    Kim, Wan Kee; Kim, Ho Jin; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2017-11-16

    Unlike degenerative mitral valve (MV) disease, the advantages of valve repair procedure over replacement have been debated in rheumatic MV disease. This study aims to evaluate the impact of procedural types on long-term outcomes through analyses on a large data set from an endemic area of rheumatic disease. We evaluated 1731 consecutive patients (52.3±12.5 years; 1190 women) undergoing MV surgery for rheumatic MV disease between 1997 and 2015. Long-term survival and valve-related outcomes were compared between repair and replacement procedures. To adjust for selection bias, propensity score analyses were performed. Patients undergoing repair were younger and had more predominant mitral regurgitation than mechanical and bioprosthetic replacement groups (61.6% vs 15.6% vs 24.4%; Pvalve-related complications. Propensity score matching yielded 188 pairs of repair and replacement patients that were well balanced for baseline covariates. In the matched cohort, there was no significant difference in the mortality risk between the repair and replacement groups (HR, 1.24; 95% CI 0.62 to 2.48). The risk of composite valve-related complications, however, was significantly lower in repair group (HR, 0.57; 95% CI 0.33 to 0.99) principally derived by a lower risk of haemorrhagic events (HR, 0.23; 95% CI 0.07 to 0.70). The incidence of reoperation was not significantly different between groups in the matched cohort (HR, 1.62; 95% CI 0.49 to 5.28). Valve repair in well-selected patients with severe rheumatic MV disease led to comparable survival, but superior valve-related outcomes compared with valve replacement surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Pre-operative Tei Index does not predict left ventricular function immediately after mitral valve repair

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Echocardiographic assessment of systolic left ventricular (LV function in patients with severe mitral regurgitation (MR undergoing mitral valve (MV repair can be challenging because the measurement of ejection fraction (EF or fractional area change (FAC in pathological states is of questionable value. The aim of our study was to evaluate the usefulness of the pre-operative Tei Index in predicting left ventricular EF or FAC immediately after MV repair. One hundred and thirty patients undergoing MV repair with sinus rhythm pre- and post-operatively were enrolled in this prospective study. Twenty-six patients were excluded due to absence of sinus rhythm post-operatively. Standard transesophageal examination(IE 33,Philips,Netherlands was performed before and after cardiopulmonary bypass according to the guidelines of the ASE/SCA. FAC was determined in the transgastric midpapillary short-axis view. LV EF was measured in the midesophageal four- and two-chamber view. For calculation of the Tei Index, the deep transgastric and the midesophageal four-chamber view were used. Statistical analysis was performed with SPSS 17.0. values are expressed as mean with standard deviation. LV FAC and EF decreased significantly after MV repair (FAC: 56±12% vs. 50±14%, P<0.001; EF: 58±11 vs. 50±12Έ P<0.001. The Tei Index decreased from 0.66±0.23 before MV repair to 0.41±0.19 afterwards (P<0.001. No relationship between pre-operative Tei Index and post-operative FAC or post-operative EF were found (FAC: r=−0.061, P=0.554; EF: r=−0.29, P=0.771. Conclusion: Pre-operative Tei Index is not a good predictor for post-operative FAC and EF in patients undergoing MV repair.

  7. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 1: Clinical Trial Design Principles: A Consensus Document From the Mitral Valve Academic Research Consortium.

    Science.gov (United States)

    Stone, Gregg W; Vahanian, Alec S; Adams, David H; Abraham, William T; Borer, Jeffrey S; Bax, Jeroen J; Schofer, Joachim; Cutlip, Donald E; Krucoff, Mitchell W; Blackstone, Eugene H; Généreux, Philippe; Mack, Michael J; Siegel, Robert J; Grayburn, Paul A; Enriquez-Sarano, Maurice; Lancellotti, Patrizio; Filippatos, Gerasimos; Kappetein, Arie Pieter

    2015-07-21

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 2: Endpoint Definitions: A Consensus Document From the Mitral Valve Academic Research Consortium.

    Science.gov (United States)

    Stone, Gregg W; Adams, David H; Abraham, William T; Kappetein, Arie Pieter; Généreux, Philippe; Vranckx, Pascal; Mehran, Roxana; Kuck, Karl-Heinz; Leon, Martin B; Piazza, Nicolo; Head, Stuart J; Filippatos, Gerasimos; Vahanian, Alec S

    2015-07-21

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure in Postpartum Woman With Rheumatic Mitral Valve Disease: Benefit, Factors Furthering the Success of This Procedure, and Review of the Literature

    Science.gov (United States)

    Fayad, Georges; Larrue, Benoît; Modine, Thomas; Azzaoui, Richard; Regnault, Alexi; Koussa, Mohammad; Gourlay, Terry; Fourrier, François; Decoene, Christophe; Warembourg, Henri

    2007-01-01

    Abstract: Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40°C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient’s medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support. PMID:17672195

  10. Regional pulmonary edema caused by acute mitral insufficiency after rupture of chordae tendinae with prolaps of the posterior mitral valve; Regionales Lungenoedem bei akuter Mitralinsuffizienz nach Chordae-tendineae-Abriss mit Prolaps des posterioren Mitralsegels

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    Mauser, M.; Wiedemer, B.; Fleischmann, D. [Klinikum Lahr (Germany). Medizinische Klinik; Billmann, P. [Klinikum Lahr (Germany). Inst. fuer Radiologie; Ennker, J. [Herzzentrum Lahr/Baden (Germany). Abt. fuer Herzchirurgie

    2003-07-01

    An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention. The mechanism of the regional edema is an excentric regurgitation jet into the left atrium, which is usually directed to the orifice of the right upper lobe pulmonary vein which increases the hydrostatic vascular pressure in the corresponding lung segment. For the confirmation of the diagnosis, transesophageal echogradiographye is helpful in documenting the direction of the regurgitant flow and detecting differential gradients between the right and left pulmonary venous systems. The pulmonary infiltrations, which persisted for several weeks, dissappeared within a few days after surgical mitral-valve-reconstruction in both cases. (orig.) [German] Ein einseitiges oder ueberwiegend lobaeres Lungenoedem ist ein seltener klinischer und radiologischer Befund, der haeufig initial zur Fehldiagnose einer weitaus haeufigeren fokaleren Lungenerkrankung fuehrt. Wir berichten ueber 2 Faelle, bei denen nach Auftreten einer akuten Mitralinsuffizienz auf dem Boden eines Sehnenfadenabrisses am posterioren Mitralsegel ein regionales Lungenoedem zunaechst als pneumonisches Infiltrat fehlgedeutet wurde, was die weitere kardiologische Diagnostik und chirurgische Therapie verzoegerte. Wie in den wenigen in der Literatur beschriebenen Faellen findet sich hierbei ein exzentrischer Regurgitationsjet in den linken Vorhof, der ueblicherweise auf die Einmuendung der rechten oberen Pulmonalvene gerichtet ist und in dem dazugehoerigen

  11. Prevalence and pattern of asymptomatic bacteriuria among ...

    African Journals Online (AJOL)

    Most of the cultured organism (89%) were sensitive to Nitrofurantoin. Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women at the UPTH is high. The most prevalent organism was Klebsiella. Keywords: Asymptomatic bacteriuria, Prevalence, Pattern, Klebsiella, Nitrofurantion, Morbidity ...

  12. Echocardiographic measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair.

    Science.gov (United States)

    Cook, Richard C; Nifong, L Wiley; Lashley, Graham G; Duncan, Robert A; Campbell, Julie A; Law, Y Brandon; Chitwood, W Randolph

    2006-07-01

    Successful mitral valve repair (MVP) is dependent on accurate annuloplasty band sizing. This is difficult and time-consuming when performed via port-access, or through a 4-cm minithoracotomy used in robotically assisted MVP. With the goal of moving toward a less-invasive approach and minimizing cross-clamp time, an attempt was made to determine annuloplasty band size using transesophageal echocardiography (TEE) alone. The intertrigonal distance (ITD) was determined by dividing the left ventricular outflow tract diameter (LVOT: measured on standard midesophageal aortic valve long-axis view) by 0.8. The ITD was compared to a nomogram developed to select the best Cosgrove-Edwards annuloplasty band size. Between July and October, 2004, 11 patients (mean age 52.6 +/- 17.9 years; four Barlow's valves with bileaflet prolapse, four posterior leaflet prolapses, one anterior leaflet prolapse, one rheumatic, one dilated annulus) undergoing robotically assisted MVP had the annuloplasty band chosen using TEE alone. Seven patients (63.6%) had no or mild mitral regurgitation (MR) on postoperative TEE. Three patients (27.2%) had some systolic anterior motion (SAM), with one (Barlow's valve) requiring a second repair (same operation). One patient (9.1%, rheumatic) had grade 2+ MR on postoperative TEE. In this small case series, a substantial proportion of patients had suboptimal immediate postoperative results. This suggests that selection of the annuloplasty band should not be based on a single echocardiographic variable as it depends on the etiology of the MR, and other dimensions of the mitral valve. Further studies are ongoing to develop a non-invasive method for the selection of annuloplasty band size.

  13. 23. Epidemiological aspects and clinical outcomes of mitral valve prolapse in Saudi adults over a 10 year period

    Directory of Open Access Journals (Sweden)

    A. alkahtani

    2016-07-01

    Full Text Available Mitral valve prolapse (MVP is a well recognized clinical entity that is associated with significant morbidity. Epidemiology, echocardiographic (echo characteristics and clinical outcome of MVP in Saudi Arabia have not been studied. To determine the prevalence, echo features and clinical outcome of MVP among the adult Saudi patients who underwent echo evaluation over a 10-year period.Retrospective review of consecutive cases of MVP or any of its components as diagnose by echocardiogram. Study was conducted in King Abdulaziz Cardiac Center, Riyadh and included 121,419 adult echo studies done between January 2003 and December 2012. Study population consisted of 77,176 patients after removing duplicate studies. Echo parameters for all Saudi nationals ⩾14 y of age were collected from the Xcelera database. Mitral valve disease due to non-myxomatous prolapse were excluded. Among the study population (n = 77,176 600 patients were labled as having MVP or any of its echo features (0.7%. Mean age was 64 years and 62% were males. Majority of patients (54.4% had mild MVP, while moderate and severe prolapse were present in 21.1% and 24.5% respectively. Severe mitral regurgitation was present in 16.5% and chordal rupture was noted in 9%. Left ventricular size was moderately dilated in 7.6% and severely dilated in 1.3%.Prevalence of MVP in Saudi nationals at a referral cardiac center is less than the reported international figure of 1-3%. In contrary to published literature MVP in Saudi population seems to be more common in males and seems to be diagnosed at a later age.

  14. Does mitral valve repair offer an advantage over replacement in patients undergoing aortic valve replacement?

    Science.gov (United States)

    Thourani, Vinod H; Suri, Rakesh M; Rankin, J Scott; He, Xia; O'Brien, Sean M; Badhwar, Vinay; Ailawadi, Gorav; Vassileva, Christina M; Shults, Christian C; Svensson, Lars G; Gammie, James S

    2014-08-01

    Concomitant aortic and mitral valve (MV) operations have more than doubled over the past decade. We utilized the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD) to evaluate outcomes for patients undergoing combined aortic valve replacement (AVR) and MV repair or replacement. From 1993 to 2007, 23,404 patients undergoing concomitant AVR+MV surgery were identified. Patients with mitral stenosis, emergent or salvage status, and endocarditis were excluded. Outcomes were expressed as unadjusted operative mortality, adjusted odds ratio (OR) for mortality, and a composite of mortality and major complications. The MV repair was perfor