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Sample records for rupture post mitral

  1. Mitral valve repair for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Wijdh-den Hamer, Inez J.; Klinkenberg, Theo J.; Kuijpers, Michiel; Bijleveld, Aanke; van der Horst, Iwan C. C.; Erasmus, Michiel E.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.

    2013-01-01

    Papillary muscle rupture (PMR) is a rare, but serious mechanical complication of myocardial infarction (MI). Although mitral valve replacement is usually the preferred treatment for this condition, mitral valve repair may offer an improved outcome. In this study, we sought to determine the outcome o

  2. Long-term survival after mitral valve surgery for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Wijdh-den Hamer, Inez J.; Koene, Bart M.; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E.; Jainandunsing, Jayant S.; van der Horst, Iwan C. C.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.

    2015-01-01

    Background: Papillary muscle rupture (PMR) is a rare, but dramatic mechanical complication of myocardial infarction (MI), which can lead to rapid clinical deterioration and death. Immediate surgical intervention is considered the optimal and most rational treatment, despite high risks. In this study

  3. [Left Ventricular Rupture during Both Mitral and Aortic Valve Replacements].

    Science.gov (United States)

    Kurumisawa, Soki; Aizawa, Kei; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Ohki, Shinnichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation.

  4. Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Hamer, Inez J. Wijdh-den; Koene, Bart M.; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E.; van der Horst, Iwan C. C.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.

    2014-01-01

    Background: Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear

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

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    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.

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

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    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.

  7. 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.

  8. A Case of Idiopathic Hypereosinophilic Syndrome Causing Mitral Valve Papillary Muscle Rupture

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    Tiffany Tamse

    2015-01-01

    Full Text Available Idiopathic Hypereosinophilic Syndrome (IHES is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses.

  9. Use of Bovine Pericardium and Sutureless Biological Glue in Left Ventricular Rupture After Mitral Valve Replacement, Five Years of Follow-up.

    Science.gov (United States)

    Costa, Mário Augusto Cray da; Laforga, Fernando Cesar; Maftum, Josué Abrão; Favaro, Mateus Gustavo

    2015-01-01

    Rupture of the left ventricular wall after mitral valve replacement is an infrequent but lethal complication. Reporting correction technique of ventricular rupture with bovine pericardium patch secured with glue and without suturing: a 51 years-old female patient, with double rheumatic mitral lesion, severe stenosis and discrete insufficiency, who had a mitral valve replacement. During surgery, the patient presented a ventricular rupture of the posterior wall (atrioventricular disruption), which was successfully repaired using bovine pericardium with sutureless biological glue over the epicardium of the damaged area. Sixty months after surgery the patient has no symptoms.

  10. 二尖瓣置换术后左室破裂的外科处理%Surgical treatment of left ventricular rupture after mitral valve replacement

    Institute of Scientific and Technical Information of China (English)

    祝岩; 王辉山; 汪曾炜; 李新民; 金岩

    2012-01-01

    目的 探讨二尖瓣置换术后左心室破裂的原因、治疗及预防措施.方法 1981年5月至2010年11月,2638例患者行二尖瓣置换术,其中11例发生左心室破裂,男4例,女7例;年龄28~71岁.术前心功能Ⅱ级2例,Ⅲ级9例.超声心动图提示左心室舒张期末直径32 ~62 mm.结果 根据左心室破裂时间分类,延迟破裂4例,早期破裂7例;无晚期左心室破裂.破裂类型经手术或尸检证实Ⅰ型5例,Ⅱ型4例,Ⅲ型2例.手术抢救成功4例,死亡7例.结论 女性、高龄、病理改变以二尖瓣狭窄为主、小左心室(舒张期末直径< 35 mm)和体重过低等是左心室破裂的危险因素.过多去除二尖瓣环上的钙化斑块;置换瓣膜型号过大,尤其是生物瓣瓣脚过高;瓣环处缝合进针过深;对乳头肌牵拉过度或者切除过多;心肌血肿以及粗暴搬动心脏等因素增加了左心室破裂的危险性.一旦发现左心室破裂,应尽快恢复体外循环,根据实际情况可以直接缝合或在心腔内、外同时修补较为确实、可靠,有可能挽救患者的生命.%Objective To evaluate the causes,treatment,and prevention of left ventricular rupture after mitral valvereplacement.Methods From May 1981 to November 2010,11 cases occurred in 4 male and 7 female patients aged 28 - 71 years old.There were 2 cases of New York Heart Association (NYHA) functional class Ⅱ and 9 cases of class Ⅲ.Echocardiography showed that the left ventricular end diastolic internal diameter (LVEDI) was 32 -62 mm.Results Rupture probably occurs after endocardial damage to a thin myocardium that has lost the internal buttress of the subvalvar apparatus.With the rise in intraventricular pressure at the end of bypass blood dissects into the myocardium,resulting in a large haematoma and eventual rupture.According to the onset of ruptures,there were 4 cases of delayed rupture which occured at several hours till days post operation after the patients had been back in

  11. Spontaneous rupture of ovarian cystadenocarcinoma: pre- and post-rupture computed tomography evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Salvadori, Priscila Silveira; Atzingen, Augusto Castelli von; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Bomfim, Lucas Novais [Universidade Tiradentes (UNIT), Maceio, AL, (Brazil)

    2015-09-15

    Epithelial ovarian tumors are the most common malignant ovarian neoplasms and, in most cases, eventual rupture of such tumors is associated with a surgical procedure. The authors report the case of a 54-year-old woman who presented with spontaneous rupture of ovarian cystadenocarcinoma documented by computed tomography, both before and after the event. In such cases, a post-rupture staging tends to be less favorable, compromising the prognosis. (author)

  12. Tracheal rupture post-emergency intubation

    OpenAIRE

    Andrea Billè; Luca Errico; Francesco Ardissone; Luciano Cardinale

    2009-01-01

    Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surg...

  13. PATIENT’S TOLERANCE OF PHYSICAL EFFORT AFTER MITRAL VALVE REPLACEMENT IN DURABLE POST-OPERATIVE PERIODS

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    S.I. Kitavina

    2008-06-01

    Full Text Available It is reasonable for the replacement findings of the mitral valve in case of durable post-operative periods, to evaluate patient’s tolerance of physical effort, which results, firstofall, in the condition of the cardio-vascular system. Taking into consideration the seriousness of patients' condition of understudy, data about physical tolerance maybe received with the help of dosed physical effort. A group of factors, also choice of mitral valve replacement method, influences on degree of patients' physical effort. The more preferable method of correction of mitral valve disease in case of prosthesis is a preservation of subvalvular structures of mitral valve.

  14. Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

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    Magdy Gomaa

    2016-12-01

    Conclusion: Minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.

  15. The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

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    Bai Zhigang

    2011-07-01

    Full Text Available Abstract Background The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae (RMCT has not yet been investigated with a large study. Methods Clinical, hemodynamic, surgical, and pathological findings were reviewed for 242 patients with a preoperative diagnosis of RMCT that required mitral valvular surgery. Subjects were consecutive in-patients at Fuwai Hospital in 2002-2008. Patients were evaluated by thoracic echocardiography (TTE and transesophageal echocardiography (TEE. RMCT cases were classified by location as anterior or posterior, and classified by degree as partial or complete RMCT, according to surgical findings. RMCT cases were also classified by pathology into four groups: myxomatous degeneration, chronic rheumatic valvulitis (CRV, infective endocarditis and others. Results Echocardiography showed that most patients had a flail mitral valve, moderate to severe mitral regurgitation, a dilated heart chamber, mild to moderate pulmonary artery hypertension and good heart function. The diagnostic accuracy for RMCT was 96.7% for TTE and 100% for TEE compared with surgical findings. Preliminary experiments demonstrated that the sensitivity and specificity of diagnosing anterior, posterior and partial RMCT were high, but the sensitivity of diagnosing complete RMCT was low. Surgical procedures for RMCT depended on the location of ruptured chordae tendineae, with no relationship between surgical procedure and complete or partial RMCT. The echocardiographic characteristics of RMCT included valvular thickening, extended subvalvular chordae, echo enhancement, abnormal echo or vegetation, combined with aortic valve damage in the four groups classified by pathology. The incidence of extended subvalvular chordae in the myxomatous group was higher than that in the other groups, and valve thickening in combination with AV damage in the CRV group was higher than that in the other

  16. Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-Senning patient with transposition of the great arteries

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    Abdullah Al-Farqani

    2011-06-01

    Full Text Available Accessory mitral valve tissue is a rare congenital anomaly associated with congenital cardiac defects and is usually detected in the first decade of life. We describe the case of an 18-year old post-Senning asymptomatic patient who was found to have accessory mitral valve tissue on transthoracic echocardiography producing severe left ventricular outflow tract obstruction.

  17. 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

  18. [A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully].

    Science.gov (United States)

    de Lima, R; Perdigão, C; Neves, L; Cravino, J; Dantas, M; Bordalo, A; Pais, F; Diogo, A N; Ferreira, R; Ribeiro, C

    1990-09-01

    The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity.

  19. Globe Rupture of a Post-LASIK Keratectasia Eye From Blunt Trauma.

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    Cheung, Albert Y; Heidemann, David G

    2016-12-01

    To report a case of globe rupture in a patient with post-laser in situ keratomileusis (LASIK) ectasia after blunt trauma. Observational case report. A 42-year-old man with a history of post-LASIK ectasia sustained paracentral corneal rupture secondary to blunt trauma from a fist to his left eye (OS). Slit-lamp examination revealed rupture in the posterior stroma (inferior paracentral) of the OS with an overlying intact LASIK flap; however, the inferior edges of the LASIK flap were Seidel positive. The anterior chamber was flat. Although he was initially managed with cyanoacrylate glue and a bandage contact lens, the patient eventually required tectonic penetrating keratoplasty. The postoperative course was unremarkable, and over 1 year later, the visual acuity OS was 20/25 with -7.50 + 2.00 × 0.50. Globe rupture from blunt trauma has not been shown to be more common in patients with a history of LASIK. Although blunt trauma to the post-LASIK globe would generally incur a similar risk of rupture to that of the normal eye, keratectasia after LASIK may predispose the globe to rupture.

  20. Rupture

    CERN Multimedia

    Association du personnel

    2006-01-01

    Our Director-General is indifferent to the tradition of concertation foreseen in our statutes and is "culturally" unable to associate the Staff Association with problem-solving in staff matters. He drags his heels as long as possible before entering into negotiations, presents "often misleading" solutions at the last minute which he only accepts to change once a power struggle has been established. Faced with this rupture and despite its commitment to concertation between gentlemen. The results of the poll in which the staff is invited to participate this week. We therefore need your support to state our claims to the Governing Bodies. The Staff Association proposes a new medium of communication and thus hopes to show that it is ready for future negotiations. The pages devoted to the Staff Association are presented in a more informative, reactive and factual manner and in line with the evolution of the social situation at CERN. We want to establish strong and continuous ties between the members of CERN and ou...

  1. POST INSTRUMENTAL INCOMPLETE UTERINE RUPTURE WITH LEFT OVARIAN CYST A RARE CASE

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    Vijayalakshmi

    2015-08-01

    Full Text Available Uterine rupture stands as a single obstetric accident during pregnancy and child birth, and one of the leading causes for maternal and fetal morbidity and mortality. Although there is decline in different studies, it is a potentially catastrophic event in which the integrity of myometrial wall is breeched . ( 1 Survivors are often encumbered with morbidities such as impaired reproductive function as a result of surgical management leading to marital disharmony and psychological trauma . (2 The incidence of uterine rupture can be dropped with good antenatal care, access to skilled delivery and emergency obstetric care, emergency transport system, equitable distribution of health staff and availability of blood banks with sustainable blood supply . Uterine rupture usually occurs during delivery due to misuse of oxytocics, obstetrical procedure like forceps/vacuum which are applied without fulfillment of criteria for application and inadequate skills. We here by present a case report of post instrumental incomplete u terine rupture.

  2. Post-Traumatic Chordae Rupture of Tricuspid Valve

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    Kyomars Abbasi

    2015-10-01

    Full Text Available Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses.

  3. Diagnosis of Rupture of Mitral Chordae Tendinese by Color Doppler Eehocardiogrphy%二尖瓣腱索断裂的彩色多普勒超声心动图诊断

    Institute of Scientific and Technical Information of China (English)

    侯传举; 邓东安; 张玉威; 张仁福

    1996-01-01

    In 6016 patients of different cardiovascular diseases operated,5 cases with rupture of mitral chordae tendineae(RMCT)were detected by color Doppler eehocardiography(CDE).The accuracy rate of CDE was 100%.The ultrasonic manifeslations of RMCT in CDE were"flail shape" change of the mitral leaflets with ruptued ehordae tendineae in two-dimensional echocardiography (2DE)and a shade of multi-colored resurgitated jet of blood through mitral valve during systol in CDE.It is concluded that CDE has specific value in the diagnosis of RMCT and can replace the angiocardiography.It is necessary to differentiate RMCT from mitral valve prolapse(MVP)and mitral valve vegetation(MVV)by CDE.Surgical treatment should be done as soon as the diagnosis of RMCT iS confirmed.%应用彩色多普勒超声心动图(CDE)在已手术的6016例各种心血管疾病中检出5例二尖瓣腱索断裂(RMCT),CDE诊断准确率100%.本病的CDE表现是两维超声心动图(2DE)显示腱索断裂的二尖瓣叶呈"槤枷样"或"甩鞭样"改变,彩色多普勒(CD)显示收缩期过二尖瓣五彩相间返流束血流信号.结果表明CDE对本病有特异性诊断价值,可代替心血管造影检查.CDE诊断本病需与二尖瓣脱垂(MVP)和二尖瓣叶赘生物(MVV)相鉴别.一旦确诊应及早手术治疗.

  4. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

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    Shreedhar S Joshi

    2014-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

  5. Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture.

    Science.gov (United States)

    Suydam, Stephen M; Buchanan, Thomas S; Manal, Kurt; Silbernagel, Karin Gravare

    2015-03-01

    The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post-rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 months post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during overground walking. Achilles lengths at 6 and 12 months post-surgery were significantly longer (p Achilles tendon rupture; no side-to-side difference was found in the healthy controls. The triceps surae muscles' activations were fair to moderately correlated to the Achilles lengths (0.38 Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength, an important treatment goal appears to be to minimize tendon elongation.

  6. Compensatory muscle activation caused by tendon lengthening post Achilles tendon rupture

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    Suydam, Stephen M.; Buchanan, Thomas S.; Manal, Kurt; Silbernagel, Karin Gravare

    2013-01-01

    Purpose The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. Method The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 month post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during over-ground walking. Results Achilles lengths at 6 and 12 months post-surgery were significantly longer (p Achilles tendon rupture; no side to side difference was found in the healthy controls. The triceps surae muscles’ activations were fair to moderately correlated to the Achilles lengths (0.38 Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength an important treatment goal appears to be to minimize tendon elongation. Level of evidence Prognostic prospective case series. Level IV. PMID:23609529

  7. Rotura de aurícula izquierda y hemopericardio en un cocker spaniel con degeneración de la válvula mitral: caso clínico (Left atrial rupture and hemopericardium in a cocker spaniel with mitral valve degeneration: case report

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    Caro-Vadillo, A.

    2009-04-01

    Full Text Available SummaryA 12 year old male cocker previously diagnosed of mitral valvedegeneration presented to our Hospital stuporous, with hemorrhagicdiarrhea and severe signs of hypovolemia; owners suspected ingestion of large doses of non-steroidal drugs. Emergency treatment (mainly fluid resuscitation and gastrointestinal protective drugs was effective for initial stabilization, but hemodynamic status worsened later; cardiac ultrasound revealed pericardial effusion. Necropsy confirmed left atrial rupture. In spite of severe hypovolemia, Central Venous Pressure (CVP was above normal values at presentation, probably due to the increase in transmuralpressure induced by pericardial effusion associated with left atrial rupture. We conclude that elevated CVP values in hypovolemic patients warrant further investigation of concurrent pathologies.

  8. Acute aortic and mitral valve regurgitation following blunt chest trauma.

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    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  9. Cause and management of left ventricular rupture following mitral valve replacement%二尖瓣置换术并发左室破裂的原因及对策

    Institute of Scientific and Technical Information of China (English)

    戚晓通; 陈亦江; 吴延虎; 张石江

    2011-01-01

    目的 探讨二尖瓣置换术并发左室破裂的原因及对策.方法 回顾性分析二尖瓣置换术并发左室破裂10例临床资料.4例为单纯二尖瓣置换术,2例同时行主动脉瓣置换术,3例同时行三尖瓣成形术,1例同时行冠状动脉旁路移植术.其中的8例为早期破裂,2例为延迟破裂.左室破裂原因为风湿活动控制不好、心肌脆弱或手术操作不当,如牵拉剪除乳头肌过多,清除钙化过深.9例摘除原置换瓣膜行修补手术.8例I型破裂采用心内心外同时修补;2例Ⅲ型破裂,1例采取心内心外同时修补,另1例采取心外修补的方法.结果 1例Ⅲ型破裂患者存活,其余9例均死亡.9例死亡病例均死于手术无法修补破口.结论 对可能发生左室破裂的高危患者术前应正规抗风湿治疗,术中积极预防、避免意外损伤,术后有效控制血压波动;一旦发生左室破裂,应早期诊断、尽早再次手术修补.%Objective To summarize the cause and management of left ventricular rupture (LVR) following mitral valve replacement(MVR). Methods Data of ten LVR cases following MVR were retrospectively analyzed, of whom 4 cases underwent MVR alone, 2 cases MVR plus aortic valve replacement(AVR), 3 cases MVR plus tricuspid surgery, and one case MVR plus coronary artery bypass grafting (CABG). Eight patients had an early rupture and two patients had a delayed rupture.The causes of rupture included uncontrollable rheumatic fever, fragile myocardium and inappropriate procedure such as overexcision of calcification or stretch of papillary muscle. Urgent repair of the rupture was performed under cardiopulmonary bypass in all cases, in whom the mitral prostheses were taken out in nine cases. Eight patients were type Ⅰ rupture and the ruptures were repired via internal and external approa. Of 2 cases with type Ⅲ rupture, one was repired via internal and external approaches,and the other via external approach. Results Only one patient

  10. INFLUENCE OF GRADED AEROBIC EXERCISE ON QUALITY OF LIFE IN POST SURGICAL MITRAL VALVE DISEASE INDIVIDUAL A PROSPECTIVE RANDOMIZED OPEN LABEL STUDY

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    Shanthi C

    2016-10-01

    Full Text Available Background: Post surgical mitral valve disease individual focus their cardiac rehabilitation training on two major goal that is to improve cardiac output response exercises and place an important role in determining exercise tolerance and to improve quality of life. Cardiac rehabilitation programs involve prescribed exercise and education however various other method are being used to improve quality of life. But our study to find out the effectiveness of graded aerobic exercise protocol on ejection fraction and quality of life in post surgical mitral valve disease individuals. Methods: The study design was open label studies total of 100 post surgical mitral valve disease individuals patients from the age group of 20-60 years were recruited from SVIMS hospital. They were randomly divided into two groups. Group I underwent a twelve week structured graded individually tailored exercises. The group II received only none graded (not individualized exercise training. The ejection fraction and quality of life was measured before and after 12 weeks of exercise training for two groups. Results: Repeated measures ANOVA was used to compare mean values of continuous variables between baseline and at the time of discharge and three months after surgery for each parameter. Comparison of means between groups was done by the unpaired student t test. Mean age of the subjects was 40.18±10.29. There was a significant increase in the ejection fraction in the group I(61.34±2.49 to 64.4±3.31 compared to with the group II (61.06±2.51. to 61.62 ±2.37. QOL had improved in group I than group II at p<0.05. Conclusion: A 12 week structured graded aerobic exercise training significantly improved ejection fraction and quality of life in post surgical mitral valve disease individuals.

  11. Effect of Post-Weld Heat Treatment on Creep Rupture Properties of Grade 91 Steel Heavy Section Welds

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    Li, Leijun

    2012-11-02

    This project will conduct a systematic metallurgical study on the effect of post-weld heat treatment (PWHT) on the creep rupture properties of P91 heavy section welds. The objective is to develop a technical guide for selecting PWHT parameters, and to predict expected creep-rupture life based on the selection of heat treatment parameters. The project consists of four interdependent tasks: Experimentally and numerically characterize the temperature fields of typical post-weld heat treatment procedures for various weld and joint configurations to be used in Gen IV systems. Characterize the microstructure of various regions, including the weld fusion zone, coarse-grain heat-affected zone, and fine-grain heat affected zone, in the welds that underwent the various welding and PWHT thermal histories. Conduct creep and creep-rupture testing of coupons extracted from actual and physically simulated welds. Establish the relationship among PWHT parameters, thermal histories, microstructure, creep, and creep-rupture properties.

  12. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

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    Celermajer David S

    2007-02-01

    Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

  13. Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report

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    Dhaliwal Surinder

    2012-10-01

    Full Text Available Abstract Background Ventricular septal rupture (VSR, a mechanical complication following an acute myocardial infarction (MI, is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE with color flow Doppler and cardiac MRI (CMR are reliable tests for the non-invasive diagnosis of VSR. Case presentation A 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography. Conclusion We review the presentation, diagnosis and management of VSR post MI.

  14. Breeding Strategy Determines Rupture Incidence in Post-Infarct Healing WARPing Cardiovascular Research.

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    Sophie Deckx

    Full Text Available Von Willebrand A domain Related Protein (WARP, is a recently identified extracellular matrix protein. Based upon its involvement in matrix biology and its expression in the heart, we hypothesized that WARP regulates cardiac remodeling processes in the post-infarct healing process.In the mouse model of myocardial infarction (MI, WARP expression increased in the infarcted area 3-days post-MI. In the healthy myocardium WARP localized with perlecan in the basement membrane, which was disrupted upon injury. In vitro studies showed high expression of WARP by cardiac fibroblasts, which further increases upon TGFβ stimulation. Furthermore, WARP expression correlated with aSMA and COL1 expression, markers of fibroblast to myofibroblast transition, in vivo and in vitro. Finally, WARP knockdown in vitro affected extra- and intracellular basic fibroblast growth factor production in myofibroblasts. To investigate the function for WARP in infarction healing, we performed an MI study in WARP knockout (KO mice backcrossed more than 10 times on an Australian C57Bl/6-J background and bred in-house, and compared to wild type (WT mice of the same C57Bl/6-J strain but of commercial European origin. WARP KO mice showed no mortality after MI, whereas 40% of the WT mice died due to cardiac rupture. However, when WARP KO mice were backcrossed on the European C57Bl/6-J background and bred heterozygous in-house, the previously seen protective effect in the WARP KO mice after MI was lost. Importantly, comparison of the cardiac response post-MI in WT mice bred heterozygous in-house versus commercially purchased WT mice revealed differences in cardiac rupture.These data demonstrate a redundant role for WARP in the wound healing process after MI but demonstrate that the continental/breeding/housing origin of mice of the same C57Bl6-J strain is critical in determining the susceptibility to cardiac rupture and stress the importance of using the correct littermate controls.

  15. Robotic mitral valve replacement.

    Science.gov (United States)

    Senay, Sahin; Gullu, Ahmet Umit; Kocyigit, Muharrem; Degirmencioglu, Aleks; Karabulut, Hasan; Alhan, Cem

    2014-01-01

    Robotic surgical techniques allow surgeons to perform mitral valve surgery. This procedure has gained acceptance, particularly for mitral valve repair in degenerative mitral disease. However, mitral repair may not always be possible, especially in severely calcified mitral valve of rheumatic origin. This study demonstrates the basic concepts and technique of robotic mitral valve replacement for valve pathologies that are not suitable for repair.

  16. A PROSPECTIVE COMPARATIVE STUDY BETWEEN CLOSED MITRAL VALVOTOMY AND BALLOON VALVOPLASTY AS TREATMENT FOR RHEUMATIC NON CALCIFIC MITRAL STENOSIS

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    Ravikrishnan

    2015-08-01

    Full Text Available BACKGROUND: Treatment of rheumatic mitral stenosis ranges from conservative medical management to closed mitral valvotomy and the more recent balloon mitral valvoplasty. This is a prospective study to compare the results of closed mitral valvotomy with percutaneous b alloon valvoplasty in 100 cases (50 patients in each group of rheumatic non - calcific mitral stenosis. MATERIALS AND METHODS: From November 2011 to March 2012, 50 patient underwent closed mitral valvotomy and another 50 had percutaneous balloon mitral valv oplasty. Balloon mitral valvoplasty was performed by Inoue technique and closed mitral valvotomy was carried out through standard anterolateral thoracotomy with transventricular gradual Tubbs dilatation. NYHA functional status, left atrial size, transmitra l end diastolic gradient, mean diastolic gradient and mitral valve area were recorded. The results at the 4 day post procedure and the results at the 6 months follow up were compared. RESULTS: Residual atrial septal defect (ASD was present in 6 patients a t 6 month follow up after balloon mitral valvoplasty. Severe mitral regurgitation occurred in 3 cases of closed mitral valvotomy group as compared to 7 cases of balloon mitral valvoplasty group. Urgent mitral valve replacement was needed in 2 patient of ba lloon mitral valvoplasty group. There was single mortality in each group. CONCLUSION: No statistical significant difference between the result of closed mitral valvotomy and balloon mitral valvoplasty but better outcome obtained by closed mitral valvotomy. Hemodynamic and functional improvement was sustained through 6 month of follow up in both groups. Procedural cost of closed mitral valvotomy was significantly lower than the procedural cost of balloon mitral valvoplasty.

  17. Emergency endovascular repair of iliac artery rupture caused by post-stenting angioplasty with an endograft

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yu-bin; WU Dan-ming; XU Ke; WANG Cheng-gang; YI Wei; JIA Qi; SUN Yu-xin

    2007-01-01

    @@ Iliac artery rupture is a rare complication of poststenting angioplasty and can lead to massive lifethreatening haemorrhage. Conventional surgery can not repair the damaged vessel easily and may cause substantial blood loss and high operative morbidity and mortality. We report our experience with a selfexpanding covered endoprosthesis for endovascular repair of the rupture of an iliac artery caused by stenting angioplasty.

  18. Homoenxerto mitral: uma realidade

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    Francisco Diniz Affonso da COSTA

    1998-07-01

    áfico tardio demonstra a persistência dos bons resultados imediatos. Conclusões: Os resultados imediatos e a curto prazo da substituição da valva mitral por homoenxerto mitral criopreservado foram bastante satisfatórios. Somente com tempos mais prolongados de observação poderemos determinar a durabilidade desse enxerto e, eventualmente, expandir as suas indicações.Background: the use of cryopreserved aortic valve homografts is associated with excellent quality of life, low morbidity and satisfactory durability. We expect to achieve similar results in the mitral position with the use of cryopreserved mitral homografts. Objectives: Evaluate the immediate and short-term results of mitral valve replacement with cryopreserved mitral homografts. Material and Methods: Between July/97 and February/98, 8 patients with a mean age of 40.3 ± 6.2 years were submitted to mitral valve replacement with cryopreserved mitral homografts. Operative technique consisted of latero-lateral papillary muscle fixation, a running continuous suture at annulus level and annuloplasty with a Carpentier ring. Before hospital discharge, all patients were submitted to Doppler echocardiographic control for assessment of valvar and ventricular function. Patients were requested to return at the first and subsequently every 3 months postoperatively for further clinical and echocardiographic control. Results: There was one early non valve-related death. Echocardiographic evaluation before hospital discharge revealed a mean mitral valve area of 3.1 ± 0.6 cm2 and a mean gradient of 3.5 ± 1.6 mmHg. Valvar insufficiency was graded as non-existent or trivial in four cases and mild in the remaining three patients. Ejection fraction which was 57 ± 7% pre-operatively was well preserved in the postoperative period (62 ± 6%. Pulmonary hipertension reduced significantly from 87 ± 15 mmHg pre-operatively to 48 ± 12 mmHg post-operatively. There was also a reduction in the left atrial cavity from 61 ± 10 mm to 53

  19. Post-Seismic Fault Healing on the Rupture Zone of the 1999 M7.1 Hector Mine, California Earthquake

    Science.gov (United States)

    Li, Y.; Vidale, J. E.; Day, S. M.; Oglesby, D. D.; Cochran, E.; Gross, K.; Burdette, T.; Alvarez, M.

    2002-12-01

    We probed the rupture zone of the October 1999 M7.1 Hector Mine earthquake using repeated near-surface explosions in October, 2000 and November, 2001. Three dense linear seismic arrays were deployed across the north and south Lavic Lake faults (LLF) that broke to the surface in the mainshock, and across the Bullion fault (BF) that experienced minor slip in that event. Two explosions each year were detonated in the rupture zone on the middle and south LLF, respectively. We found that P and S velocities of fault-zone rocks increased by ~0.7 to 1.4% and ~0.5 to 1.0% between 2000 and 2001, respectively. In contrast, the velocities for P and S waves in surrounding rocks increased much less. This trend indicates the Hector Mine rupture zone has been healing by strengthening after the mainshock, which we attribute to the closure of cracks that opened during the 1999 earthquake. The 'crack dilatancy' mechanisms are most likely to operate for fault healing at shallow depth although the healing may be controlled by a combination of mechanical and chemical processes on the fault during the earthquake cycle. The observed fault-zone strength recovery is consistent with an apparent crack density decrease of 1.5% within the rupture zone. The ratio of travel time decrease for P to S waves was 0.72, consistent with partially fluid-filled cracks near the fault zone were. We also find variability in healing rates between the fault segments. The velocity increase with time varies from one fault segment to another at the Hector Mine rupture zone. We see greater changes on the LLF than on the BF, and the greatest change is on the middle LLF at shallow depth. We speculate that greater damage was inflicted, and thus greater healing is observed, in regions with larger slip in the mainshock. This post-seismic restrengthening of the Hector Mine rupture zone is similar to that observed on the Johnson Valley fault which ruptured in the 1992 M7.4 Landers earthquake (Li and Vidale, GRL, 2001

  20. Acute severe mitral regurgitation: consideration of papillary muscle architecture

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    Pascoe Edward

    2008-01-01

    Full Text Available Abstract We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology.

  1. The change in NT-pro-BNP and post-PTMC echocardiography parameters in patients with mitral stenosis. A pilot study.

    Science.gov (United States)

    Safi, Morteza; Bayat, Fariba; Ahmadi, Zahra; Shekarchizadeh, Masood; Khaheshi, Isa; Naderian, Mohammadreza

    2017-06-01

    The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory reductions reported early after successful PTMC (percutaneous transvenous mitral commissurotomy). The present study aims to assess the change in the level of NT-pro BNP following PTMC in patients with mitral stenosis and also to determine the association between circulatory NT-pro-BNP reduction and post-PTMC echocardiography parameters. Twenty five symptomatic consecutive patients with severe MS undergoing elective PTMC were prospectively enrolled. All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-pro-BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram. It was shown a significant decrease in the parameters of PPG (Peak Pressure Gradient), MPG (Mean Pressure Gradient), PHT (Pressure Half Time), PAP (Pulmonary Arterial Pressure), LAV (Left Atrial Volume), and also a significant increase in MVA (Mitral Valve Area) RVS (Right Ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-pro-BNP before PTMC was 309.20 ± 17.97 pg/lit that significantly diminished after PTMC to 235.72 ± 22.46 pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was shown in the group with AF. However, more change in the level of NT-pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia. PTMC procedure leads to reduce the level of NT-pro-BNP. The

  2. [Functional mitral regurgitation].

    Science.gov (United States)

    Sade, Leyla Elif

    2009-07-01

    Functional mitral regurgitation (FMR) is the mitral regurgitation that occurs due to myocardial disease in the presence of normal mitral valve leaflets. This scenario has the different characteristics than the organic mitral regurgitation. Functional mitral regurgitation is a disease of the ventricle and occurs by the deformation of the mitral valve leaflets. This morbid entity is frequent and has bad prognosis. Functional mitral regurgitation is the result of complex pathophysiologic process including left ventricular local and global remodeling, mitral annular and papillary muscle dysfunction, and left ventricular dysfunction. The dynamic behavior of FMR complicates the quantification of the regurgitation. Exercise stress echocardiography is of particular importance in the evaluation of the hemodynamic burden of FMR. Particular pathophysiological properties of the FMR necessitate different therapeutic approaches than the current ones for classical mitral regurgitation.

  3. Transcatheter Aortic Valve Replacement in a Patient With a Previous Bioprosthetic Mitral Valve Replacement: Report of a Delayed Fatal Interaction.

    Science.gov (United States)

    Poulin, Frédéric; Lamarche, Yoan; Le, Van Hoai Viet; Doucet, Michel; Roméo, Philippe; Généreux, Philippe

    2016-02-01

    We report on a man with bioprosthetic mitral valve perforation who presented late after transcatheter aortic valve replacement with a balloon-expandable transcatheter heart valve (THV). The protrusion of the commissural strut of the bioprosthetic mitral valve coupled with the low implanted THV resulted in repetitive trauma leading to rupture of a mitral leaflet. Potential preventive strategies are discussed. This case illustrates the importance of preprocedural imaging screening and cautious THV deployment in patients with a bioprosthetic mitral valve.

  4. Mitral Valve Stenosis

    Science.gov (United States)

    ... up around the ring around the mitral valve (annulus), which can occasionally cause mitral valve stenosis. Other ... the condition of your lungs. Transesophageal echocardiogram. A small transducer attached to the end of a tube ...

  5. [Mitral valve repair for mitral regurgitation induced by infective endocarditis complicated with ulcerative colitis; report of a case].

    Science.gov (United States)

    Shiraishi, Shoichiro; Koike, Masato; Aoshima, Minoru; Asai, Tohru

    2014-05-01

    Infective endocarditis is a rare complication of ulcerative colitis. We report on a 22-year-old man, who had been treated of ulcerative colitis for 5 years. He presented with dyspnea on effort. In spite of medical treatment, he developed congestive heart failure. Transthoracic echocardiography showed a large perforation on the anterior leaflet of the mitral valve, and prolapses of the posterior leaflet of the mitral valve with rupture of the chordae. The patient underwent mitral valve repair with an autologous pericardial patch on the anterior leaflet combined with butterfly resection and suture of the posterior leaflet. The postoperative course was uneventful.

  6. [A case of death due to mitral regurgitation caused by traumatic mitral valve injury].

    Science.gov (United States)

    Iwasaki, Y; Kojima, T; Yasui, W; Nagasawa, N; Yashiki, M

    1996-06-01

    A 51-year-old male, who had been driving a motor bicycle, was involved in a traffic accident with a trailer, and he died immediately after the accident. According to the external examination of the victim, no fatal injuries were found. The medico-legal autopsy revealed a rupture of the left side of the pericardium, and a tear of the posterior leaflet of the mitral valve. There were no injuries of the papillary muscles and chordae. The cause of death was due to traumatic mitral regurgitation.

  7. Continuity or Rupture? Roma/Gypsy Communities in Rural and Urban Environments under Post-Socialism

    Science.gov (United States)

    Ruzicka, Michal

    2012-01-01

    The aim of the article is to contribute to existing research and debates on social change associated with the post-socialist transformation in Eastern and Central Europe. It does so by drawing attention to and examining the diversity of ways in which such change has been lived through and reflected upon by members of Roma (Gypsy) communities…

  8. Continuity or Rupture? Roma/Gypsy Communities in Rural and Urban Environments under Post-Socialism

    Science.gov (United States)

    Ruzicka, Michal

    2012-01-01

    The aim of the article is to contribute to existing research and debates on social change associated with the post-socialist transformation in Eastern and Central Europe. It does so by drawing attention to and examining the diversity of ways in which such change has been lived through and reflected upon by members of Roma (Gypsy) communities…

  9. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study.

    Science.gov (United States)

    Jielile, Jiasharete; Badalihan, Ayinazi; Qianman, Bayixiati; Satewalede, Tuerde; Wuerliebieke, Jianati; Kelamu, Mailamuguli; Jialihasi, Ayidaer

    2016-07-01

    Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI). Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed. Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group. Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture. II.

  10. Post-seismic velocity changes along the 2008 M7.9 Wenchuan earthquake rupture zone revealed by S coda of repeating events

    Science.gov (United States)

    Li, Le; Niu, Fenglin; Chen, Qi-Fu; Su, Jinrong; He, Jiabin

    2017-02-01

    We investigated post-seismic velocity changes within the fault zone of the 2008 M7.9 Wenchuan earthquake using coda wave data of repeating small earthquakes. We employed template matching and grid search methods to identify well-defined repeating earthquakes in order to minimize artefacts induced by variations in source location. We identified a total of 12 isolated patches in the fault zone that ruptured more than twice in a 1 yr period after the M7.9 earthquake. We applied the coda wave interferometry technique to the waveform data of the 34 identified repeating earthquakes to estimate velocity changes between the first and subsequent events in each cluster. We found that major post-seismic velocity changes occurred in the southwestern part of the rupture area, where the main rupture was initiated and characterized by thrust motion, while the Beichuan area in the northeastern part of the rupture zone appears to experience very little post-seismic velocity changes.

  11. 5. Mitral valve replacement for mitral stenosis: 15 years single center experience

    Directory of Open Access Journals (Sweden)

    A. Arifi

    2016-07-01

    Full Text Available Mitral valve replacement (MVR with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. This study aimed to evaluate and compare the early and late outcome of mitral valve replacement (mechanical versus bioprosthetic for severe mitral stenosis. A retrospective cohort study was performed on prospectively collected data involving mitral stenosis patients who have undergone MVR with either bioprosthetic (BMV (n = 50 or mechanical (MMV (n = 145 valves in our institute from 1999 to 2012. Data were analyzed for early and late mortality, NYHA functional classes, stroke, early and late valve-related complications, and survival. Chi Square test, logistic regression, Kaplan Meier curve, and dependent proportions tests were performed. A total of 195 patients were included in the study with a follow-up of 190 patients (97.5%. One patient died early post-operatively; twelve patients died late in the post-operative period, BMV group (6 and the MMV (6. The Late mortality had significantly associated with post-op stroke (p < 0.001 and post-op NYHA classes III and IV (p = 0.002. Post-op NYHA class was significantly associated with age (p = 0.003, pulmonary disease (p = 0.02, mitral valve implant type (p = 0.01, and post-op stroke (p = 0.02; 14 patients had strokes in the MMV (9 and in the BMV (5 groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001. Bioprosthetic valves were significantly associated with worse survival (p = 0.03, worse NYHA post-op (p = 0.01, and more re-operations (p = 0.006. Survival was significantly better with mechanical valves (p = 0.03. When the two groups were matched for age and mitral regurgitation, the analysis revealed that bioprosthetic valves were significantly associated with re-operations (p = 0.02 but not significantly associated with worse survival (p = 0.4 or worse NYHA (p = 0.4. Mechanical mitral valve

  12. Parabolic resection for mitral valve repair.

    Science.gov (United States)

    Drake, Daniel H; Drake, Charles G; Recchia, Dino

    2010-02-01

    Parabolic resection, named for the shape of the cut edges of the excised tissue, expands on a common 'trick' used by experienced mitral surgeons to preserve tissue and increase the probability of successful repair. Our objective was to describe and clinically analyze this simple modification of conventional resection. Thirty-six patients with mitral regurgitation underwent valve repair using parabolic resection in combination with other techniques. Institution specific mitral data, Society of Thoracic Surgeons data and preoperative, post-cardiopulmonary bypass (PCPB) and postoperative echocardiography data were collected and analyzed. Preoperative echocardiography demonstrated mitral regurgitation ranging from moderate to severe. PCPB transesophageal echocardiography demonstrated no regurgitation or mild regurgitation in all patients. Thirty-day surgical mortality was 2.8%. Serial echocardiograms demonstrated excellent repair stability. One patient (2.9%) with rheumatic disease progressed to moderate regurgitation 33 months following surgery. Echocardiography on all others demonstrated no or mild regurgitation at a mean follow-up of 22.8+/-12.8 months. No patient required mitral reintervention. Longitudinal analysis demonstrated 80% freedom from cardiac death, reintervention and greater than moderate regurgitation at four years following repair. Parabolic resection is a simple technique that can be very useful during complex mitral reconstruction. Early and intermediate echocardiographic studies demonstrate excellent results.

  13. Mitral valve prolapse.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C

    1984-05-01

    Mitral valve prolapse is a very common condition. It occurs in 4-5% of the population. It may be idiopathic or associated with a number of other conditions. Myxomatous degeneration is the underlying mechanism of mitral valve prolapse. Most patients with mitral valve prolapse have no symptoms. When symptoms do occur, palpitations, chest pain and dyspnea are the major complaints. The midsystolic click occasionally followed by the late systolic murmur are the typical physical findings. The echocardiogram plays a big role in the diagnosis of mitral valve prolapse. The beta blockers are used in the treatment of the symptomatic patient.

  14. Live three-dimensional transesophageal echocardiography in mitral valve surgery

    Institute of Scientific and Technical Information of China (English)

    MA Ning; LI Zhi-an; MENG Xu; YANG Ya

    2008-01-01

    Background Live three-dimensional transesophageal echocardiography (live-3D-TEE) is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.Methods Twenty-four patients with mitral valve disease (mean age (47.1 rdiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE. Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

  15. [A Case of Mitral Valvular Re-repair in a Patient with Hemolytic Anemia after Mitral Valvular Repair].

    Science.gov (United States)

    Tomino, Mikiko; Miyata, Kazuto; Takeshita, Yuji; Kaneko, Koki; Kanazawa, Hiroko; Uchino, Hiroyuki

    2015-07-01

    A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant.

  16. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  17. Surgical double valve replacement after transcatheter aortic valve implantation and interventional mitral valve repair.

    Science.gov (United States)

    Wendeborn, Jens; Donndorf, Peter; Westphal, Bernd; Steinhoff, Gustav

    2013-11-01

    Transcatheter aortic valve implantation, as well as interventional mitral valve repair, offer reasonable therapeutic options for high-risk surgical patients. We report a rare case of early post-interventional aortic valve prosthesis migration to the left ventricular outflow tract, with paravalvular leakage and causing severe mitral valve regurgitation. Initial successful interventional mitral valve repair using a clipped edge-to-edge technique revealed, in a subsequent procedure, the recurrence of mitral valve regurgitation leading to progressive heart failure and necessitating subsequent surgical aortic and mitral valve replacement.

  18. 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.

  19. Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.

    Science.gov (United States)

    Ender, Jörg; Sgouropoulou, Sophia

    2013-11-01

    The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role.

  20. Reparación de válvula mitral en insuficiencia mitral funcional isquémica y ecocardiografía: Serie de casos Mitral valve repair in ischemic functional mitral insufficiency and echocardiography: Case series

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    Álvaro H Rodríguez

    2011-02-01

    Full Text Available La insuficiencia mitral isquémica es una complicación de la enfermedad coronaria que se asocia con resultados pobres. Su mecanismo básico es la remodelación del ventrículo izquierdo isquémico, que a su vez provoca desplazamiento de los músculos papilares, dilatación anular y tracción apical de las valvas. A pesar de que se ha comprobado que la reparación de la válvula mitral es superior al reemplazo de la válvula mitral para la corrección de la insuficiencia mitral severa orgánica, todavía hay un gran dilema en cuanto a qué procedimiento es el más adecuado para su tratamiento. Al parecer, en la actualidad la técnica de mayor uso para el tratamiento quirúrgico de pacientes con insuficiencia mitral isquémica severa, es la anuloplastia restrictiva de la válvula mitral; sin embargo, este procedimiento se asocia con 10% a 20% de persistencia post-operatoria temprana, y con 50% a 70% de tasas de recurrencia a cinco años. Además, la presencia de insuficiencia mitral isquémica severa persistente o recurrente, se asocia con mayor incidencia de eventos cardiacos y reducción de la supervivencia.Ischemic mitral valve insufficiency is a complication of coronary disease associated to poor results. Its basic mechanism is remodeling of ischemic left ventricle that causes the displacement of papillary muscles, annular dilation and valves apical traction. Although there is enough evidence that mitral valve repair is superior to mitral valve replacement for correction of severe organic mitral insufficiency, there is still a great dilemma as to which procedure is more suitable for its treatment. Apparently, now the most used technique for the surgical treatment of patients with severe ischemic mitral insufficiency is restrictive annuloplasty of the mitral valve; however, this procedure is associated to 10% to 20% of early post-operative persistence, and to 50% to 70% of recurrence rate at five years. Furthermore, the presence of persistent

  1. Mitral Valve Prolapse

    Science.gov (United States)

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  2. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

    National Research Council Canada - National Science Library

    Sadeghpour, Anita; Abtahi, Firoozeh; Kiavar, Majid; Esmaeilzadeh, Maryam; Samiei, Niloofar; Ojaghi, Seyedeh Zahra; Bakhshandeh, Hooman; Maleki, Majid; Noohi, Feridoun; Mohebbi, Ahmad

    2008-01-01

    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...

  3. 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

  4. Endocardite valvar mitral causada por Chlamydia psittaci: apresentação de um caso raro Chlamydia psittaci as a cause of mitral valve endocarditis: presentation of a rare case

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    Rinaldo Luiz Wolker

    2006-06-01

    Full Text Available Relatamos o caso de um criador de pássaros que desenvolveu um quadro consuntivo, febril, com mialgia e hemoculturas negativas. Internado por três ocasiões, foi tratado empiricamente com antibióticos, sem melhora. Após quatro meses, apresentou piora com sinais de infecção sistêmica. Ecocardiograma demonstrou insuficiência mitral moderada, com vegetações, não presentes em exame prévio. Sorologia positiva para Chlamydia psittaci (imunofluorescência indireta. Na cirurgia, identificou-se grande destruição da valva mitral, com cúspide anterior rota e vegetações. Após a cirurgia, apresentou melhora clínica, recebendo alta em treze dias, com antibioticoterapia específica. Apesar de pouco freqüente, a Chlamydia psittaci deve ser lembrada em casos de endocardite com hemoculturas negativas, quando houver história de exposição a pássaros.The authors report a clinical case of bird breeder who evolved with fever, myalgia, weight lost and negative blood cultures. On three occasions he was treated with different antibiotics, without improvement. He became progressively worse and after four months a diagnosis of endocarditis was made. An echocardiogram showed mitral valve dysfunction with vegetation that had not been seen previously. A blood test proved positive for Chlamydia psittaci (indirect immunofluorescence. In surgery the mitral valve was seen to have severe lesions with anterior cuspid rupture and large areas with vegetation. After surgery, he presented with a clinical improvement and was discharged on the thirteenth post-operative day on specific antibiotic therapy. Although rare, Chlamydia psittaci must be considered in cases of endocarditis with negative blood cultures, when there is a possibility of contact with birds.

  5. Percutaneous mitral valve repair.

    Science.gov (United States)

    Gillinov, A Marc; Liddicoat, John R

    2006-01-01

    Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.

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

    LENUS (Irish Health Repository)

    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.

  7. Mitral valve repair in a patient with mesocardia.

    Science.gov (United States)

    Morisaki, Akimasa; Hattori, Koji; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2014-01-01

    A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.

  8. Mitral valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  9. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement

    Science.gov (United States)

    Khan, Jaffar M.; Rogers, Toby; Schenke, William H.; Mazal, Jonathan R.; Faranesh, Anthony Z.; Greenbaum, Adam B.; Babaliaros, Vasilis C.; Chen, Marcus Y.; Lederman, Robert J.

    2017-01-01

    OBJECTIVES The authors propose a novel transcatheter transection of the anterior mitral leaflet to prevent iatrogenic left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). BACKGROUND LVOT obstruction is a life-threatening complication of TMVR caused by septal displacement of the anterior mitral leaflet. METHODS In vivo procedures in swine were guided by biplane x-ray fluoroscopy and intracardiac echocardiography. Retrograde transaortic 6-F guiding catheters straddled the anterior mitral leaflet. A stiff 0.014-inch guidewire with polymer jacket insulation was electrified and advanced from the LVOT, through the A2 leaflet base, into the left atrium. The wire was snared and externalized, forming a loop that was energized and withdrawn to lacerate the anterior mitral leaflet. RESULTS The anterior mitral leaflet was successfully lacerated in 7 live and 1 post-mortem swine under heparinization. Lacerations extended to 89 ± 19% of leaflet length and were located within 0.5 ± 0.4 mm of leaflet centerline. The chordae were preserved and retracted the leaflet halves away from the LVOT. LVOT narrowing after benchtop TMVR was significantly reduced with intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction than without (65 ± 10% vs. 31 ± 18% of pre-implantation diameter, p < 0.01). The technique caused mean blood pressure to fall (from 54 ± 6 mm Hg to 30 ± 4 mm Hg, p < 0.01), but blood pressure remained steady until planned euthanasia. No collateral tissue injury was identified on necropsy. CONCLUSIONS Using simple catheter techniques, the anterior mitral valve leaflet was transected. Cautiously applied in patients, this strategy can prevent anterior mitral leaflet displacement and LVOT obstruction caused by TMVR. PMID:27609260

  10. Mitral Valve Prolapse in Pregnancy

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    Full Text Available Abstract Mitral valve prolapse is a benign condition. Mitral regurgitation is only complicated in patients with severe mitral valve prolapse. Women with mitral valve prolapse in the absence of other cardiovascular disorders tolerate pregnancy well and do not develop remarkable cardiac complications. Nevertheless, serious complications of mitral valve prolapse, including arrhythmia, infective endocarditis and cerebral ischemic events, can be present in pregnancy. Debates remain with regard to the use of prophylactic antibiotics and β-blockers in the pregnant women with mitral valve prolapse. The prognosis of the pregnant patients might be closely related to the pathological and (or functional changes of the mitral valve. Non-myxomatous mitral valve prolapse poses no or little obstetric risks in terms of pregnancy, labor and neonatal complications; whereas myxomatous mitral valve prolapse is a major etiology of valvular heart disease in women of childbearing age. In the pregnant patients with mitral valve prolapse progressing into major complications, surgical interventions are considered. Medicinal treatment of such patients with β-blockers should be a concern for the fetal safety.

  11. Delayed endovascular treatment of descending aorta stent graft collapse in a patient treated for post- traumatic aortic rupture: a case report

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    Stegher Silvia

    2011-05-01

    Full Text Available Abstract Background We report a case of delayed endovascular correction of graft collapse occurred after emergent Thoracic Endovascular Aortic Repair (TEVAR for traumatic aortic isthmus rupture. Case presentation In 7th post-operative day after emergent TEVAR for traumatic aortic isthmus rupture (Gore TAG® 28-150, a partial collapse of the endoprosthesis at the descending tract occurred, with no signs of visceral ischemia. Considering patient's clinical conditions, the graft collapse wasn't treated at that time. When general conditions allowed reintervention, the patient refused any new treatment, so he was discharged. Four months later the patient complainted for severe gluteal and sural claudication, erectile disfunction and abdominal angina; endovascular correction was performed. At 18 months the graft was still patent. Discussion and Conclusion Graft collapse after TEVAR is a rare event, which should be detected and treated as soon as possible. Delayed correction of this complication can be lethal due to the risk of visceral ischemia and limbs loss.

  12. Transvalvular mitral regurgitation following mitral valve replacement a diagnostic dilemma

    OpenAIRE

    U S Dinesh Kumar; Umesh Nareppa; Shyam Prasad Shetty; Murugesh Wali

    2015-01-01

    After mitral valve replacement with a prosthetic valve, the valve should be competent and there should not be any residual prosthetic valve regurgitation. Transvalvular residual prosthetic valve regurgitation are difficult to diagnose and quantify. we are reporting interesting TEE images as a diagnostic dilemma in a case of transvalvular mitral regurgitation following mitral valve replacement secondary to entrapment of sub-valvular apparatus in a Chitra mechanical heart valve.

  13. SERUM MAGNESIUM LEVELS IN AORTIC AND MITRAL VALVE REPLACEMENT SURGERIES

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    Srinivasa Rao

    2015-08-01

    Full Text Available BACKGROUND : The purpose of the study was to analyze serum magnesium concentration in patients undergoing Aortic and Mitral Valve replacement surgeries. METHODS: This prospective study was conducted in 60 patients who underwent elective Aortic and Mitral va lve replacement surgeries. Blood samples from radial artery were collected just before induction of anesthesia and three days post - operatively for estimation of serum magnesium. RESULTS: Magnesium level was 2.02mg/dl at baseline, 2.28mg/dl, 2.08mg/dl and 1 .90mg/dl respectively on three consecutive days post - operatively. CONCLUSION: The lowering of serum magnesium in Aortic and Mitral valve replacement surgeries postoperatively recommends the use of routine serum magnesium determination and administration to prevent post - operative arrhythmias.

  14. Mitral regurgitation: challenges and solutions

    Directory of Open Access Journals (Sweden)

    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

  15. Post Earthquake Investigation Of The Mw7.8 Haida Gwaii, Canada, Rupture Area And Constraints On Earthquake Source Models

    Science.gov (United States)

    Haeussler, P. J.; Witter, R. C.; Wang, K.

    2013-12-01

    The October 28, 2012 Mw 7.8 Haida Gwaii, British Columbia, earthquake was the second largest historical earthquake recorded in Canada. Earthquake seismology and GPS geodesy shows this was an underthrusting event, in agreement with prior studies that indicated oblique underthrusting of the Haida Gwaii by the Pacific plate. Coseismic deformation is poorly constrained by geodesy, with only six GPS sites and two tide gauge stations anywhere near the rupture area. In order to better constrain the coseismic deformation, we measured the upper limit of sessile intertidal organisms at 26 sites relative to sea level. We dominantly measured the positions of bladder weed (fucus distichus - 617 observations) and the common acorn barnacle (Balanus balanoides - 686 observations). Physical conditions control the upper limit of sessile intertidal organisms, so we tried to find the quietest water conditions, with steep, but not overhanging faces, where slosh from wave motion was minimized. We focused on the western side of the islands as rupture models indicated that the greatest displacement was there. However, we were also looking for calm water sites in bays located as close as possible to the often tumultuous Pacific Ocean. In addition, we made 322 measurements of sea level that will be used to develop a precise tidal model and to evaluate the position of the organisms with respect to a common sea level datum. We anticipate the resolution of the method will be about 20-30 cm. The sites were focused on the western side of the Haida Gwaii from Wells Bay on the south up to Otard Bay to the north, with 5 transects across strike. We also collected data at the town of Masset, which lies outside of the deformation zone of the earthquake. We observed dried and desiccated bands of fucus and barnacles at two sites on the western coast of southern Moresby Island (Gowgia Bay and Wells Bay). Gowgia Bay had the strongest evidence of uplift with fucus that was dried out and apparently dead. A

  16. 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.

  17. Post myocardial infarction cardiogenic shock: a review of current therapies.

    Science.gov (United States)

    Ng, Ramford; Yeghiazarians, Yerem

    2013-01-01

    Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents and mechanical support devices may temporize the patient's hemodynamic status until definitive therapy by percutaneous or surgical intervention can be performed. Despite prompt management, post-MI cardiogenic shock mortality remains high.

  18. Performance of language tasks in patients with ruptured aneurysm of the left hemisphere worses in the post-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Ana Cláudia C. Vieira

    2016-08-01

    Full Text Available ABSTRACT Sub-arachnoid hemorrhage (SAH promotes impairment of upper cortical functions. However, few information is available emphasizing changes in language after aneurismal SAH and aneurysm location influence. Objective To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA, left middle cerebral artery (L-MCA and left posterior comunicating artery (L-PcomA. Methods Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms’ location. Results Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. Conclusion After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

  19. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

    Directory of Open Access Journals (Sweden)

    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.

  20. Insuficiencia mitral grave posvalvuloplastia mitral percutánea

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    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.

  1. Mid-term results of mitral valve repair with autologous pericardium in pediatric patients.

    Science.gov (United States)

    Takahashi, Hiroaki; Kadowaki, Tasuku; Maruo, Ayako; Yutaka, Okita; Oshima, Yoshihiro

    2014-05-01

    Mitral valve repair to treat mitral regurgitation (MR) in pediatric patients remains challenging because of the complex morphology and fragility of the leaflets. The study aim was to review retrospectively the authors' experience with mitral valve repair using autologous pericardium. Between April 2004 and November 2011, nine pediatric patients (six males, three females; mean age 2.4 +/- 4.5 years) underwent mitral valve repair with an autologous fresh (n = 5) or glutaraldehyde-treated pericardium (n = 4) to treat severe MR. The etiology of the MR was acute endocarditis, acute chordal rupture and congenital disease in three, two, and four patients, respectively. Autologous pericardium was used for valvuloplasty, leaflet extension plasty and commissuroplasty in two, five, and two patients, respectively. Artificial chordal replacement was performed in three patients. No operative deaths or postoperative endocarditis occurred. One patient required mitral valve replacement at three days after the initial mitral repair. The most recent echocardiography findings of the remaining patients after a mean of 6.3 years (range: 1.3-9.0 years) showed that the severity of mitral insufficiency, left ventricular diastolic diameter and fractional shortening were 1.8 +/- 0.6 (grades 0-4), 40.4 +/- 8.4 mm (114.2 +/- 15.8% of normal) and 35.0 +/- 5.0%, respectively. Mitral valve repair using autologous fresh pericardium is associated with mid-term durability and resistance to infection when used for mitral valve repair of active endocarditis in pediatric patients. Augmentation with autologous pericardium could become an alternative to current surgical options.

  2. Mitral valve repair: an echocardiographic review: Part 2.

    Science.gov (United States)

    Maslow, Andrew

    2015-04-01

    Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair.

  3. Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.

    Science.gov (United States)

    Said, S A; Veerbeek, A; van der Wieken, L R

    1991-07-01

    A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

  4. Robotic mitral valve surgery.

    Science.gov (United States)

    Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2003-12-01

    A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for

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

    Science.gov (United States)

    Priye, Shio; Sathyanarayan, J; Shivaprakash, S; Reddy, Durgaprasad

    2015-12-01

    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.

  6. 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.

  7. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    Science.gov (United States)

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  8. 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.

  9. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement.

    Science.gov (United States)

    Inoue, Takahiro; Hashimoto, Kazuhiro; Sakamoto, Yoshimasa; Nagahori, Ryuichi; Yoshitake, Michio; Matsumura, Yoko; Takagi, Tomomitsu; Kinami, Hiroo

    2016-06-01

    Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2 years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings.

  10. 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.

  11. Strut fracture in the new Bjørk-Shiley mitral valve prosthesis.

    Science.gov (United States)

    Brubakk, O; Simonsen, S; Källman, L; Fredriksen, A

    1981-04-01

    The case of a patient with the new type Bjørk-Shiley aortic and mitral valve prosthesis is described. Three months after implant she suffered acute heart failure and died. Post-mortem examination revealed a fractured outlet strut in the mitral valve prosthesis with dislocation of the disc. The fracture was regarded as due to excessive brittleness caused by demonstrated deposition of chromium-tungsten-carbide.

  12. Angiographic analysis of congenital mitral stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo; Yeon, Kyung Mo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-09-15

    Congenital mitral stenosis may be defined as a development abnormality of the mitral valve leaflets, commissures, interchordal spaces, papillary muscles, annulus or immediate supravalvular area producing obstruction to left ventricular filling. Authors had experience of nine case of congenital mitral stenosis confirmed by two dimensional echocardiography, angiocardiography and surgery in recent 5 years since 1979, and analyzed them with emphasis on the angiographic findings. The results are as follows: 1. Among 9 cases, 6 patients were male and 3 were female. Age distribution was from 4 month to 11 years. 2. The types of congenital mitral stenosis were 1 typical congenital mitral stenosis, 5 cases of parachute mitral valve and 3 cases of supramitral ring. 3. Angiographically typical congenital mitral stenosis showed narrowing of mitral valvular opening, parachute mitral valve displayed single large papillary muscle with narrowing valvular opening and supramitral ring disclosed semilunar shaped filling defect between left atrium and ventricle. 4. Associated cardiac and extracardiac anomalies of congenital mitral stenosis, as frequency wise, were ventricular septal defect, patent ductus arteriosus, coarctation of aorta, supra and subvalvular aortic stenosis, mitral regurgitation and double outlet right ventricle. 5. Cardiac angiography is essential to diagnose congenital mitral stenosis, but the need of two dimensional echocardiography cannot be ignored.

  13. MitraClip Therapy for Mitral Regurgitation: Secondary Mitral Regurgitation.

    Science.gov (United States)

    Feldman, Ted; Mehta, Arjun; Guerrero, Mayra; Levisay, Justin P; Salinger, Michael H

    2016-01-01

    Therapy for mitral regurgitation (MR) has been synonymous with mitral valve surgery. Operative approaches for degenerative MR repair have been associated with excellent results, with durable long term outcomes. Surgery for functional MR has been less successful. MitraClip has shown promise for functional MR, especiall in patinets who are high risk for surgery. The aggregate of nonrandomized global experience with MitraClip in functional MR has been consistent in showing improvements in symptoms and left ventricular remodeling. It remains to be seen how MitraClip therapy will compare with best medical therapy. The COAPT trial will clarify this question.

  14. Delayed presentation of traumatic intraperitoneal bladder rupture

    Energy Technology Data Exchange (ETDEWEB)

    Brown, D.; Magill, H.L.; Black, T.L.

    1986-03-01

    A child with urine ascites as a delayed manifestation of post-traumatic intraperitoneal bladder rupture is presented. The diagnosis was suggested by abdominal CT scan and confirmed with a cystogram. While uncommon, late presentation of intraperitoneal bladder rupture following trauma may occur from masking of a primary laceration or development of secondary rupture at the site of a hematoma in the bladder wall. Since CT may be a primary diagnostic study performed following abdominal trauma, the radiologist should be aware of CT findings suggesting bladder rupture and of the possibility of delayed presentation of this injury.

  15. Additional value of three-dimensional transesophageal echocardiography for patients with mitral valve stenosis undergoing balloon valvuloplasty.

    Science.gov (United States)

    Langerveld, Jorina; Valocik, Gabriel; Plokker, H W Thijs; Ernst, Sjef M P G; Mannaerts, Herman F J; Kelder, Johannes C; Kamp, Otto; Jaarsma, Wybren

    2003-08-01

    The objective of this study was to validate the additional value of 3-dimensional (3D) transesophageal echocardiography (TEE) for patients with mitral valve stenosis undergoing percutaneous mitral balloon valvotomy (PTMV). Therefore, in a series of 21 patients with severe mitral valve stenosis selected for PTMV, 3D TEE was performed before and after PTMV. The mitral valve area was assessed by planimetry pre- and post-PTMV; the mitral valve volume was assessed and attention was paid to the amount of fusion of the commissures. These results were compared with findings by 2-dimensional transthoracic echocardiography using pressure half-time method for assessment of mitral valve area, and were analyzed for the prediction of successful outcome. Pre-PTMV the mitral valve area assessed by 3D TEE was 1.0 +/- 0.3 cm(2) vs 1.2 +/- 0.4 cm(2) assessed by 2-dimensional transthoracic echocardiography (P =.03) and post-PTMV it was 1.8 +/- 0.5 cm(2) vs 1.9 +/- 0.6 cm(2) (not significant), respectively. The mitral valve volume could be assessed by 3D TEE (mean 2.4 +/- 2.5 cm(3)) and was inversely correlated to a successful PTMV procedure (P <.001). The 3D TEE method enabled a better description of the mitral valvular anatomy, especially post-PTMV. We conclude that 3D TEE will have additional value over 2-dimensional echocardiography in this group of patients, for selection of patients pre-PTMV, and for analyzing pathology of the mitral valve afterward.

  16. Left ventricular rupture postmitral valve replacement: Surviving a catastrophe

    Directory of Open Access Journals (Sweden)

    Samarjit Bisoyi

    2015-01-01

    Full Text Available One of the dreaded mechanical complications of mitral valve replacement (MVR is rupture of the left ventricle (LV. This report describes the early diagnosis and successful repair of rupture of posterior wall of LV in an elderly patient who underwent MVR. We have discussed the risk factors and perioperative issues implicated in such complication. The anesthesiologist as an intra-operative echocardiographer can aid in identifying the patient at risk. Though important surgical steps are necessary to prevent the complication; nonetheless, the anesthesiologist needs to take key measures in the perioperative period.

  17. Ruptured chordae tendineae in acromegaly. An autopsy case.

    Science.gov (United States)

    Kaku, T; Nakashima, Y; Ichiyasu, H; Soejima, M; Baba, K; Kuroiwa, A

    1991-07-01

    A 57-year-old woman with acromegaly associated with mitral chordal rupture is reported. She was noted to have abnormal development in the size of her hands and feet in childhood. She occasionally suffered from shortness of breath on exertion and nocturnal dyspnea for several years, and was diagnosed and treated as having congestive heart failure due to valvular heart disease. On admission to our hospital, chordal rupture was suspected on the basis of M-mode and two-dimensional echocardiography. Seven years after discharge, she died of congestive heart failure. On autopsy, the heart weight and ventricular wall thickness were increased. Rupture of the posterior chordae was confirmed, but evidence of an old myocardial infarction was not found. There was severe interstitial fibrosis in the left ventricular wall. A possible etiology of the chordal rupture in this case was thought to be the excessive stretching caused by the disproportional visceromegaly of the heart.

  18. Accuracy of 3-Dimensional Transoesophageal Echocardiography in Assessment of Prosthetic Mitral Valve Dehiscence with Comparison to Anatomical Specimens

    Science.gov (United States)

    Brown, Martin R.; Javorsky, George; Platts, David G.

    2010-01-01

    The evolution of echocardiography from 2-Dimensional Transthoracic Echo through to real time 3-Dimensional Transoesophageal Echo has enabled more accurate visualisation and quantification of valvular disorders especially prosthetic mitral valve paravalvular regurgitation. However, validation of accuracy is rarely confirmed by surgical or post-mortem specimens. We present a case directly comparing different echocardiographic modality images to post mortem specimens in a patient with prosthetic mitral valve paravalvular regurgitation. PMID:20886015

  19. Papillary muscle rupture caused by bacterial endocarditis: role of transesophageal echocardiography.

    Science.gov (United States)

    Habib, G; Guidon, C; Tricoire, E; Djiane, V; Monties, J R; Luccioni, R

    1994-01-01

    A 22-year-old man had severe pulmonary congestion and required mechanical ventilation. Endocarditis was suspected because a 2/6 systolic murmur was heard at the apex and because Osler nodes were present. Transthoracic and transesophageal echocardiography allowed correct diagnosis of papillary muscle rupture causing massive mitral regurgitation. To our knowledge, this is the first reported case of papillary muscle rupture caused by bacterial endocarditis diagnosed by transthoracic and transesophageal echocardiography.

  20. Percutaneous mitral valve repair: a feasibility study in an ovine model of acute ischemic mitral regurgitation.

    Science.gov (United States)

    Liddicoat, John R; Mac Neill, Briain D; Gillinov, A Marc; Cohn, William E; Chin, Chi-Hui; Prado, Aldo D; Pandian, Natesa G; Oesterle, Stephen N

    2003-11-01

    Annuloplasty is the cornerstone of surgical mitral valve repair. A percutaneous transvenous catheter-based approach for mitral valve repair was tested by placing a novel annuloplasty device in the coronary sinus of sheep with acute ischemic mitral regurgitation. Mitral regurgitation was reduced from 3-4+ to 0-1+ in all animals (P < 0.03). The annuloplasty functioned by reducing septal-lateral mitral annular diameter (30 +/- 2.1 mm preinsertion vs. 24 +/- 1.7 mm postinsertion; P < 0.03). These preliminary experiments demonstrate that percutaneous mitral annuloplasty is feasible. Further study is necessary to demonstrate long-term safety and efficacy of this novel approach.

  1. Mitral valve surgery - minimally invasive

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  2. [Anomalous mitral arcade: a disguised and silent lesion leading to a recurrent wheezing in children. A case report].

    Science.gov (United States)

    Villalba, Claudia N; Mouratian, Mariela; Lafuente, María V; Barretta, Jorge; Capelli, Horacio

    2015-12-01

    Recurrent wheezing is a very common clinical ailment throughout infancy and childhood. The most common diagnosis in children with wheezing is asthma. However, some other causes should be considered in the differential diagnosis such as a congenital cardiac defect. We present a case of a four year old boy presenting with recurrent wheezing who was referred to our institution for cardiac evaluation. Severe mitral stenosis secondary to an anomalous mitral arcade was diagnosed by physical examination, chest X-ray, electrocardiogram and mainly transthoracic and transesophageal echocardiography. Anomalous mitral arcade is a rare congenital malformation of the mitral tensor apparatus which comprises the chordae tendineae and papillary muscles. This abnormal anatomy leads to increased filling pressure of the left ventricle, a retrograde post capillary pulmonary hypertension and interstitial aedema. The patient was referred to cardiac surgery and underwent a successful procedure with complete removal of the obstructive mitral lesion.

  3. Mitral Valve Disease

    Science.gov (United States)

    ... for more information on procedures, news, and pre- & post-operative care. Section Navigation Select Topic Aortic Valve Disease ... is most commonly caused by inflammation from rheumatic fever, a disease that is related to strep infections; ...

  4. The Difficult Diagnosis of Ischaemic Papillary Muscle Rupture; Case report from an urban emergency department

    Directory of Open Access Journals (Sweden)

    Christian T. Braun

    2016-05-01

    Full Text Available We present a rare case of severe ischaemic papillary muscle rupture in a 67-year-old male patient who was admitted to the Emergency Department of the University Hospital Bern, Switzerland, in November 2013 with acute chest pain. On admission, the patient’s blood pressure was 60/40 mm/Hg, his pulse was 110 beats per minute and his respiratory rate was 20 breaths per minute. An electrocardiogram was normal and focused assessment with sonography in trauma was negative. Transthoracic echocardiography showed possible thickening of the mitral valve leaflet with no indications of severe mitral insufficiency or wall motion abnormalities. Triple-ruleout computed tomography angiography revealed no pulmonary emboli or aortic dissection, although coronary atherosclerosis was present. Finally, severe insufficiency of the mitral valve with rupture of the papillary muscle, likely due to ischaemia, was observed via transoesophageal echocardiography. The patient underwent a successful surgical intervention and was discharged 10 days later in stable condition.

  5. Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy

    Science.gov (United States)

    Ramasamy, Ramona; Kaliappan, Tamilarasu; Gopalan, Rajendiran; Palanimuthu, Ramasmy; Anandhan, Premkrishna

    2017-01-01

    Introduction Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. Aim To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. Materials and Methods Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin’s scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. Results Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin’s score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV

  6. Early Clinical Outcome of Mitral Valve Replacement Using a Newly Designed Stentless Mitral Valve for Failure of Initial Mitral Valve Repair.

    Science.gov (United States)

    Nishida, Hidefumi; Kasegawa, Hitoshi; Kin, Hajime; Takanashi, Shuichiro

    2016-12-21

    Here we report the early outcome of mitral valve replacement using a newly designed stentless mitral valve for failure of initial mitral valve repair. Mitral valve plasty (MVP) for mitral regurgitation is currently a standard technique performed worldwide. However, whether mitral valve repair should be performed for patients with advanced leaflet damage or complicated pathology remains controversial. Mitral valve replacement might be feasible for patients who have undergone failed initial MVP; however, it is not an optimal treatment because of poor valve durability and the need for anticoagulative therapy. We report two cases of successful mitral valve replacement using a newly designed stentless mitral valve made of fresh autologous pericardium, which may have a potential benefit over mitral valve repair or mitral valve replacement with a mechanical or bioprosthetic valve.

  7. Isoproterenol Stress Echocardiography in Assessing Mitral Valve Area Reserve before and after Percutaneous Balloon Valvuloplasty

    Institute of Scientific and Technical Information of China (English)

    刘品明; 傅向阳; 吕俊豪; 吴群; 杨福庆

    2001-01-01

    Objective To determine whether successful valvuloplasty causes an increase of mitral valve area reserve in patients with mitral stenosis, isoproterenol stress echocardiography was used to compare mitral valve area and hemodynamic changes between pre- and post- valvuloplasty under conditions of increased cardiac work. Methods Thirtyeight patients with pure rheumatic mitral stenosis who had received successful percutaneous balloon valvulo plasty underwent isoproterenol stress echocardiography pre- and post- valvuloplasty. Mitral valve area (by direct planimetry of two- dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M -mode echocardiography) were measured at rest and under isoproterenol stress to achieve heart rate of different stages. Results Mitral valve area (0. 91± 0. 28 to 1. 87±0.23cm2, P <0.01), mean transmitral pressure gradient ( 12.5 ± 6. 3 to 3.9 ± 1.9mmHg, P < 0.01 ) and cardiac output (3.93 ± 1.44to 4. 73 ± 1.01 L/min, P < 0.05) at rest between pre - and post -valvuloplasty were significantly different.Pre-valvuloplasty, as heart rate increased under stress, mean transmitral pressure gradient increased significantly ( P < 0.01 ), but there were no significant differences in the measurements of mitral valve area and cardiac output (both P > 0.05). In contrast, as heart rate increased post- valvuloplasty, there was a significant increase in mean transmitral pressure gradient (P < 0.01), but both mitral valve area and cardiac output further increased significantly (both P < 0. 01) . Moreover, valvuloplasty decreased mean transmitral pressure gradient at peak heart rate from 23.0 ± 4. 5 to 7.75 ± 2.30 mmHg ( P < 0.01 ) under submaximal stress. Conclusions Successful percu taneous balloon valvuloplasty soon causes a significant increase of mitral valve area reserve in patients with mitral stenosis, which is markedly manifested under conditions of

  8. 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.

  9. Left Ventricular Outflow Tract Obstruction after Bioprosthetic Mitral Valve Replacement with Posterior Mitral Leaflet Preservation

    OpenAIRE

    Guler, Niyazi; Ozkara, Cenap; Akyol, Aytac

    2006-01-01

    We present a case of transient left ventricular outflow tract obstruction after mitral valve replacement with a high-profile bioprosthesis; only the posterior native mitral valve leaflet was preserved.

  10. Mitral valve plasty for mitral regurgitation after blunt chest trauma.

    Science.gov (United States)

    Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

    2001-06-01

    A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

  11. Mitral Valve Replacement After Failed Mitral Ring Insertion With or Without Leaflet/Chordal Repair for Pure Mitral Regurgitation.

    Science.gov (United States)

    Roberts, William C; Moore, Meagan; Ko, Jong Mi; Hamman, Baron L

    2016-06-01

    Mitral repair operations for correction of pure mitral regurgitation (MR) are generally quite successful. Occasionally, however, the reparative procedure incompletely corrects the MR or the MR recurs. From March 1993 to January 2016, twenty nine patients had mitral valve replacement after the initial mitral repair operation, and observations in them were analyzed. All 29 patients at the repair operation had an annular ring inserted and later (1 year in 21) mitral valve replacement. The cause of the MR before the repair operation appears to have been prolapse in 16 patients (55%), secondary (functional) in 12 (41%) (ischemic in 5), and infective endocarditis which healed in 1 (3%). At the replacement operation the excised anterior mitral leaflet was thickened in all 29 patients. Some degree of stenosis appeared to have been present in 16 of the 29 patients before the replacement operation, although only 10 had an echocardiographic or hemodynamic recording of a transvalvular gradient; at least 11 patients had restricted motion of the posterior mitral leaflet; 10, ring dehiscence; 2, severe hemolysis; and 2, left ventricular outflow obstruction. In conclusion, there are multiple reasons for valve replacement after earlier mitral repair. Uniformly, at the time of the replacement, the mitral leaflets were thickened by fibrous tissue. Measurement of the area enclosed by the 360° rings and study of the excised leaflet suggest that the ring itself may have contributed to the leaflet scarring and development of some transmitral stenosis.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Mitral valve repair and redo repair for mitral regurgitation in a heart transplant recipient

    NARCIS (Netherlands)

    Bouma, Wobbe; Brugemann, Johan; Wijdh-den Hamer, Inez J.; Klinkenberg, Theo J.; Koene, Bart M.; Kuijpers, Michiel; Erasmus, Michiel E.; van der Horst, Iwan C. C.; Mariani, Massimo A.

    2012-01-01

    A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation du

  14. 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 ...... with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets....

  15. 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....

  16. Resultados tardios da plastia mitral em pacientes reumáticos Late outcomes of mitral repair in rheumatic patients

    Directory of Open Access Journals (Sweden)

    Elaine Soraya Barbosa de Oliveira Severino

    2011-12-01

    performed in 33 cases, comissutoromy in 21 cases, and comissurotomy with posterior ring annuloplasty in 50 patients. There was no operative mortality. The late mortality was 2.8% (three patients. The late reoperation was associated with residual mitral valve regurgitation after surgery (P<0.001, pulmonary hypertension at the pre-operative time (P<0.001, age (P<0.04 and functional class at the post-operative time (P<0.001. We observed freedom from reoperation rates at 5 and 10 years of 91.2 ± 3.4% and 71.1 ± 9.2%, respectively. CONCLUSION: Repair of mitral valve in rheumatic valve disease is feasible with good long-term outcomes. Preoperative pulmonary hypertension, residual mitral valve regurgitation after surgery, age and functional class are predictors of late reoperation.

  17. Mapping of mitral regurgitant defects by cardiovascular magnetic resonance in moderate or severe mitral regurgitation secondary to mitral valve prolapse

    Directory of Open Access Journals (Sweden)

    Raffel Owen C

    2008-04-01

    Full Text Available Abstract Purpose In mitral valve prolapse, determining whether the valve is suitable for surgical repair depends on the location and mechanism of regurgitation. We assessed whether cardiovascular magnetic resonance (CMR could accurately identify prolapsing or flail mitral valve leaflets and regurgitant jet direction in patients with known moderate or severe mitral regurgitation. Methods CMR of the mitral valve was compared with trans-thoracic echocardiography (TTE in 27 patients with chronic moderate to severe mitral regurgitation due to mitral valve prolapse. Contiguous long-axis high temporal resolution CMR cines perpendicular to the valve commissures were obtained across the mitral valve from the medial to lateral annulus. This technique allowed systematic valve inspection and mapping of leaflet prolapse using a 6 segment model. CMR mapping was compared with trans-oesophageal echocardiography (TOE or surgical inspection in 10 patients. Results CMR and TTE agreed on the presence/absence of leaflet abnormality in 53 of 54 (98% leaflets. Prolapse or flail was seen in 36 of 54 mitral valve leaflets examined on TTE. CMR and TTE agreed on the discrimination of prolapse from flail in 33 of 36 (92% leaflets and on the predominant regurgitant jet direction in 26 of the 27 (96% patients. In the 10 patients with TOE or surgical operative findings available, CMR correctly classified presence/absence of segmental abnormality in 49 of 60 (82% leaflet segments. Conclusion Systematic mitral valve assessment using a simple protocol is feasible and could easily be incorporated into CMR studies in patients with mitral regurgitation due to mitral valve prolapse.

  18. Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

    Directory of Open Access Journals (Sweden)

    Preetham R Muskula

    2017-04-01

    Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

  19. Acute Effect of Treatment of Mitral Stenosis on Left Atrium Function

    Science.gov (United States)

    Rohani, Atooshe; Kargar, Shahram; Fazlinejad, Afsoon; Ghaderi, Fereshte; Vakili, Vida; Falsoleiman, Homa; Bagheri, Ramin Khamene

    2017-01-01

    Aim: Peak atrial longitudinal strain (PALS) is used to evaluate left atrium (LA) function in patients with mitral stenosis (MS), before and after percutaneous transmitral commissurotomy (PTMC) and mitral valve replacement (MVR). Methods: Patients with severe symptomatic MS, who were referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery or PTMC from October of 2014 to October of 2015, were included in the study. Result: The peak systolic global LA strain improved post-PTMC (P < 0.001) and post-MVR (P = 0.012). This difference was statistically highly significant. Conclusion: PALS is impaired in patients with severe symptomatic MS and improved acutely after treatment and may be a good indicator of LA function and may predict the right time for intervention on mitral valve. PMID:28074794

  20. Resection of left ventricular fibroma with subacute papillary muscle rupture.

    Science.gov (United States)

    Leja, Monika J; Perryman, Lynda; Reardon, Michael J

    2011-01-01

    Cardiac fibroma is a rare, benign tumor that occurs chiefly in children and rarely in adults. Most fibromas occur in the ventricles and may reach a very large size that complicates surgical removal. Herein, we report the case of a 38-year-old woman who presented with shortness of breath, fatigue, and lightheadedness and was found to have a 6 × 8-cm fibroma of the left ventricle. Surgical resection was successful, but 7 days later she developed sudden-onset severe mitral regurgitation due to partial disruption of the posterolateral papillary muscle. Mitral valve replacement with a 27-mm mechanical valve was performed. Five years later, the patient remained well, without evident tumor recurrence or cardiac dysfunction.Mitral valve dysfunction with regurgitation has been reported to occur before, immediately after, and late after the resection of left ventricular fibromas. To our knowledge, this is the 1st report of subacute papillary muscle rupture after the resection of a left ventricular fibroma. This case highlights the need to evaluate mitral valve function by carefully inspecting the resection margins after surgery and interpreting the echocardiographic results during the acute, subacute, and late time frames.

  1. 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.

  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. 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.

  4. Surgical treatment of functional mitral regurgitation

    NARCIS (Netherlands)

    Braun, Jerry

    2012-01-01

    In this thesis the surgical options for treatment of functional mitral regurgitation (MR) are described. In functional MR, the mitral valve has a normal anatomy, which distinguishes this type of insufficiency from organic MR. Regurgitation in functional MR is related to an abnormal geometry of the l

  5. Achilles Tendon Rupture

    Science.gov (United States)

    Achilles tendon rupture Overview By Mayo Clinic Staff Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back ... but it can happen to anyone. The Achilles tendon is a strong fibrous cord that connects the ...

  6. Post-Earthquake Characterization of Surface Displacements and Spatial Variation of Deformation Kinematics near the Southern End of the Recent West Napa Fault Rupture

    Science.gov (United States)

    Lutz, A. T.; Hitchcock, C. S.; Wade, A. M.

    2014-12-01

    We performed detailed mapping along more than 1.3 km of surface rupture between Cuttings Wharf and CA-12 in order to characterize the location, width, orientation, amount, direction, and kinematics of permanent ground deformation produced in the hours, days, and weeks following the August 24 M6.0 South Napa earthquake. Surface rupture along a 550 m long reach between Middle Ave and South Ave near Los Carneros Ave is expressed as a series of right-stepping, 337° striking intervals roughly 2 to 6 m wide and 30 to 60 m long. The dextral component of displacement produced localized transpressional strain and formed narrow pressure ridges 15 to 20 cm high and 0.5 to 1.5 m wide. Each of these right-stepping reaches are composed of an irregular pattern of smaller scale (0.3 to 8 m long) left-stepping en echelon fractures striking 355° to 030°, with more easterly oriented fractures tending to be longer. In additional to pressure ridges, the deformation field exhibits a broad west-up sense of vertical displacement. Total station survey data from two faulted fence lines indicate 34 ± 4 cm and 30.5 ± 4.5 cm of dextral displacement and 15 ± 4 cm and 12 ± 2 cm of net west-up vertical displacement. The average direction of dextral displacement is 330° ± 5° along this reach. Surface rupture along a 800 m long reach from Las Amigas Road south to Los Carneros Creek is expressed as a series of left-stepping, N20°W striking intervals roughly 1.5 to 4 m wide and 40 to 70 m long. Each of these intervals are composed of a regular pattern of smaller scale (4 to 6 m long) left-stepping en echelon fractures striking 000° to 015°. Multiple measurements indicate a gradual southward decrease in the amount of dextral surface displacement from 12 ± 2 cm near Las Amigas Road to 7.5 ± 1.5 cm near Los Carneros Creek; these dextral displacements are consistently 2 to 3 times larger than co-located net west-up vertical displacements. The dominant direction of dextral displacement is

  7. 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.

  8. Misconceptions and Facts About Mitral Regurgitation.

    Science.gov (United States)

    Argulian, Edgar; Borer, Jeffrey S; Messerli, Franz H

    2016-09-01

    Mitral regurgitation is a common heart valve disease. It is defined to be primary when it results from the pathology of the mitral valve apparatus itself and secondary when it is caused by distortion of the architecture or function of the left ventricle. Although the diagnosis and management of mitral regurgitation rely heavily on echocardiography, one should bear in mind the caveats and shortcomings of such an approach. Clinical decision making commonly focuses on the indications for surgery, but it is complex and mandates precise assessment of the mitral pathology, symptom status of the patient, and ventricular performance (right and left) among other descriptors. It is important for healthcare providers at all levels to be familiar with the clinical picture, diagnosis, disease course, and management of mitral regurgitation.

  9. 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......: Three consecutive patients with an Society of Thoracic Surgeons (STS) mortality score of >22% were selected for transcatheter mitral valve implantation (TMVI) on compassionate grounds. All patients were elderly, had severe mitral regurgitation (MR), were in Class IV heart failure and deemed unsuitable...... bypass surgery (n = 2), severe pulmonary hypertension (n = 1) and moderate to severe chronic renal failure (n = 3). A CardiAQ mitral valve was implanted using fluoroscopy and transoesophageal (TEE) guidance via a standard transapical approach. RESULTS: Accurate prosthesis positioning and deployment...

  10. Double orifice mitral valve: A case report

    Directory of Open Access Journals (Sweden)

    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.

  11. New insights into the surgical treatment of mitral regurgitation

    NARCIS (Netherlands)

    Bouma, Wobbe

    2016-01-01

    New Insights into the Surgical Treatment of Mitral Regurgitation. The mitral valve and mitral valve repair techniques have been subject of extensive research over the past few decades. Mitral valve repair techniques have evolved considerably and have become the gold standard for common conditions su

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

    Science.gov (United States)

    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.

  13. Recurrent stuck mitral valve: eosinophilia an unusual pathology.

    Science.gov (United States)

    Awasthy, Neeraj; Bhat, Yasser; Radhakrishnan, S; Sharma, Rajesh

    2015-03-01

    Eosinophilia is a very unusual and rare cause of thrombosis of prosthetic mitral valve. We report a 10-year-old male child of recurrent stuck prosthetic mitral valve. The child underwent mitral valve replacement for severe mitral regurgitation secondary to Rheumatic heart disease. He had recurrent prosthetic mitral valve thrombosis, despite desired INR levels. There was associated eosinophilia. The child was treated on the lines of tropical eosinophilia with oral prednisolone and diethylcarbamazine, the eosinophil count dropped significantly with no subsequent episode of stuck mitral valve. We discuss the management of recurrent stuck mitral valve and also eosinophilia as a causative factor for the same.

  14. Self-Rupturing Hermetic Valve

    Science.gov (United States)

    Tucker, Curtis E., Jr.; Sherrit, Stewart

    2011-01-01

    For commercial, military, and aerospace applications, low-cost, small, reliable, and lightweight gas and liquid hermetically sealed valves with post initiation on/off capability are highly desirable for pressurized systems. Applications include remote fire suppression, single-use system-pressurization systems, spacecraft propellant systems, and in situ instruments. Current pyrotechnic- activated rupture disk hermetic valves were designed for physically larger systems and are heavy and integrate poorly with portable equipment, aircraft, and small spacecraft and instrument systems. Additionally, current pyrotechnically activated systems impart high g-force shock loads to surrounding components and structures, which increase the risk of damage and can require additional mitigation. The disclosed mechanism addresses the need for producing a hermetically sealed micro-isolation valve for low and high pressure for commercial, aerospace, and spacecraft applications. High-precision electrical discharge machining (EDM) parts allow for the machining of mated parts with gaps less than a thousandth of an inch. These high-precision parts are used to support against pressure and extrusion, a thin hermetically welded diaphragm. This diaphragm ruptures from a pressure differential when the support is removed and/or when the plunger is forced against the diaphragm. With the addition of conventional seals to the plunger and a two-way actuator, a derivative of this design would allow nonhermetic use as an on/off or metering valve after the initial rupturing of the hermetic sealing disk. In addition, in a single-use hermetically sealed isolation valve, the valve can be activated without the use of potential leak-inducing valve body penetrations. One implementation of this technology is a high-pressure, high-flow-rate rupture valve that is self-rupturing, which is advantageous for high-pressure applications such as gas isolation valves. Once initiated, this technology is self

  15. [Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

    Science.gov (United States)

    Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants.

  16. Sapien XT Transcatheter Mitral Valve Replacement Under Direct Vision in the Setting of Significant Mitral Annular Calcification.

    Science.gov (United States)

    Murashita, Takashi; Suri, Rakesh M; Daly, Richard C

    2016-03-01

    Mitral valve replacement carries a high risk in patients with extensive mitral annular calcification. We report the case of a 71-year-old woman with severely calcified mitral valve stenosis and extensive annular calcification. We approached the mitral valve through a left atriotomy using cardiopulmonary bypass and cardiac arrest. We successfully deployed a 29-mm Sapien XT valve under direct visualization with satisfactory positioning. We further balloon-expanded the device to diminish the likelihood of periprosthetic regurgitation. Open mitral valve replacement with a transcatheter valve can be performed without the need for decalcification of the mitral annulus and is a good alternative to conventional mitral valve replacement.

  17. Percutaneous balloon valvuloplasty in mitral stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Oh, Byung Hee; Park, Kyung Ju; Kim, Seung Hyup; Lee, Young Woo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-02-15

    Percutaneous balloon valvuloplasty(PBV) was successfully performed in 8 mitral stenosis patients for recent 3 months. Five patients have aortic insufficiencies also and two patients have mitral regurgitations below grade II/IV. All patients showed sinus rhythm on EKG, and had no mitral valvular calcification on echocardiography and fluoroscopy. PBV resulted in an increase in mitral valve area from 1.22{+-}0.22 to 2.57{+-}0.86 cm{sup 2}, a decrease in mean left atrial pressure from 23.4{+-}9.6 to 7.5{+-}3.4 mmHg and a decrease in mean mitral pressure gradient from 21.3{+-}9.4 to 6.8{+-}3.1 mmHg. There were no significant complications except 2 cases of newly appeared and mildly aggravated mitral regurgitation. We believe that PBV will become a treatment modality of choice replacing surgical commissurotomy or valve replacement in a group of mitral stenosis patients, because of its effectiveness and safety.

  18. Traumatic Mitral Valve and Pericardial Injury

    Directory of Open Access Journals (Sweden)

    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.

  19. Quadriceps tendon rupture - treatment results

    Directory of Open Access Journals (Sweden)

    Popov Iva

    2013-01-01

    Full Text Available Introduction. Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. Material and Methods. This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men. Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic, various surgical techniques, type of injuries (unilateral or bilateral as well as the presence or absence of comorbid risk factors in the patients. Results. The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. Discussion and Conclusion. Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.

  20. A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report

    Directory of Open Access Journals (Sweden)

    Stephen JO

    2009-11-01

    Full Text Available Abstract An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal. This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.

  1. A novel mathematical technique to assess of the mitral valve dynamics based on echocardiography

    CERN Document Server

    Karvandi, Mersedeh; Hassantash, Seyed Ahmad; Foroughi, Mahnoosh

    2015-01-01

    Purpose: The mechanics of the mitral valve leaflet as a nonlinear, inelastic and anisotropic soft tissue results from an integrated response of many mathematical/physical indexes' that illustrate the tissue. In the past decade, finite element modeling of complete heart valves has greatly aided evaluation of heart valve surgery, design of bioprosthetic valve replacements, and general understanding of healthy and abnormal cardiac function. Such a model must be based on an accurate description of the mechanical behavior of the valve material. It is essential to calculate velocity/displacement and strain rate/strain at a component level that is to work at the cellular level. In this study we developed the first three-dimensional displacement vectors field in the characterization of mitral valve leaflets in continuum equations of inelasticity framework based on echocardiography. Method: Much of our knowledge of abnormal mitral valve function is based on surgical and post-mortem studies while these studies are quan...

  2. Mitral Valve Replacement with Half-and-Half Technique for Recurrent Mitral Paravalvular Leakage.

    Science.gov (United States)

    Morisaki, Akimasa; Kato, Yasuyuki; Takahashi, Yosuke; Shibata, Toshihiko

    2015-05-01

    Reoperation for paravalvular leakage can cause recurrent paravalvular leakage through severe damage to the mitral annulus. Previously, mitral valve replacement using a half-and-half technique for extensive mitral annular calcification was reported; here, application of the technique to treat recurrent paravalvular leakage is described. A 78-year-old male with three prior mitral valve replacements developed recurrent paravalvular leakage, for which he had undergone his third mitral valve replacement at the age of 69 years. On this occasion, a mechanical valve with circumferential equine pericardial patch reinforcement of the annulus had been used. Five years later, the patient developed hemolytic anemia and congestive heart failure due to recurrent paravalvular leakage. Intraoperatively, broad dehiscence was seen between the prosthetic valve and mitral annulus at two sites, the anterior and posterior commissures, without infection. A fourth mitral valve replacement was performed with a St. Jude Medical valve, using a half-and-half technique. This entailed the use of non-everting mattress sutures on the anterior half of the annulus, and everting mattress sutures on the left atrial wall around the posterior half of the annulus. Extensive annular defects required reinforcement of the posterior mitral annulus with a bovine pericardial patch. Postoperative echocardiography showed no paravalvular leakage. The half-and-half technique may be useful in treating recurrent paravalvular leakage of the mitral valve.

  3. Mitral Valve Replacement with a Mechanical Valve for Severe Mitral Regurgitation in a Small Dog

    Directory of Open Access Journals (Sweden)

    Daisuke Taguchi

    2014-01-01

    Full Text Available A seven-year-old Shih Tzu with refractory repeated pulmonary edema and syncope was presented for surgical operation. From the results of cardiovascular examinations, the dog was diagnosed as severe mitral regurgitation (ACVIM consensus class D and mild tricuspid regurgitation. The dog first underwent surgery with mitral valve plasty; however, the results were unsatisfactory due to severe damage of the whole mitral valve. The operation was quickly changed to mitral valve replacement using a mechanical valve (19 mm. The dog survived surgery and lived for 2 years and one month after operation using long-term anticoagulant (warfarin therapy in spite of several thrombosis-related events.

  4. Transapical Mitral Valve Replacement for Mixed Native Mitral Stenosis and Regurgitation.

    Science.gov (United States)

    Bedzra, Edo; Don, Creighton W; Reisman, Mark; Aldea, Gabriel S

    2016-08-01

    A 71-year-old man presented with New York Heart Association (NYHA) class IV heart failure. He had undergone transapical mitral valve replacement for mixed mitral stenosis and mitral regurgitation. At the 1 month follow-up, the patient reported symptom resolution. An echocardiogram revealed a low gradient and no regurgitation. Our case shows that with careful multidisciplinary evaluation, preoperative planning, and patient selection, percutaneous mitral intervention can become an alternative therapy for high-risk patients who cannot undergo conventional surgical therapy.

  5. Tromboflebitis del miembro inferior postruptura de implante de silicona para aumento de pantorrillas Lower limb trombophlebitis post-rupture of silicone calf augmentation implant

    Directory of Open Access Journals (Sweden)

    E. A. Moretti

    2007-09-01

    Full Text Available La colocación de implantes de silicona en los miembros inferiores con el objetivo de embellecimiento es una práctica no exenta de complicaciones. La mayoría de ellas se describen en el postoperatorio inmediato y están relacionadas con procesos infecciosos. Las complicaciones de tipo fibrosis capsular no son motivo frecuente de queja, como acontece en la región mamaria, ya que dicho endurecimiento no preocupa al paciente. Por lo tanto, las complicaciones tardías de este procedimiento no son descritas con gran frecuencia. Presentamos un caso de una paciente de 44 años que se había sometido a una cirugía de colocación de implantes de gel de silicona para corrección de la zona de los gastrocnemios 8 años antes y que debuta con tromboflebitis de miembro inferior y rotura espontánea del implante. Se describe el caso clínico, los estudios efectuados y el tratamiento instituido en esta complicación.Correction of lower limbs for cosmetic purpose with silicone implants is not a practice free of com- plications. Most of them are described in the inme- diate postoperative and are related to infections. The capsular contraction is not a frecuent cause of com- plaint because the hardness does not worry the patients. That is the reason why later complicatones are not frecuently described. We present a 44 years old female patient with sili- cone calf implants that had been operated 8 years ago. She consulted because of lower limb trombophlebitis and spontaneous rupture of the implant. We described the clinical case, study procedures and treatment to resolve this complication.

  6. 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 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...... (n = 562), and all-cause mortality rates were assessed. RESULTS: Among the 87,432 twins alive January 1, 1977, or later, 494 (0.57%) MR individuals were identified. Six MR concordant pairs were found, of which 3 were monozygotic. Proband-wise concordance rate when accounting for right censoring...

  7. Ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  8. Tenecteplase in prosthetic mitral valve thrombosis

    OpenAIRE

    2010-01-01

    In the few reported cases of prosthetic mitral valve thrombosis, where surgical intervention was considered as high risk, fibrinolytic therapy had proved life saving. The authors present clinical, laboratory, and imaging data from such a patient, with prosthetic mitral valve thrombosis and its successful management with tenecteplase. The use of tenecteplase as a viable fibrinolytic agent for the first time was justified, due to the lack of immunogenicity concerns compared to streptokinase.

  9. Tenecteplase in prosthetic mitral valve thrombosis.

    Science.gov (United States)

    Ayyub Ghori, Masood; Bakir, Sherif; Ellahham, Samer; Al Nassir, Adnan; Al Zubaidi, Abdulmajeed; Augustin, Norbert; Abdelaziz, Moataz Ayman; Turrin, Nicolas Patrick; Al Mahmeed, Wael Abdulrahman

    2011-04-01

    In the few reported cases of prosthetic mitral valve thrombosis, where surgical intervention was considered as high risk, fibrinolytic therapy had proved life saving. The authors present clinical, laboratory, and imaging data from such a patient, with prosthetic mitral valve thrombosis and its successful management with tenecteplase. The use of tenecteplase as a viable fibrinolytic agent for the first time was justified, due to the lack of immunogenicity concerns compared to streptokinase.

  10. DIAGNOSTICS AND TREATMENT OF MITRAL VALVE PROLAPSE

    Directory of Open Access Journals (Sweden)

    D. A. Kuzhel

    2010-01-01

    Full Text Available The mitral valve prolapse (MVP is one of the most inconsistent diagnose. In the most cases patients with MVP have the good long-term prognosis, and therapy is aimed at reduction in psychovegetative dysfunction. Careful follow-up and timely cardiosurgical correction should be performed, if necessary, in patients with classical MPV. The choice method in these cases is the mitral valve plasty.

  11. Single-centre experience with mitral valve repair in asymptomatic patients with severe mitral valve regurgitation

    NARCIS (Netherlands)

    W.J. van Leeuwen (Wouter); S.J. Head (Stuart); L.E. de Groot-de Laat (Lotte); M.L. Geleijnse (Marcel); A.J.J.C. Bogers (Ad); L.A. van Herwerden (Lex); A.P. Kappetein (Arie Pieter)

    2013-01-01

    textabstractOBJECTIVES: Guidelines recommend surgical mitral valve repair in selected patients with asymptomatic severe mitral valve regurgitation (MR), but the role of repair remains a matter of debate. Survival analyses of operated asymptomatic patients have been reported, but long-term haemodynam

  12. Mitral isthmus ablation in patients with prosthetic mitral valves

    Institute of Scientific and Technical Information of China (English)

    LONG De-yong; MA Chang-sheng; JIANG Hong; DONG Jian-zeng; LIU Xing-peng; HUANG He; TANG Yan-hong; WU Gang; HUANG Cong-xin

    2010-01-01

    Background Previous studies have investigated the technique of linear ablation at the mitral isthmus (MI) in patients with idopathic atrial fibrillation (AF), but MI ablation in patients with prosthetic natural mitral valves (MVs) was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium (LA) mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan.Results During the study period, a consecutive of 19 patients (male/female=12/7, mean age of (48±-6) years) with prosthetic MVs (16 with metal valves, 3 with biologic valves) entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages ((2.0±1.0) vs. (3.1±1.3) mV, P=0.002), more fragmented potentials (19/19 vs. 20/15, P<0.001 ), and higher impedance ((132±34) vs. (110±20) Ω, P=0.004). After initial ablation, more residual gaps along the MI lesions were found in study group (2.4±0.4 vs. 1.7±0.3, P <0.001). The mean length of MI ((6.2±3.3) vs. (7.1±2.3) cm, P=0.25) was comparable between 2 groups, but the MI in study group was much thicker ((3.1 ±1.8) vs. (2.1±1.07) cm, P=0.01 ) and all were found as pouch type (19/19 vs. 2/35, P <0.001). The follow-up results were comparable (65.1% vs. 72.3%, P=0.30).Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.

  13. Biological Glue Application in Repair of Atrioventricular Groove Rupture: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmet Baris-Durukan

    2015-10-01

    Full Text Available Atrioventricular groove rupture is a rare, albeit mortal, complication following mitral valve surgery. Avoidance is the best strategy but it cannot fully prevent the occurrence of this complication. Several repair techniques have been described with varying success rates; however, the rarity of the complication precludes consensus about the safest technique.Here we report two cases of posterior atrioventricular groove rupture. Both cases were diagnosed immediately after the cessation of cardiopulmonary bypass. Repair was performed successfully with a technique involving the use of biological glue. The postoperative course was uneventful for both of them. Both cases are well with normally functioning mitral prostheses; one with a follow-up time of 5.5 years and the other 10 months. We believe that the glue provides additional hemostasis and support to the repaired area.

  14. New Research Results on Mechanism, Surface Rupture, Deep Controlling Factors and Stress Measurements of the Wenchuan Earthquake-Earth Scientists' Post-quake Actions

    Institute of Scientific and Technical Information of China (English)

    DONG Shuwen

    2009-01-01

    @@ It has been a year since the devastating Wenchuan earthquake struck Sichuan Province, China on May 12, 2008, which caused tremendous casualties, geological disasters and economic losses. With a deep feeling of grief at the sight of the shattered world in quake-stricken areas, geologists and geophysicists once again profoundly felt their heavy responsibilities for geo-hazard prevention and reduction, and resolved to make their due contributions--what we, as scientists, could do for the quake relief efforts and post-quake reconstruction and what scientific explanations we could offer to the public for the occurrence of the devastating natural disaster.

  15. Anterior Mitral Leaflet Augmentation for Ischemic Mitral Regurgitation Performed Via a Right Thoracotomy Approach.

    Science.gov (United States)

    Mihos, Christos G; Pineda, Andres M; Horvath, Sofia A; Santana, Orlando

    2016-01-01

    Ischemic mitral regurgitation (MR) after myocardial infarction is associated with poor long-term survival, and the optimal treatment strategy remains debated. The most common repair technique used is a restrictive annuloplasty. However, up to 15% to 30% of patients experience recurrent MR owing to progressive left ventricular remodeling and geometric distortion of the mitral valve apparatus. Anterior mitral leaflet augmentation using a pericardial patch, in combination with a true-sized mitral annuloplasty, has been proposed as an adjunctive technique to increase the durability of valve repair for ischemic MR. Herein, we describe 2 cases of anterior mitral leaflet augmentation with annuloplasty repair for severe ischemic MR via a minimally invasive right thoracotomy, and review the literature regarding patient selection and clinical outcomes of this technique.

  16. Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: Pathophysiology of hemodynamic collapse and peri-operative management issues

    Directory of Open Access Journals (Sweden)

    Praveen Reddy Bayya

    2014-01-01

    Full Text Available Severe mitral regurgitation (MR following balloon mitral valvotomy (BMV needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV.

  17. Pathological rupture of malarial spleen.

    Directory of Open Access Journals (Sweden)

    Mokashi A

    1992-07-01

    Full Text Available Two cases of spontaneous rupture of malarial spleen are reported here. One of them was a male who was on chloroquine for an acute attack of malaria. While on therapy, he complained of pain in left hypochondrium followed by palpitations. The other patient was a female who was admitted for continuous dull aching pain and fever. In both the patients, exploratory laparotomy revealed an enlarged spleen with tear. Splenectomy was performed. Histopathological examination revealed dilated congested sinusoid with follicular atrophy, and RBCs with malarial parasites. The post-operative course was smooth in both patients.

  18. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Rengin etin Guven; Tolga Sinan G uven

    2016-01-01

    Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiog-raphy is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompa-nied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with sub-sequent surgical intervention to repair or replace the valve.

  19. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rengin Çetin Güvenç

    2016-03-01

    Full Text Available Acute mitral regurgitation (MR is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

  20. Initial experience of percutaneous treatment of mitral regurgitation with MitraClip® therapy in Spain.

    Science.gov (United States)

    Carrasco-Chinchilla, Fernando; Arzamendi, Dabit; Romero, Miguel; Gimeno de Carlos, Federico; Alonso-Briales, Juan Horacio; Li, Chi-Hion; Mesa, Maria Dolores; Arnold, Roman; Serrador Frutos, Ana María; Pan, Manuel; Roig, Eulalia; Rodríguez-Bailón, Isabel; de la Fuente Galán, Luis; Hernández, José María; Serra, Antonio; Suárez de Lezo, José

    2014-12-01

    Symptomatic mitral regurgitation has an unfavorable prognosis unless treated by surgery. However, the European registry of valvular heart disease reports that 49% of patients with this condition do not undergo surgery. Percutaneous treatment of mitral regurgitation with MitraClip® has been proved a safe, efficient adjunct to medical treatment in patients with this profile. The objective of the present study is to describe initial experience of MitraClip® therapy in Spain. Retrospective observational study including all patients treated between November 2011 and July 2013 at the 4 Spanish hospitals recording the highest numbers of implantations. A total of 62 patients (77.4% men) were treated, mainly for restrictive functional mitral regurgitation (85.4%) of grade III (37%) or grade IV (63%), mean (standard deviation) ejection fraction 36% (14%), and New York Heart Association functional class III (37%) or IV (63%). Device implantation was successful in 98% of the patients. At 1 year, 81.2% had mitral regurgitation ≤ 2 and 90.9% were in New York Heart Association functional class ≤ II. One periprocedural death occurred (sepsis at 20 days post-implantation) and another 3 patients died during follow-up (mean, 9.1 months). Two patients needed a second implantation due to partial dehiscence of the first device and 2 others underwent heart transplantation. In Spain, MitraClip® therapy has principally been aimed at patients with functional mitral regurgitation, significant systolic ventricular dysfunction, and high surgical risk. It is considered a safe alternative treatment, which can reduce mitral regurgitation and improve functional capacity. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  1. Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence

    Directory of Open Access Journals (Sweden)

    McLenachan Jim

    2006-10-01

    Full Text Available Abstract A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event.

  2. Complete rupture of the anterolateral papillary muscle caused by coronary spasm.

    Science.gov (United States)

    Yamazaki, Masataka; Fukui, Toshihiro; Mahara, Keitaro; Takanashi, Shuichiro

    2015-12-01

    Papillary muscle rupture usually occurs as a catastrophic complication of acute myocardial infarction in patients with coronary artery stenosis; it is therefore less common in patients without coronary artery stenosis. We report the case of a 67-year old woman without coronary artery stenosis who suffered an acute anterolateral papillary muscle rupture and was successfully treated with mitral valve replacement. Evidence of coronary spasm was found on a coronary vasomotion test, suggesting that a high sensitivity to coronary spasm may explain a mechanism of isolated papillary muscle infarction.

  3. Exuberant accessory mitral valve tissue with possible true parachute mitral valve: a case report

    Directory of Open Access Journals (Sweden)

    Nikolic Aleksandra

    2012-09-01

    Full Text Available Abstract Introduction A parachute mitral valve is defined as a unifocal attachment of mitral valve chordae tendineae independent of the number of papillary muscles. Data from the literature suggests that the valve can be distinguished on the basis of morphological features as either a parachute-like asymmetrical mitral valve or a true parachute mitral valve. A parachute-like asymmetrical mitral valve has two papillary muscles; one is elongated and located higher in the left ventricle. A true parachute mitral valve has a single papillary muscle that receives all chordae, as was present in our patient. Patients with parachute mitral valves during childhood have multilevel left-side heart obstructions, with poor outcomes without operative treatment. The finding of a parachute mitral valve in an adult patient is extremely rare, especially as an isolated lesion. In adults, the unifocal attachment of the chordae results in a slightly restricted valve opening and, more frequently, valvular regurgitation. Case presentation A 40-year-old Caucasian female patient was admitted to a primary care physician due to her recent symptoms of heart palpitation and chest discomfort on effort. Transthoracic echocardiography showed chordae tendineae which were elongated and formed an unusual net shape penetrating into left ventricle cavity. The parasternal short axis view of her left ventricle showed a single papillary muscle positioned on one side in the posteromedial commissure receiving all chordae. Her mitral valve orifice was slightly eccentric and the chordae were converting into a single papillary muscle. Mitral regurgitation was present and it was graded as moderate to severe. Her left atrium was enlarged. There were no signs of mitral stenosis or a subvalvular ring. She did not have a bicuspid aortic valve or coarctation of the ascending aorta. The dimensions and systolic function of her left ventricle were normal. Our patient had a normal body habitus

  4. Unusual redo mitral valve replacement for bleeding in Glanzmann thrombasthenia.

    Science.gov (United States)

    Garcia-Villarreal, Ovidio A; Fernández-Ceseña, Ernesto; Solano-Ricardi, Mercedes; Aguilar-García, Alma L; Vega-Hernández, Raquel; Del Angel-Soto, Gustavo

    2016-01-01

    We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

  5. Acute severe mitral regurgitation. Pathophysiology, clinical recognition, and management.

    Science.gov (United States)

    DePace, N L; Nestico, P F; Morganroth, J

    1985-02-01

    Acute severe mitral regurgitation often goes unrecognized as an emergency requiring prompt, lifesaving treatment. Its causes, physical signs, natural history, echocardiographic features, and findings on chest roentgenography, electrocardiography, and nuclear scintigraphic scanning are reviewed. Acute severe mitral insufficiency can be differentiated from chronic severe mitral insufficiency by noninvasive two-dimensional echocardiography. M-mode echocardiography is a valuable tool in evaluating mitral prosthetic paravalvular regurgitation.

  6. A comparison of hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve repair / replacement for severe mitral stenosis

    Directory of Open Access Journals (Sweden)

    Ravikumar Gandham

    2013-01-01

    Full Text Available Aims and Objectives: We aimed to compare the hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve surgery on cardiopulmonary bypass (CPB. Materials and Methods: Sixty patients were divided into 2 groups of 30 each. Group-L patients received levosimendan 0.1 μg/kg/min and Group-D patients received dobutamine 5 μg/kg/min while weaning off CPB. Additional inotrope and/or vasoconstrictor were started based on hemodynamic parameters. Hemodynamic data were collected at the end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours post-CPB. Mean arterial pressure (MAP, central venous pressure (CVP, heart rate (HR, cardiac index (CI, systemic vascular resistance index (SVRI, and lactate levels were measured. Results: Group-L showed increased requirement of inotropes and vasoconstrictors. The SVRI, CVP, and MAP were reduced more in Group-L. The CI was low in Group-L in the initial period when compared to Group-D. Later Group-L patients showed a statistically significant increase in CI even after 12 hrs of discontinuation of levosimendan infusion. The HR was increased more in Group-D. Lactate levels, intensive care unit stay, and duration of ventilation were similar in both groups. Conclusions: Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation and lesser inotropic activity in patients undergoing mitral valve surgery for mitral stenosis. Levosimendan compared to dobutamine showed a statistically significant increase in CI even after 12 hrs of discontinuation. The requirement of another inotrope or vasopressor was frequent in levosimendan group.

  7. [Mitral surgery by superior biatrial septotomy].

    Science.gov (United States)

    Saade, A; Delepine, G; Lemaitre, C; Baehrel, B

    1995-01-01

    The superior biatrial septotomy approach consists of two semicircular right atrial and septal incisions joined at the superior end of the interatrial septum and extended across the dome of the left atrium, allowing exposure of the mitral valve by reflecting the ventricular side using stay sutures. From 1991 to 1993, 81 patients underwent mitral valve surgery by this technic. Mitral valve operation was combined with other cardiac procedures in 30 patients (37%) and was performed as a second operation in 21 patients (25.9%). Duration of cardiopulmonary bypass and aortic occlusion was not significantly different from that of patients operated via a conventional left atrial approach. The five hospital deaths (6.2%) were not related to this operative approach. Only 2 patients (3.3%) with preoperative in sinus rythm were discharged in atrial fibrillation after operation. In one patient (1.6%), atrioventricular block appeared at late follow-up. There were no cases of bleeding, atrioventricular nodal dysfunction or intra-atrial shunting related to the approach. This approach provides excellent exposure of the mitral valve even in unfavorable situations such as a small left atrium, dense adhesions from previous procedures or a previously implanted aortic prosthesis, without damage to various cardiac structures due to excessive traction. No retractor or vena cava repair are required. These data support a wide application of the superior biatrial septotomy approach in mitral valve surgery.

  8. Autotransplante de cordas tendíneas: nova técnica para o tratamento cirúrgico da insuficiência mitral por rotura de cordas tendíneas da cúspide anterior Allotransplantation of chordae tendineae: new technique for the surgical approach of mitral insufficiency

    Directory of Open Access Journals (Sweden)

    Francisco Gregori Jr

    1992-12-01

    Full Text Available Uma das causas mais freqüentes de prolapso valvar mitral, com conseqüente regurgitação, é a rotura de cordas tendíneas. Várias técnicas têm sido empregadas em tal situação. Entretanto, a substituição valvar mitral tem sido o procedimento mais utilizado. E apresentada uma nova técnica cirúrgica empregada em 4 pacientes com insuficiência valvar mitral severa devido a rotura de cordas tendíneas da cúspide anterior da valva mitral. Um autotransplante de cordas da valva tricúspide para a valva mitral é realizado. Em 2 casos, um retalho é retirado da cúspide anterior da valva tricúspide com cordas tendíneas e parte do músculo papilar correspondente. Nos outros 2 casos a cúspide posterior da valva tricúspide foi retirada, inteiramente, com cordas e músculo papilar. Na primeira variante técnica, a cúspide anterior da valva tricúspide foi reparada e, na segunda, através, da plicatura do anel, a valva tricúspide foi transformada em bicúspide. A peça retirada é transplantada para a valva mitral, sendo suturada a cúspide doadora com a cúspide anterior da valva mitral e o músculo papilar doador com o topo do músculo papilar posterior da valva mitral em 3 casos e com o músculo papilar anterior e 1 caso. Os 4 pacientes foram reestudados clínica e laboratorialmente aos 15, 11, 2 e 1 mês de pós-operatório, respectivamente, com execelente evolução. Apesar da limitada experiência, acreditamos ser esta nova técnica uma boa alternativa para o tratamento cirúrgico da insuficiência mitral por rotura de cordas tendíneas da cúspide anterior.One of the most frequent causes of mitral valve prolapse is rupture of the chordae tendineae. Several techniques have been used to correct severe mitral regurgitation. However, mitral valve replacement is the principal surgical approach to it. We describe a technique used in four patients with marked mitral regurgitation due to ruptured chordae tendineae of the anterior leaflet. We

  9. Mitral Valve Regurgitation Causing Right Upper Lobe Pulmonary Edema

    OpenAIRE

    Young, Andrew L.; Langston, Charles S.; Schiffman, Robert L.; Shortsleeve, Michael J.

    2001-01-01

    When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.

  10. [Exceptional iatrogenic ureteral rupture].

    Science.gov (United States)

    Martínez-Vieira, Almudena; Valera-Sánchez, Zoraida; Sousa-Vaquero, José María; Palacios-González, Carmen; García-Poley, Antonio; Bernal-Bellido, Carmen; Alamo-Martínez, José María; Millán-López, Ana; Blanco-Domínguez, Manuel; Galindo-Galindo, Antonio

    2005-08-01

    Rupture of the ureter is an infrequent event that can have serious consequences. The most frequent cause is surgical iatrogenic ureter disease. Other possible causes are urological procedures and urographic studies. In our patient, which, to our knowledge, is the first to be reported in the literature, the ureteral rupture was produced by a traumatic urinary catheterism, because the balloon was filled inside the ureter. The normal presentation is nephritic colic, although acute abdomen is also a possibility. The possibility of ureteral rupture in abdominopelvic surgery or in urological techniques should be evaluated when patients present these clinical symptoms. Treatment is surgical, although in some cases conservative measures can be used.

  11. Aortic and Mitral Valve Replacement Through a Single Transverse Aortotomy: A Useful Approach in Difficult Mitral Valve Exposure

    OpenAIRE

    Carmichael, Michael J.; Cooley, Denton A.; Favor, Arsenio S.

    1983-01-01

    Replacement of the mitral valve through a standard vertical left atriotomy in patients requiring both aortic and mitral valve replacement can be very difficult. This is especially true in patients who have undergone previous median sternotomy. Replacement of the mitral valve through the aortic root after excision of the aortic valve is described in two case reports. This is a convenient approach when traditional exposure of the mitral valve is impractical in patients requiring double valve re...

  12. [Interventional mitral valve replacement. Current status].

    Science.gov (United States)

    Lutter, G; Frank, D

    2016-02-01

    Approximately 30 % of patients suffering from severe valvular heart disease, such as mitral valve regurgitation are non-compliant to the gold standard of minimally invasive surgery, reconstruction or valve replacement. The number of these mostly old patients with severe comorbidities is increasing; therefore, transcatheter interventions have been developed to address an unmet clinical need and may be an alternative therapeutic option to the reference standard. Apart from the successful MitraClip therapy, alternative transcatheter reconstruction technologies are being developed. As with transcatheter aortic valve implantation (TAVI) procedures, the off-pump implantation of a valved stent into the mitral position mainly via a transapical approach will be of great benefit. Recently, the feasibility of transcatheter mitral valved stent implantation in high-risk patients has already been reported.

  13. Surgical Treatment of Congenital Mitral Valve Dysplasia.

    Science.gov (United States)

    Vida, Vladimiro L; Carrozzini, Massimiliano; Padalino, Massimo; Milanesi, Ornella; Stellin, Giovanni

    2016-05-01

    Congenital mitral valve (MV) dysplasia is a relatively rare and highly complex cardiac disease. We present our results and illustrate the techniques used to repair these valves. Between 1972 and 2014, 100 consecutive patients underwent surgical repair of congenital MV dysplasia at our institution. Predominant MV regurgitation was present in 53 patients (53%) whereas mitral stenosis was prevalent in 47 (47%). There were five early (5%) and eight late deaths (9%). Actuarial survival was 95%, 94%, and 93% at 5, 10, and 20 years, respectively. Sixteen patients (18%) required reintervention due to subsequent MV dysfunction. Actuarial freedom from reintervention for MV dysfunction was 95%, 92%, and 89% at 5, 10, and 20 years, respectively. The mechanism underlying the valve dysfunction in congenital mitral valve dysplasia is multifactorial and requires the application of a variety of surgical techniques for repair. doi: 10.1111/jocs.12743 (J Card Surg 2016;31:352-356). © 2016 Wiley Periodicals, Inc.

  14. Acute mitral regurgitation in Takotsubo cardiomyopathy.

    Science.gov (United States)

    Bouabdallaoui, Nadia; Wang, Zhen; Lecomte, Milena; Ennezat, Pierre V; Blanchard, Didier

    2015-04-01

    Takotsubo cardiomyopathy (TTC) is a well-recognised entity that commonly manifests with chest pain, ST segment abnormalities and transient left ventricular apical ballooning without coronary artery obstructive disease. This syndrome usually portends a favourable outcome. In the rare haemodynamically unstable TTC patients, acute mitral regurgitation (MR) related to systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) is to be considered. Bedside echocardiography is key in recognition of this latter condition as vasodilators, inotropic agents or intra-aortic balloon counter-pulsation worsen the patient's clinical status. We discuss here a case of TTC where nitrate-induced subaortic obstruction and mitral regurgitation led to haemodynamic instability.

  15. Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo Renda; Martins, Wendell Santos; de Araújo e Sá, Frederico Browne Correia; Lustosa, Pablo César; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

    2012-12-01

    Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with 95% confidence interval and P-values (that will be considered statistically significant when mitral valve replacement preservation and 1917 for mitral valve replacement non-preservation). There was significant difference between mitral valve replacement preservation and mitral valve replacement non-preservation groups in the risk of 30-day mortality (OR 0.418, P mitral valve apparatus during mitral valve replacement.

  16. Ruptured episiotomia resutured primarily.

    Science.gov (United States)

    Monberg, J; Hammen, S

    1987-01-01

    In a randomized study, 35 patients with ruptured episiotomy were treated in two ways. One group, treated with Clindamycin and primary resuture, did better than the other group, not resutured but spontaneously healed.

  17. Achilles tendon rupture - aftercare

    Science.gov (United States)

    Heel cord tear; Calcaneal tendon rupture ... MRI scan to see what type of Achilles tendon tear you have. An MRI is a type ... partial tear means at least some of the tendon is still OK. A full tear means your ...

  18. Spontaneous uterine rupture

    African Journals Online (AJOL)

    After ultrasound scan, uterine rupture was diagnosed and an ... delivery. The birth weights ranged between 2900 and 3200g. The last 2 .... abdominal pains and signs of shock, at which made up of altered blood and we think that the.

  19. Distal Biceps Tendon Rupture

    Science.gov (United States)

    2010-06-01

    distal tendon . Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows...Distal Biceps Tendon Rupture Military Medicine Radiology Corner, 2006 Radiology Corner Distal Biceps Tendon Rupture Contributors: CPT Michael

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  2. Undersized annuloplasty for functional mitral regurgitation: is it responsible for clinically relevant mitral stenosis during exercise?

    Science.gov (United States)

    Grimaldi, Antonio; De Bonis, Michele; Pappalardo, Federico; Taramasso, Maurizio; Verzini, Alessandro; Calabrese, Maria Chiara; Maisano, Francesco; Alfieri, Ottavio

    2012-07-01

    The study aim was to assess if an undersized mitral annuloplasty for functional mitral regurgitation (FMR) in dilated cardiomyopathy can determine a clinically relevant mitral stenosis during exercise. Both, rest and stress echocardiography were performed in 12 patients submitted to an undersized ring annuloplasty for FMR in dilated cardiomyopathy. The mean ring size was 27 +/- 1.3 mm. All patients were in NYHA functional classes I-II, were in stable sinus rhythm, and without significant residual mitral regurgitation (grade stroke volume (63 +/- 15 versus 77 +/- 14 ml, p FMR. Stress echocardiography represents a valuable tool to assess an appropriate cardiac response to exercise and to detect a significant exercise-induced pulmonary hypertension after undersized annuloplasty ring surgery.

  3. 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.

  4. Mitral valve repair and redo repair for mitral regurgitation in a heart transplant recipient

    Directory of Open Access Journals (Sweden)

    Bouma Wobbe

    2012-09-01

    Full Text Available Abstract A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation may not only improve the patient’s functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts.

  5. RESEARCH ON REDUCING PREMATURITY RUPTURE OF MEMBRANE

    Directory of Open Access Journals (Sweden)

    Maria URSACHI (BOLOTA

    2016-12-01

    -term (3 days and distance (2 years interventional methods applied; clinical investigation of complications arising post intervention; studying behavior synthetic amnion. Conclusions: The cause of PRAS is multifactorial. Traditionally, fetal membrane rupture has been attributed to increased physical stress, which weakens the membranes. At the molecular level PRAS is the result of reducing collagen synthesis, alteration of the structure of collagen to accelerate degradation. In addition, these biochemical changes can be amplified and biophysical stress today. The priorities of this research include elucidation of the normal biological process of fetal membranes, including extracellular matrix remodeling, apoptosis.

  6. Predictors of Developing Significant Mitral Regurgitation Following Percutaneous Mitral Commissurotomy with Inoue Balloon Technique

    Directory of Open Access Journals (Sweden)

    Abdelfatah A. Elasfar

    2011-01-01

    Full Text Available Background. Despite the high technical expertise in percutaneous mitral commissurotomy (PMC, mitral regurgitation (MR remains a major procedure-related complication. The aim of this work is to find out the most sensitive and applicable predictors of development of significant mitral regurgitation (SMR following percutaneous mitral commissurotomy using Inoue balloon technique. Methods. We studied prospectively the preprocedural (clinical, echocardiography, and hemodynamic and procedural predictors of significant mitral regurgitation (identified as increase of ≥2/4 grades of pre-PMC MR by color Doppler flow mapping following valvuloplasty using Inoue balloon in 108 consecutive patients with severe mitral stenosis. Multiple stepwise logistic regression analysis was performed for variables found positive on univariate analysis to determine the most important predictor(s of developing SMR. Results. The incidence of SMR following PMC using Inoue technique was 18.5% (10 patients. MV scoring systems were the only variables that showed significant differences between both groups (Group A without SMR and Group B with SMR. However, no clinical, other echocardiographic measurements, hemodynamic or procedural variables could predict the development of SMR. Using multiple regression analysis, the best predictive factor for the risk of SMR after Inoue BMV was the total MR-echo score with a cutoff point of 7 and a predictive percentage of 97.7%. Conclusions. The total MR-echo score is the only independent predictor of SMR following PMC using Inoue technique with a cutoff point of 7.

  7. 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.

  8. [Successful mitral valve replacement in a patient with functional mitral regurgitation induced by cardiac sarcoidosis;report of a case].

    Science.gov (United States)

    Sato, Ken; Takazawa, Ippei; Aizawa, Kei; Misawa, Yoshio

    2015-03-01

    We report a case of cardiac sarcoidosis associated with mitral valve regurgitation. A 62-year-old woman with cardiac sarcoidosis was admitted for the treatment of an intractable mitral regurgitation. She had been treated for cardiac sarcoidosis with prednisolone, and she had undergone pacemaker implantation because of advanced complete A-V block 5 years before. However, her hemodynamics deteriorated, and echocardiography revealed severe functional mitral regurgitation, thinning of the ventricular septum, and left ventricular dysfunction. The patient underwent mitral valve replacement with a mechanical prosthetic valve, and her postoperative course was uneventful. She is currently well without exacerbation of heart failure at 2 years after operation. Functional mitral regurgitation is a relatively common complication in patients with cardiac sarcoidosis. Mitral valve replacement should be considered in patients with medically intractable mitral valve dysfunction due to cardiac sarcoidosis.

  9. Echocardiographic Assessment of Mantle Radiation Mitral Stenosis.

    Science.gov (United States)

    Bastiaenen, Rachel; Sneddon, James; Sharma, Rajan

    2016-02-01

    The long-term sequelae of mantle radiotherapy include lung disease and cardiac disorders. Dyspnea on exertion is a common complaint and can be due to one or more pathologies. We describe a case of mantle radiotherapy-induced mitral stenosis, characterized by aorto-mitral continuity calcification and absent commissural fusion which precludes balloon valvotomy. The latency period is long, and this patient presented 42 years after radiotherapy. Importantly, as previously described with radiation-induced valve disease, significant mitral stenosis developed 10 years after surgery for significant aortic stenosis. Two-dimensional and three-dimensional transthoracic and transesophageal echocardiography should be considered during assessment of symptomatic survivors of Hodgkin's disease where the index of suspicion for valvular stenosis increases over time. Given the natural history of mantle radiation valvular disease, a lower threshold for surgical intervention in radiation-induced mitral stenosis may need to be considered if cardiac surgery is planned for other reasons in order to avoid repeated sternotomy in patients with prior irradiation.

  10. Surgical strategy for mild ischemic mitral insufficiency

    Institute of Scientific and Technical Information of China (English)

    GU Cheng-xiong; WEI Hua; YU Yang

    2010-01-01

    @@ To the Editor: We read with the interest the article by FAN Hong-guang and colleagues~1 having obtained outstanding early and long-term clinical outcomes of left ventricular restoration for the patients with postinfarction ventricular aneurysm and low left ventricular ejection fraction (LVEF) of mean 37.7%. We would like to comment on surgical strategy for mild ischemic mitral insufficiency.

  11. Anatomical challenges for transcatheter mitral valve intervention

    DEFF Research Database (Denmark)

    De Backer, Ole; Luk, Ngai H V; Søndergaard, Lars

    2016-01-01

    development process and mixed clinical results with these novel technologies. This review aims to discuss the several anatomical aspects and challenges related to transcatheter mitral valve intervention - the relevant anatomy will be reviewed in relation to specific requirements for device design...

  12. 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 th...

  13. Intracardiac ultrasonic suture welding for knotless mitral valve replacement.

    Science.gov (United States)

    Ruel, Marc; Streeter, Richard B; de la Torre, Ralph; Liddicoat, John R; Cohn, William E

    2002-02-01

    The difficulty in tying multiple knots with endoscopic instruments constitutes a technical obstacle to the development of closed-chest valve surgery. The following set of experiments was undertaken to ascertain the in-vivo feasibility of using an intracardiac ultrasonic welding device for knotless suture fixation during mitral valve replacement (MVR). Five adult sheep weighing 48-52 kg underwent MVR with a commercially available mechanical prosthesis, using pledgetted interrupted polypropylene sutures. An ultrasonic suture welder designed for intracardiac use was used to adjust suture tension and fuse strands together without knots. Echocardiographic assessment of the mitral prosthesis was carried out at baseline and after maintenance of supraphysiologic arterial pressures for 60 min. Subsequently, the animals' explanted hearts were assessed under sustained left ventricular (LV) pressurization to 180 mmHg in an ex-vivo pressure-loop system. MVR was successfully performed in all animals and welds reliably completed in less than 1 s. One sheep could not successfully be weaned off cardiopulmonary bypass; however, a normal prosthetic valve implant was confirmed at post-mortem examination. Echocardiographic assessment prior to and during LV pressurization revealed normal seating and function of the prosthesis in all cases. At post-mortem examination all valves were adequately implanted, suture tails laid flat on the surface of the prosthesis' sewing ring, welded suture strands were intact and accurately point-fused together, and no evidence of perivalvular leak was found around any of the prostheses despite sustained LV pressurization. This new modality proved reliable in an acute sheep model of MVR and could constitute a promising avenue towards facilitation of total endoscopic valve procedures in humans.

  14. The Effectiveness of Cognitive-Behavioral Therapy (CBT in Reducing Worry, Anxiety and Panic Attacks Mitral Valve Prolapse Patients

    Directory of Open Access Journals (Sweden)

    AR Jamshidzehi ShahBakhsh

    2016-07-01

    Full Text Available Introduction: The mitral valve prolapse is a heart syndrome that is characterized by considerable physical and psychological consequences for affected patients. This study aimed to assess the efficacy of cognitive-behavioral therapy in reducing worrying, generalized anxiety and panic attacks in patients with mitral valve prolapse. Methods: This study is quasi-experimental research with pretest-posttest and control group. 16 patients with mitral valve prolapse divided into to two groups: experimental (n = 8 and control (n = 8 groups. CBT was used during 10 sessions twice a week with a focus on cognitive restructuring, modification of cognitive distortions and training of behavioral techniques for the experimental group. For participants health  concerns spot and doush (HCQ, Generalized anxiety disorder (GAD- 7 and Albania panic scales as pre-test, post-test. Results: Data were analyzed by covariance analysis. The results showed that worrying, anxiety, and panic attacks significantly reduced in the experimental group. Discussion: Cognitive behavioral therapy is remarkably effective for reducing fear, anxiety and panic patients with mitral valve prolapse. Therefore, it is recommended for the patients with mitral valve prolapse that cognitive behavioral therapy can be used as a complementary therapy.

  15. Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian-qun; CHI Li-qun; KONG Qing-yu; ZHENG Si-hong; XIAO Wei

    2010-01-01

    Background Repair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge"technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3-4.8 cm2 (mean (3.78:±0.52) cm2), the mean regurgitation area was (0.45:±0.22) cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26±11.12) mm, post-operation (37.57±9.56) mm, P <0.05; the end-diastolic diameter of the left ventricle:pre-operation (61.43±8.24) mm, post-operation (42.35±10.79) mm, P<0.01).Conclusion "Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.

  16. Technical aspects of mitral valve replacement with an allograft for acute bacterial endocarditis.

    OpenAIRE

    Conklin, L D; Reardon, M J

    1999-01-01

    Mitral valve replacement with a mitral valve allograft is receiving a resurgence of interest. We discuss the technical aspects of this procedure as it applies to cases of acute bacterial endocarditis infecting the mitral valve.

  17. Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation.

    Science.gov (United States)

    Hulman, Michal; Bena, Martin; Artemiou, Panagiotis; Gasparovic, Ivo; Hudec, Vladan; Rajani, Ronak; Bapat, Vinayak

    2016-10-01

    Transcatheter mitral valve replacement using balloon-expandable valves is an emerging technique for the treatment of patients with significant mitral regurgitation who have been judged to be inoperable owing to significant mitral valve annulus calcification. Although initial reports have been promising, there remains a lack of consensus as to how to plan for transcatheter mitral valve replacement deployment in terms of appropriateness, sizing, and positioning to mitigate the risks of valve displacement and paravalvular regurgitation. We describe two cases of transcatheter mitral valve replacement in patients with significant mitral valve annulus calcification. The first was complicated by valve displacement into the left atrium, which was successfully managed by surgical redeployment and fixation. The second case was thereafter performed successfully using iterative learning and the application of specific preprocedural planning techniques acquired from a root cause analysis of the first case. We describe our experience with both cases and the specific planning principles required to prevent transcatheter mitral valve replacement displacement in patients with mitral valve annulus calcification.

  18. Dynamic change in mitral annular area and motion during percutaneous mitral annuloplasty for ischemic mitral regurgitation: preliminary animal study with real-time 3-dimensional echocardiography.

    Science.gov (United States)

    Daimon, Masao; Gillinov, A Marc; Liddicoat, John R; Saracino, Giuseppe; Fukuda, Shota; Koyama, Yasushi; Hayase, Motoya; Cohn, William E; Ellis, Stephen G; Thomas, James D; Shiota, Takahiro

    2007-04-01

    We used a novel 3-dimensional (3D) echocardiographic technique to evaluate the impact of a coronary sinus-based percutaneous transvenous mitral annuloplasty (PTMA) on dynamic changes in mitral annular geometry and motion during the cardiac cycle in 8 sheep with ischemic mitral regurgitation. Using real-time 3D echocardiographic data before and after PTMA, 10 points along the saddle-shaped annulus were identified. For every 3D volume/frame during a cardiac cycle, we assessed mitral annular area and excursion defined as the traveling distance of the annular center. The PTMA device reduced both minimum and maximal mitral annular area (9.5 +/- 0.9-7.0 +/- 0.6 and 12.8 +/- 1.3-9.8 +/- 1.5 cm(2), P < .001 for both, respectively) with reduction of mitral regurgitation jet area (5.1 +/- 2.3-1.2 +/- 0.8 cm(2), P < .001), whereas it did not significantly impair mitral annular excursion amplitude (8.3 +/- 1.1-7.0 +/- 1.9 mm, P = .13). This 3D echocardiographic method noninvasively enabled dynamic study of mitral annular geometry and motion with quantitative analysis of the impact of PTMA.

  19. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.

    Science.gov (United States)

    Marak, Creticus P; Joy, Parijat S; Gupta, Pragya; Bukovskaya, Yana; Guddati, Achuta K

    2013-01-01

    Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH.

  20. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation

    Directory of Open Access Journals (Sweden)

    Creticus P. Marak

    2013-01-01

    Full Text Available Diffuse alveolar hemorrhage (DAH can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH.

  1. Rupture, waves and earthquakes

    Science.gov (United States)

    UENISHI, Koji

    2017-01-01

    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but “extraordinary” phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable. PMID:28077808

  2. Rupture, waves and earthquakes.

    Science.gov (United States)

    Uenishi, Koji

    2017-01-01

    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but "extraordinary" phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable.

  3. Ekhokardiografi Endokardiosis Penyakit Katup Mitral Jantung Anjing (ECHOCARDIOGRAPHY OF ENDOCARDIOSIS MITRAL VALVE HEART DISEASE IN DOGS

    Directory of Open Access Journals (Sweden)

    Deni Noviana

    2013-08-01

    Full Text Available Endocardiosis is a disease commonly found in Pomeranian dog characterized by progressive myxomatousdegeneration of the atrio-ventricular valves especially in the mitral valve. The purpose of this study was todefine the diagnose and severeity of this disease on the Pomeranian by using brightness mode, motion mode,dan color flow Doppler echocardiography technique. Echocardiography was performed on 8 Pomeranianconsisting of 6 males and 2 females with age range of 2-14 years. Brightness mode echocardiography wasused to see the echotexture of endocardium, mitral valve, and the valve movement. The results showedendocardium thickening, along with chronic fibrosis and nodular thickening of the anterior and posteriormitral valve leaflet. Three out of seven cases showed prolapsed of the mitral valve. Motion modeechocardiography was performed in order to measure left ventricle internal dimension, myocardium thickness,fractional shortening, left atrial and aortic dimension. The results showed myocardium thickening, alongwith left atrial enlargement. Color flow Doppler echocardiography was used to confirm the mitral valveregurgitation. Three of seven cases showed the presence of regurgitation signed by turbulence color of theprolapsed mitral valve. Based on the degree of severity, scoring system used in this study, endocardiosis canbe divided into three types that are mild, moderate and severe.

  4. Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli

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    Feroze Mahmood

    2014-01-01

    Full Text Available Aims and Objectives: The objective of this study was to assess the clinical feasibility of using echocardiographic data to generate three-dimensional models of normal and pathologic mitral valve annuli before and after repair procedures. Materials and Methods: High-resolution transesophageal echocardiographic data from five patients was analyzed to delineate and track the mitral annulus (MA using Tom Tec Image-Arena software. Coordinates representing the annulus were imported into Solidworks software for constructing solid models. These solid models were converted to stereolithographic (STL file format and three-dimensionally printed by a commercially available Maker Bot Replicator 2 three-dimensional printer. Total time from image acquisition to printing was approximately 30 min. Results: Models created were highly reflective of known geometry, shape and size of normal and pathologic mitral annuli. Post-repair models also closely resembled shapes of the rings they were implanted with. Compared to echocardiographic images of annuli seen on a computer screen, physical models were able to convey clinical information more comprehensively, making them helpful in appreciating pathology, as well as post-repair changes. Conclusions: Three-dimensional printing of the MA is possible and clinically feasible using routinely obtained echocardiographic images. Given the short turn-around time and the lack of need for additional imaging, a technique we describe here has the potential for rapid integration into clinical practice to assist with surgical education, planning and decision-making.

  5. Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli.

    Science.gov (United States)

    Mahmood, Feroze; Owais, Khurram; Montealegre-Gallegos, Mario; Matyal, Robina; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal R

    2014-01-01

    The objective of this study was to assess the clinical feasibility of using echocardiographic data to generate three-dimensional models of normal and pathologic mitral valve annuli before and after repair procedures. High-resolution transesophageal echocardiographic data from five patients was analyzed to delineate and track the mitral annulus (MA) using Tom Tec Image-Arena software. Coordinates representing the annulus were imported into Solidworks software for constructing solid models. These solid models were converted to stereolithographic (STL) file format and three-dimensionally printed by a commercially available Maker Bot Replicator 2 three-dimensional printer. Total time from image acquisition to printing was approximately 30 min. Models created were highly reflective of known geometry, shape and size of normal and pathologic mitral annuli. Post-repair models also closely resembled shapes of the rings they were implanted with. Compared to echocardiographic images of annuli seen on a computer screen, physical models were able to convey clinical information more comprehensively, making them helpful in appreciating pathology, as well as post-repair changes. Three-dimensional printing of the MA is possible and clinically feasible using routinely obtained echocardiographic images. Given the short turn-around time and the lack of need for additional imaging, a technique we describe here has the potential for rapid integration into clinical practice to assist with surgical education, planning and decision-making.

  6. Open re-rupture of the Achilles tendon after surgical treatment

    Directory of Open Access Journals (Sweden)

    Mitsuru Hanada

    2011-12-01

    Full Text Available The rate of re-rupture of Achilles tendon after surgical treatment were reported to 1.7-5.6% previously. Re-rupture of Achilles tendon generally occurs subcutaneously. We experienced two rare cases of the open re-ruptures of Achilles tendon with a transverse wound perpendicular to the primary surgical incision. Re-rupture occurred 4 and 13 weeks after surgical treatment. We suggest that open re-rupture correlates more closely with skin scaring and shortening. Another factor may be adhesion between the subcutaneous scar and the suture of the paratenon and Achilles tendon with post-operative immobilization.

  7. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

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    Ilić Radoje

    2005-01-01

    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  8. En face view of the mitral valve: definition and acquisition.

    Science.gov (United States)

    Mahmood, Feroze; Warraich, Haider Javed; Shahul, Sajid; Qazi, Aisha; Swaminathan, Madhav; Mackensen, G Burkhard; Panzica, Peter; Maslow, Andrew

    2012-10-01

    A 3-dimensional echocardiographic view of the mitral valve, called the "en face" or "surgical view," presents a view of the mitral valve similar to that seen by the surgeon from a left atrial perspective. Although the anatomical landmarks of this view are well defined, no comprehensive echocardiographic definition has been presented. After reviewing the literature, we provide a definition of the left atrial and left ventricular en face views of the mitral valve. Techniques used to acquire this view are also discussed.

  9. Finite element analysis to model complex mitral valve repair.

    Science.gov (United States)

    Labrosse, Michel; Mesana, Thierry; Baxter, Ian; Chan, Vincent

    2016-01-01

    Although finite element analysis has been used to model simple mitral repair, it has not been used to model complex repair. A virtual mitral valve model was successful in simulating normal and abnormal valve function. Models were then developed to simulate an edge-to-edge repair and repair employing quadrangular resection. Stress contour plots demonstrated increased stresses along the mitral annulus, corresponding to the annuloplasty. The role of finite element analysis in guiding clinical practice remains undetermined.

  10. Complete Achilles tendon ruptures.

    Science.gov (United States)

    Landvater, S J; Renström, P A

    1992-10-01

    Achilles tendon ruptures can be treated nonsurgically in the nonathletic or low-end recreational athletic patient, particularly those more than 50 years of age, provided the treating physician does not delay in the diagnosis and treatment (preferably less than 48 hrs and possibly less than 1 week). The patient should be advised of the higher incidence of re-rupture of the tendon when treated nonsurgically. Surgical treatment is recommended for patients who are young and athletic. This is particularly true because the major criticism of surgical treatment has been the complication rate, which has decreased to a low level and to a mild degree, usually not significantly affecting the repair over time. Surgical treatment in these individuals seems to be superior not only in regard to re-rupture but also in assuring the correct apposition of the tendon ends and in placing the necessary tension on the tendon to secure appropriate orientation of the collagen fibers. This in turn allows them to regain full strength, power, endurance, and an early return to sports. Surgery is also recommended for late diagnosed ruptures where there is significant lengthening of the tendon. Surgical technique should involve a medial incision to avoid the sural nerve, absorbable suture, and augmentation with fascia or tendon where there is a gap or late rupture. Postoperatively, the immobilization should be 7 to 10 days in a splint. A walking boot with early motion in plantar flexion or a short leg cast with the tendon under slight tension should thereafter be used for 4 to 5 weeks. An early and well-supervised rehabilitation program should be initiated to restore the patient to the preinjury activity level.

  11. Mitral valve prolapse and electrolyte abnormality: a dangerous combination for ventricular arrhythmias.

    Science.gov (United States)

    Rajani, Ali Raza; Murugesan, Vagishwari; Baslaib, Fahad Omar; Rafiq, Muhammad Anwer

    2014-05-14

    A 27-year-old woman with a history of bileaflet mitral valve prolapse and moderate mitral regurgitation presented to our emergency with untractable polymorphic wide complex tachycardia and unstable haemodynamics. After cardiopulmonary resuscitation, return of spontaneous circulation was achieved 30 min later. Her post-resuscitation ECG showed a prolonged QT interval which progressively normalised over the same day. Her laboratory investigations revealed hypocalcaemia while other electrolytes were within normal limits. A diagnosis of ventricular arrhythmia secondary to structural heart disease further precipitated by hypocalcaemia was made. Further hospital stay did not reveal a recurrence of prolonged QT interval or other arrhythmias except for an episode of non-sustained ventricular tachycardia. However, the patient suffered diffuse hypoxic brain encephalopathy secondary to prolonged cardiopulmonary resuscitation.

  12. [Infectious mitral endocarditis after radiofrequency catheter ablation of a left lateral accessory pathway].

    Science.gov (United States)

    Benito Bartolomé, F; Sánchez Fernández-Bernal, C

    2001-08-01

    A 2-years-old child with Wolff-Parkinson-White syndrome associated with life-threatening symptoms underwent radiofrequency ablation of a left lateral accessory pathway. A deflectable 5F bipolar electrode catheter positioned above the atrioventricular groove by transeptal approach was used for ablation. The catheters were repeatedly used after ethylene oxide sterilisation. Although immediate post-ablation echocardiography demonstrated no complications, the patient was readmitted two days later with fever and a new mitral murmur. Penicillin-susceptible Staphylococcus aureus was isolated and intravenous antibiotics were administered. In the following weeks, the patient developed constrictive pericarditis requiring surgical treatment and acute hemiplegia caused by brain embolism arising from valvular vegetation. At 5 years of follow-up the patient presents residual hemiparesia and grade II/IV mitral insufficiency.

  13. Rupture of the plantar fascia.

    Science.gov (United States)

    Pai, V S

    1996-01-01

    Rupture of the plantar fascia in athletes engaged in sports that require running and jumping has been reported. However, spontaneous degenerative rupture of the plantar fascia is not well documented in the literature. This paper reports a patient with degenerative rupture of the plantar fascia.

  14. Diagnosis and Management of Papillary Muscle Rupture Complicating Acute Myocardial Infarction: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Suarez

    2015-08-01

    Full Text Available Introduction The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.

  15. 142. Insuficiencia mitral y enfermedad coronaria

    OpenAIRE

    I. Moriones Elosegui; A. De la Fuente Calixto; R. Sánchez Quintana; J.L. Fernández Rodríguez; L. Jiménez Alfaro

    2010-01-01

    Analizamos los parámetros clínicos y resultados quirúrgicos comparativos entre la insuficiencia mitral isquémica (GR.A) y la insuficiencia mitral de otras causas con lesiones coronarias acompañantes (GR.B). Material y métodos: Ochenta pacientes cuya edad media es 67 años. Varones fueron 58 y mujeres 22. Pertenecían al GR.A 49 y 31 al GR.B. Clínica comparativa entre el GR.A y GR.B fue: fracción de eyección [FE] = 0,43 frente a 0,45 (p = no significativa [NS]). GF.IV = 66 frente a 35% (p < 0...

  16. Minimally Invasive Transaortic Mitral Decalcification During Aortic Valve Replacement.

    Science.gov (United States)

    Totsugawa, Toshinori; Sakaguchi, Taichi; Hiraoka, Arudo; Matsushita, Hiroshi; Hirai, Yuki; Yoshitaka, Hidenori

    2015-01-01

    Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

  17. Chimney technique for mitral valve replacement in children.

    Science.gov (United States)

    González Rocafort, Álvaro; Aroca, Ángel; Polo, Luz; Rey, Juvenal; Villagrá, Fernando

    2013-11-01

    Severe mitral stenosis is unusual in children, but it represents an important challenge for surgeons because of the scarcity of solutions. Several mitral percutaneous and surgical valvuloplasties are performed repetitively to delay mitral valve replacement. Most of the time these procedures show discouraging results. When mitral valve replacement is performed, the annulus may not be large enough to fit a substitute. We present, to our best knowledge, a new technique to implant a large prosthesis in a small annulus without negatively affecting the opening of the leaflets.

  18. Mitral-aortic annular enlargement: modification of Manouguian's technique

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    Costa Mario Gesteira

    2002-01-01

    Full Text Available We hereby present a technical modification for mitral-aortic annular enlargement. The mitral valve is replaced through the retro-septal approach, avoiding patches for left atrial roof closure. We report a mitral-aortic valve replacement in a patient whose original annuli would preclude adequate prostheses. The simultaneous annular enlargement may be necessary for avoiding patient-prosthesis mismatch and for reconstructing destroyed mitral and aortic annuli. The technique may minimize the risk of bleeding and of paravalvular leakage, using an approach well known to cardiac surgeons.

  19. Mitral Regurgitation after Percutaneous Balloon Mitral Valvotomy in Patients with Rheumatic Mitral Stenosis: A Single-Center Study

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    Naser Aslanabadi

    2015-10-01

    Full Text Available Background: Percutaneous balloon mitral valvotomy (BMV is the gold standard treatment for rheumatic mitral stenosis (MS in that it causes significant changes in mitral valve area (MVA and improves leaflet mobility. Development of or increase in mitral regurgitation (MR is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients.Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG, left atrial (LA pressure, pulmonary artery systolic pressure (PAPs, and MR severity before and after BMV, were evaluated.Results: Totally, 105 patients (80% female at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001. MVA significantly increased (mean area = 0.64 ± 0.29 cm2 before BMV vs. 1.90 ± 0.22 cm2 after BMV; p value < 0.001 and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1% patients, but it increased in 18 (17.1% and decreased in 5 (4.8% patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001 and lower MVA before BMV (0.81± 0.23 vs.0.94 ± 0.18; p value = 0.010. There were no major complications.Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to

  20. 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

    2017-01-01

    Background 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. Methods 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. Results 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. Conclusions 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. PMID:28203538

  1. MITRAL VALVE REPLACEMENT AT 11 YEARS OLD GIRL WITH RHEUMATIC MITRAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Suryani Malik

    2015-05-01

    Full Text Available Rheumatic heart disease (RHD is the permanent heart valve damage resulting from one or more attacks of acute rheumatic fever (ARF, representing the permanent lesions of the cardiac valve. Rheumatic heart disease’s patient with valvar involvement usually require long term follow-up. The ultimate decision of clinical management or invasive therapy is made on an individual basis. We reported a 11-year-old girl with RHD and severe mitral stenosis whom underwent   mitral valve replacement with mechanical valve. Postoperative echocardiogram showed no mitral regurgitation and we gave anticoagulant to maintain INR of 3-4 by giving warfarin 2mg / kg each day for lifelong to prevent bleeding and thrombosis. [MEDICINA 2014;45:120-6]    

  2. Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo Renda; Martins, Wendell Santos; de Araújo e Sá, Frederico Browne Correia; Lustosa, Pablo César; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

    2012-01-01

    Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with 95% confidence interval and P-values (that will be considered statistically significant when <0.05). The ORs were combined across studies using a weighted DerSimonian–Laird random-effects model. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA). Twenty studies (3 randomized and 17 non-randomized) were identified and included a total of 3835 patients (1918 for mitral valve replacement preservation and 1917 for mitral valve replacement non-preservation). There was significant difference between mitral valve replacement preservation and mitral valve replacement non-preservation groups in the risk of 30-day mortality (OR 0.418, P <0.001), postoperative low cardiac output syndrome (OR 0.299, P <0.001) or 5-year mortality (OR 0.380, P <0.001). No publication bias or important heterogeneity of effects on any outcome was observed. In conclusion, we found evidence that argues in favour of the preservation of mitral valve apparatus during mitral valve replacement. PMID:23027596

  3. Robotic Transcatheter Mitral Valve Replacement Using the Sapien XT in the Setting of Severe Mitral Annular Calcification.

    Science.gov (United States)

    Koeckert, Michael S; Loulmet, Didier F; Williams, Mathew R; Neuburger, Peter J; Grossi, Eugene A

    2016-05-01

    We describe the use of the Sapien XT, placed in the mitral position using a totally endoscopic robotic approach in a 76-year-old man with extensive circumferential mitral calcifications and severe stenosis. The patient was at high risk for traditional open surgery and a large mitral valve annulus prevented safe transcatheter deployment due to size mismatch. Our novel approach offered a minimally invasive technique for native mitral valve replacement in a high-risk patient with anatomical constraints prohibitive to conventional approaches. doi: 10.1111/jocs.12737 (J Card Surg 2016;31:303-305).

  4. Impact of failed mitral valve repair on hospital outcome of redo mitral valve procedures.

    Science.gov (United States)

    Onorati, Francesco; Gatti, Giuseppe; Perrotti, Andrea; Mariscalco, Giovanni; Reichart, Daniel; Milano, Aldo; Della Ratta, Ester; Rubino, Antonio; Santarpino, Giuseppe; Salsano, Antonio; Biancari, Fausto; Detter, Christian; Chocron, Sidney; Beghi, Cesare; De Feo, Marisa; Mignosa, Carmelo; Fischlein, Theodor; Pappalardo, Aniello; D'Errigo, Paola; Santini, Francesco; Faggian, Giuseppe

    2017-05-01

    The prognostic impact of failed mitral valve repair (FMR) on in-hospital outcome after redo mitral valve surgery has not been thoroughly investigated. Hospital outcomes after redo mitral valve surgery because of an FMR in patients from nine European centres were reported. Logistic regressions identified predictors of mortality in combined or isolated redo mitral valve operations. Hospital outcome was compared between propensity-matched cohorts with FMR and native mitral valves in the context of redo surgery and FMR versus failed prostheses. A total of 246 patients with FMR yielded a 6.5% mortality rate at redo surgery. FMR per se did not impact mortality at multivariable analysis ( P = 0.64). A preoperative Global Initiative for Chronic Obstructive Lung Disease (GOLD) score ≥2 chronic obstructive lung disease (COPD) (OR 15.2, P FMR population. GOLD ≥ 2 COPD (OR 12.3, P = 0.049), age at surgery (OR 1.15 for each incremental year, P = 0.049) and cardiopulmonary bypass duration (OR 1.02, P = 0.022) predicted mortality in isolated redo mitral valve surgery for FMR. The fourth (> 68 years = 13.8% mortality) and the fifth quintiles of age (≥73.4 years = 14.8%) reported the highest mortality (OR 3.8 and 4.2 respectively, P = 0.002) in this subgroup. Propensity-matched cohorts of FMR and native mitral valves in the context of redo surgery showed no differences in terms of mortality ( P = 0.69) and major morbidity (acute myocardial infarction P = 0.31, stroke P = 0.65, acute kidney injury P  = 1.0), whereas more perioperative dialysis ( P = 0.04) and transfusions ( P = 0.02) were noted in propensity-matched failed prostheses compared to FMR. A failed mitral repair does not impact hospital outcome of redo surgery. Given the role of severe left ventricular dysfunction and advanced age on hospital mortality rates, an early indication for redo surgery may improve outcome.

  5. 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

  6. 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...... onset of symptoms or changes in the standard ECG. Therefore, this study investigates, if advanced ECG can predict the severity of mitral regurgitation (MR) in dogs with myxomatous mitral valve disease (MMVD) and thereby improve the diagnostic value of ECG. The study included 77 privately owned Cavalier...

  7. Complications of plantar fascia rupture associated with corticosteroid injection.

    Science.gov (United States)

    Acevedo, J I; Beskin, J L

    1998-02-01

    From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

  8. The Viable Mitral Annular Dynamics and Left Ventricular Function after Mitral Valve Repair by Biological Rings

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    Farideh Roshanali

    2012-12-01

    Full Text Available Objective: Considering the importance of annular dynamics in the valvular and ventricular function, we sought to evaluate the effects of treated pericardial annuloplasty rings on mitral annular dynamics and left-ventricular (LV function after mitral valve repair. The results were compared with the mitral annular dynamics and LV function in patients with rigid and flexible rings and also in those without any heart problems. Materials and Methods: One hundred and thirty-six consecutive patients with a myxomatous mitral valve and severe regurgitation were prospectively enrolled in this observational cohort study. The patients underwent comparable surgical mitral valve reconstruction; of these 100 received autologous pericardium rings (Group I, 20 were given flexible prosthetic rings (Group II, and 16 received rigid rings (Group III. Other repair modalities were also performed, depending on the involved segments. The patients were compared with 100 normal subjects in whom an evaluation of the coronary artery was not indicative of valvular or myocardial abnormalities (Group IV. At follow-up, LV systolic indices were assessed via two-dimensional echocardiography at rest and during dobutamine stress echocardiography. Mitral annular motion was examined through mitral annulus systolic excursion (MASE. Peak transmitral flow velocities (TMFV and mitral valve area (MVA were also evaluated by means of continuous-wave Doppler. Results: A postoperative echocardiographic study showed significant mitral regurgitation (>=2+ in one patient in Group I, one patient in Group II, and none in Group III. None of the patients died. There was a noteworthy increase in TMFV with stress in all the groups, the increase being more considerable in the prosthetic ring groups (Group I from 1.10 ± 0.08 to 1.36 ± 0.13 m/s, Group II from 1.30 ± 0.11 to 1.59 ± 0.19 m/s, Group III from 1.33 ± 0.09 to 1.69 ± 0.21 m/s, and Group IV from 1.08 ± 0.08 to 1.21 ± 0.12 m

  9. Rupture of Renal Transplant

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    Shona Baker

    2015-01-01

    Full Text Available Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L. LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.

  10. Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

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    Josip Vincelj

    2015-08-01

    Full Text Available Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE and transesophageal echocardiography (TEE was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male with complete ruptures of papillary muscle following acute myocardial infarction (AMI. Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.

  11. Mitral valve prolapse and body habitus in children.

    Science.gov (United States)

    Arfken, C L; Schulman, P; McLaren, M J; Lachman, A S

    1993-01-01

    Mitral valve prolapse has generally been associated in adults with a thin body habitus. However, prior studies used biased samples or limited anthropometric measures. In addition, no information has been available on the subjective assessment of body habitus and diagnosis of mitral valve prolapse, especially in children. We conducted a cross-sectional study on 813 children with uniform assessment of anthropometric measures and mitral valve prolapse. Consistent with research conducted on adults, those subjects with mitral valve prolapse were lighter, thinner, and had, on average, lower values for several, quantifiable anthropometric parameters with the exception of height. However, the subjective assessment showed that while the assessment did not differ by diagnosis, those subjects with mitral valve prolapse were never described as fat. These data support an association between mitral valve prolapse and slender body habitus and extends it to children, thus underscoring the clinical importance that a thin body habitus may be a marker for mitral valve prolapse throughout the age span. This association may partly explain the observed genetic distribution of mitral valve prolapse.

  12. Mitral Valve Aneurysm: A Rare Complication of Aortic Valve Endocarditis

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    A Moaref

    2008-11-01

    Full Text Available A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophagealechocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of theanterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valverepair.

  13. In Vitro Mitral Simulator to Evaluate Effectiveness of Valvoplasty Technique

    Institute of Scientific and Technical Information of China (English)

    H. Doi; M. Arita; M. Okuda; R. Noda; K. Iwasaki; T. Tanaka; H. Kasegawa; M. Umezu1

    2004-01-01

    The edge-to-edge technique is one of the surgical procedures for anterior mitral leaflet prolapse. The purpose of this study is to evaluate the effect of this technique by using an in vitro mitral simulator. The results provide a useful suggestion and can be contributed to evidence-based medicine (EBM).

  14. Functional Mitral Regurgitation: Appraising the Evidence Behind Recommended Treatment Strategies.

    Science.gov (United States)

    Samad, Zainab; Velazquez, Eric J

    2016-12-01

    Functional mitral regurgitation (MR) is the most common type of MR encountered in clinical practice. Because the disease arises from the ventricular aspect of the mitral valve apparatus, treatment therapies are less defined and outcomes are poor. In this review, the state of evidence for medical and surgical therapy in functional MR is appraised. Future directions for research in this area are also defined.

  15. A heart team's perspective on interventional mitral valve repair

    DEFF Research Database (Denmark)

    Treede, Hendrik; Schirmer, Johannes; Rudolph, Volker

    2012-01-01

    Surgical mitral valve repair carries an elevated perioperative risk in the presence of severely reduced ventricular function and relevant comorbidities. We sought to assess the feasibility of catheter-based mitral valve repair using a clip-based percutaneous edge-to-edge repair system in selected...

  16. Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement: an intraoperative dilemma.

    Science.gov (United States)

    Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai-Sudhakar, Chittoor B

    2015-03-01

    High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery.

  17. Mitral valve prolapse: associations with symptoms and anxiety.

    Science.gov (United States)

    Arfken, C L; Lachman, A S; McLaren, M J; Schulman, P; Leach, C N; Farrish, G C

    1990-03-01

    Mitral valve prolapse has been studied extensively in the adult population, but less is known about it in children. Therefore, 813 children between 9 and 14 years of age were examined by a team of cardiologists and technicians. The children also responded to a questionnaire concerning the presence of symptoms and the What I Think and Feel anxiety instrument. The prevalence of mitral valve prolapse using auscultatory criteria was 4.2% (6.2% for girls, 2.3% for boys). Of those with mitral valve prolapse, 85% had a solitary click, 9% had a click and systolic murmur, and 6% had multiple clicks. Children with auscultatory mitral valve prolapse were less likely to have symptoms than those free of cardiac abnormalities. No difference in average anxiety scores was detected between the two groups. It is concluded that auscultatory mitral valve prolapse is common in children and not accompanied by an increased likelihood of symptoms or anxiety.

  18. Prosthetic valve thrombosis in a patient with mitral valve replacement.

    Science.gov (United States)

    Bilal, Muhammad; Khan, Muhammad Shahzeb; Haseeb, Abdul; Khan, Abdul Bari

    2015-07-01

    Prosthetic valve thrombosis within one year after mitral valve replacement is rarely seen in patients on warfarin therapy and without any risk factor. Here, we describe a case of a 39-year- old female, who presented with dyspnoea and shortness of breath 11 months after mitral valve replacement. The echocardiogram revealed severe valvular stenosis due to presence of clots on the mitral valve and restricted motion of the mitral leaflets. As a result of deterioration of general condition and haemodynamic un-stability, plan was made to re-operate for her valve replacement surgery. This case report highlights the diagnosis, prevention and management of patients with prosthetic valve thrombosis following mitral valve replacement.

  19. A Rare Case of Mitral Valve Prolapse in Endomyocardial Fibrosis.

    Science.gov (United States)

    Xavier, Joseph; Haranal, Maruti Yamanappa; Reddy, Shashidhar Ranga; Suryaprakash, Sharadaprasad

    2016-09-01

    Mitral valve prolapse in endomyocardial fibrosis (EMF) is an unusual entity. Literature search reveals only 1 report of mitral valve prolapse assosiated with EMF. A 32-year-old woman, of African origin, who presented with features of right heart failure, was diagnosed to have mitral valve prolapse of rheumatic origin with severe mitral regurgitation and severe pulmonary hypertension (PAH). Intraoperative findings lead to the diagnosis of EMF. We report this rare case of mitral valve prolapse in EMF, in a geographical area where rheumatic heart disease is endemic, to showcase how a rare manifestation of EMF can be misdiagnosed as that of rheumatic heart disease. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

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    Mahnoosh Foroughi

    2014-01-01

    Full Text Available Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome.

  1. Percutaneous mitral valve repair with MitraClip.

    Science.gov (United States)

    Cilingiroğlu, Mehmet; Salinger, Michael

    2012-03-01

    Over the last decade, several technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high-risk for the traditional open-heart mitral valve repair or replacement. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. It is adapted from the surgical technique that was initially described by Dr. Alfieri and his group by placement of a suture approximating the edges of the mitral leaflets at the origin of the MR jet, leading to creation of so-called bow-tie or double orifice with significant reduction in the MR jet. Here, we review the details of the technology, its procedural perspective as well as currently available data for its safety and effectiveness on a case-based report.

  2. Porcine mitral valve interstitial cells in culture.

    Science.gov (United States)

    Lester, W; Rosenthal, A; Granton, B; Gotlieb, A I

    1988-11-01

    There are connective tissue cells present within the interstitium of the heart valves. This study was designed to isolate and characterize mitral valve interstitial cells from the anterior leaflet of the mitral valve. Explants obtained from the distal part of the leaflet, having been scraped free of surface endocardial cells, were incubated in medium 199 supplemented with 10% fetal bovine serum. Cells grew out of the explant after 3 to 5 days and by 3 weeks these cells were harvested and passaged. Passages 1 to 22 were characterized in several explant sets. The cells showed a growth pattern reminiscent of fibroblasts. Growth was dependent on serum concentration. Cytoskeletal localization of actin and myosin showed prominent stress fibers. Ultrastructural studies showed many elongated cells with prominent stress fibers and some gap junctions and few adherens junctions. There were as well cells with fewer stress fibers containing prominent Golgi complex and dilated endoplasmic reticulum. In the multilayered superconfluent cultures, the former cells tended to be on the substratum of the dish or surface of the multilayered culture, whereas the latter was generally located within the layer of cells. Extracellular matrix was prominent in superconfluent cultures, often within the layers as well. Labeling of the cells with antibody HHF 35 (Tsukada T, Tippens D, Gordon D, Ross R, Gown AM: Am J Pathol 126:51, 1987), which recognizes smooth muscle cell actin, showed prominent staining of the elongated stress fiber-containing cells and much less in the secretory type cells. These studies show that interstitial mitral valve cells can be grown in culture and that either two different cell types or one cell type with two phenotypic expressions is present in culture.

  3. Pseudopapillary fibroelastoma of the mitral valve.

    Science.gov (United States)

    Madu, E; Myles, J; Fraker, T D

    1995-01-01

    Papillary fibroelastomas are well-recognized benign cardiac neoplasms. They are primarily asymptomatic, but occasionally are associated with neurologic and cardiac symptoms. Pseudopapillary fibroelastomas presenting with usual clinical and echocardiographic manifestations of papillary fibroelastoma but lacking characteristic histologic features have not been described previously. This article describes a 42-year-old, previously healthy female admitted with sudden hemiparesis and dysarthria. Symptoms completely resolved within 4 days. Extensive investigations revealed no etiology except for a pedunculated mitral valve mass with echocardiographic appearance suggestive of papillary fibroelastoma. Histologic staining, however, failed to reveal characteristic features of papillary fibroelastoma.

  4. 142. Insuficiencia mitral y enfermedad coronaria

    Directory of Open Access Journals (Sweden)

    I. Moriones Elosegui

    2010-01-01

    Conclusiones: a la GR.A presentó mayor comorbilidad, alteraciones preoperatorias de la función cardíaca, complicaciones, estancia media y más mortalidad que los del GR.B; b la asociación de enfermedad coronaria en el GR.B no afectó a los resultados en este grupo, y c la reparación mitral en el GR.A aportó mejores resultados que la sustitución.

  5. MITRAL VALVE PAPILLARY FIBROELASTOMA:CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    HUANG Ying(黄英); JIANG Mier(蒋米尔); Yves GLOCK

    2003-01-01

    Objective To evaluate the transesophageal echocardiography(TEE) and surgical treatment to cardiac papillary fibroelastomas (CPFE). Methods CPFE is a rare benign tumor occuring mainly in valves and often revealed by serious cerebral, coronary and peripheral embolism or even sudden death. We report a case of mitral PFE diagnosed by transesophageal echocardiography (TEE), and surgical resection was performed. Results Surgical intervention is successful, and the follow-up courses are uneventful. Conclusion TEE is helpful to diagnosis and guiding the operation. Operation is recommended to prevent recurrent embolization complications.

  6. Successful application of subcutaneous adipose tissue with fibrin glue in conservative treatment of tracheobronchial rupture.

    Science.gov (United States)

    Tokuishi, Keita; Yamamoto, Satoshi; Anami, Kentaro; Moroga, Toshihiko; Miyawaki, Michiyo; Chujo, Masao; Yamashita, Shin-Ichi; Kawahara, Katsunobu

    2012-11-01

    An 84-year-old woman underwent aortic and mitral valve replacement. After weaning from cardiopulmonary bypass, hemorrhage was observed in the endobronchial tube. The bleeding bronchus was isolated to protect the airway using the blocker cuff of a Univent tube (Fuji Systems Corp, Tokyo, Japan). Computed tomography showed a pulmonary pseudoaneurysm in the left upper lobe. She underwent selective pulmonary angiography and embolization of the pseudoaneurysm. Bronchoscopy revealed a 5-mm bronchial rupture at the left upper lobe bronchus. The laceration was filled with adipose tissue and fibrin glue. Bronchoscopy showed a completely reepithelialized membrane, and she was discharged 38 days postoperatively.

  7. Plastia da valva mitral com a técnica do "Duplo Teflon": resultados de 10 anos Mitral valve repair with "Double Teflon" technique: 10-year results

    Directory of Open Access Journals (Sweden)

    Carlos Manuel de Almeida Brandão

    2007-12-01

    1994 and 2003, 133 patients with degenerative mitral insufficiency due to ruptured or elongated chordae in the posterior leaflet underwent repair with this technique. The mean patient age was 60.4 years and 60.9% patients were male. According to clinical evaluation, 29.3% of the patients were in New York Heart Association functional class IV, 55.7% in class III and 15.0% in class II. Associated techniques of mitral valve repair were used in 15.2% of the patients; the most common was chordal shortening. Twenty six (19.5% patients had associated procedures. RESULTS: There was one (0.75% operative death. In the late postoperative period, 95.5% of the surviving patients were in New York Heart Association functional class I. Linearized rates of thromboembolism, reoperation and death were 0.9%, 0.3% and 0.6% patient/year, respectively. The actuarial survival at 10 years was 94.7% ± 3.6%. Actuarial freedom from thromboembolism and reoperation were 97.3 ± 1.5% and 99.2 ±0.8%, respectively. There were no episodes of hemolysis or endocarditis. CONCLUSION: Mitral valve repair with "Double Teflon" technique presents low morbimorbidity and good clinical late evolution.

  8. Progression to calcific mitral stenosis in end-stage renal disease.

    Science.gov (United States)

    D'Cruz, I A; Madu, E C

    1995-12-01

    A 59-year-old man with end-stage renal disease and on hemodialysis had neither mitral stenosis nor mitral calcification on echo-Doppler examination in 1989, but had extensive mitral calcification and definite mitral stenosis on conventional and transesophageal echocardiography in 1994. The left ventricle had marked concentric hypertrophy. To our knowledge this is the first documentation of the development of calcific mitral stenosis in end-stage renal disease revealed by serial echo-Doppler studies.

  9. Use of autologous pericardium for mitral leaflet reconstruction in a child with endocarditis

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    Olcay Murat Disli

    2013-06-01

    Full Text Available We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period was uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.

  10. Estenosis mitral por mixoma auricular izquierdo

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    Orlando D. Navarro

    2016-07-01

    Full Text Available Los tumores cardiacos representan el 0.2% y pueden ser primarios o metastásicos (secundarios, siendo estos últimos 20 a 40 veces más comunes que los primarios. De los tumores primarios, el 75% son benignos y aproximadamente el 50-85% de estos corresponden a mixomas, con una incidencia de 0.5-1 por 106 individuos por año. Se presenta el caso de un paciente de 56 años de edad, sin factores de riesgo cardiovascular ni antecedentes patológicos, con un mixoma auricular izquierdo de 4,6 × 4,5 cm, que prolapsaba hacia la válvula mitral en diástole provocando obstrucción intermitente de la misma y estenosis mitral severa. El diagnóstico se realizó mediante una ecocardiografía transtorácica, sin requerir de otras pruebas diagnósticas. Se realizó resección quirúrgica, lográndose la resección completa del tumor. La evolución posterior del paciente fue satisfactoria, siendo egresado a los 11 días de la intervención.

  11. [Personal experience with 2,500 closed heart mitral commissurotomies].

    Science.gov (United States)

    Popa, I P; Făgărăşanu, D; Pavelescu, I; Stefănescu, T; Proinov, F; Constantinescu, M; Litarczek, G; Fotiade, B; Constantinescu, D; Bălan, A; Petrilă, T

    1977-01-01

    Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention. Comparing the results in relation with the functional stage of the disease (62.5% of the patients were classified in the III-IV evolutive degree, according to the NIHA classification), pulmonary hypertension (61.6% of the patients had medium or severe pulmonary hypertension), associated lesions (present in 17% of the cases--mitral failure predominated, together with tricuspid or aortic failures), it is appreciated that the technique of mitral commissurotomy on closed heart is an useful therapeutic method (88.6% very good and good results, a global death rate of 3.9%) that can be applied in a large category of patients, although there is a trend toward open-heart surgery, with all medico-economical major implications.

  12. 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

    Full Text Available FUNDAMENTO: A reconstrução mitral é bem aceita em crianças com febre reumática. OBJETIVO: Analisar os resultados da reconstrução cirúrgica mitral, em crianças com lesões reumáticas, após quatro anos de evolução. MÉTODOS: Estudo retrospectivo de 40 pacientes menores de 18 anos, operados no Instituto Nacional de Cardiologia (RJ, entre janeiro de 1998 e janeiro de 2003. Foram analisados o grau da regurgitação mitral pelo ecocardiograma, a técnica cirúrgica, a classe funcional pré e pós-operatória, a evolução dos casos, a necessidade de troca valvar e óbitos. RESULTADOS: Vinte e um pacientes (52,5% eram do sexo feminino. A insuficiência mitral era grave em 32 pacientes (80% e moderada em oito (20%. Ocorreram três óbitos imediatos (7,5%. Após três meses da cirurgia, o ecocardiograma demonstrou que em 35 de 37 casos (94,6% não havia regurgitação valvar ou essa era leve, e em dois pacientes (5,2% era grave. A classe funcional no pré-operatório era III e IV em 33 casos (82,5% e, três meses após a cirurgia, todos os 37 casos (100% estavam em classe funcional I e II. A diferença entre os dados do grau de regurgitação mitral e classe funcional no pré e no pós-operatório foram estatisticamente significativos (pFUNDAMENTO: La reconstrucción mitral tiene buena aceptación en niños con fiebre reumática. OBJETIVO: Analizar los resultados de la reconstrucción quirúrgica mitral en niños con lesiones reumáticas después de cuatro años de evolución. MÉTODOS: Estudio retrospectivo de 40 pacientes menores de 18 años, operados en el Instituto Nacional de Cardiología (RJ, entre enero de 1998 y enero de 2003. Se analizó el grado de regurgitación mitral por ecocardiograma, la técnica quirúrgica, la clase funcional pre y post operatoria, la evolución de los casos, la necesidad de cambio valvular y óbitos. RESULTADOS: Veintiún pacientes (52,5% eran del sexo femenino. La insuficiencia mitral era grave en 32

  13. [Percutaneous mitral commissurotomy using Inoue's balloon during pregnancy].

    Science.gov (United States)

    Murillo, H; Ayala, F; Badui, E; Almazán, A; Solorio, S; Enciso, R; Madrid, R; Lepe, L; Rangel Abundis, A; Chávez, E

    1996-01-01

    The authors present three cases of pregnant women with symptomatic severe mitral stenosis with a mean age of 28.6 +/- 2.3 years, and during 27.6 +/- 1.52 weeks of pregnancy. Two patients were in class III and one in class IV of the New York Heart Association (NYHA). All patients had a mitral valvular area equal or less than 1 cm2, with a Wilkins score of 7 to 9 and mitral insufficiency grade I in two cases; two, had severe pulmonary arterial hypertension (mean > 50 mm Hg). After Percutaneous Mitral Valvuloplasty (PMV) the mitral valve measured by 2D echocardiography increased form 0.83 +/- 0.2 cm2 to 1.8 +/- 0.15 cm2; the mean transmitral gradient diminished from 13 +/- 3.4 mm Hg to 3.6 +/- 1.15 mm Hg; the degree of mitral insufficiency was no modified in neither case. Hemodynamic results revealed increasing of the mitral valve from 0.83 +/- 0.18 cm2 to 2.23 +/- 0.3 cm2; the mean mitral gradient decreased from 21.6 +/- 9 to 4.3 +/- 0.5 mm Hg; the mean left atrial pressure from 30 +/- 12 to 12.3 +/- 4 mm Hg; the mean pressure of the pulmonary artery diminished suddenly from 44.3 +/- 16 to 25.6 +/- 11 mm Hg. The average fluoroscopic time was 15.3 +/- 3 minutes. There were no complications. The patients were discharged 48 hours after the procedure and continued their pregnancies in class I NYHA, which resolved in a non complicated vaginal delivery with normal products. We conclude that PMV is a safe and useful therapy in pregnant patient with severe mitral stenosis refractory to medical treatment.

  14. Predisposing factors to development of mitral regurgitation and valve area

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    Kazemi Khaledi A

    1999-07-01

    Full Text Available Background: Percutaneous Transeptal Mitral Commisurotomy (PTMC has been used in treating mitral stenosis with variable success, its main complication being mitral incompetence. There is a need to define the subgroup of the patients who benefit mostly from the procedure. Methods: We studied 110 patients (age 17 to 60 years; mean 33.2 with mitral stenosis. PTMC was performed though femoral vein. All patients underwent echocardiographic evaluation, both before and after the procedure. Clinical, hemodynamic and echocardiographic data were gathered and used to predict the outcome. Results: PTMC was successful in all 110 patients in alleviating the stenosis (mean transmitral gradient before procedure was 17.1 mmHg; after procedure 4.4 mmHg. There was no mortality or major complication other than occurrence of mitral regurgitation in 9 cases. In this group only one patient subsequently needed a mitral valve replacement operation. The following parameters were found to have a significant correlation with the success rate of PTMC: lower age, shorter duration of illness, functional class III and IV, larger EF slope, smaller EPSS, smaller amplitude of valve motion, limitation of the posterior leaflet motion and negative history for open commisurotomy. The incidence of mitral regurgitation after procedure was found to be correlated with: atrial fibrillation rhythm before PTMC, lower age, longer duration of illness, more frequent relapse of rheumatic fever, functional class III and IV, less EF slope, limitation of the valve motion, larger left atrium, calcification of posterior leaflet and subvalvular extension. Conclusions: Balloon Mitral Valvuloplasty is an effective and relatively safe procedure in the management of the mitral stenosis. With the proper selection of the patients with the favorable outcome parameters, the rate of complication can be reduced.

  15. A case of testicular rupture

    OpenAIRE

    野俣, 浩一郎; 林, 幹男

    1987-01-01

    A case of testicular rupture is reported. A 26-year-old man was referred to our hospital because of testicular trauma. Ultrasound of the testis was performed preoperatively. Ultrasonography revealed a disruption of the tunica albuginea and dense clusters of echoes in the tunica vaginalis. In the case of acute testicular trauma, this echo pattern suggests testicular rupture.

  16. Minimally Invasive Mitral Valve Replacement and Transfemoral Aortic Valve Implantation.

    Science.gov (United States)

    Rustenbach, Christian; Baumbach, Hardy; Hill, Stephan; Franke, Ulrich F W

    2015-01-01

    The case is reported of a symptomatic elderly patient with severe mitral regurgitation, severe aortic valve stenosis, and coronary heart disease. The coronary artery disease had been interventionally treated four years previously with stent implantation into the right coronary artery. Published studies have shown that a combination of mitral and aortic valve surgery is associated with a significantly increased risk of mortality and morbidity, particularly in elderly patients. In the present patient, both valvular malformations were successfully treated with a single-step interdisciplinary approach, namely an initial surgical mitral valve replacement followed by transfemoral transcatheter aortic valve replacement.

  17. Early outcome of minimally invasive mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Shawky Fareed

    2016-08-01

    Conclusion: Right anterolateral mini-thoracotomy minimally invasive technique provides excellent exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. It should be used as an initial approach for mitral valve surgery. Furthermore, it was believed that less spreading of the incision, no interference with the diaphragm and less tissue dissection might improve outcomes, particularly respiratory function.

  18. Mitral valve prolapse in patients with Hashimoto's thyroiditis Tiroiditis de Hashimoto y prolapso de la válvula mitral

    Directory of Open Access Journals (Sweden)

    Federico Uribe Londoño

    1991-03-01

    Full Text Available The prevalence of mitral valve prolapse was determined en 67 patients with Hashimoto's thyroiditis (TH, and in 48 healthy control individuals. Mitral valve prolapse was found in 14 of 67 (20.9% patients with TH and in none of the controls. The presence of mitral valve prolapse should be investigated whenever this diagnosed. Se investigó la prevalencia de prolapso de la válvula mitral por ecocardiografía modo M y bidimensional en 67 pacientes que cumplían como mínimo tres de los criterios de Fisher y asociados, para el diagnóstico clínico de tiroiditis de Hashimoto (TH y que fueron comprobados por biopsia por aspiración de la glándula tiroides, con aguja fina, leída según los criterios de Kline; se incluyeron como controles 48 individuos normales. Se encontraron 14 casos (20.9% de prolapso de la válvula mitral en los pacientes con TH y ninguno entre los controles. Desconocemos por qué en esta serle la frecuencia del prolapso de la válvula mitral en pacientes con TH fue solamente la mitad de la observada en otra serle (41%, a pesar de que se utilizaron procedimientos y criterios diagnósticos similares. Con base en los hallazgos se sugIere buscar el prolapso de la válvula mitral en todo paciente con TH.

  19. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.

    Science.gov (United States)

    Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin

    2017-04-01

    The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  20. 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

  1. Splenic rupture following colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Francisco Guerra; Ignacio San Francisco; Fernando Pimentel; Luis Ibanez

    2008-01-01

    Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

  2. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  3. Spontaneous Rupture of Pyometra

    Directory of Open Access Journals (Sweden)

    Fatemeh Mallah

    2013-01-01

    Full Text Available Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

  4. Spontaneous Rupture of Pyometra

    Science.gov (United States)

    Mallah, Fatemeh; Eftekhar, Tahere; Naghavi-Behzad, Mohammad

    2013-01-01

    Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra. PMID:24024054

  5. Nontraumatic spontaneous rupture of the kidney : etiology and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Tae Haeng; Jeon, Hae Jeong; Shin, Hyun Joon [Konkuk Univ. College of Medicine, chungju (Korea, Republic of); Kim, Bo Hyun [Seongkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of); Cho, Kyoung Sik [Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Kim, Young Hwa [Soonchunhyang Univ. College of Medicine, Asan (Korea, Republic of); Kim, Seung Hyup [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Park, Churl Min [Korea Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-08-01

    To evaluate the usefulness of CT scanning in determining the etiology of spontaneous rupture of the kidney We retrospectively analyzed the CT findings of spontaneous rupture of the kidney in eleven patients, Four were male and seven were female, and they were aged between 20 and 71 (mean, 46.6) years. Both pre- and post-contrast enhanced CT scanning was performed in all patients. Spontaneous renal rupture was induced in seven cases by neoplasms (three angiomyolipomas, three renal cell carcinomas, and one metastatic choriocarcinoma), in three cases by infection or inflammation (acute and chronic pyelonephritis, and renal abscess), and in one, by renal cyst. Common CT findings of rupture of the kidney were the accumulation of high density fluid in the perirenal and anterior pararenal space, and inhomogeneous irregular low density of renal parenchyma and the rupture site. Angiomyolipoma showed fat and an angiomatous component in the lesion, while acute and chronic pyelonephrities revealed thinning of the renal parenchyma and an irregular renal outline. Renal cell carcinoma showed a dense soft tissue mass in the parenchyma. Well-defined, round low-density lesions were noted in the case of renal cyst and renal abscess. CT is very useful in diagnosing and determining the etiology of non-traumatic spontaneous rupture of the kidney and plays an important role in the evaluation of emergency cases.

  6. [Plurifragmentary ruptures of the kidney. Wrapping by absorbable mesh].

    Science.gov (United States)

    Spay, G

    1985-09-07

    In two patients presenting with rupture of the kidney, the fragments of that organ were kept together by wrapping in a resorbable mesh after haemostasis and trimming. The post-operative period was uneventful. This method facilitates conservative renal surgery, even in cases with severe damage.

  7. 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

    2016-12-01

    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 mm; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm; P 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.

  8. [Long-term results of closed mitral commissurotomy--comparative study of closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) and mitral valve replacement (MVR)].

    Science.gov (United States)

    Suzuki, S; Kondo, J; Imoto, K; Kajiwara, H; Tobe, M; Sakamoto, A; Isoda, S; Yamazaki, I; Noishiki, Y; Matsumoto, A

    1993-09-01

    As the technique of open heart surgery has improved, CMC has been abandoned in favor of OMC and MVR. We evaluated and compared the results of CMC, OMC and MVR. METHOD. Between 1965 and 1978, 141 patients with mitral stenosis (MS) underwent CMC, and late follow-up obtained in 117 (83%) of them (CMC group). Between 1980 and 1989, 72 patients and 37 patients underwent OMC (OMC group) and MVR (MVR group), respectively. Cumulative follow-up periods were 1982, 632 and 200 patient-years in the CMC, OMC and MVR groups, respectively. RESULTS. (1) Survival rate; In the CMC group there were 2 operative deaths due to severe mitral regurgitation (MR). There were 17 late deaths, due to reoperations in 4 patients, cerebral infarction in 4 patients, congestive heart failure in 3 patients, myocardial infarction in 2 patients and unknown causes in 4 patients. The survival rate was 95%, 91% and 86% at 5, 10 and 15 years, respectively, in the CMC group. In the OMC and MVR groups there was no death. (2) The event free rate was 89%, 79% and 58% at 5, 10 and 15 years, respectively, in the CMC group, 97% and 97% at 5 and 10 years in the OMC group, and 95% and 90% at 4 and 5 years in the MVR group. (3) Reoperations; In the CMC group of 40 patients (34%) required reoperations in an average of 10.4 years after the initial operation, due to re-MS in 22 patients, MR in 10 patients and MRS in the 8 patients. Reoperative findings consisted of clefts in the mitral leaflets in 7 patients. There were pulmonary hypertension in 15 patients and tricuspid regurgitation in 22 patients. Fourteen patients underwent tricuspid anuloplasty and one patient underwent a tricuspid valve replacement. In the OMC group one patient required a reoperation due to MR; in the MVR group one patient required a reoperation due to a thrombosed valve. CONCLUSION. In the CMC group the survival rate and the event free rate were lower, and the rate of reoperation was higher than in the other two groups.

  9. Repeat Minimally Invasive Mitral Valve Replacement for Recurrent Mitral Stenosis after OMC in Patients Who Decline Blood Product Transfusion for Religious Reasons.

    Science.gov (United States)

    Ito, Yujiro; Nakamura, Yoshitsugu; Tagusari, Osamu; Yoshida, Shigehiko

    2015-01-01

    Cardiac surgery for Jehovah's Witness (JW) patients is considered to be high risk because of patients' refusal to receive blood transfusion. We report a successful mitral valve replacement for recurrent mitral stenosis after OMC with minimally invasive right thoracotomy, without any transfusion of allogeneic blood or blood products. This minimally invasive mitral valve replacement through right thoracotomy was an excellent approach for JW patients.

  10. 167. Estenosis mitral funcional y recurrencia de insuficiencia tras anuloplastia en la insuficiencia mitral isquémica crónica

    Directory of Open Access Journals (Sweden)

    C.E. Martín López

    2010-01-01

    Conclusiones: La anuloplastia mitral aporta una corrección efectiva y durable de la insuficiencia mitral isquémica crónica. Esta técnica puede inducir estenosis mitral funcional durante el ejercicio, debiéndose valorar, a largo plazo, un posible impacto adverso en la clase funcional y supervivencia.

  11. Spontaneous unscarred fundal rupture after normal vaginal delivery

    Directory of Open Access Journals (Sweden)

    Shreya Thapa

    2014-06-01

    Full Text Available Uterine rupture is one of the most dangerous obstetric situation carrying an increased risk of maternal and perinatal morbidity and mortality, associated with poorly managed labour. The incidence of spontaneous rupture of unscarred uterus is around 1 in 8000 to 1 in 15000 deliveries. We report this unusual case of spontaneous unscarred fundal rupture after normal vaginal delivery. This case under reference developed shock soon after delivery and was explored due to suspected intraperitoneal hemorrhage. This case is being reported to emphasis the need for proper post-delivery monitoring not only to diagnose post-partum hemorrhage but also to suspect uterine rupture as a cause of unexplained shock developing after delivery inspite of all resuscitative measures. Although unexpected in a woman with an unscarred uterus, rupture should be considered as a possible cause of unusual pain or hypotension in the mother. The most effective way to reduce the number of morbidity and mortality would be to prevent unwanted pregnancies by informed and effective use of contraception. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 780-782

  12. The spectrum of transcatheter mitral valve replacement devices.

    Science.gov (United States)

    Dudiy, Yuriy; Brownlee, Andrew; Ruiz, Carlos E

    2016-06-01

    Mitral regurgitation is the most common valvular heart disease. The gold standard for patients not suitable for valve repair is a surgical valve replacement. A significant proportion of patients, however are not referred for surgery due to comorbidities, advanced age or severe LV dysfunction. Transcatheter mitral valve replacement may be a viable therapeutic option for these high risk patients. With improvements in technology and data on the durability of the transcatheter mitral valve, this technology has the potential to be used in a lower risk population. A number of transcatheter systems have emerged recently and are at different stages of investigation. In this review, we outline the key elements and challenges of the transcatheter mitral valve design as well as the status of devices that have reached First in Man status.

  13. [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.

  14. A self-retaining retractor for mitral valve operations.

    Science.gov (United States)

    Cosgrove, D M

    1986-08-01

    A new self-retaining retractor for mitral valve operations is described. It is universally adjustable, may be affixed to any sternal retractor, and is completely removable when not required for the intracardiac portion of the procedure.

  15. Self-retaining pledgeted suture as retractor for mitral procedure.

    Science.gov (United States)

    Ng, Choi-Keung; Benedikt, Peter; Schwarz, Christian; Hartl, Peter

    2009-04-01

    A simple reliable maneuver to optimize exposure of the left atrium for mitral valve operations is described. It offers more space to mobilize the valvular structure, facilitating complicated reconstruction in the posteromedial commisural area.

  16. Caseous Necrosis of Mitral Annulus: A Rare Cause of Stroke

    Directory of Open Access Journals (Sweden)

    Jérôme Corre

    2013-01-01

    Full Text Available The current report describes a rare case of a caseous necrosis presenting as a pseudotumor in ventricle, revealed by stroke. Cerebral MRI, showing multiples lacunes, evocates a cardioembolic mechanism. Transthoracic and transesophageal echocardiography demonstrate a large hyperechogenic mass fixed to the posterior mitral valve and annulus while thoracic tomography revealed a fully calcified lesion, at the mitral annulus, evocative of caseus necrosis. Medical therapy was preferred (anticoagulation, because of her age and the decaying nature of surgery.

  17. Comparação da evolução a longo prazo da valvoplastia mitral percutânea por balão com a técnica de inoue versus a do balão único: análise dos fatores de risco para óbito e eventos maiores Comparison of the inoue and single balloon techniques during long term percutaneous balloon mitral valvoplasty follow-up: analysis of risk factors for death and major events

    Directory of Open Access Journals (Sweden)

    Ivana Picone Borges

    2007-07-01

    Full Text Available OBJETIVO: Analisar a evolução a longo prazo de pacientes submetidos a valvoplastia mitral percutânea por balão com a técnica do balão de Inoue versus a técnica do balão único Balt, identificando os fatores que predisseram óbito e eventos maiores (óbito, nova valvoplastia mitral por balão ou cirurgia valvar mitral. MÉTODOS: O período de seguimento, nos grupos do balão único e do balão de Inoue, foi de 54 ± 31 (1 a 126 meses e de 34 ± 26 (2 a 105 meses, respectivamente (p 50 anos e escore ecocardiográfico > 8 predisseram, independentemente, óbito, e escore ecocardiográfico > 8 e área valvar mitral pós-procedimento 50 anos, escore ecocardiográfico > 8 e área valvar mitral pós-procedimento OBJECTIVE: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery. METHODS: The follow-up for the single and Inoue balloon groups were 54 ± 31 (1 to 126 months and 34 ± 26 (2 to 105 months, respectively (p 50 years and an echocardiographic score > 8 were independent predictors of death; and an echocardiographic score > 8 and post operative mitral valve area 50 years, echocardiographic score > 8 and mitral valve area < 1.50 cm² after the procedure.

  18. Mechanics of cutaneous wound rupture.

    Science.gov (United States)

    Swain, Digendranath; Gupta, Anurag

    2016-11-07

    A cutaneous wound may rupture during healing as a result of stretching in the skin and incompatibility at the wound-skin interface, among other factors. By treating both wound and skin as hyperelastic membranes, and using a biomechanical framework of interfacial growth, we study rupturing as a problem of cavitation in nonlinear elastic materials. We obtain analytical solutions for deformation and residual stress field in the skin-wound configuration while emphasizing the coupling between wound rupture and wrinkling in the skin. The solutions are analyzed in detail for variations in stretching environment, healing condition, and membrane stiffness.

  19. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation.

    Science.gov (United States)

    Li, Chi-Hion; Arzamendi, Dabit; Carreras, Francesc

    2016-04-01

    Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Ruptured Pebbles - a coseismic and paleoseismic indicator?

    Science.gov (United States)

    Weismüller, Christopher; Reicherter, Klaus

    2017-04-01

    fostered the assumption that these pebbles must have been fractured in-situ in the matrix. During slow deformation in combination with the contrast in competence between pebble and matrix, the pebbles would rotate and realign along a shear plane within the matrix. We explain the observed shearing of pebbles in the debris flow to be the product of a temporary tensile stress induced by the propagation of a seismic wave through the sediment body. The quick deformation causes the pebbles and matrix to engage in a state of similar competence, enabling the shearing of the clasts in the matrix. Under the given circumstances, we conclude the near-fault presence of ruptured pebbles in a soft sediment body to indicate paleoseismic activity and coseismic deformation. In contrast to that we regard aligned pebbles as a slow deformation, probably caused by afterslip and post-seismic deformation.

  1. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

    2014-11-15

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

  2. The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty

    NARCIS (Netherlands)

    Wijdh-den Hamer, Inez J.; Bouma, Wobbe; Lai, Eric K.; Levack, Melissa M.; Shang, Eric K.; Pouch, Alison M.; Eperjesi, Thomas J.; Plappert, Theodore J.; Yushkevich, Paul A.; Hung, Judy; Mariani, Massimo A.; Khabbaz, Kamal R.; Gleason, Thomas G.; Mahmood, Feroze; Acker, Michael A.; Woo, Y. Joseph; Cheung, Albert T.; Gillespie, Matthew J.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    2016-01-01

    Objectives: Repair for ischemic mitral regurgitation with undersized annuloplasty is characterized by high recurrence rates. We sought to determine the value of pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in predicting recurrence at 6 months. Methods: Intraoperative

  3. The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty

    NARCIS (Netherlands)

    Wijdh-den Hamer, Inez J.; Bouma, Wobbe; Lai, Eric K.; Levack, Melissa M.; Shang, Eric K.; Pouch, Alison M.; Eperjesi, Thomas J.; Plappert, Theodore J.; Yushkevich, Paul A.; Hung, Judy; Mariani, Massimo A.; Khabbaz, Kamal R.; Gleason, Thomas G.; Mahmood, Feroze; Acker, Michael A.; Woo, Y. Joseph; Cheung, Albert T.; Gillespie, Matthew J.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    Objectives: Repair for ischemic mitral regurgitation with undersized annuloplasty is characterized by high recurrence rates. We sought to determine the value of pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in predicting recurrence at 6 months. Methods: Intraoperative

  4. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures.

    Science.gov (United States)

    Rineer, Craig A; Ruch, David S

    2009-03-01

    Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol. Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone. This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions.

  5. Ruptured thought: rupture as a critical attitude to nursing research.

    Science.gov (United States)

    Beedholm, Kirsten; Lomborg, Kirsten; Frederiksen, Kirsten

    2014-04-01

    In this paper, we introduce the notion of ‘rupture’ from the French philosopher Michel Foucault, whose studies of discourse and governmentality have become prominent within nursing research during the last 25 years. We argue that a rupture perspective can be helpful for identifying and maintaining a critical potential within nursing research. The paper begins by introducing rupture as an inheritance from the French epistemological tradition. It then describes how rupture appears in Foucault's works, as both an overall philosophical approach and as an analytic tool in his historical studies. Two examples of analytical applications of rupture are elaborated. In the first example, rupture has inspired us to make an effort to seek alternatives to mainstream conceptions of the phenomenon under study. In the second example, inspired by Foucault's work on discontinuity, we construct a framework for historical epochs in nursing history. The paper concludes by discussing the potential of the notion of rupture as a response to the methodological concerns regarding the use of Foucault-inspired discourse analysis within nursing research. We agree with the critique of Cheek that the critical potential of discourse analysis is at risk of being undermined by research that tends to convert the approach into a fixed method.

  6. Percutaneous Trans-Coronary Venous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: Analysis of Poznan Carillon Registry Data.

    Science.gov (United States)

    Kałmucki, Piotr; Jerzykowska, Olga; Dankowski, Rafał; Baszko, Artur; Kramer, Lucyna; Szyszka, Andrzej; Siminiak, Tomasz

    2016-12-01

    The purpose of our study is to verify, whether percutaneous mitral annuloplasty results in reverse remodeling in patients with functional mitral regurgitation (FMR) and impaired ejection fraction (EF) and to investigate which echo parameters may help in prediction of the efficacy of the procedure. FMR exacerbates left ventricular (LV) dilatation and contributes to both LV remodeling and heart failure. We analyzed baseline and 1 month follow-up data in 22 consecutive patients with FMR, who underwent successful percutaneous trans-coronary venous mitral annuloplasty with the Carillon device. Significant reduction of FMR echo parameters, including vena contracta (VC), effective regurgitant orifice area (EROA), and regurgitant volume (RV) were observed and maintained throughout 1 month follow up and did not correlate with baseline annular, LV or with the left atrial diameters. Baseline mitral tenting area correlated negatively with the relative improvement (% difference) of EROA (r = -0.5898) and RV (r = -0.4363), but not with VC (r = 0.1341). In addition, increased EF as well as a significant reduction in left ventricular diameters were noted. The increase in EF negatively correlated with the change in EROA (r = -0.50058), PISA (r = -0.5327), and RV (r = -0.5457). Baseline mitral tenting area significantly correlated with the 1 month change in EF (r = 0.5946) and stroke volume (r = 0.6913). The improvement of FMR after treatment with the Carillon device is associated with LV reverse remodeling and an increase in systolic performance, that correlates with the reduction in mitral regurgitation, being not dependent on baseline heart diameters. Mitral tenting area seems to be an important parameter in prediction of benefit from percutaneous mitral annuloplasty. © 2016, Wiley Periodicals, Inc.

  7. Growth of mitral annulus in the pediatric patient after suture annuloplasty of the entire posterior mitral annulus.

    Science.gov (United States)

    Komoda, Takeshi; Huebler, Michael; Berger, Felix; Hetzer, Roland

    2009-08-01

    When mitral annuloplasty is performed in small children, room for annular growth should be allowed. However, it has not been reported how the valve develops after mitral annuloplasty of the entire posterior annulus. We report a case showing traces of annular growth at redo surgery. A female patient suffering from mitral valve insufficiency due to annular dilatation underwent modified Paneth plasty with Kay-Wooler commissural plication annuloplasty at the age of two years one month. In redo surgery 8.4 years after initial repair, enlargement of the commissural portion of the posterior annulus in addition to enlargement of the anterior leaflet and anterior annulus was observed. Modified Paneth plasty reinforced with a pericardial strip and Kay-Wooler annuloplasty of the posteromedial commissure were performed. Mitral orifice size measured with the Hegar dilator was 18 mm after the re-repair, increasing from 16 mm after the initial repair. Taking into account the normal mitral annulus diameter related to body surface area (BSA) of 16 mm at initial operation and 20 mm at redo surgery, the increase in mitral orifice size from 16 mm to 18 mm in this patient may be regarded as the annular growth in 8.4 years.

  8. Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability.

    Science.gov (United States)

    Thériault-Lauzier, Pascal; Mylotte, Darren; Dorfmeister, Magdalena; Spaziano, Marco; Andalib, Ali; Mamane, Samuel; Chetrit, Michael; Blanke, Philipp; Cecere, Renzo; Buithieu, Jean; Martucci, Giuseppe; Tchetche, Didier; Modine, Thomas; van Mieghem, Nicolas; Lange, Rüdiger; Windecker, Stephan; Bilodeau, Luc; Leipsic, Jonathon; Piazza, Nicolo

    2016-10-10

    Transcatheter mitral valve replacement (TMVR) is an emerging technology with the potential to treat patients with severe mitral regurgitation at excessive risk for surgical mitral valve surgery. Multimodality imaging of the mitral valvular complex and surrounding structures will be an important component for patient selection for TMVR. Our aim was to describe and evaluate a systematic multi-slice computed tomography (MSCT) image analysis methodology that provides measurements relevant for transcatheter mitral valve replacement. A systematic step-by-step measurement methodology is described for structures of the mitral valvular complex including: the mitral valve annulus, left ventricle, left atrium, papillary muscles and left ventricular outflow tract. To evaluate reproducibility, two observers applied this methodology to a retrospective series of 49 cardiac MSCT scans in patients with heart failure and significant mitral regurgitation. For each of 25 geometrical metrics, we evaluated inter-observer difference and intra-class correlation. The inter-observer difference was below 10% and the intra-class correlation was above 0.81 for measurements of critical importance in the sizing of TMVR devices: the mitral valve annulus diameters, area, perimeter, the inter-trigone distance, and the aorto-mitral angle. MSCT can provide measurements that are important for patient selection and sizing of TMVR devices. These measurements have excellent inter-observer reproducibility in patients with functional mitral regurgitation.

  9. 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.

  10. Echocardiographic Assessment of Ischaemic Mitral Regurgitation, Mechanism, Severity, Impact on Treatment Strategy and Long Term Outcome

    Science.gov (United States)

    Naser, Nabil; Dzubur, Alen; Kusljugic, Zumreta; Kovacevic, Katarina; Kulic, Mehmed; Sokolovic, Sekib; Terzic, Ibrahim; Haxihibeqiri-Karabdic, Ilirijana; Hondo, Zorica; Brdzanovic, Snjezana; Miseljic, Sanja

    2016-01-01

    Introduction: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Research Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE

  11. Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2004-01-01

    Full Text Available The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2 of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.

  12. Spontaneous rupture of unscarred gravid uterus.

    Science.gov (United States)

    Gurudut, Kolala S; Gouda, Hareesh S; Aramani, Sunil C; Patil, Raju H

    2011-01-01

    Rupture of gravid uterus during pregnancy is a rare entity. Overall incidence of rupture of uterus during pregnancy is 0.07%. The maternal and fetal prognoses are bad especially when the rupture occurs in an unscarred uterus. Fortunately, the sole major risk factor of spontaneous rupture of unscarred uterus is preventable, which is "multiparity." In this article, we report the death of a pregnant woman and her unborn child because of spontaneous rupture of unscarred uterus.

  13. Changes in peak left atrial longitudinal strain after percutaneous balloon mitral valvotomy and its long term impact on left atrial volumes in patients in sinus rhythm

    Directory of Open Access Journals (Sweden)

    Mohamed Ismail Ahmed

    2014-04-01

    Full Text Available Background: The prognostic signi cance of left atrial (LA size on cardiovascular outcome is now well recognised in literature. Balloon mitral valvotomy (BMV can reduce complications and improve outcome in rheumatic patients. On long term follow up in rheumatic mitral stenosis patients after BMV, left atrial volumes were shown to decrease. Methods: This is a prospective study that enrolled 54 patients who undergone successful BMV. Longitudinal Left atrial function was evaluated by speckle tracking derived strain. Left atrial volumes were measured before valvotomy, after the procedure and after 12 months during follow-up. The e ect of transmitral pressure gradient drop after balloon mitral valvotomy on left atrial strain was studied. In addition the relation between post-procedural increase of LA strain and left atrial volumes after 12 months was also evaluated. Results: There is signi cant reduction of mean trans-mitral pressure gradient from 13.104 ± 4.694 to 4.067±1.502 mmHg and signi cant improvement of mitral valve area from 1.0217 ±0.1178 to 1.766 ± 0.2307cms2 after the procedure (P value < 0.001. The mean peak longitudinal left atrial strain was much improved after BMV from 19.80±9.66 % to 34.39±12.86%. This di erence was statistically highly signi cant. (P value was <0.0001. The percent improvement of left atrial longitudinal strain correlated signi cantly with mean trans-mitral pressure gradient drop. Also left atrial mean peak left atrial longitudinal strain correlated signi cantly with left atrial volumes reductions after 12 months. Conclusions: Successful BMV results in reduction of mean left atrial volumes after 12 months which is well correlated with PALS percent change after BMV.

  14. The evaluation of mitral heart disease by angiocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul [National Medical Center, Seoul (Korea, Republic of)

    1980-12-15

    Left ventriculography with RAO projection gives many information about the states of mitral apparatus and of left ventricular function. The knowledge about these are very important to determination of performance, time and method of cardiac surgery in mitral valvular heart diseases. 20 patients of mitral valvular heart disease were studied with left ventriculographies in RAO projection which were taken before open heart surgery at department of radiology, National Medical Center during 1976 to June 1980, Comparing with operative findings and pathologic specimens. The results are as follows; 1. Poor motilities and irregularities of mitral valves which were visible above the fulcrum, and irregularities and severe retraction of the fornix during left ventricular systolic phases on left ventriculographies were compatible to the stage III by Sellers' classification of mitral valvular stenosis on operative findings. Mild degree of irregularities and restriction with smooth fornix suggested the stage I. The findings between these two, the stage II. 2. MI group showed left ventricular dilation without hypertrophy, MS group, no significant effect on LV, Ao group, enlargement with hypertrophy. 3. In Ms and MI groups, ejection fraction were relatively well preserved until grade I-II of NYHA Classification. But grade III-IV revealed decreased ejection fraction. E. F. was below 0.55 in 86% of grade III-IV. In Ao group, grade IV showed well preservation of E. F. 4. The pattern of left ventricular contraction demonstrated hypokinetic synesis or asynesis in 44.4% of grade IV, but was normal in all cases below grade III. Hyperkinetic synesis was visible in all Ao group. 5. Left ventriculography is essential to evaluation of mitral valve apparatus and LV function in mitral heart diseases before cardiac surgery.

  15. ANP and BNP plasma levels in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty

    Directory of Open Access Journals (Sweden)

    Łukasz Mazurkiewicz

    2017-03-01

    Full Text Available Introduction: Atrial (ANP and B-type (BNP natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload. Aim: To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV and to investigate factors associated with endpoints. Material and methods: The study included 96 patients (90.7% females, age 51.6 ±12.2 years with rheumatic mitral valve stenosis (mitral valve area (MVA 1.18 (1.01–1.33 cm2, mean mitral gradient (MMG 8.2 (7.1–9.2 mm Hg, NYHA 2.09 (1.9–2.5. Patients were followed up for 29.1 months for the search of endpoints. Results : The PBMV was successful in all cases. After the procedure MVA increased (1.18–1.78 cm2, p < 0.01 and pulmonary capillary wedge pressure (PCWP decreased (29.8–21.8 mm Hg, p < 0.01. Concentration of ANP significantly rose 30 min after the PBMV (79.2 vs. 134.2 pg/ml, p = 0.012 and dropped significantly after 24 h (134.2 vs. 70.4 pg/ml, p = 0.01. Furthermore, after 36 months concentration of ANP did not differ from the baseline value (p = NS. BNP concentration at day 1 was lower than at baseline (94.5 vs. 80.2 pg/ml, p = 0.032. Moreover, during the follow-up period BNP continued to fall at all time points. In univariate analysis parameters associated with endpoint occurrence were baseline PAP (p = 0.023, baseline PCWP (p = 0.022, baseline NYHA (p = 0.041 and increase in 6-minute walk test (6MWT (p = 0.043. In multivariate analysis the only factor associated with endpoint occurrence was baseline NYHA (HR = 1.52, 95% CI: –1.3–1.91, p = 0.022. Conclusions : Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure.

  16. Mitral tissue inhibitor of metalloproteinase 2 is associated with mitral valve surgery outcome.

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    Tsung-Hsien Lin

    Full Text Available BACKGROUND: Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an association between tissue inhibitor of metalloproteinase 2 (TIMP-2 expression and mitral valve (MV disease. However, the determinants and prognostic value of mitral TIMP2 after MV surgery are unknown. METHODS: This retrospective study of 164 patients after MV surgery in a tertiary medical center in Taiwan assessed mitral TIMP2 on a semiquantitative scale (0-2 by immunohistochemical staining. The primary endpoints were the composite of cardiovascular death and heart failure admission. RESULTS: Mean age was 50.4±13.7 years. After a mean follow-up period of 101±59 months, primary endpoints had occurred in 25 (15.2% subjects. Patients with and without primary endpoint events significantly differed in terms of age (56.6±14.4 vs. 49.2±13.4 years, respectively; p = 0.013 and left ventricular end-systolic diameter (LVESD (39.7±8.2 vs. 35.5±7.5 mm, p = 0.010 at surgery. The TIMP2 had a significant dose-dependent association with development of a primary endpoint (p = 0.002. Kaplan-Meier analysis showed that TIMP2 expression has a significant positive association with primary endpoint-free survival (log-rank test; p = 0.004. Cox regression analysis showed that independent predictors of primary endpoints were TIMP2 (hazard ratio [HR] 0.28; 95% confidence interval [CI] 0.12-0.65; p = 0.003, age (HR 1.05; 95% CI 1.02-1.09; p = 0.003 and LVESD (HR 1.05; 95% CI 1.01-1.10; p = 0.020. CONCLUSIONS: The lack of mitral TIMP2 expression is associated with increases in cardiovascular death and heart failure following MV surgery.

  17. Dynamic rupture in a damage-breakage rheology model

    Science.gov (United States)

    Lyakhovsky, Vladimir; Ben-Zion, Yehuda; Ilchev, Assen; Mendecki, Aleksander

    2016-08-01

    We present a thermodynamically based formulation for modelling dynamic rupture processes in the brittle crust using a continuum damage-breakage rheology. The model combines aspects of a continuum viscoelastic damage framework for brittle solids with a continuum breakage mechanics for granular flow within dynamically generated slip zones. The formulation accounts for the density of distributed cracking and other internal flaws in damaged rocks with a scalar damage parameter, and addresses the grain size distribution of a granular phase in the slip zone with a breakage parameter. A dynamic brittle instability is associated with a critical level of damage in the solid, leading to loss of convexity of the solid strain energy, localization and transition to a granular phase associated with lower energy level. The continuum damage-breakage rheology model treats the localization to a slip zone at the onset of dynamic rupture and post-failure recovery process as phase transitions between solid and granular states. The model generates sub- and supershear rupture velocities and pulse-type ruptures seen also in frictional models, and additional important features such as strong dynamic changes of volumetric strain near the rupture front and diversity of nucleation mechanisms. The propagation of rupture front and slip accumulation at a point are correlated with sharp dynamic dilation followed by a gradual decay to a level associated with the final volumetric change associated with the granular phase transition in the slipping zone. The local brittle failure process associated with the solid-granular transition is expected to produce isotropic radiation in addition to the deviatoric terms. The framework significantly extends the ability to model brittle processes in complex geometrical structures and allows analysing the roles of gouge thickness and other parameters on nucleation, rupture and radiation characteristics.

  18. Heart rate, heart rate variability, and arrhythmias in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

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

    2012-01-01

    Autonomic modulation of heart rhythm is thought to influence the pathophysiology of myxomatous mitral valve disease (MMVD).......Autonomic modulation of heart rhythm is thought to influence the pathophysiology of myxomatous mitral valve disease (MMVD)....

  19. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve

    NARCIS (Netherlands)

    Dal-Bianco, Jacob P; Aikawa, Elena; Bischoff, Joyce; Guerrero, J Luis; Hjortnaes, Jesper; Beaudoin, Jonathan; Szymanski, Catherine; Bartko, Philipp E; Seybolt, Margo M; Handschumacher, Mark D; Sullivan, Suzanne; Garcia, Michael L; Mauskapf, Adam; Titus, James S; Wylie-Sears, Jill; Irvin, Whitney S; Chaput, Miguel; Messas, Emmanuel; Hagège, Albert A; Carpentier, Alain; Levine, Robert A

    2016-01-01

    BACKGROUND: In patients with myocardial infarction (MI), leaflet tethering by displaced papillary muscles induces mitral regurgitation (MR), which doubles mortality. Mitral valves (MVs) are larger in such patients but fibrosis sets in counterproductively. The investigators previously reported that e

  20. Our First Experience on Percutaneous Transvenous Mitral Commissurotomy (PTMC: Case Report

    Directory of Open Access Journals (Sweden)

    Aziz Karabulut

    2005-01-01

    Full Text Available Rheumatic heart disease remains a significant healt problem especially in devaloping countries. In rheumatic heart disease, mitral valve is affected in nearly all cases; mitral stenosis is the most common lesion. Percutaneous Transvenous Mitral Commissurotomy (PTMC is an important tool in the treatment of rheumatic mitral stenosis. In this study, our first PTMC case is presented, and the PTMC indications and the comparison of patients underwent PTMC with those patients underwent surgical intervention is discussed with the literature.

  1. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  2. Tricuspid regurgitation after successful mitral valve surgery.

    Science.gov (United States)

    Katsi, Vasiliki; Raftopoulos, Leonidas; Aggeli, Constantina; Vlasseros, Ioannis; Felekos, Ioannis; Tousoulis, Dimitrios; Stefanadis, Christodoulos; Kallikazaros, Ioannis

    2012-07-01

    The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified.

  3. Electrocardiographic Changes in Mitral Valve Prolapse Syndrome

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    Mohamad Mehdi Peighambari

    2014-03-01

    Full Text Available Background- Mitral valve prolapse syndrome (MVP is most common valvular abnormality in young and is correlated with increased frequency of cardiac dysrhythmias and sudden death. The aim of this study was to compare frequency of "early repolarization" in electrocardiogram (ECG between MVP patients and healthy adults. Methods- In this cross-sectional study, we compared ECG presentations of early repolarization including notch in descending arm of QRS and J-point and/or ST segment changes in 100 patients with MVP with 100 healthy individuals. MVP patients were referred to cardiology clinic with symptoms of palpitation, chest pain or anxiety. Results-The mean age in patients with MVP was significantly less than healthy subjects (29.5 ± 9.3 years versus 31.0 ± 6.9 years in control group, p=0.1967. We detected an early repolarization as a prevalent sign in ECG of patients, which was a notch in descending arm of QRS and/or ST segment or J-point elevation seen in 74% of patients ( 51% in inferior leads and 23% in I and aVL leads , whilst the same findings was seen in 8 men (8% in control group (p=0.0001. Conclusion- Early repolarization in ECG presented as a notch in descending arm of QRS and/or ST segment or J-point elevation is more frequent in in young patients with MVP syndrome.

  4. A simplified study of trans-mitral Doppler patterns

    Directory of Open Access Journals (Sweden)

    Thomas George

    2008-11-01

    Full Text Available Abstract Background Trans-mitral Doppler produces complex patterns with a great deal of variability. There are several confusing numerical measures and indices to study these patterns. However trans-mitral Doppler produces readymade data visualization by pattern generation which could be interpreted by pattern analysis. By following a systematic approach we could create an order and use this tool to study cardiac function. Presentation of the hypothesis In this new approach we eliminate the variables and apply pattern recognition as the main criterion of study. Proper terminologies are also devised to avoid confusion. In this way we can get some meaningful information. Testing the hypothesis Trans-mitral Doppler should be seen as patterns rather than the amplitude. The hypothesis can be proven by logical deduction, extrapolation and elimination of variables. Trans-mitral flow is also analyzed vis-à-vis the Starling's Law applied to the left atrium. Implications of the hypothesis Trans-mitral Doppler patterns are not just useful for evaluating diastolic function. They are also useful to evaluate systolic function. By following this schema we could get useful diagnostic information and therapeutic options using simple pattern recognition with minimal measurements. This simplified but practical approach will be useful in day to day clinical practice and help in understanding cardiac function better. This will also standardize research and improve communication.

  5. Usefulness of radionuclide angiocardiography in predicting stenotic mitral orifice area

    Energy Technology Data Exchange (ETDEWEB)

    Burns, R.J.; Armitage, D.L.; Fountas, P.N.; Tremblay, P.C.; Druck, M.N.

    1986-12-01

    Fifteen patients with pure mitral stenosis (MS) underwent high-temporal-resolution radionuclide angiocardiography for calculation of the ratio of peak left ventricular (LV) filling rate divided by mean LV filling rate (filling ratio). Whereas LV filling normally occurs in 3 phases, in MS it is more uniform. Thus, in 13 patients the filling ratio was below the normal range of 2.21 to 2.88 (p less than 0.001). In 11 patients in atrial fibrillation, filling ratio divided by mean cardiac cycle length and by LV ejection fraction provided good correlation (r = 0.85) with modified Gorlin formula derived mitral area and excellent correlation with echocardiographic mitral area (r = 0.95). Significant MS can be detected using radionuclide angiocardiography to calculate filling ratio. In the absence of the confounding influence of atrial systole calculation of 0.14 (filling ratio divided by cardiac cycle length divided by LV ejection fraction) + 0.40 cm2 enables accurate prediction of mitral area (+/- 4%). Our data support the contention that the modified Gorlin formula, based on steady-state hemodynamics, provides less certain estimates of mitral area for patients with MS and atrial fibrillation, in whom echocardiography and radionuclide angiocardiography may be more accurate.

  6. Intraoperative assessment of mitral valve area after mitral valve repair: comparison of different methods.

    Science.gov (United States)

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

    2011-04-01

    In the present study, 3 different methods to measure the mitral valve area (MVA) after mitral valve repair (MVRep) were studied. Data obtained immediately after repair were compared with postoperative data. The objective was to determine the feasibility and correlation between intraoperative and postoperative MVA data. A prospective study. A tertiary care medical center. Twenty-five elective adult surgical patients scheduled for MVRep. Echocardiographic data included MVAs obtained using the pressure half-time (PHT), 2-dimensional planimetry (2D-PLAN), and the continuity equation (CE). These data were obtained immediately after cardiopulmonary bypass and were compared with data obtained before hospital discharge (transthoracic echocardiogram 1) and 6 to 12 months after surgery (transthoracic echocardiogram 2). Intraoperative care was guided by hemodynamic goals designed to optimize cardiac function. The data show good agreement and correlation between MVA obtained with PHT and 2D-PLAN within and between each time period. MVA data obtained with the CE in the postoperative period were lower than and did not correlate or agree as well with other MVA data. The MVA recorded immediately after valve repair, using PHT, correlated and agreed with MVA data obtained in the postoperative period. These results contrast with previously published data and could highlight the impact of hemodynamic function during the assessment of MVA. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. 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)....

  8. A Case of Mitral Valve Tophus in a Patient with Severe Gout Tophaceous Arthritis

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2012-01-01

    Full Text Available A few cases of cardiac valve tophi have been reported in literature. In this case report, the echocardiographic characteristics of the hyperechoic mass in the posterior leaflet mitral valve, intact mitral valve ring, and the occurrence of severe tophaceous gout arthritis suggested the diagnosis of a gout tophus on the mitral valve.

  9. Immediate, intermediate and long term clinical outcomes of percutaneous transvenous mitral commissurotomy

    Directory of Open Access Journals (Sweden)

    Satya Narayana Murthy Jayanthi Sriram

    2015-03-01

    Conclusions: MV score, Mitral valve area, mitral gradient and pulmonary artery pressures appeared to influence the outcome of PTMC. A clear-cut prospective assessment of individual components of the mitral valve apparatus using 3-D echocardiographic images may provide a more precise prediction of the PTMC outcome based on its morphological abnormalities.

  10. Quadriceps and patellar tendon rupture.

    Science.gov (United States)

    Ramseier, L E; Werner, C M L; Heinzelmann, M

    2006-06-01

    Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.

  11. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  12. Ecodopplercardiografia transesofágica intra-operatória: utilidade na cirurgia da valva mitral The usefulness of intraoperative transesofageal echocardiography for mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Álvaro Villela de Moraes

    1992-12-01

    valor no auxílio do planejamento cirúrgico nas doenças da VM, bem como na avaliação imediaata dos resultados operatórios possibilitando ao cirurgião uma adequada análise anatômica e funcional da estrutura abordada.The usefulness of routine intraoperative transesophageal echocardiography (TEE for mitral valve (MV surgery was studied in 65 patients (pts with MV disease (mean age = 31 ± 14.8 to 62 yrs: 1 - Mitral regurgitation (MR: 19 pts-MV prolapse in 12 pts; Ischemic in 6 pts and post repair of ASD: 1 pt; 2 - Mitral stenosis (MS: 23 pts (4 of them with previous surgery; 3 - MS+MR and/or tricuspid valve (TV lesions: 16 pts; 4 - Bioprosthetic valve (BV dysfunction: 6 pts and 5 - Left atrial myxoma: 1 pt. Initial precardiopulmonary bypass TEE was used to confirm MV dysfunction, TV involvement and to assess LV function. On the 1 st run bypass (RBP, the MV commissurotomy was performed in 27 pts (23 with MS and 4 with MS+MR; the MV was replaced with BV (pericardial #21 to #29 in 18 pts (6 with BV dysfunction and 12 with MS+MR and the MV repair was performed in all of 19 pts with MR. The 2nd RBP was required in 7 pts (11%: 1 pt with MR; 4 pts with MS+MR and 2 pts with MS. TEE caused changes in pre pump plans in 9 pts with TV lesions and in 10 pts with MS or MS+MR - preservation of native in 6 pts in which replacement was planned. Thus intraoperative TEE provides helpful information in MV surgery and can help avoid a mitral replacement in pts with MS or MS+MR.

  13. [Does mitral valve annuloplasty improve long-term survival in patients having moderate ischemic mitral regurgitation undergoing CABG?].

    Science.gov (United States)

    Silberman, Shuli; Merin, Ofer; Fink, Daniel; Alshousha, Atia; Shachar, Sigal; Tauber, Rachel; Butnaro, Adi; Bitran, Daniel

    2014-12-01

    The best surgical approach for patients with moderate ischemic mitral regurgitation (IMR) is still undetermined. We examined long term outcomes in patients with moderate IMR undergoing coronary bypass (CABG), and compared outcomes between those undergoing isolated CABG to those undergoing concomitant restrictive annuloplasty. Between the years 1993-2011, 231 patients with moderate IMR underwent CABG: group 1 (n = 186) underwent isolated CABG, group 2 (n = 15) underwent CABG with concomitant mitral valve annuloplasty. Univariate analysis was used to compare baseline parameters. Kaplan-Meier estimates were used to compare survival. Cox multivariate regression was used to determine predictors for late survival. Survival data up to 20 years is 97% complete. The groups were similar with respect to age, prior MI, LV function, and incidence of atrial fibrillation. Patients undergoing mitral repair had a higher incidence of congestive heart failure (CHF) (p < 0.0001). After surgery more repair patients required use of inotropes (p = 0.0005). Overall operative mortality was 7% and similar between groups. Ten year survival was 55% and 52% for groups 1 and 2 respectively (p = 0.2). Predictors of late mortality included age, CHF, LV dimensions and LV dysfunction. Neither the addition of a mitral procedure and type of ring implanted nor residual MR after surgery, emerged as predictors of survival. In patients with moderate ischemic MR, neither operative mortality nor long term survival are affected by the performance of a restrictive annuloplasty. For patients with CHF, mitral repair may be beneficial in terms of survival.

  14. Untreated silicone breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten

    2004-01-01

    Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether...... untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic...... breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations...

  15. Ruptured Aneurysm of the Splenic Artery: A Rare Cause of Abdominal Pain after Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Jalalludin Khoshnevis

    2013-01-01

    Full Text Available Introduction: Splenic artery aneurysms (SAAs are rare (0.2-10.4%; however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.Case Presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

  16. Protecting geothermal operations with rupture disks

    Energy Technology Data Exchange (ETDEWEB)

    Porter, D.W.

    1983-02-01

    Potential rupture disk applications in geothermal operations are reviewed. Several wells manifolded together, to form the geothermal feed, cause erratic pressure. Rupture disks are used for relief. Flash tanks are equipped with rupture disks. Brine separators, heat exchanger shells, and turbine casings are protected by rupture disks. An analysis of geothermal steam will determine the rupture disk metal. Reverse Buckling disks are recommended over tension loaded disks for dealing with geothermal pressure cycling. Erratic temperature suggests that metals which retain tensile strength with temperature be used (Inconel is mentioned). In summary, geothermal projects represent an excellent rupture disk market.

  17. Surgical phantom for off-pump mitral valve replacement

    Science.gov (United States)

    McLeod, A. Jonathan; Moore, John; Guiraudon, Gerard M.; Jones, Doug L.; Campbell, Gordon; Peters, Terry M.

    2011-03-01

    Off-pump, intracardiac, beating heart surgery has the potential to improve patient outcomes by eliminating the need for cardiopulmonary bypass and aortic cross clamping but it requires extensive image guidance as well as the development of specialized instrumentation. Previously, developments in image guidance and instrumentation were validated on either a static phantom or in vivo through porcine models. This paper describes the design and development of a surgical phantom for simulating off-pump mitral valve replacement inside the closed beating heart. The phantom allows surgical access to the mitral annulus while mimicking the pressure inside the beating heart. An image guidance system using tracked ultrasound, magnetic instrument tracking and preoperative models previously developed for off-pump mitral valve replacement is applied to the phantom. Pressure measurements and ultrasound images confirm the phantom closely mimics conditions inside the beating heart.

  18. The Ross II procedure: pulmonary autograft in the mitral position.

    Science.gov (United States)

    Athanasiou, Thanos; Cherian, Ashok; Ross, Donald

    2004-10-01

    The surgical management of mitral valve disease in women of childbearing age, young patients, and children with congenital mitral valve defects is made difficult by the prospect of lifelong anticoagulation. We suggest the use of a pulmonary autograft in the mitral position (Ross II procedure) as an alternative surgical technique. We present a review of the literature, historical perspectives, indications, selection criteria, and surgical technique for the Ross II procedure. Our literature search identified 14 studies that reported results from the Ross II operation. Performed in 103 patients, the overall in-hospital mortality was 7 (6.7%), with a late mortality of 10 (9%). Although further research is needed, current evidence suggests the Ross II operation is a valuable alternative in low-risk young patients where valve durability and the complication rate from other procedures is unsatisfactory and anticoagulation not ideal.

  19. Sudden cardiac death and mitral and aortic valve disease

    Directory of Open Access Journals (Sweden)

    Bockeria O.L.

    2013-09-01

    Independent determinants of sudden death were left ventricular ejection fraction and atrial fibrillation. The main cause of death in patients with mitral valve stenosis is a thromboembolism from the left heart chambers to systemic circulation, and the risk of the latter increases with atrial fibrillation. There is no sudden cardiac death in mitral valve stenosis. The absence of left ventricular remodeling in mitral valve stenosis probably explains this finding. Onset of symptoms and signs of left ventricular dysfunction are the main predictors of sudden death and are indications for surgery. It should be emphasized that the database of sudden cardiac death in patients with valvular heart disease is very limited compared to patients with coronary heart disease and cardiomyopathies. Some issues related to predictors and mechanisms of SCD are currently poorly understood, therefore prevention of sudden cardiac death is difficult, especially in asymptomatic patients.

  20. Reemplazo valvular mitral en edad pediátrica

    Directory of Open Access Journals (Sweden)

    H S Diliz-Nava

    2017-01-01

    Full Text Available ANTECEDENTES: el reemplazo valvular mitral en pediatría es un procedimiento raro asociado con dificultades técnicas y clínicas únicas. Estudios recientes reportan mejores resultados, a corto y largo plazo, posteriores al procedimiento.   OBJETIVO: analizar la experiencia del reemplazo valvular mitral en el Instituto Nacional de Pediatría.   MATERIALES Y MÉTODOS: se revisaron los expedientes de los pacientes con reemplazo valvular mitral, en el Instituto Nacional de Pediatría, entre agosto del 2002 y agosto del 2012. Las variables de evaluación primaria fueron mortalidad, complicaciones de la anticoagulación y resultados a largo plazo. Se incluyó a doce pacientes, con mediana de edad de 12.5 años (tres pacientes menores de 5 años. RESULTADOS: en 11 casos la anomalía mitral fue considerada congénita. La manifestación clínica más frecuente fue insuficiencia mitral. La mediana de la fracción de eyección del ventrículo izquierdo fue de 62% antes de la cirugía. Se colocó prótesis mecánica en 11 casos. Dos pacientes fallecieron en el postoperatorio inmediato, con supervivencia a 30 días de 83%, sin reporte de ninguna muerte en el periodo de seguimiento. Un paciente presentó sangrado de  tubo digestivo leve y dos arritmia auricular. No se reportaron eventos tromboembólicos ni necesidad de nueva intervención. La mediana del tiempo de seguimiento fue de 16.6 meses.   CONCLUSIÓN: en nuestras condiciones el reemplazo valvular mitral parece ser una buena opción para los pacientes que no pueden beneficiarse de la reparación, con resultados aceptables a corto y mediano plazos.

  1. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  2. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  3. Simultaneous bilateral patellar tendon rupture

    Directory of Open Access Journals (Sweden)

    Diogo Lino Moura

    Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  4. Rupture of Achilles Tendon : Usefulness of Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam Hyeon; Ki, Won Woo; Yoon, Kwon Ha; Kim, Song Mun; Shin, Myeong Jin [Ulsan Medical College, Ulsan (Korea, Republic of); Kwon, Soon Tae [Chungnam University College of Medicine, Daejeon (Korea, Republic of)

    1996-06-15

    To differentiate a complete rupture of Achilles tendon from an incomplete one which is important because its treatment is quite different. And it is necessary to know the exact site of the rupture preoperatively. Fifteen cases of fourteen patients which were diagnosed as Achilles tendon rupture by ultrasonography and surgery were reviewed. We compared sonographic rupture site with surgical findings. Ultrasonographic criteria for differentiation of complete and incomplete rupture was defined as follows : the discreteness, which means the proximal intervening hypoechogenicity to the interface echogenicity of distal margin of ruptured tendon : the slant sign, which represents the interface of ruptured distal margin which was seen over the 3/4 of the thickness of the tendon without intervening low echogeneicity : the invagination sign, which means the echogenic invagination from Kager triangle into posterior aspect of Achilles tendon over the half thickness of the tendon. The sites of complete tendon rupture were exactly corresponded to surgical finding in four cases of ten complete ruptures. And the discrepancy between sonographic and surgical findings in the site of complete rupture was 1.2 {+-} 0.4 cm in six cases. Three of ten complete ruptures showed the discreteness sign, all of ten showed the slant sign and two of ten showed the invagination sign. It is helpful to differentiate a complete from incomplete rupture of the Achilles tendon and to localize the site of the complete rupture with the ultrasonographic evaluation

  5. Two-Dimensional Echo-cardiographic Estimation of the Size of the Mitral Valve Annulus

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1982-12-01

    Full Text Available The diameter of the mitral annulus as measured on the long axis by two-dimensional echocardiogram was found to correlate well with the size of the sewing ring used to replace the mitral valve in 35 consecutive patients. The size of the prosthesis which was used could be predicted within 1 mm of error in 83% of the mitral stenosis (MS patients and in 76% of the mitral regurgitation (MR patients in the study. Preoperative echocardiographic estimation of the size of the mitral valve annulus and prediction of the sewing ring size of the prosthetic valve used could reduce the incidence of valve prosthesis-patient mismatch.

  6. Echocardiographic Monitoring of Cardiac Parameters after Mitral Valve Replacement with the Preservation of Subvalvular Structures

    Institute of Scientific and Technical Information of China (English)

    Rasul Sadirhanovich Parpiyev; Mirdjamal Mirumarovich Zufarov; Khamidulla Amannullaevich Abdumadjivov; Sayora Abdullaeva; Khusan Gazihanovich Khalikulov

    2011-01-01

    @@ TO date many monitoring techniques have been used to determine the efficacy of surgical correction of mitral valve disease.The most common non-invasive method in use is echocardiography which can assess the myocardial and mitral valve function changes after mitral valve replacement procedures.In this study,we investigated the five-year follow-up echocardiographic results of 143 patients undergoing mitral valve replacement with preservation of subvalvuiar apparatus to analyze the recovery of myocardial and mitral valve functions.

  7. 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.

  8. Do all hemolytic anemias that occur after mitral valve repair require surgical treatment?

    Science.gov (United States)

    Gungunes, Askin; Akpinar, Ibrahim; Dogan, Mehmet; Baser, Kazim; Yildirim, Ismail Safa; Haznedaroglu, Ibrahim C

    2010-12-01

    We report on a 29-year-old woman with severe hemolytic anemia following mitral valve annuloplasty. Although hemolysis due to mechanical prosthetic mitral valve is well recognized, hemolytic anemia associated with mitral valve repair is an uncommon condition. Reoperation may be considered if the patient has serious and persistent anemia. Although valve replacement is suggested to be a unique intervention, it may not be the solution every time because of mechanical effects. Various mechanisms of hemolysis related to mitral valve repair were suggested, but sufficient and precise data is not available. In this case, we tried to emphasize whether all hemolytic anemias that occur after mitral valve repair require surgical treatment.

  9. Rotura ventricular após substituição da valva mitral Ventricular disruption after mitral valve replacement

    Directory of Open Access Journals (Sweden)

    Marcelo Campos Christo

    1989-04-01

    Full Text Available Entre 1979 e 1988, 4 casos de rotura do ventrículo esquerdo (VE, após substituição da valva mitral (SVM, foram registrados entre 332 pacientes. Os autores reconhecem, entre seus casos, 3 roturas na junção atrioventricular, ocorridas logo após a saída de by-pass e 1 rotura em parede posterior do VE, ocorrida na unidade de terapia intensiva (UTI. Os pacientes eram todos do sexo feminino e tinham, em média, 58 anos de idade. Tais acidentes aconteceram 3 vezes após substituição isolada da valva mitral e 1 vez em operação combinada de SVM e revascularização do miocárdio. Admitem que o mecanismo principal da rotura está ligado à criação de zona de acinesia isquêmica, localizada em parede do VE, secundária à superdistensão de anel mitral. Relacionam o desencadeamento dos acidentes com a superdistensão dos anéis valvares, avaliados com medidores inadequados, usados em corações profundamente relaxados pela cardioplegia. Preconizam modificações na cabeça desses medidores, adaptando-os a cabos maleáveis, de modo a permitir um posicionamento mais perfeito da cabeça do medidor do anel mitral. Admitem que o perfil mais ou menos elevado das próteses não parece haver influenciado no aparecimento, ou na prevenção desses acidentes, mas sim na determinação do tipo anatômico da lesão. Estão de acordo com outros autores, quando admitem que a fragilidade do miocárdio, em pacientes idosos, agravada com a remoção do aparelho valvar mitral (ventrículo sem sustentação, criaria condições para o aparecimento desses acidentes. Consideram desejável a preservação do aparelho valvar mitral nas SVM, mas consideram que técnicas seguras, com essa finalidade, precisam ser ainda desenvolvidas.Between 1979 and 1988 four fatal cases of left ventricular disruption after mitral valve replacement were registered among 332 patients submitted to mitral valve replacement, with two different types of porcine prosthesis in isolated or

  10. Surgical repair of mitral valve prolapse with valve regurgitation%二尖瓣脱垂并关闭不全的外科修补

    Institute of Scientific and Technical Information of China (English)

    余翼飞; 朱朗标; 王冬青; 李功宋; 杨建安; 刘明辉

    2001-01-01

    目的 总结二尖瓣脱垂的外科修复经验。 方法 对44例二尖瓣脱垂患者的临床资进行回顾分析。44例患者中风湿性2例,非风湿性42例(22例合并先天性心脏病);关闭不全中度24例,重度20例;腱索断裂或缺如12例,腱索过长32例,其中多根腱索过长6例。治疗行腱索移植10例,腱索缩短25例(多根腱索缩短6例),人工腱索1例,瓣叶折叠3例,瓣叶切除5例;同时行瓣裂缝合8例,瓣环成形28例(后环缝缩14例)。 结果 全组无手术死亡病例。1例风湿性患者术后1个月发生左心房血栓再次手术行瓣膜替换。二尖瓣功能正常34例(77.8%),基本正常6例(13.6%),残留轻至中度关闭不全3例(6.8%)。随访1~18年(平均6.5年),效果良好。 结论 外科修复治疗二尖瓣脱垂是一种安全有效的手术方法。%Objective To review the experience in surgical repair of mitralvalve prolapse with valve regurgitation. Methods From January 1981 to June 1998, 44 patients with mitral valve prolapse were treated. Among them, 2 had rheumatic valve disease, 20 mitral valve prolapse, and 22 congenital heart disease combined with mitral prolapse. All the patients had mitral valve regurgitation (moderate 24, severe 20). Chordae rupture or absence was observed in 12 patients and chordae elongation in 32. Chordae transplantation was performed in 10 patients. Elongated chordae was shortened in 25 patients and milti-chordae shortened in 6. Artificial chordae was reconstructed in one patient. Concomitant procedures included mitral leaflet removal (5 patients), leaflet plication (3), closure of mitral cleft(8), and anuloplasty (28). Results There no operative mortality occurred. Follow-up averaged 6.5 years (range 1-18 years). In 34 patients (77.8%), mitral function was normal. Slight and mild-moderate regurgitation were noted in 6 and 3 patients respectively. In one of the patients, mitral valve

  11. Mathematical multi-scale model of the cardiovascular system including mitral valve dynamics. Application to ischemic mitral insufficiency

    Directory of Open Access Journals (Sweden)

    Moonen Marie

    2011-09-01

    Full Text Available Abstract Background Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions. Methods A cardiovascular and circulatory system (CVS model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate "open on pressure, close on flow" law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle. Results Simulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends. Conclusions The resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves.

  12. Achilles tendon rupture; assessment of nonoperative treatment

    National Research Council Canada - National Science Library

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place...

  13. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    Hadi Mirfazaelian

    2014-01-01

    Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

  14. Spontaneous bilateral quadriceps tendon rupture.

    Science.gov (United States)

    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  15. 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...... 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...

  16. Recriticality of reactor during cooling post loss of coolant accident due to great ruptures; Recriticalidade do reator durante resfriamento apos um acidente de perda de refrigeracao por grandes rupturas

    Energy Technology Data Exchange (ETDEWEB)

    Ponzoni Filho, Pedro [Universidade Federal, Rio de Janeiro, RJ (Brazil). Fundacao Universitaria Jose Bonifacio

    2000-07-01

    The reduction of boron concentration in Angra 1 Boron Injection Tank (BIT) to the room temperature solubility level makes necessary a recalculation, to meet the post-LOCA subcriticality requirement. The main conclusions are the following: the new boron concentration of accumulators, Refueling Water Storage Tank (RWST) and BIT must be 2500 to 3000 ppm; all the devices used for heating BIT and the lines and valves associated to it may be turned off; the time for switch over from cold leg to hot leg recirculation must change from 24 to 13 hours; the new range of boron concentration will assure subcriticality of Angra 1 during a LOCA long term reactor cooling. (author)

  17. A case of recurrent spontaneous vesical rupture subsequent to irradiation for uterine cancer

    Energy Technology Data Exchange (ETDEWEB)

    Takemura, Hiroshi; Baba, Katsuyuki; Yajima, Michitaka; Yamakawa, Katsunori; Nishida, Shigehito; Iwamoto, Teruaki [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

    2000-04-01

    The patient, a 68-year-old woman, had undergone radical hysterectomy and post-operative radiotherapy for uterine cancer in 1974. She was admitted to our hospital complaining of abdominal pain in February, 1996. Contrast-enhanced computed tomographic scan and cystography showed leakage of contrast medium around the bladder. We diagnosed her with spontaneous vesical rupture, and performed conservative therapy. Two months later, she was re-admitted with recurrent vesical rupture. We again performed conservative therapy. We consider that conservative therapy can be indicated for spontaneous vesical rupture with good general condition and no severe urinary tract infection. (author)

  18. Type 1 Achilles tendon rupture caused by grooming trauma in a young dog

    Directory of Open Access Journals (Sweden)

    M. Isaka

    2014-05-01

    Full Text Available Achilles tendon rupture is uncommon in small animal practice. A 9-month-old, female, mixed breed dog (weighing 2.2kg was referred to our hospital with a primary complaint of right hind limb lameness. Complete right Achilles tendon rupture was diagnosed by physical examination and radiography. The tendon was surgically repaired the next day by using a three-loop and single near-far-far-near suture methods. Complete healing was achieved by 97 days post-surgery. This report describes the surgical technique used for complete Achilles tendon rupture repair in a young dog.

  19. Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

    OpenAIRE

    Liu, Ching-Jung; Chien, Rong-Nan; Yen, Cho-li; Chang, Jia-Jang

    2007-01-01

    Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors, connective tissue disease, infiltrating liver disease, preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a non-cirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hemat...

  20. Renal pelvis rupture in a kidney with ureteropelvic junction obstruction and extrarenal calyces.

    Science.gov (United States)

    Ransford, George; Young, Ezekiel; Castellan, Miguel; Labbie, Andrew

    2013-06-01

    The extrarenal calyx (ERC) is a rare congenital anomaly, associated with various other abnormalities of the urogenital system. We report a unique case of ERC in a solitary functioning kidney with a massively dilated pelvis that developed spontaneous rupture. A dismembered pyeloplasty was performed at the time of rupture. The patient did well post-operatively with a stable creatinine and stable SFU grade 2 hydronephrosis.

  1. Mechanics of Multifault Earthquake Ruptures

    Science.gov (United States)

    Fletcher, J. M.; Oskin, M. E.; Teran, O.

    2015-12-01

    The 2010 El Mayor-Cucapah earthquake of magnitude Mw 7.2 produced the most complex rupture ever documented on the Pacific-North American plate margin, and the network of high- and low-angle faults activated in the event record systematic changes in kinematics with fault orientation. Individual faults have a broad and continuous spectrum of slip sense ranging from endmember dextral strike slip to normal slip, and even faults with thrust sense of dip slip were commonly observed in the aftershock sequence. Patterns of coseismic slip are consistent with three-dimensional constrictional strain and show that integrated transtensional shearing can be accommodated in a single earthquake. Stress inversions of coseismic surface rupture and aftershock focal mechanisms define two coaxial, but permuted stress states. The maximum (σ1) and intermediate (σ2) principal stresses are close in magnitude, but flip orientations due to topography- and density-controlled gradients in lithostatic load along the length of the rupture. Although most large earthquakes throughout the world activate slip on multiple faults, the mechanical conditions of their genesis remain poorly understood. Our work attempts to answer several key questions. 1) Why do complex fault systems exist? They must do something that simple, optimally-oriented fault systems cannot because the two types of faults are commonly located in close proximity. 2) How are faults with diverse orientations and slip senses prepared throughout the interseismic period to fail spontaneously together in a single earthquake? 3) Can a single stress state produce multi-fault failure? 4) Are variations in pore pressure, friction and cohesion required to produce simultaneous rupture? 5) How is the fabric of surface rupture affected by variations in orientation, kinematics, total geologic slip and fault zone architecture?

  2. Magnetic resonance imaging in acute tendon ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  3. [Enthesopathy of the upper insertion of the musculus rectus femoris. A retrospective sign of tendon rupture in sports pathology].

    Science.gov (United States)

    Baudrillard, J C; Lerais, J M; Segal, P; Durot, J F; Gatfosse, M; Auquier, F; Toubas, O

    1986-03-01

    We report 4 cases of post-traumatic enthesopathy occurring later after rupture of rectus femoris tendon from the anterior superior iliac spine. Radiographic feature and clinical picture are typical of diagnosis.

  4. 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.

  5. Controversy in mitral valve repair, resection or chordal replacement?

    Science.gov (United States)

    Sawazaki, Masaru; Tomari, Shiro; Zaikokuji, Kenta; Imaeda, Yusuke

    2014-10-01

    Mitral valve plasty has superseded valve replacement as the standard technique for treating degenerative mitral valve prolapse. Quadrangular resection is considered the gold standard for posterior leaflet prolapse. Chordal replacement was first developed to treat the anterior leaflet and subsequently became widely used for the posterior leaflet, after which a new version of posterior leaflet resection was developed that did not involve local annular plication. In the era of the mini-thoracotomy, the premeasured loop technique is simple to adopt and is as durable as quadrangular resection. However, there is controversy surrounding whether resection or chordal replacement is the optimal technique. The resection technique is curative because it removes the main pathologic lesion. The disadvantage of the resection is that it can be complicated and often requires advanced surgical skills. In contrast, chordal replacement is not pathologically curative because it leaves behind a redundant leaflet. However, the long-term results appear to be equivalent in many reports. Functionally, chordal replacement retains greater posterior leaflet motion with a lower trans-mitral pressure gradient than quadrangular resection. Moreover, chordal replacement is simple and yields uniform results. The optimal technique depends on whether the anterior leaflet or posterior leaflet is involved, the Barlow or non-Barlow disease state, and whether a mini-thoracotomy or standard sternotomy approach is used. For mitral valve repair, the most superior and reliable technique for the posterior leaflet is resection using the newer resection technique with a sternotomy approach, which requires a skilled surgeon.

  6. Evaluation of mitral valve replacement anchoring in a phantom

    Science.gov (United States)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

  7. Situaciones especiales. Insuficiencia mitral isquémica

    Directory of Open Access Journals (Sweden)

    Jorge Rodríguez-Roda

    2010-10-01

    Full Text Available La insuficiencia mitral (IM funcional tras un infarto de miocardio (IAM se produce por un desequilibrio entre los componentes del aparato subvalvular mitral, conllevando un pronóstico adverso, y llega a doblar la mortalidad. Esta enfermedad se denomina «insuficiencia mitral isquémica» (IMI. La ecocardiografía continúa siendo la herramienta más útil en su diagnóstico, aunque las pruebas para demostrar viabilidad miocárdica son cada vez más necesarias. En la actualidad se continúa debatiendo cuál es el tratamiento óptimo debido a que ninguna de las múltiples estrategias ha conseguido resultados realmente satisfactorios y por la ausencia de estudios aleatorizados. Las técnicas quirúrgicas han evolucionado desde la revascularización aislada a la cirugía mitral asociada con resultados controvertidos. Nuestro objetivo es revisar sus fundamentos básicos y las opciones quirúrgicas para clarificar su tratamiento.

  8. 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...

  9. Papel del ecocardiograma en la reparación mitral

    Directory of Open Access Journals (Sweden)

    Vanessa Moñivas

    2010-10-01

    Full Text Available La insuficiencia mitral (IM es muy prevalente en Europa a pesar de la reducción de la fiebre reumática. El desarrollo de las técnicas de reparación mitral introducido por Alain Carpentier ha cambiado el pronóstico y el manejo de los pacientes con IM. Las técnicas de imagen son fundamentales para la evaluación del tipo de lesión anatómica, etiología, mecanismo, cuantificación, así como para valorar la posibilidad de éxito de la reparación. La ecocardiografía transesófagica (ETE bidimensional se emplea de forma rutinaria para planear la reparación mitral. Sin embargo, la ETE tiene una serie de dificultades en relación a las relaciones anatómicas y las anomalías morfológicas de la válvula mitral (VM. La recientemente introducida ecocardiografía tridimensional (3D nos ha permitido entender la anatomía funcional de la VM, la fisiopatología de las lesiones mitrales y, en especial, de la insuficiencia mitral funcional (IMF. En la actualidad, la ecotransesofágico 3D (ETE-3D supone una herramienta imprescindible, tanto para el diagnóstico de lesiones mitrales como para la monitorización en el quirófano de cirugía cardíaca y de los procedimientos percutáneos en hemodinámica. Permite evaluar online todas las estructuras cardíacas y ofrece nuevos planos como la «vista de cirujano» para valorar la morfología de la VM en una sola adquisición. El objetivo de este artículo es revisar la aportación de la ETE, así como la ETE-3D en el conocimiento de la anatomía funcional de la VM, sus aplicaciones clínicas y sus implicaciones terapéuticas.

  10. Acute diaphragmatic rupture following open type IV paraesophageal hernia repair.

    Science.gov (United States)

    Reames, Bradley N; Reddy, Rishindra M

    2011-06-01

    Open primary transthoracic repair is a well established treatment for large paraesophageal hernias. The rate of major post-operative complications has been reported to be low, and no cases of acute diaphragmatic injury have previously been reported. Here we present a case of open primary transthoracic repair of a type IV paraesophageal hernia that was complicated by rupture of the left diaphragm in the immediate post-operative period, and was successfully repaired with Gore DualMesh® (W.L Gore and Assoc. Flagstaff, AZ). © JSCR.

  11. Serotonin concentrations in platelets, plasma, mitral valve leaflet, and left ventricular myocardial tissue in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Cremer, Signe Emilie; Singletary, G.E.; Olsen, Lisbeth Høier

    2014-01-01

    HYPOTHESIS/OBJECTIVES: Altered serotonin (5-hydroxytryptamine, 5HT) signaling is postulated in development and progression of canine myxomatous mitral valve disease (MMVD). Little is known regarding platelet, plasma, valvular, or myocardial 5HT concentration ([5HT]) in affected dogs. We quantified...

  12. 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.

  13. 206. Reparación mitral como tratamiento de la insuficiencia mitral crónica. Estudio de 119 casos

    Directory of Open Access Journals (Sweden)

    S. Ramis

    2010-01-01

    Conclusiones: La cirugía de reparación mitral es una técnica segura y eficaz que permite corregir adecuadamente el vicio valvular. Su morbimortalidad hospitalaria es baja, presentando excelentes resultados a corto y medio plazo, además de evitar todas las complicaciones propias de las prótesis.

  14. Ultrasonography in traumatic rupture of Schilles tendon

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Kil Ho; Byun, Woo Mok; Lee, Dong Chul; Kim, Se Dong; Park, Bok Hwan [Yeungnam University College of Medicine, Gyeongsan (Korea, Republic of)

    1993-12-15

    Ultrasonography was performed prospectively in 16 patients with suspected rupture of Achilles tendon from March to October 1992 to evaluate the diagnostic value of ultrasonography. Ultrasonography examinations were done according to standard techniques, and then dynamic evaluations were performed during passive plantar flexion of the ankle. We reviewed 10 confirmed cases of ruptured tendons, among which 9 cases were confirmed by operation,and one by ultrasonography and MRI. ultrasonic results were compared with the findings at physical examination and surgery. The normal thickness of the Achilles tendons in healthy sides on ultrasonography ranged from 3 to 5mm.The ruptured tendons were 6-10mm thick at 1-2cm superior to the upper margin of Os Calcis. Rupture sites on ultrasonography were exactly predicted in 7 among the 9 operative cases. In on non-operative case, the rupture site on ultrasonography corresponded to that seen on MRI. Tendon bucking on dynamic ultrasonography was positive in all 4 complete ruptures. In 2 of the 6 partial ruptures which were near complete tears, tendon buckling was also observed. In conclusion, ultrasonography is a valuable diagnostic modality in the diagnosis of Achilles tendon rupture, the differentiation between total and partial rupture, and in determining the rupture site. We consider ultrasonography of tendon as an important diagnostic toot that may guide the treatment plan in the traumatic rupture of the Achilles tendon

  15. The diagnosis of breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse; Conrad, Carsten;

    2005-01-01

    STUDY OBJECTIVE: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. MATERIAL AND METHODS: The study population consisted of 64 women with 118 implants, who had...... participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture...... (intracapsular or extracapsular), possible rupture or intact implant was then obtained. Strict predetermined rupture criteria were applied as described in this report and findings at surgery were abstracted in a standardised manner and results compared. RESULTS: At MRI, 66 implants were diagnosed as ruptured...

  16. 3. Early outcomes of minimally invasive versus conventional mitral valve surgery in mitral valve diseases. A single institutional experience

    Directory of Open Access Journals (Sweden)

    E. Nourelden

    2016-07-01

    Full Text Available Minimally invasive techniques in cardiac surgery gained popularity due to many advantages like less postoperative pain, minimal blood loss, less hospital stay, less cost. Minimally invasive mitral valve surgery through right anterolateral mini thoracotomy became safe technique. In our study we compared mini-MV surgery with conventional technique regarding cross clamp time, bypass time, total blood loss, reopening for bleeding, and hospital and ICU length of stay. In our institution between 2010 and 2015, 147patients underwent minimally invasive mitral surgery through right lateral minithoracotomy 8 cm incision and 118 patient underwent conventional mitral valve surgery through median sternotomy in minimally invasive technique: mean age was 38 ± 20 vs 59 ± 21, 70.7% were female (n = 104 vs 39.8% (n = 47, 23.8% were associated with tricuspid valve regurgitation (n = 33 vs 55% in conventional technique (n = 65, 0.08% were able to use endovascular clamp (n = 12, mean Euroscore predected risk of mortality 14.7 ± 13.6% vs 8.7 ± 10.9%. Minimally invasive mitral valve repair surgery was accomplished in 77.5% (n = 114 vs 46.15% (n = 55 and replacement of mitral valve in 22.4% (n = 30 vs 53.8% (n = 64 , concomitant procedures consists of tricuspid valve surgery in 23.8% (n = 35 vs 55% (n = 65, primary mitral valve repair included implantation of rigid annuloplasty ring in 79.6% vs 38.9% (n = 46, duration of cardiopulmonary bypass in minimally invasive surgery was 123 ± 64 min vs 116 ± 62 min, cross clamp time was 64 ± 27 min vs 59 ± 23 min, postoperative mechanical ventilation time 4 ± 1.5 h vs 6.5 ± 2 h, ICU lenght of stay (LOS was 48 ± 12 h vs 3 ± 1 days. Minimally invasive mitral surgery can be performed very safely with excellent early results. mini-MV surgery can be performed with a reasonable operative time, good perioperative course with decrease in postoperative ICU and hospital

  17. [Quadriceps and patellar tendon ruptures].

    Science.gov (United States)

    Grim, C; Lorbach, O; Engelhardt, M

    2010-12-01

    Ruptures of the quadriceps or patellar tendon are uncommon but extremely relevant injuries. Early diagnosis and surgical treatment with a stable suture construction are mandatory for a good postoperative clinical outcome. The standard methods of repair for quadriceps and patellar tendon injuries include the placement of suture loops through transpatellar tunnels. Reinforcement with either a wire cerclage or a PDS cord is used in patellar tendon repair. The PDS cord can also be applied as augmentation in quadriceps tendon repair. In secondary patellar tendon repair an autologous semitendinosus graft can be used. For chronic quadriceps tendon defects a V-shaped tendon flap with a distal footing is recommended. The different methods of repair should lead to early functional postoperative treatment. The clinical outcome after surgical treatment of patellar and quadriceps tendon ruptures is mainly good.

  18. Bubble rupture in bubble electrospinning

    Directory of Open Access Journals (Sweden)

    Chen Rouxi

    2015-01-01

    Full Text Available As the distinctive properties and different applications of nanofibers, the demand of nanofibers increased sharply in recently years. Bubble electrospinning is one of the most effective and industrialized methods for nanofiber production. To optimize the set-up of bubble electrospinning and improve its mass production, the dynamic properties of un-charged and charged bubbles are studied experimentally, the growth and rupture process of a bubble are also discussed in this paper.

  19. Molecular dynamics of interface rupture

    Science.gov (United States)

    Koplik, Joel; Banavar, Jayanth R.

    1993-01-01

    Several situations have been studied in which a fluid-vapor or fluid-fluid interface ruptures, using molecular dynamics simulations of 3000 to 20,000 Lennard-Jones molecules in three dimensions. The cases studied are the Rayleigh instability of a liquid thread, the burst of a liquid drop immersed in a second liquid undergoing shear, and the rupture of a liquid sheet in an extensional flow. The late stages of the rupture process involve the gradual withdrawal of molecules from a thinning neck, or the appearance and growth of holes in a sheet. In all cases, it is found that despite the small size of the systems studied, tens of angstroms, the dynamics is in at least qualitative accord with the behavior expected from continuum calculations, and in some cases the agreement is to within tens of percent. Remarkably, this agreement occurs even though the Eulerian velocity and stress fields are essentially unmeasurable - dominated by thermal noise. The limitations and prospects for such molecular simulation techniques are assessed.

  20. Splenic rupture following routine colonoscopy.

    Science.gov (United States)

    Rasul, Tabraze; Leung, Edmund; McArdle, Kirsten; Pathak, Rajiv; Dalmia, Sanjay

    2010-10-01

    Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.

  1. Molecular dynamics of interface rupture

    Science.gov (United States)

    Koplik, Joel; Banavar, Jayanth R.

    1993-01-01

    Several situations have been studied in which a fluid-vapor or fluid-fluid interface ruptures, using molecular dynamics simulations of 3000 to 20,000 Lennard-Jones molecules in three dimensions. The cases studied are the Rayleigh instability of a liquid thread, the burst of a liquid drop immersed in a second liquid undergoing shear, and the rupture of a liquid sheet in an extensional flow. The late stages of the rupture process involve the gradual withdrawal of molecules from a thinning neck, or the appearance and growth of holes in a sheet. In all cases, it is found that despite the small size of the systems studied, tens of angstroms, the dynamics is in at least qualitative accord with the behavior expected from continuum calculations, and in some cases the agreement is to within tens of percent. Remarkably, this agreement occurs even though the Eulerian velocity and stress fields are essentially unmeasurable - dominated by thermal noise. The limitations and prospects for such molecular simulation techniques are assessed.

  2. Plástica da valva mitral em portadores de febre reumática

    Directory of Open Access Journals (Sweden)

    Pablo M. A. Pomerantzeff

    1998-07-01

    95,6 ± 2,7% no grupo maior de 16 anos (Grupo 2, com uma diferença estatisticamente significativa (p Purpose: To analyze the late results of mitral valve repair in rheumatic patients. Material and Methods: Between March 1980 and December 1997, 201 rheumatic patients underwent mitral valve repair in the Heart Institute of HCFMUSP. Average age was 26.9 ± 15.4 years and 59.6% were female. Other diagnoses were present in 67.7% of patients and the most common was tricuspid regurgitation (31.3%. The techniques of repair were: Carpentier ring annuloplasty in 75 (37.3%, posterior annuloplasty with pericardial sling in 68 (33.8%, posterior segmental annuloplasty in 16 (7.9%, quadrangular resection of the posterior leaflet in 11 (5.5%, partial resection of the anterior leaflet in 6 (3%, De Vega type annuloplasty in 6 (3%, Kay in 5 (2.5%, Reed in 4 (2% and others in 10 patients. Associated techniques were employed in 94 patients (46.8%, the most frequent was chordal shortening (48 patients - 23.9%. Associated procedures were performed in 113 patients (56.2%. The actuarial curves (Kaplan-Meier were compared through linear regression analysis. Results: Hospital mortality was 4 patients (2.0% and the causes were multiorgan failure in 2 (50% and low cardiac output in 2 (50%. In the late postoperative period, 83.9% of the patients were in functional class I (NYHA. The actuarial survival was 93.9 ± 1.9% in 125 months. Twenty three patients were reoperated in the post-operative period with a mean interval of 35.7 months. The actuarial freedom from reoperation was 43.3 ± 13.7% in 125 months. Comparing the patients according to age, in the group over 16 years (group 1, the actuarial survival was 91.3 ± 3.8%, against 95.6 ± 2.7% in the group with more than 16 years (group 2, with a statistic difference (p < 0.0001. Freedom from reoperation was 50.8 ± 16.9% in group 1 and 47.0 ± 14.9% in group 2 (p < 0.0001. Conclusions: Late results with mitral valve repair in rheumatic mitral

  3. Echocardiographic Follow-up of Robotic Mitral Valve Repair for Mitral Regurgitation due to Degenerative Disease

    Institute of Scientific and Technical Information of China (English)

    Yao Wang; Chang-Qing Gao; Yah-Song Shen; Gang Wang

    2016-01-01

    Background:Mitral valve (MV) repair can now be carried out through small incisions with the use of robotic assistance.Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation (MR).However,there has been limited information regarding the echocardiographic follow-up of these patients.The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV.Methods:A retrospective analysis was undertaken using data from the echocardiographic database of our department.Between March 2007 and February 2015,84 patients with degenerative MR underwent robotic MV repair.The repair techniques included leaflet resection in 67 patients (79.8%),artificial chordae in 20 (23.8%),and ring annuloplasty in 79 (94.1%).Eighty-one (96.4%) of the 84 patients were eligible for echocardiographic follow-up assessment,and no patients were lost to follow-up.Results:At a median echocardiographic follow-up of 36.0 months (interquartile range 14.3-59.4 months),four patients (4.9%) developed recurrent mild MR,and no patients had more than mild MR.Mean MR grade,left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDD),and left ventricular ejection fraction (LVEF) were significantly decreased when compared with preoperative values.Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 (Z =-8.456,P < 0.001),LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm (t =15.131,P < 0.001),LVEDD from 51.0 ± 5.0 to 43.3 ± 2.2 mm (t =14.481,P < 0.001),and LVEF from 67.3 ± 7.0% to 63.9 ± 5.1% (t =4.585,P < 0.001).Conclusion:Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR,and a significant improvement in MR grade,LAD,and LVEDD,but a significant decrease in LVEF at echocardiographic follow-up.

  4. Ruptura subaguda da parede livre do ventrículo esquerdo pós-infarto agudo do miocárdio: relato de caso e revisão de literatura Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Alexandre Siciliano Colafranceschi

    2006-03-01

    Full Text Available A ruptura da parede livre do ventrículo esquerdo é uma complicação potencialmente fatal e de tratamento essencialmente cirúrgico. A correção cirúrgica é o tratamento de escolha, mas o manejo pré-operatório e as técnicas de correção ainda não estão claramente definidos, sendo determinados conforme as condições clínicas do paciente. Há carência na literatura de grandes séries envolvendo este tipo de afecção e os relatos são baseados nas experiências individuais, com pequeno número de pacientes. São apresentados dois casos de ruptura subaguda da parede livre do ventrículo esquerdo como complicação da evolução do infarto agudo do miocárdio. Discute-se a abordagem cirúrgica completa, com revascularização miocárdica concomitante e a utilização de circulação extracorpórea. A opção de correção do defeito por meio da sutura epicárdica com retalho de pericárdio bovino e a revascularização completa do miocárdio, sobretudo sem circulação extracorpórea, parece ser a melhor estratégia para um grupo de pacientes que apresentam ruptura subaguda da parede livre do ventrículo esquerdo pós-infarto agudo do miocárdio.Post-infarction left ventricular free wall rupture is life threatening and not uncommon. Surgical experience is largely anecdotal with different techniques being used since the first successful surgical treatment was described. Here we present two patients with subacute left ventricular rupture that were managed using different perioperative strategies. Although the aim of surgical intervention is first and foremost to remove the threat to life by relieving of tamponade and closure of the ventricular defect, longer-term goals were those of conventional coronary operations, i.e., to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, and are discussed. The small number of patients involved prevent us to determine which

  5. Quinapril therapy in patients with chronic mitral regurgitation.

    Science.gov (United States)

    Schön, H R; Schröter, G; Barthel, P; Schömig, A

    1994-05-01

    Pre- and afterload reduction is known to have beneficial effects in patients with chronic mitral regurgitation. To date, no controlled study has been reported analyzing the long term influence of angiotensin-converting enzyme inhibitor treatment on patients with chronic mitral regurgitation. Therefore the aim of this study was to assess the effects of one year angiotensin-converting enzyme inhibition with quinapril on myocardial performance in patients with chronic mitral regurgitation. Twelve patients with moderate to severe isolated chronic mitral regurgitation and no coronary disease on coronary angiography were studied under control conditions and followed up until one year of quinapril therapy (10-20mg/day) using echocardiography and simultaneous right heart catheterization, and radionuclide ventriculography at rest and exercise. As the result of a significant pre- and afterload reduction after one year quinapril treatment regurgitant fraction fell from 0.43 +/- 0.10 at control before therapy to 0.25 +/- 0.08 (p = 0.0001), left ventricular end-diastolic volume was reduced from 146 +/- 26 to 109 +/- 24 ml/m2 (p = 0.0001) and end-systolic volume decreased from 63 +/- 43 to 47 +/- 29 ml/m2 (p = 0.02). Left ventricular ejection fraction at control averaged 0.59 +/- 0.20 at rest, increased to 0.65 +/- 0.21 with maximum exercise and was unchanged after one year quinapril therapy. After one year treatment left ventricular mass was reduced by 15% (p = 0.0004) and septal wall thickness decreased from 11.8 +/- 0.7 to 10.8 +/- 0.8 mm (p = 0.0006). Moreover, there was significant functional improvement of nearly one NYHA class after one year quinapril therapy. In conclusion, in patients with chronic mitral regurgitation long term angiotensin-converting enzyme inhibition with quinapril reduces regurgitation and decreases left ventricular size and mass thereby demonstrating functional improvement. In addition, these data suggest that angiotensin-converting enzyme inhibition

  6. Minimally invasive approach for redo mitral valve surgery.

    Science.gov (United States)

    Botta, Luca; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

    2013-11-01

    Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these

  7. 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

    Full Text Available Desde 1974, temos empregado anuloplastia sem suporte para tratamento da insuficiência mitral de etiologia reumática em uma população predominantemente jovem. A avaliação dos resultados tardios forma a base deste relato. São 154 pacientes com insuficiência mitral isolada (sem estenose ou dupla lesão, sendo 55 (36% do sexo masculino e 99 (64% do feminino, idade média = 36 ± 16 (5 a 73 anos; as lesões associadas foram: 47 lesões aórticas, 21 tricuspídeas e 2 comunicações interatriais; a classe funcional pré-operatória foi I-II em 19% e III-IV em 81 % e o índice cardiotorácico 0,61 ± 0,10. Todos os pacientes foram submetidos a uma anuloplastia similar à descrita por WOOLER et alii 21 que consiste na redução da porção mural do anel mitral obtida pela aplicação de dois pontos ancorados em feltros nas comissuras, sem comprometer a extensão de cúspide septal. Quando necessário, procedimentos adicionais sobre as cordas tendíneas foram realizados. Nenhum paciente recebeu suporte anular por anel ou barra posterior. A mortalidade precoce foi de 3 (1,9% pacientes: falência miocárdica (1 e embolia pulmonar (2. A mortalidade tardia foi de 9 (5,8%, falência miocárdica (3, septicemia (1, embolia pulmonar (1 e morte súbita (1 e causa desconhecida (3. Reoperações foram realizadas em 28 (18,2% casos, dos quais 2 (1,3% por disfunção de prótese aórtica. Sopro sistólico residual esteve presente em 48% dos casos. Complicações tardias: embolias sistêmicas 5,8% (1/3 como prótese aórtica, endocardite infecciosa 1,3% e embolia pulmonar 0,7%. Classe funcional pós-operatória (p. a. foi I - II em 84% e III - IV em 16%; índice cardiotorácico p. o. 0,58 ± 0,10. Probalidade atuarial de sobrevida tardia é estimada em 79,5 ± 5,3% aos 10 anos e 71,0 ± 7,4% aos 14 anos. Sobrevida sem eventos: 67,9 ± 8,9% aos 10 anos e 56,1 ± 11,7% aos 14 anos. A insuficiência mitral reumática pode ser tratada efetivamente por anuloplastia

  8. [Traumatic Testicular Rupture Complicated with Hydrocele: A Case Report].

    Science.gov (United States)

    Yamamichi, Gaku; Tsutahara, Koichi; Okusa, Takuya; Taniguchi, Ayumu; Kishimoto, Nozomu; Tanigawa, Go; Takao, Tetsuya; Yamaguchi, Seiji

    2015-10-01

    A 17-year-old man presented with right hydrocele because of an athletic injury. His scrotum was hit with a ball 2 months ago while playing baseball. He was diagnosed with post-traumatic hydrocele and underwent needle puncture at another hospital 1 month after the trauma. However, the hydrocele did not improve. Therefore, he was referred to our hospital for surgical treatment. For diagnosis of the traumatic hydrocele testis, a hydrocelectomy was scheduled. When we opened the tunica vaginalis, we realized that the tunica albuginea had been ruptured and the testicular parenchyma had gushed out. We tried to replace all the escaped testicular parenchyma into the tunica albuginea, but it was impossible. Therefore were moved some of the redundant testicular parenchyma, and replaced the remnants into the tunica albuginea. After the operation, right hydrocele and testicular atrophy did not occur. Traumatic testicular rupture complicated with hydrocele is rare.

  9. A surgical case for severe hemolytic anemia after mitral valve repair.

    Science.gov (United States)

    Shingu, Yasushige; Aoki, Hidetoshi; Ebuoka, Noriyoshi; Eya, Kazuhiro; Takigami, Ko; Oba, Junichi; Fukuhara, Takashi

    2005-06-01

    We report a rare case of severe hemolytic anemia accompanied by moderate renal insufficiency after mitral valve repair. Although the degree of the residual mitral regurgitation was less than 1+ during the first three weeks after the operation, the maximum lactate dehydrogenase (LDH) was up to 7,430 U/l and the minimum hemoglobin was 4.9 g/dl. The mitral valve replacement successfully resolved the hemolysis, but the renal function did not completely recover.

  10. Exposure of the mitral valve using flexible self-retaining retractors and an atrial hook.

    Science.gov (United States)

    Shibata, Toshihiko; Yasuoka, Takashi; Inoue, Kazushige; Ikuta, Takeshi; Bito, Yasuyuki

    2007-10-01

    We hereby present our technique for using the self-retaining flexible arm retractor and its attachments for mitral valve exposure. The Aortic Valve Assistant, which was developed for aortic valve exposure, is also very useful for exposure of the inferior wall of the left atrium. Our modified atrial hook provides excellent exposure of the anterior mitral annulus. Extensive dissection and the combined use of the flexible arm and attachments allows us comfortable access for mitral valve operations.

  11. Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era.

    Science.gov (United States)

    Nombela-Franco, Luis; Ribeiro, Henrique Barbosa; Urena, Marina; Allende, Ricardo; Amat-Santos, Ignacio; DeLarochellière, Robert; Dumont, Eric; Doyle, Daniel; DeLarochellière, Hugo; Laflamme, Jerôme; Laflamme, Louis; García, Eulogio; Macaya, Carlos; Jiménez-Quevedo, Pilar; Côté, Mélanie; Bergeron, Sebastien; Beaudoin, Jonathan; Pibarot, Philippe; Rodés-Cabau, Josep

    2014-06-24

    Significant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients.

  12. Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors,connective tissue disease, infiltrating liver disease,preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a noncirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hematoma and rupture of liver were documented by image studies. The patients' condition gradually stabilized after fluid resuscitation. The reported case and literature review suggest that spontaneous rupture of liver must be considered in a differential diagnosis of acute hemoperitoneum. A high index of suspicion and early diagnosis with imaging are critically important.

  13. Mitral valve mechanics following posterior leaflet patch augmentation

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... on the valve, patch augmentation may have an adverse long-term influence on mitral valve function and remodeling....

  14. Amplatzer Amulet left atrial appendage occluder entrapment through mitral valve.

    Science.gov (United States)

    González-Santos, Jose María; Arnáiz-García, María Elena; Arribas-Jiménez, Antonio; López-Rodríguez, Javier; Rodríguez-Collado, Javier; Vargas-Fajardo, María del Carmen; Dalmau-Sorlí, María José; Bueno-Codoñer, María Encarnación; Arévalo-Abascal, R Adolfo

    2013-11-01

    We report on a 77-year-old woman in whom percutaneous left atrial appendage (LAA) closure was performed. The patient had a left atrial myxoma resection 3 years previously, and 2 years later, she suffered a transient ischemic attack. Atrial fibrillation was detected and anticoagulation therapy was established. An episode of intracranial bleeding forced interruption of anticoagulation. Thus, percutaneous LAA closure with an Amplatzer Amulet LAA Occluder (St Jude Medical) was proposed. During the procedure, the LAA occluder migrated and became trapped in the mitral valve. Secondary massive mitral regurgitation and hemodynamic instability forced emergent cardiac surgery. Successful removal of the Amplatzer Amulet LAA Occluder was achieved. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  15. [Mitral valve replacement in a patient with Sheehan's syndrome].

    Science.gov (United States)

    Morokuma, H; Nakayama, Y; Minematsu, N

    2008-09-01

    Sheehan' syndrome is caused by pituitary apoplexy occurring during parturition and results in hypopituitarism, adrenal insufficiency and hypothyroidism. A 66-year-old woman with Sheehan's syndrome had received corticosteroids and thyroid hormones for about 18 years. The patient underwent mitral valve replacement for mitral regurgitation. Intraoperatively, just after the initiation of cardiopulmonary bypass, hypotension and severe edema suddenly occurred. Crystalloid fluid was rapidly administered to increase intravascular volumes. Postoperatively the body weight increased by 9.4 kg. The patient was intubated for 64 hours, stayed in the intensive care unit (ICU) for 7 days and was discharged from hospital on the postoperative day 36. Careful perioperative hormone supplementation is necessary for patients with Sheehan's syndrome.

  16. Percutaneous mitral valve edge-to-edge repair

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: The use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited. OBJECTIVES: The aim of this multinational registry is to present...... 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...... and December 2012 in 25 centers in 8 European countries. The prevalent pathogenesis was functional mitral regurgitation (FMR) (n = 452 [72.0%]). The majority of patients (85.5%) were highly symptomatic (New York Heart Association functional class III or higher), with a high logistic EuroSCORE (European System...

  17. Histologic analysis of ruptured quadriceps tendons.

    Science.gov (United States)

    Trobisch, Per David; Bauman, Matthias; Weise, Kuno; Stuby, Fabian; Hak, David J

    2010-01-01

    Quadriceps tendon ruptures are uncommon injuries. Degenerative changes in the tendon are felt to be an important precondition for rupture. We retrospectively reviewed 45 quadriceps tendon ruptures in 42 patients. Quadriceps tendon ruptures occurred most often in the sixth and seventh decade of life. Men were affected six times as often as women. A tissue sample from the rupture-zone was obtained in 22 cases and histologic analysis was performed. Degenerative changes were present in only 14 (64%) of the 22 samples. We observed an increasing ratio of degenerative to nondegenerative tendons with increasing patient age. Our data suggests that quadriceps tendon rupture, especially in younger patients, can occur in the absence of pathologic tendon degeneration.

  18. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    Science.gov (United States)

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial "Surgical Treatment of Moderate Ischemic Mitral Regurgitation". They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled.

  19. 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.

  20. Transapical Mitral Valve-in-Valve Replacement in Patient With Previous Complex Sternal Reconstruction.

    Science.gov (United States)

    Hynes, Conor F; Fatemi, Omid; Sharma, Aditya C; Nagy, Christian D; Trachiotis, Gregory D

    2016-01-01

    We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve. Transapical valve-in-valve replacement of a stenotic mitral bioprosthesis is a viable solution in a patient with previous complex chest wall reconstruction and multiple comorbidities.

  1. Mitral valve replacement in systemic lupus erythematosus associated Libman-Sacks endocarditis.

    Science.gov (United States)

    Akhlaq, Anam; Ali, Taimur A; Fatimi, Saulat H

    2016-04-01

    Libman-Sacks endocarditis, first discovered in 1924, is a cardiac manifestation of systemic lupus erythematosus (SLE). Valvular involvement has been associated with SLE and antiphospholipid syndrome (APS). Mitral valve, especially its posterior leaflet, is most commonly involved. We report a case of a 34 year old woman with antiphospholipid antibody syndrome and SLE, who presented with mitral valve regurgitation. The patient underwent a prosthetic mitral valve replacement, with no followup complications. We suggest mechanical valve replacement employment in the management of mitral regurgitation in Libman-Sacks endocarditis, in view of the recent medical literature and our own case report.

  2. Effects of Mitral Balloon Valvuloplasty on Left Ventricular Systolic Functions: Assessment with Color Tissue Doppler

    Directory of Open Access Journals (Sweden)

    Cevat Kırma

    2010-04-01

    Full Text Available Objective: Left ventricular (LV systolic functions are generally depressed in Mitral Stenosis (MS. Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV. Systolic mitral annular velocity (S' by Tissue Doppler Imaging (TDI predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years. A full transthoracic echocardiographic study (TTE including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by Inoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination. Results: MBV performed successfully in 43 patients (Group A, and severe mitral regurgitation developed in 5 patients(Group B. Mitral valve area, and S’ wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP were reduced significantly by MBV in group A patients (p<0.01, =0.046, <0.01, <0.01, <0.01, <0.01, respectively. But, only mitral valve area increased significantly ingroup B patients (p<0.01. LVEF by teicholz did not change significantly in both groups. Conclusion: Improvements of LV systolic functions after successfull MBV can easily showed by color TDI where2D echocardiography could not indicate.

  3. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm.

    Science.gov (United States)

    Tomsic, Anton; Li, Wilson W L; van Paridon, Marieke; Bindraban, Navin R; de Mol, Bas A J M

    2016-08-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

  4. Pulmonary hemosiderosis due to mitral valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eung Yeop; Kim, Tae Sung; Han, Joung Ho; Lee, Kyung Soo [Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    We report a case of biopsy-proven secondary hemosiderosis of the lung in a 58-year-old patient with mitral valvular heart disease. Both chest radiography and high-resolution CT demonstrated patchy areas of ground-glass opacity ; the former indicated that it was in both lungs, while the latter showed inter-and intralobular septal thickening. These findings were reversible when pulmonary venous hypertension was corrected.

  5. Degenerative processes in bioprosthetic mitral valves in juvenile pigs

    Directory of Open Access Journals (Sweden)

    Pedersen Torben B

    2011-05-01

    Full Text Available Abstract Background Glutaraldehyde-treated bioprosthetic heart valves are commonly used for replacement of diseased heart valves. However, calcification and wear limit their durability, and the development of new and improved bioprosthetic valve designs is needed and must be evaluated in a reliable animal model. We studied glutaraldehyde-treated valves 6 months after implantation to evaluate bioprosthetic valve complications in the mitral position in juvenile pigs. Materials The study material comprised eight, 5-month old, 60-kg pigs. All pigs received a size 27, glutaraldehyde-treated, stented, Carpentier-Edwards S.A.V. mitral valve prosthesis. After six months, echocardiography was performed, and the valves explanted for gross examination, high resolution X-ray, and histological evaluation. Results Five pigs survived the follow-up period. Preexplant echocardiography revealed a median peak and mean velocity of 1.61 m/s (range: 1.17-2.00 and 1.20 (SD = ±0.25, respectively, and a median peak and mean pressure difference of 10.42 mmHg (range: 5.83-16.55 and 6.51 mmHg (SD = ±2.57, respectively. Gross examination showed minor thrombotic depositions at two commissures in two valves and at all three commissures in three valves. High resolution X-ray imaging revealed different degrees of calcification in all explanted valves, primarily in the commissural and belly areas. In all valves, histological evaluation demonstrated various degrees of fibrous sheath formation, limited immunological infiltration, and no overgrowth of host endothelium. Conclusions Bioprosthetic glutaraldehyde-treated mitral valves can be implanted into the mitral position in pigs and function after 6 months. Echocardiographic data, calcification, and histological examinations were comparable to results obtained in sheep models and human demonstrating the suitability of the porcine model.

  6. Mitral flow propagation velocity in non-sedated healthy cats

    OpenAIRE

    SILVA, A.C.; R.A.L. Muzzi; G. Oberlender; L.A.L. Muzzi; M.R. Coelho; R.B. Nogueira

    2014-01-01

    Mitral flow propagation velocity (Vp) is an index used to evaluate the left ventricular diastolic function. Its influence on human and small animal cardiopathies has been studied; however there are few reports evaluating this variable in domestic felines. In addition, there is a lack of studies in non-sedated healthy cats. Therefore, the purpose of this study was to establish values for Vp and its correlation with other echocardiographic indexes in non-sedated healthy cats in order to provide...

  7. Takotsubo syndrome after mitral valve replacement for acute endocarditis.

    Science.gov (United States)

    Gariboldi, Vlad; Jop, Bertrand; Grisoli, Dominique; Jaussaud, Nicolas; Kerbaul, François; Collart, Frédéric

    2011-03-01

    Takotsubo syndrome is characterized by transient and acute left ventricular dysfunction and apical ballooning, with electrocardiographic abnormalities, but without coronary disease. We report a case of Takotsubo syndrome occurring after emergent mitral valve replacement for acute infective endocarditis. The patient is a 66-year-old woman who regained complete recovery of left ventricular function. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs.

    Science.gov (United States)

    Vörös, Károly; Szilvási, Viktória; Manczur, Ferenc; Máthé, Ákos; Reiczigel, Jenő; Nolte, Ingo; Hungerbühler, Stephan

    2015-12-01

    Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 ± 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 ± 2.3 years, which was significantly different from that of dogs without MVI (5.1 ± 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 ± 2.8 kg) and those without MVI (12.8 ± 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature.

  9. Mitral valve repair with a malleable bovine pericardium ring

    Directory of Open Access Journals (Sweden)

    Marco Antônio Volpe

    2000-11-01

    Full Text Available OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male patients, aged between 9 and 66 (M=36.4±17.2 years, were studied over a 16-month period, with 100% follow-up. In 23 (72% of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2% fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions. Of four (12% of the remaining patients, 6% had moderate and 6% had seigre insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%, II (32%, and III (3%, according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.

  10. LEFT ATRIUM THROMBOSIS IN PATIENTS WITH RHEUMATIC MITRAL VALVULAR DISEASE

    Directory of Open Access Journals (Sweden)

    N. D. Kaverin

    2012-01-01

    Full Text Available Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs from Pub Med database, as well as domestic literature were used.

  11. LEFT ATRIUM THROMBOSIS IN PATIENTS WITH RHEUMATIC MITRAL VALVULAR DISEASE

    Directory of Open Access Journals (Sweden)

    N. D. Kaverin

    2014-07-01

    Full Text Available Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs from Pub Med database, as well as domestic literature were used.

  12. Treatment of bronchial ruptures by delayed surgery

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.

  13. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  14. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Troelsen, Anders

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment ofacute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  15. Right ventricular function before and after percutaneous balloon mitral valvuloplasty.

    Science.gov (United States)

    Burger, W; Brinkies, C; Illert, S; Teupe, C; Kneissl, G D; Schräder, R

    1997-01-01

    Aim of this study was to evaluate right ventricular performance in patients with mitral stenosis and its modification by balloon valvuloplasty. Right ventricular volumes of 24 patients with postrheumatic mitral stenosis were determined by thermodilution 1 or 2 days before and 1 or 2 days after valvuloplasty. Right ventricular ejection fraction at rest was 43 (36-47)% (median and interquartile range). Right ventricular end-diastolic volume was 100 (86-119) ml/m2. Supine bicycle exercise (50 Watt) reduced right ventricular ejection fraction to 30 (29-37)% (P volume to 124 (112-141) ml/m2 (P improvement of right ventricular ejection fraction correlated inversely with the value of this parameter before valvuloplasty (r = -0.88, P volume (r = 0.57, P < 0.01). The right ventricular function curve, disturbed before commissurotomy, was reestablished by the procedure. In conclusion, at the here investigated stage of mitral stenosis right ventricular function is reversibly impaired. This is predominantly caused by the hemodynamic consequences of the valvular defect and not by an impairment of right ventricular myocardial function.

  16. Mitral flow propagation velocity in non-sedated healthy cats

    Directory of Open Access Journals (Sweden)

    A.C. Silva

    2014-02-01

    Full Text Available Mitral flow propagation velocity (Vp is an index used to evaluate the left ventricular diastolic function. Its influence on human and small animal cardiopathies has been studied; however there are few reports evaluating this variable in domestic felines. In addition, there is a lack of studies in non-sedated healthy cats. Therefore, the purpose of this study was to establish values for Vp and its correlation with other echocardiographic indexes in non-sedated healthy cats in order to provide new perspectives related to diastolic function in this species. Twenty-six clinically healthy cats were submitted to echocardiography to assess the animals' cardiac conditions. Variables such as age, heart rate (HR, body surface area (BSA, initial (E mitral and late (A mitral ventricular filling waves, isovolumic relaxation time (IVRT and E/IVRT relation were correlated to Vp. No proven relation between any of these variables and Vp was observed in this present study, except for HR and BSA. In the variability analysis, higher values were verified for inter-observer analysis. This study concludes that Vp proved to be an useful index for estimating left ventricular relaxation in non-sedated healthy domestic cats and provides reference ranges for this variable.

  17. Ruptured jejunum following Heimlich maneuver.

    Science.gov (United States)

    Razaboni, R M; Brathwaite, C E; Dwyer, W A

    1986-01-01

    The Heimlich maneuver, over time, has proved to be a useful resuscitative procedure in the management of cases with airway occlusion secondary to foreign body. Medical treatments, however, can have side effects, and this maneuver is no exception. A previously unreported complication is presented, that of jejunal rupture. The proper application of the maneuver minimizes the number of side effects; however, since they do occur, it is suggested that all persons subject to this maneuver be subsequently evaluated by a physician as soon after the incident as is practicable.

  18. The rupture in visual language:

    OpenAIRE

    Kula, Ömür; Kula, Omur

    2006-01-01

    The shift of arts from conventional forms of canvas-painting and sculpture to collage, ready-mades, installations and performances as it had occurred in the history of western art follow a linear and natural unfolding in parallel with sociopolitical evolvements. In the case of Turkish visual arts, this kind of a transformation projects to the time period between 1960s to 1990s where the face of arts change not smoothly but rather in the form of a 'rupture' as new tendencies are embraced, prac...

  19. Mechanical model of vulnerable atherosclerotic plaque rupture

    Institute of Scientific and Technical Information of China (English)

    SU; Haijun; ZHANG; Mei; ZHANG; Yun

    2004-01-01

    Rupture of atherosclerotic plaque is the main trigger of acute cardiovascular events, but the mechanism of plaque rupture is still unknown. We have constructed a model describing the motion of the fibrous cap of the plaque using the theory of elastic mechanics and studied the stability of the plaque theoretically. It has shown that plaque rupture is the result of a dynamic interplay between factors intrinsic to the plaque itself and extrinsic factors. We have proposed a new mechanism of plaque rupture, given a new explanation about the nonlinear dynamic progress of atherosclerosis and suggested a method to identify the vulnerable plaques to manage atherosclerosis.

  20. Stress rupture properties of GH4169 superalloy

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    Xudong Lu

    2014-04-01

    Full Text Available GH4169 alloy is a nickel-based superalloy extensively used in the aircraft engine industry because of its excellent mechanical properties and good fabrication ability. The mechanical properties of the GH4169 at high temperature, rupture stress under severe condition deserves a close attention. In this paper, the creep rupture of the GH4169 alloy under constant load and different temperatures from 550 °C to 700 °C conditions is systematically evaluated and major impact factors in the stress rupture behavior are analyzed. Furthermore, an improving method for the alloy stress rupture is proposed.

  1. Mitral valve repair is not always needed in patients with functional mitral regurgitation undergoing coronary artery bypass grafting and/or aortic valve replacement

    Science.gov (United States)

    Lindeboom, J.E.; Jaarsma, W.; Kelder, J.C.; Morshuis, W.J.; Visser, C.A.

    2005-01-01

    Background and aim Functional mitral regurgitation (FMR) is defined as mitral regurgitation in the absence of intrinsic valvular abnormalities. We prospectively evaluated the effect of coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR), without additional mitral valve repair, on the degree of moderate or severe FMR. Study design and methods From a cohort of 2829 patients undergoing CABG and/or AVR in the St. Antonius Hospital, 67 patients were identified with moderate or severe FMR by transthoracic and transoesophageal Doppler echocardiography. Results Two out of the 67 patients (3%) died perioperatively. During follow-up (3-18 months) mitral regurgitation decreased by one grade in 29 patients, by two grades in 28, by three grades in five patients and remained unchanged in one patient (p=0.0001). Of all patients, 85% had grade I mitral regurgitation or less. Grade II mitral regurgitation remained in nine patients with a previous large myocardial infarction and/or annular calcifications. NYHA class improved from 3.1+0.5 to 1.4+0.4 (p=0.0001). Ejection fraction increased from 46 to 55% (p=0.0001). Overall, left atrial and left ventricular end-diastolic dimensions decreased significantly. In contrast, no decrease in dimensions was seen in patients with postoperative grade II mitral regurgitation. Conclusion FMR may improve significantly following CABG and/or AVR, although a previous large myocardial infarction and/or annular calcifications may affect outcome. PMID:25696484

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

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    Bijl Marc

    2010-03-01

    Full Text Available Abstract 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 (APS. Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results.

  3. Valvoplastia mitral em pacientes jovens com cardiopatia reumática Mitral valvuloplasty in young patients with rheumatic heart disease

    Directory of Open Access Journals (Sweden)

    Fernando Antônio Fantini

    1992-06-01

    Full Text Available No período, de setembro de 1988 a janeiro de 1992, 56 pacientes com até 20 anos de idade (4 a 20 anos, média de 12,7 com insuficiência mitral pura ou predominante de etiologia reumática foram submetidos a valvoplastia mitral. Noventa e quatro por cento dos pacientes estavam em classe funcional III ou IV da NYHA. A técnica cirúrgica básica usada em todos os pacientes foi a anuloplastia assimétrica preconizada por Reed et alii 31, associada em 69,7% dos casos a outros procedimentos sobre as cúspides e aparelho subvalvar mitral. Dois pacientes foram submetidos, concomitantemente, a plastia da valva tricúspide e 4 a troca da valva aórtica. Estudo ecodopplercardiográfico per-operatório foi utilizado após a correção em todos os casos e mostrou ausência de lesões residuais em 76% dos pacientes e insuficiência mitral discreta nos demais. Náo houve mortalidade hospitalar. Ecopplercardiograma realizado antes da alta hospitalar mostrou boa correlação com o estudo per-operatório. Foi possível colher informações do seguimento tardio de 53 pacientes. Ocorreu 1 óbito tardio três meses após a cirurgia, por morte súbita. Quatro pacientes foram reoperados e submetidos a troca valvar: uma paciente no 4º mês de pós-operatório (PO, por falha primária do procedimento, e outros três no 6º, 34º e 38º meses de PO, por comprovada recidiva da cardite reumática. Os demais encontram-se em classe funcional I e II (NYHA. Concluímos, baseados nos resultados apresentados, que a anuloplastia mitral assimétrica é um excelente procedimento para pacientes jovens com valvopatia reumática, constituindo-se numa boa alternativa à troca de valva ou implante de anéis, sendo, no entanto, extremamente importante o controle de recidivas da doença reumática.From September 1988 to July 1990, 56 patients under 20 years of age (mean 12.7 ± 5.12 years with pure or predominant mitral valve regurgitation secondary to rheumatic valve disease

  4. [Calculation of the mitral valve area with the proximal convergent flow method with Doppler-color in patients with mitral stenosis].

    Science.gov (United States)

    Aguilar, J A; Summerson, C; Flores, D; Espinosa, R A; Enciso, R; Badui, E; Hurtado, R

    1994-01-01

    In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.

  5. ADDITIONAL VALUE OF BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN ASSESSING THE GENESIS OF MITRAL REGURGITATION AND THE FEASIBILITY OF VALVE REPAIR

    NARCIS (Netherlands)

    PIEPER, EPG; HELLEMANS, IM; HAMER, HPM; RAVELLI, ACJ; VANDENBRINK, RBA; EBELS, T; LIE, KI; VISSER, CA

    1995-01-01

    To determine the additional diagnostic value of biplane transesophageal echocardiography (TEE) in patients undergoing mitral valve surgery, we studied 48 patients with severe mitral regurgitation. Transesophageal echocardiographic video recordings were reorganized in separate transverse and longitud

  6. Quadriceps and patellar tendon ruptures.

    Science.gov (United States)

    Lee, Dennis; Stinner, Daniel; Mir, Hassan

    2013-10-01

    The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.

  7. CHANGES OF PLASMA DYNORPHIN LEVELS BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL COMMISSUROTOMY IN PATIENTS WITH MITRAL STENOSIS

    Institute of Scientific and Technical Information of China (English)

    尹瑞兴; 陶新智; 曾知恒; 赵定菁; 朱树雄; 夏树楹

    1995-01-01

    Plamna dynorphin Al-13 levels were measured in 33 patients with mitral stenosis before and afteT percutaneous balloon mitral eommimurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were signifieantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphln levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the anteeubltal vein had decreased significantly, but they did not decrease to the normal range. Plasmm dynorphin levels in blood from the femoral vein were positively correlated with the mean laft atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the anteeubital vein were positively correlated with the heart rate and the mean transmittal presstme gradient,and negatively with the mitral valve area before and 72 hours after PBMC.

  8. Late results of mitral valve repair with glutaraldehyde-treated autologous pericardium.

    Science.gov (United States)

    Shomura, Yu; Okada, Yukikatsu; Nasu, Michihiro; Koyama, Tadaaki; Yuzaki, Mitsuru; Murashita, Takashi; Fukunaga, Naoto; Konishi, Yasunobu

    2013-06-01

    Mitral valve repair is an established surgical procedure for treating severe organic mitral regurgitation. The mechanisms of mitral regurgitation due to infective endocarditis include rheumatic disease and congenital diseases such as a lack of leaflet tissue, and thus additional material is required to create a functional coaptation surface. We review our experience with 139 patients who underwent mitral valve repair with glutaraldehyde-treated autologous pericardium to treat organic mitral regurgitation between March 1992 and November 2011. Mitral valve disease mainly consisted of infective endocarditis in 51 patients (active, n = 32; healed, n = 19) and rheumatic disease in 47. This procedure was also applied to 12 patients who required reoperation after mitral valve repair for degenerative, congenital, or rheumatic mitral regurgitation. The mean follow-up was 4.5 ± 4.3 years (maximum 19.1). Actuarial survival at 10 years was 84% ± 5%. Eleven reoperations proceeded at a mean of 68 months after surgery. The causes of reoperation were rheumatic disease progression (n = 4), infection (n = 3), patch dehiscence (n = 2), progressive fibrosis of the remaining mitral valve tissue after infective endocarditis (n = 1), and patch tear (n = 1). Mitral valves were replaced in 8 patients and re-repaired in 3 patients. The autologous pericardium was not calcified at the time of reoperation. The rate of freedom from reoperation was 82% ± 7% at 10 years. Mitral valves that might otherwise require replacement can be durably and predictably repaired using glutaraldehyde-treated autologous pericardium. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. Uterine rupture following incomplete molar pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Pourali L

    2013-03-01

    Full Text Available Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non metastatic. The aim of this study is to report a case of uterine rupture following incomplete molar pregnancy.Case presentation: The patient was a 26 year old woman with obstetric history of an abortion and one molar pregnancy and no child. She was referred to emergency unit in Ghaem University Hospital, Mashhad, Iran in May 2011. She had an evacuation curettage following molar pregnancy three months before and without any follow up visit. The patient was referred to emergency unit with hemorrhagic shock. She immediately underwent laparotomy. The uterine fundal rupture was repaired and evacuation curettage performed. In post operative evaluation, she had a nine millimeter metastatic nodule in base of right Lung. As a patient in low risk stage III, she received weekly intramuscular methotrexate (40mg/m2 for six courses. In follow up visit -hCG titer was negative (<10miu/ml at 5th week. Conclusion: In cases of in complete molar pregnancy risk of metastasis is very low. Serial beta-hCG titer is the most accurate method for detection of persistent gestational trophoblastic disease (GTN. In neglected cases like this case preservation of ruptured uterus in GTN is possible.

  11. Spontaneous rupture of choledochal cyst: case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ho Seob; Nam, Kyung Jin; Lee, Jin Hwa; Kim, Chan Sung; Choi, Jong Cheol; Oh, Jong Young [Dong-a University College of Medicine, Pusan (Korea, Republic of)

    2002-11-01

    Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

  12. Ruptured liver abscess in a neonate

    Directory of Open Access Journals (Sweden)

    Prashant Jain

    2012-01-01

    Full Text Available We report a rare case of 17-day-old neonate, diagnosed to have ruptured liver abscess secondary to Methicillin-resistant Staphylococcal aureus infection. The child presented with septicemia and abdominal distension. On exploration, there was pyoperitoneum with ruptured liver abscess.

  13. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin.

  14. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  15. [Premature rupture of membranes and chorioamnionitis].

    Science.gov (United States)

    Lopez Garcia, R

    1988-01-01

    Despite advances in perinatal medicine in the past decade, the diagnosis and treatment of premature rupture of membranes remain controversial. Premature rupture occurs in 2.7-7.0% of pregnancies and most cases occur spontaneously without apparent cause. The disparity in reported rates of premature rupture is due to differences in the definition and diagnostic criteria for premature rupture and lack of comparability in the populations studied. Mexico's National Institute of Perinatology has adopted the definition of the American COllege of Gynecology and Obstetrics which views premature rupture as that occurring before regular uterine contractions that produce cervical dilation. 8.8% of its patients have premature rupture according to this definition. 20% of cases occur before the 36th week of pregnancy. Treatment of rupture occurring before 37 weeks must balance the threat of amniotic infection with the dangers of premature birth. Infections appear more common in low income patient populations. Chorioamnionitis is a serious complication of pregnancy and is the main argument against conservative treatment of premature rupture. The rate of maternal infection is directly related to the time elapsing between rupture of the membranes and birth. The rate increases after the 1st 24 hours and is at least 10 times higher after 72 hours. But recent studies suggest that there is no considerable increase in infection if vaginal explorations are avoided and careful techniques are used in treating the patient. Those who advise conservative treatment believe that prenatal outcomes are better because respiratory disease syndrome due to prematurity is avoided. Conservative management requires a white cell count at least every 24 hours and measurement of pulse, maternal temperature, and fetal heart rate ideally every 4 hours. Perinatal mortality rates due to premature rupture of membranes range from 2.5-50%. The principal causes are respiratory disease syndrome, infection, asphyxia

  16. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  17. Should the ruptured renal allograft be removed?

    Science.gov (United States)

    Dryburgh, P; Porter, K A; Krom, R A; Uchida, K; West, J C; Weil, R; Starzl, T E

    1979-07-01

    During a 16-month period when 93 renal transplants were performed, eight kidney graft ruptures were detected within 18 days of transplantation, without evidence of venous obstruction. Six grafts were removed at the time of an exploratory operation for rupture and only one showed signs of probable irreversible rejection when examined by microscopy. Two graft ruptures were repaired and one of these grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of graft rupture can be securely controlled and if the conditions of the patient and of the graft are favorable except for the rupture, it may be possible to save more than one of eight grafts.

  18. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining

  19. Mini-maze suffices as adjunct to mitral valve surgery in patients with preoperative atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Tieleman, RG; Grandjean, JG; Huet, RCG; Van der Maaten, JMAA; Pieper, EG; De Kam, PJ; Ebels, MSCT; Crijns, HJGM

    2000-01-01

    Mini-Maze and Mitral Valve Surgery. Introduction: After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach limit

  20. Differential cell-matrix responses in hypoxia-stimulated aortic versus mitral valves.

    Science.gov (United States)

    Sapp, Matthew C; Krishnamurthy, Varun K; Puperi, Daniel S; Bhatnagar, Saheba; Fatora, Gabrielle; Mutyala, Neelesh; Grande-Allen, K Jane

    2016-12-01

    Tissue oxygenation often plays a significant role in disease and is an essential design consideration for tissue engineering. Here, oxygen diffusion profiles of porcine aortic and mitral valve leaflets were determined using an oxygen diffusion chamber in conjunction with computational models. Results from these studies revealed the differences between aortic and mitral valve leaflet diffusion profiles and suggested that diffusion alone was insufficient for normal oxygen delivery in mitral valves. During fibrotic valve disease, leaflet thickening due to abnormal extracellular matrix is likely to reduce regional oxygen availability. To assess the impact of low oxygen levels on valve behaviour, whole leaflet organ cultures were created to induce leaflet hypoxia. These studies revealed a loss of layer stratification and elevated levels of hypoxia inducible factor 1-alpha in both aortic and mitral valve hypoxic groups. Mitral valves also exhibited altered expression of angiogenic factors in response to low oxygen environments when compared with normoxic groups. Hypoxia affected aortic and mitral valves differently, and mitral valves appeared to show a stenotic, rheumatic phenotype accompanied by significant cell death. These results indicate that hypoxia could be a factor in mid to late valve disease progression, especially with the reduction in chondromodulin-1 expression shown by hypoxic mitral valves. © 2016 The Author(s).

  1. 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...

  2. Sinus venosus atrial septal defect with severe mitral stenosis: A rare presentation

    Directory of Open Access Journals (Sweden)

    Shweta Shende

    2015-01-01

    Sinus venosus ASD are uncommon and constitute 2-3% of interatrial communication. However, sinus venosus ASD with mitral stenosis is an extremely rare condition which was treated successfully by patch closure with left atrialization of superior pulmonary vein and mitral valve replacement.

  3. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system

    DEFF Research Database (Denmark)

    Boekstegers, P; Hausleiter, J; Baldus, S

    2014-01-01

    The interventional treatment of mitral valve regurgitation by the MitraClip procedure has grown rapidly in Germany and Europe during the past years. The MitraClip procedure has the potential to treat high-risk patients with secondary mitral valve regurgitation and poor left ventricular function. ...

  4. Aortic valve replacement with the Nicks annulus enlargement procedure 12 years after mitral valve replacement.

    Science.gov (United States)

    Kazama, S; Kurata, A; Yamashita, Y

    1999-10-01

    An aortic valve replacement was successfully performed employing the Nicks annulus enlargement procedure in a case of aortic valve stenosis with small annulus 12 years after mitral valve replacement. Previous mitral valve replacement does not preclude feasibility of the Nicks procedure.

  5. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    2003-01-01

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining th

  6. Evaluation of acute ischemic mitral regurgitation following cardiopulmonary bypass assessed by biplane transesophageal echocardiography.

    Science.gov (United States)

    Nakao, T; Fujimoto, K; Brodman, R F; Oka, Y

    1997-03-01

    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE). Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPB] and decannulation) were excluded. In the remaining 86 patients with MR between stages 1 and 2, 45 (group A) had an increase in MR, and 41 (group B) had a decrease in MR. An increase in MR at stage 2 in group A was associated with a significant increase in annular diameter (p area (p area (p areas. In 7 patients in group A, MR increased continuously until stage 3 (after sternal closure) despite treatment. In 2 of these 7 patients, pulmonary venous systolic flow (PVSF) decreased during stage 2 and persisted to stage 3. The post operative course of these 2 patients was complicated with atrial fibrillation (AF). The increase in annular diameter and worsening in RWMA in RCA and/or LCX areas are associated with acute ischemic MR following CPB. The majority of acute ischemic MR cases were resolved by pharmacological intervention. Post operative AF was noted in 2 patients with acute ischemic MR associated with persistently decreased PVSF following CPB despite treatment.

  7. The impact of segmental volumetric changes on functional mitral regurgitation: a study using three-dimensional regional time-volume analysis combined with low-dose dobutamine.

    Science.gov (United States)

    Chen, Xiaofeng; Hsiung, Ming-Chon; Mu, Yuming

    2014-02-01

    Using transthoracic three-dimensional (3D) echo regional volume analysis combined with low-dose dobutamine to investigate the effects on regional volume, mitral configuration and functional mitral regurgitation (FMR). Fifty-six patients with ischemic cardiomyopathy (ICM) were included in this study. The effective regurgitant orifice area (EROA) of FMR secondary to ICM with depressed left ventricular ejection fraction was compared with mitral tenting area and coaptation height (CH) before and after low-dose dobutamine (10 μg/kg per min). Using 3-DQ software we measured and calculated regional stroke-volumes (rSV), the ratio of the rSV to the whole left ventricular stroke volume (rgSVratio) in all 17 segments and the average rgSVratio of 4 anterior-PM attached segments (rgSVratio-aver anter-PM), 4 posterior-PM attached segments (rgSVratio-aver post-PM), 8 PMs attached segments (rgSVratio-aver PMs) and all 17 segments before and after dobutamine. Compared with the resting condition, the SVr and rgSVratio on the basal and mid segments of anterior, lateral, inferior, and posterior walls were increased after dobutamine infusion (P FMR decreasing during low-dose dobutamine is quantitatively associated with the regional LV volume change of attached PMs. Real time transthoracic three-dimensional echocardiography may provide a simple and noninvasive approach to assess regional LV time-volume characteristic during FMR. © 2013, Wiley Periodicals, Inc.

  8. Transcatheter Mitral Valve Replacement: Long-Term Outcomes of First-In-Man Experience with an Apically Tethered Device - A Case Series from a Single Centre.

    Science.gov (United States)

    Duncan, Alison; Daqa, Anan; Yeh, James; Davies, Simon; Uebing, Anselm; Quarto, Cesare; Moat, Neil

    2017-08-13

    Transcatheter mitral valve replacement (TMVR) is a novel technique for treating mitral regurgitation. We report 18-month/2-year outcomes of the 5 first-in-man patients undergoing chronic TMVR with the Tendyne device. Five patients (STS score 14%-23%) underwent TMVR using a Tendyne system under compassionate use at a single centre. 1 patient (who was noncompliant with anti-coagulation) died 9 months after TMVR following a cerebrovascular accident. Whilst some of the remaining patients experienced recognised post-TMVR complications (left ventricular outflow tract obstruction, paravalvular leak, stent thrombosis), all patients alive at 18-months/2-years after TMVR reported significant reduction in NYHA Class and increase in exercise capacity compared to baseline. Transthoracic echocardiography demonstrated valve stability, absent transvalvular mitral regurgitation, and significant reductions in tricuspid regurgitation severity and systolic pulmonary arterial pressure. Eighteen months/2 years after compassionate use of Tendyne TMVR in a highrisk surgical group, the majority of patients were alive, patient symptoms improved, and the device was stable with good haemodynamic function and no late migration. Continued follow-up of patients treated with Tendyne TMVR are required to further describe its safety and efficacy.

  9. Resultados da valvoplastia por balão do grupo submetido a plastia mitral percutânea ou cirúrgica prévias com o tratado pela primeira vez: evolução do grupo com plastia prévia Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients: evolution of the group previously submitted to valve repair procedures

    Directory of Open Access Journals (Sweden)

    Edison Carvalho S. Peixoto

    2006-05-01

    been submitted only to mitral surgical commissurotomy, 8 only to mitral balloon valvuloplasty and 3 to surgical commissurotomy and after submitted to balloon valvuloplasty because of restenosis. In prior surgical or balloon valvuloplasty and mitral balloon valvuloplasty without previous intervention groups pre valvuloplasty there were respectively: echo mitral valve area 0.99±0.21 and 0.94±0.21 cm² (p=0.0802 and mitral valve area (Gorlin 0.94±0.18 and 0.91±0.21 cm² (p=0.2518 and post mitral valvuloplasty 1.95±0.44 and 2.05±0.42 cm² (p=0.1059. CONCLUSIONS: The hemodynamic and angiographic outcome of the prior surgical or balloon valvuloplasty group were similar to the group without previous intervention. The evolution was satisfactory in the prior valvuloplasty subgroup with long-term follow-up.

  10. Valvoplastia mitral percutânea complicada com tamponamento cardíaco em paciente gestante Percutaneous mitral valvuloplasty complicated by cardiac tamponade in a pregnant patient

    Directory of Open Access Journals (Sweden)

    Luís Seca

    2008-11-01

    Full Text Available A ocorrência de Hemopericárdio com Tamponamento Cardíaco é uma complicação da Valvoplastia Mitral Percutânea por balão (VMB, que apesar de pouco freqüente, pode ter graves conseqüências materno-fetais. Este artigo descreve o caso de um tamponamento cardíaco após VMB em uma mulher de 28 anos, com estenose mitral reumática severa na 20ª semana de gravidez.The occurrence of hemopericardium with cardiac tamponade is a complication of percutaneous balloon mitral valvuloplasty (BMV which, although uncommon, may have severe maternal and fetal consequences. This article describes a case of cardiac tamponade following BMV in a 28-year-old woman with severe rheumatic mitral stenosis in the 20th week of gestation.

  11. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation

    DEFF Research Database (Denmark)

    Leth, Peter Mygind; Knudsen, Peter Juel Thiis

    2015-01-01

    Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic...

  12. On-pump fibrillating heart mitral valve replacement with the SAPIEN™ XT transcatheter heart valve.

    Science.gov (United States)

    Ferrari, Enrico; Niclauss, Lars; Locca, Didier; Marcucci, Carlo

    2014-04-01

    In some high-risk patients, standard mitral valve replacement can represent a challenging procedure, requiring a risky extensive decalcification of the annulus. In particular, high-risk redo patients and patients with a previously implanted transcatheter aortic valve, who develop calcific mitral disease, would benefit from the development of new, minimally invasive, transcatheter or hybrid techniques for mitral valve replacement. In particular, mixing transcatheter valve therapies and well-established minimally invasive techniques for mitral replacement or repair can help in decreasing the surgical risk and the technical complexity. Thus, placing transcatheter, balloon-expandable Sapien™ XT stent-valves in calcified, degenerated mitral valves through a right thoracotomy, a left atriotomy and on an on-pump fibrillating heart, represents an attractive alternative to standard surgery in redo patients, in patients with concomitant transcatheter aortic stent-valves in place and in patients with a high-risk profile. We describe this hybrid technique in detail.

  13. [Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography].

    Science.gov (United States)

    Viossat, J; Chauvaud, S; Mihaileanu, S; Pillière, R; Sicre, P; Schnebert, B; Abbou, B; Lafont, A; Julien, J; Marino, J P

    1986-09-01

    20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

  14. Severe hemolytic anemia after repair of primum septal defect and cleft mitral valve.

    Science.gov (United States)

    Alehan, D; Doğan, R; Ozkutlu, S; Elshershari, H; Gümrük, F

    2001-01-01

    Two cases are described in which severe mechanical hemolytic anemia developed after surgical repair of primum atrial septal defect (ASD) and cleft mitral valve. In both cases there was residual mitral regurgitation after repair. Moderate mitral regurgitation and collision of the regurgitant jet with the teflon patch used for repair of the primum ASD were detected by color-Doppler echocardiography imaging. Laboratory tests showed normochromic normocytic anemia, increased indirect serum bilirubin, decreased plasma haptoglobin and hemoglobinuria. The peripheral blood smear contained numerous fragmented red cells. Following another surgical correction of the mitral valve (repair or mitral valve replacement), there was no more hemolysis. The two presented cases show that foreign materials in association with localized intracardiac turbulence may cause severe hemolysis.

  15. Mitral valve regurgitation due to annular dilatation caused by a huge and floating left atrial myxoma.

    Science.gov (United States)

    Kaya, Mehmet; Ersoy, Burak; Yeniterzi, Mehmet

    2015-09-01

    We describe a case of mitral valve annular dilatation caused by a huge left atrial myxoma obstructing the mitral valve orifice. A 50-year-old man presenting with palpitation was found to have a huge left atrial myxoma protruding into the left ventricle during diastole, causing severe mitral regurgitation. The diagnosis was made with echocardiogram. Transoesophageal echocardiography revealed a solid mass of 75 × 55 mm. During operation, the myxoma was completely removed from its attachment in the atrium. We preferred to place a mechanical heart valve after an annuloplasty ring because of severely dilated mitral annulus and chordae elongation. The patient had an uneventful recovery. Our case suggests that immediate surgery, careful evaluation of mitral valve annulus preoperatively is recommended.

  16. Artificial chordae for degenerative mitral valve disease: critical analysis of current techniques

    Science.gov (United States)

    Ibrahim, Michael; Rao, Christopher; Athanasiou, Thanos

    2012-01-01

    The surgical repair of degenerative mitral valve disease involves a number of technical points of importance. The use of artificial chordae for the repair of degenerative disease has increased as a part of the move from mitral valve replacement to repair of the mitral valve. The use of artificial chordae provides an alternative to the techniques pioneered by Carpentier (including the quadrangular resection, transfer of native chordae and papillary muscle shortening/plasty), which can be more technically difficult. Despite a growth in their uptake and the indications for their use, a number of challenges remain for the use of artificial chordae in mitral valve repair, particularly in the determination of the correct length to ensure optimal leaflet coaptation. Here, we analyse over 40 techniques described for artificial chordae mitral valve repair in the setting of degenerative disease. PMID:22962321

  17. [MITRAL VALVE REPAIR WITH MINIMALLY INVASIVE CARDIAC SURGERY APPROACH AS ROUTINE PRACTICE].

    Science.gov (United States)

    Okamoto, Kazuma; Kudo, Mikihiko; Shimizu, Hideyuki

    2016-03-01

    Although minimally invasive cardiac surgery (MICS) via right minithoracotomy is attracting attention as a minimally invasive approach in cardiac surgery, it has not become a standard, routine approach for mitral valve repair. Although it has spread rapidly in Germany (43%) and USA (20.4%), the proportion of MICS in isolated mitral valve repair still comprises only 15.6% of mitral valve repair surgeries in Japan. For safe, assured introduction of MICS as a routine approach under quality control for good surgical and mid- and long-term results, surgeons experienced in mitral valve repair who perform at least 10 mitral valve repairs per year are necessary. A team approach with surgeons, anesthesiologists, perfusionists, and nurses who are highly motivated is also important.

  18. Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty.

    Science.gov (United States)

    Arakawa, Mamoru; Yamaguchi, Atsushi; Nishimura, Takashi; Itoh, Satoshi; Yuri, Koichi; Kyo, Shunei; Adachi, Hideo

    2015-12-01

    Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.

  19. Mitral Valvuloplasty for the Treatment of Mitral Regurgitation%二尖瓣成形术治疗二尖瓣关闭不全

    Institute of Scientific and Technical Information of China (English)

    汤吟; 李亚雄; 吴剑

    2015-01-01

    The Mitral regurgitation is one of the most common heart valve disease.The main treatment of it are mitral valve replacement and mitral valvuloplasty. Patients can benefit from mitral valvuloplasty with keeping a good left ventricular function, reducing postoperative complications and raising postoperative survival rate rather then mitral valve replacement. So,it has been widely used in the treatment of mitral regurgitation. In order to achieve the best treatment ef ect, we can according to dif erent condition of mitral regurgitation with dif erent repair technology. With the development of minimal y invasive surgical technology ,minimal y invasive valve operations and robotic mitral valve reconstruction have applied to the mitral valvuloplasty. This review makes a overview focusing on the cur ent situation of mitral valvuloplasty for mitral regurgitation.%二尖瓣关闭不全是一种常见的心脏瓣膜疾病,其治疗的方法主要为二尖瓣置换术与二尖瓣成形术。二尖瓣成形术在保持良好的左心室结构形态、血流动力学及术后并发症发生、生存率等方面较二尖瓣置换术具有明显优越性。因此,其已广泛应用于二尖瓣关闭不全的治疗。针对二尖瓣关闭不全的不同病理改变,可以根据具体情况采用不同的成形技术,以达到最好的治疗效果。目前随着微创外科的发展,小切口二尖瓣成形和机器人辅助的二尖瓣成形技术也逐渐运用到二尖瓣成形中来。因此,我们将对二尖瓣成形术治疗二尖瓣关闭不全近几年来的诊疗现状做一综述。

  20. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study.

    Science.gov (United States)

    Praz, Fabien; Spargias, Konstantinos; Chrissoheris, Michael; Büllesfeld, Lutz; Nickenig, Georg; Deuschl, Florian; Schueler, Robert; Fam, Neil P; Moss, Robert; Makar, Moody; Boone, Robert; Edwards, Jeremy; Moschovitis, Aris; Kar, Saibal; Webb, John; Schäfer, Ulrich; Feldman, Ted; Windecker, Stephan

    2017-08-19

    Severe mitral regurgitation is associated with impaired prognosis if left untreated. Using the devices currently available, transcatheter mitral valve repair (TMVr) remains challenging in complex anatomical situations. We report the procedural and 30-day results of the first-in-man study of the Edwards PASCAL TMVr system. In this multicentre, prospective, observational, first-in-man study, we collected data from seven tertiary care hospitals in five countries that had a compassionate use programme in which patients underwent transcatheter mitral valve repair using the Edwards PASCAL TMVr system. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation deemed at high risk or inoperable. Safety and efficacy of the procedure were prospectively assessed at device implantation, discharge, and 30 days after device implantation. The key study endpoints were technical success assessed at the end of the procedure and device success 30 days after implantation using the Mitral Valve Academic Research Consortium definitions. Between Sept 1, 2016, and March 31, 2017, 23 patients (median age 75 years [IQR 61-82]) had treatment for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the Edwards PASCAL TMVr system. At baseline, the median EuroScore II score was 7·1% (IQR 3·6-12·8) and the median Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair was 4·8% (2·1-9·0) and 6·8% (2·9-10·1) for mitral valve replacement. 22 (96%) of 23 patients were New York Heart Association (NYHA) class III or IV at baseline. The implantation of at least one device was successful in all patients, resulting in procedural residual mitral regurgitation of grade 2+ or less in 22 (96%) patients. Six (26%) of 23 patients had two implants. Periprocedural complications occurred in two (9%) of 23 patients (one minor bleeding event and one transient ischaemic attack). Despite the anatomical

  1. Folheto mitral acessório: uma causa incomum de estenose subaórtica Accessory mitral leaflet: an uncommon form of subaortic stenosis

    Directory of Open Access Journals (Sweden)

    Marcos Alves Pavione

    2012-09-01

    Full Text Available Criança de três anos, com estenose subvalvar aórtica sem definição precisa ao ecocardiograma, apresentando como diagnóstico cirúrgico um folheto mitral acessório.Three-years-old boy presenting with a subvalvar aortic stenosis without a precise definition by echocardiography, where the surgical approach revealed an accessory mitral leaflet.

  2. Effects of percutaneous mitral valve repair with Mitraclip on clinical status, ventricular remodeling and neurohormonal profile in patients with advanced heart failure and significant functional mitral regurgitation

    OpenAIRE

    Berardini, Alessandra

    2016-01-01

    The role of percutaneous mitral valve repair (PMVR) in patients with advanced heart failure (HF) and functional mitral regurgitation (FMR) is unclear. The aim of this study was to assess the effects (PMVR) therapy on clinical outcomes , left ventricular (LV) remodeling and neurohormonal changes in inoperable critical patients with chronically symptomatic FMR despite optical medical /electrical therapy and severe LV dysfunction. We analyzed the clinical and echocardiographic data of twenty-fiv...

  3. Surgery for ischemic mitral regurgitation: should the valve be repaired?

    Science.gov (United States)

    Silberman, Shuli; Eldar, Orly; Oren, Avraham; Tauber, Rachel; Fink, Daniel; Klutstein, Marc W; Bitran, Daniel

    2011-03-01

    Patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) often have concomitant mitral regurgitation (MR). Repairing the valve at the time of surgery is not universally accepted. The results of CABG with or without mitral valve annuloplasty (MVA) were compared in patients with reduced left ventricular (LV) function and ischemic MR. Among a total of 195 patients, 108 underwent isolated CABG, and 87 underwent CABG with MVA. The study end-points included survival, degree of MR, and NYHA functional class. Patients in the MVA group were younger (mean age 63 +/- 10 versus 68 +/- 9 years; p <0.001), but had a more severe cardiac pathology, with severe LV dysfunction in 45% versus 26% (p = 0.006) and severe MR in 82% versus 14% (p < 0.001). The operative mortality was 9%, and similar in both groups. The follow up was complete, with a mean survival period of 87 +/- 50 months. Although, overall, no improvement was seen in LV function, symptomatic improvement was more pronounced in the MVA group (p = 0.006). At follow up, residual MR was present in 2% of the MVA group and in 47% of the CABG-only group (p < 0.0001). For the MVA and CABG-only groups, respectively, survival at five and 10 years was 68% and 46% versus 77% and 52% (p = NS). By multivariate analysis, neither degree of MR nor LV function at follow up had any impact on survival. In patients with a reduced LV function undergoing CABG, the addition of a mitral annuloplasty does not increase the operative risk. Although patients in the MVA group were more ill, there was a better symptomatic improvement in this group, and they attained a similar survival. It is recommended that MVA be performed at the time of CABG in patients having moderate or greater MR associated with a reduced LV function.

  4. Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction.

    Science.gov (United States)

    Loperfido, F; Biasucci, L M; Pennestri, F; Laurenzi, F; Gimigliano, F; Vigna, C; Rossi, E; Favuzzi, A; Santarelli, P; Manzoli, U

    1986-10-01

    In 72 patients with previous myocardial infarction (MI), mitral regurgitation (MR) was assessed by pulsed-wave Doppler echocardiography and compared with physical and 2-dimensional echocardiographic findings. MR was found by Doppler in 29 of 42 patients (62%) with anterior MI, 11 of 30 (37%) with inferior MI (p less than 0.01) and in none of 20 normal control subjects. MR was more frequent in patients who underwent Doppler study 3 months after MI than in those who underwent Doppler at discharge (anterior MI = 83% vs 50%, p less than 0.01; inferior MI = 47% vs 27%, p = not significant). Of 15 patients who underwent Doppler studies both times, 3 (all with anterior MI) had MR only on the second study. Of the patients with Doppler MR, 12 of 27 (44%) with a left ventricular (LV) ejection fraction (EF) greater than 30% and 1 of 13 (8%) with an EF of 30% or less (p less than 0.01) had an MR systolic murmur. Mitral prolapse or eversion and papillary muscle fibrosis were infrequent in MI patients, whether or not Doppler MR was present. The degree of Doppler MR correlated with EF (r = -0.61), LV systolic volume (r = 0.47), and systolic and diastolic mitral anulus circumference (r = 0.52 and 0.51, respectively). Doppler MR was present in 24 of 28 patients (86%) with an EF of 40% or less and in 16 of 44 (36%) with EF more than 40% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Role of Mitral Annulus Diastolic Geometry on Intraventricular Filling Dynamics.

    Science.gov (United States)

    Okafor, Ikechukwu U; Santhanakrishnan, Arvind; Raghav, Vrishank S; Yoganathan, Ajit P

    2015-12-01

    The mitral valve (MV) is a bileaflet valve positioned between the left atrium and ventricle of the heart. The annulus of the MV has been observed to undergo geometric changes during the cardiac cycle, transforming from a saddle D-shape during systole to a flat (and less eccentric) D-shape during diastole. Prosthetic MV devices, including heart valves and annuloplasty rings, are designed based on these two configurations, with the circular design of some prosthetic heart valves (PHVs) being an approximation of the less eccentric, flat D-shape. Characterizing the effects of these geometrical variations on the filling efficiency of the left ventricle (LV) is required to understand why the flat D-shaped annulus is observed in the native MV during diastole in addition to optimizing the design of prosthetic devices. We hypothesize that the D-shaped annulus reduces energy loss during ventricular filling. An experimental left heart simulator (LHS) consisting of a flexible-walled LV physical model was used to characterize the filling efficiency of the two mitral annular geometries. The strength of the dominant vortical structure formed and the energy dissipation rate (EDR) of the measured fields, during the diastolic period of the cardiac cycle, were used as metrics to quantify the filling efficiency. Our results indicated that the O-shaped annulus generates a stronger (25% relative to the D-shaped annulus) vortical structure than that of the D-shaped annulus. It was also found that the O-shaped annulus resulted in higher EDR values throughout the diastolic period of the cardiac cycle. The results support the hypothesis that a D-shaped mitral annulus reduces dissipative energy losses in ventricular filling during diastole and in turn suggests that a symmetric stent design does not provide lower filling efficiency than an equivalent asymmetric design.

  6. Mitral valve finite-element modelling from ultrasound data: a pilot study for a new approach to understand mitral function and clinical scenarios.

    Science.gov (United States)

    Votta, Emiliano; Caiani, Enrico; Veronesi, Federico; Soncini, Monica; Montevecchi, Franco Maria; Redaelli, Alberto

    2008-09-28

    In the current scientific literature, particular attention is dedicated to the study of the mitral valve and to comprehension of the mechanisms that lead to its normal function, as well as those that trigger possible pathological conditions. One of the adopted approaches consists of computational modelling, which allows quantitative analysis of the mechanical behaviour of the valve by means of continuum mechanics theory and numerical techniques. However, none of the currently available models realistically accounts for all of the aspects that characterize the function of the mitral valve. Here, a new computational model of the mitral valve has been developed from in vivo data, as a first step towards the development of patient-specific models for the evaluation of annuloplasty procedures. A structural finite-element model of the mitral valve has been developed to account for all of the main valvular substructures. In particular, it includes the real geometry and the movement of the annulus and papillary muscles, reconstructed from four-dimensional ultrasound data from a healthy human subject, and a realistic description of the complex mechanical properties of mitral tissues. Preliminary simulations allowed mitral valve closure to be realistically mimicked and the role of annulus and papillary muscle dynamics to be quantified.

  7. Hemodynamics and annuloplasty in isolated mitral regurgitation in children.

    Science.gov (United States)

    Sulayman, R; Mathew, R; Thilenius, O G; Replogle, R; Arcilla, R A

    1975-12-01

    Isolated mitral insufficiency in children is quantitated angiographically by comparing the stroke volumes of the right ventricle and left ventricle. The disease results in greater enlargement of the left atrium than of the left ventricle and is accompanied by a significant increase in left atrial "distensibility." Right and left heart pressures may be normal or may be increased; they tend to be elevated in the group with regurgitant fractions of over 50%. Annuloplasty results in marked clinical and hemodynamic improvement and may even be corrective.

  8. RVOT mural and mitral valve endocarditis: A case report.

    Science.gov (United States)

    Jawad, Maadh; Cardozo, Shaun

    2015-01-01

    Mural endocarditis is a very rare condition. This entity involves bacterial growth on cardiac walls. In addition, concomitant valvular endocarditis, along with mural endocarditis, is an extremely rare combination. The diagnosis of mural endocarditis is difficult and requires more advanced cardiac imaging, such as a transesophageal echocardiogram. The differential diagnoses of mural masses include vegetations, thrombi, metastasis, and benign and malignant tumors. We present a rare and unusual case of Methicillin-Resistant Staphylococcus aureus bacteremia with findings of both right ventricular outflow tract mural endocarditis and valvular endocarditis involving the mitral valve.

  9. The first experience of orthotropic implantation of decellularized mitral allograft

    Directory of Open Access Journals (Sweden)

    P. P. Yablonsky

    2015-01-01

    Full Text Available Traditional biological and mechanical valve substitutes have some well-known limitation, such as rapid deterioration of the tissue ones in young patient and the high risk of thrombosis and anticoagulation therapy complications for the mechanical ones. At the same time the aortic and pulmonary valves can already be replaced with decellularized allografts that showed promising results in terms of both hemodynamics and reliability while anticoagulation for them is not needed. This paper describes the first orthotropic implantation of the decellularized mitral valve allograft in sheep model. The original method without stabilizing ring is described, which have shown good echocardiographic results.

  10. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  11. Patellar tendon: From tendinopathy to rupture

    Directory of Open Access Journals (Sweden)

    Federica Rosso

    2015-10-01

    Full Text Available Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.

  12. Plantar fascia rupture: diagnosis and treatment.

    Science.gov (United States)

    Rolf, C; Guntner, P; Ericsäter, J; Turan, I

    1997-01-01

    Two patients with spontaneous medial plantar fascia rupture due to a definite injury with no prior symptoms, were referred to our institution. Clinically, there was a tender lump in the sole, and magnetic resonance imaging confirmed the diagnosis. Nonoperative treatment was sufficient in curing the acute total rupture. Endoscopic release was used on the partially ruptured plantar fascia, but it is probably more optimal in the acute phase. The literature provides no comparative data on operative or nonoperative treatment efficacy for this rare condition.

  13. RUPTURED RUDIMENTARY HORN PREGNANCY OF UNICORNUATE UTERUS

    Directory of Open Access Journals (Sweden)

    Vijay Kumar

    2015-06-01

    Full Text Available Unicornuate uterus can sometimes be associated with rudimentary horn. Pregnancy in a rudimentary horn is rare and usually ends up in rupture. Diagnosis is difficult and can be missed in routine ultrasound scan and is usually detected after rupture. We report a case of G1P1 with rudimentary horn pregnancy which raised suspicion on ultr asound and was later diagnosed by MR imaging. Patient refused termination and presented next day with shock. Laparotomy revealed ruptured right rudimentary horn pregnancy.

  14. Gastric rupture after the Heimlich maneuver.

    Science.gov (United States)

    Bintz, M; Cogbill, T H

    1996-01-01

    Since 1975, the Heimlich maneuver has been widely applied to relieve upper airway obstruction caused by aspirated material. Life-threatening complications have been documented following this simple procedure. We report two cases of gastric rupture after use of the Heimlich maneuver. Both patients experienced pulmonary and abdominal symptoms. The diagnosis was confirmed in each case by the demonstration of free intraperitoneal air on an upright chest roentgenogram. Full-thickness gastric rupture along the lesser curvature of the stomach was repaired in both patients; one patient died. Abdominal pain or persistent abdominal distention despite nasogastric suction after the Heimlich maneuver should prompt evaluation for possible gastric rupture.

  15. Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

    Directory of Open Access Journals (Sweden)

    Josué Viana Castro Neto

    2002-11-01

    Full Text Available OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90% patients (group II - GII. Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm. All 5 patients in group I (GI, who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

  16. Chronic Achilles tendon rupture reconstructed using hamstring tendon autograft.

    Science.gov (United States)

    Ellison, Philip; Mason, Lyndon William; Molloy, Andrew

    2016-03-01

    Chronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and augmentation methods are challenging when the defect exceeds 5-6 cm, especially if the distal stump is grossly tendinopathic. We describe our method of Achilles tendon reconstruction with ipsilateral semitendinosis autograft and interference screw fixation in a patient with chronic rupture, a 9 cm defect and gross distal tendinopathy. Patient reported outcome measures consistently demonstrated improved health status at 12 months post surgery: MOXFQ-Index 38-25, EQ5D-5L 18-9, EQ VAS 70-90 and VISA-A 1-64. The patient was back to full daily function, could single leg heel raise and was gradually returning to sport. No complications or adverse events were recorded. Reconstruction of chronic tears of the Achilles tendon with large defects and gross tendinopathy using an ipsilateral semitendinosis autograft and interference screw fixation can achieve satisfactory improvements in patient reported outcomes up to 1 year post-surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty.

    Science.gov (United States)

    Wijdh-den Hamer, Inez J; Bouma, Wobbe; Lai, Eric K; Levack, Melissa M; Shang, Eric K; Pouch, Alison M; Eperjesi, Thomas J; Plappert, Theodore J; Yushkevich, Paul A; Hung, Judy; Mariani, Massimo A; Khabbaz, Kamal R; Gleason, Thomas G; Mahmood, Feroze; Acker, Michael A; Woo, Y Joseph; Cheung, Albert T; Gillespie, Matthew J; Jackson, Benjamin M; Gorman, Joseph H; Gorman, Robert C

    2016-09-01

    Repair for ischemic mitral regurgitation with undersized annuloplasty is characterized by high recurrence rates. We sought to determine the value of pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in predicting recurrence at 6 months. Intraoperative transesophageal 2-dimensional echocardiography and 3-dimensional echocardiography were performed in 50 patients undergoing undersized annuloplasty for ischemic mitral regurgitation. Two-dimensional echocardiography annular diameter and tethering parameters were measured in the apical 2- and 4-chamber views. A customized protocol was used to assess 3-dimensional annular geometry and regional leaflet tethering. Recurrence (grade ≥2) was assessed with 2-dimensional transthoracic echocardiography at 6 months. Preoperative 2- and 3-dimensional annular geometry were similar in all patients with ischemic mitral regurgitation. Preoperative 2- and 3-dimensional leaflet tethering were significantly higher in patients with recurrence (n = 13) when compared with patients without recurrence (n = 37). Multivariate logistic regression revealed preoperative 2-dimensional echocardiography posterior tethering angle as an independent predictor of recurrence with an optimal cutoff value of 32.0° (area under the curve, 0.81; 95% confidence interval, 0.68-0.95; P = .002) and preoperative 3-dimensional echocardiography P3 tethering angle as an independent predictor of recurrence with an optimal cutoff value of 29.9° (area under the curve, 0.92; 95% confidence interval, 0.84-1.00; P 3-dimensional geometric multivariate model can be augmented by adding basal aneurysm/dyskinesis (area under the curve, 0.94; 95% confidence interval, 0.87-1.00; P 3-dimensional echocardiography P3 tethering angle is a stronger predictor of ischemic mitral regurgitation recurrence after annuloplasty than preoperative 2-dimensional echocardiography posterior tethering angle, which is highly influenced by viewing plane. In

  18. Low mortality and morbidity after endovascular repair of ruptured aortic aneurism

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Balezantis, Tomas; Lindholt, Jes Sanddal

    2015-01-01

    INTRODUCTION: The objective of this study was to describe the implementation and to evaluate the short-term outcome of the first Danish experience with endovascular repair of ruptured abdominal aortic aneurysm (RAAA). METHODS: This was a historical prospective cohort study including all patients ......-operative mortality and morbidity of RAAA can probably be reduced by implementation of RAAA....... shortly after the procedure. In the group with open repair, seven patients (30.7%) died within 30 days. This yields a mortality of all patients treated for rupture at our institution of 19% compared with 32% in Denmark at large. CONCLUSION: Endovascular treatment of RAAA is feasible, and the overall post...

  19. Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting.

    Science.gov (United States)

    Shao, Elichilia R; Joseph, Pantaleo M; Slootweg, Piet; Mkwizu, Elifuraha W; Kilonzo, Kajiru G; Mwasamwaja, Amos O

    2015-08-01

    Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.

  20. Partial isolated rupture of the popliteus tendon in a professional soccer player: a case report

    Directory of Open Access Journals (Sweden)

    Mariani Pier

    2009-07-01

    Full Text Available Abstract The complete isolated rupture of the popliteus tendon has been described as a rare injury and this report describes the case of a 31-year-old soccer player who sustained a partial rupture of the popliteus tendon during a game. The injury was suspected clinically and at MRI but confirmed only by the arthroscopic examination. The treatment consisted in open debridment with no tendon repair or augmentation. Seven weeks post-operation the patient was symptom-free and returned to competitive professional soccer at the same preinjury level. The clinical and arthroscopic findings of the case reported suggest a possible overuse disease with degenerative expression.

  1. Right lateral mini-thoracotomy for mitral valve surgery.

    Science.gov (United States)

    Reser, Diana; Holubec, Tomas; Yilmaz, Murat; Guidotti, Andrea; Maisano, Francesco

    2015-01-01

    Since the 1990 s, minimally invasive cardiac surgery has gained wide acceptance due to patient and economic demand. The advantages are less trauma, less bleeding, less wound infections, less pain and faster recovery. Many studies showed that the outcomes are comparable with those of conventional sternotomy. Right lateral mini-thoracotomy evolved into a routine and safe access in specialized centres for minimally invasive mitral valve surgery. The 6-cm incision is performed over the fifth intercostal space in the inframammary groove. With a double-lumen tube, the right lung is deflated before entering the pleural cavity. A soft tissue retractor is used to minimize rib spreading. The stab incisions for the endoscopic camera and the transthoracic clamp are performed in the right anterior and posterior axillary line in the third intercostal space. Surgery on the mitral valve is performed in a standard fashion under a direct vision with video assistance. One chest tube is inserted. The intercostal space is adapted with braided sutures to prevent lung herniation. Ropivacaine is used for local infiltration. The pectoral muscle, subcutaneous tissue and skin are adapted with running sutures. Complications of a right lateral mini-thoracotomy are rare (conversion to sternotomy, rethoracotomy, phrenic nerve palsy, wound infection and thoracic wall hernia) and well manageable.

  2. Methods of estimation of mitral valve regurgitation for the cardiac surgeon

    Directory of Open Access Journals (Sweden)

    Baikoussis Nikolaos G

    2009-07-01

    Full Text Available Abstract Mitral valve regurgitation is a relatively common and important heart valve lesion in clinical practice and adequate assessment is fundamental to decision on management, repair or replacement. Disease localised to the posterior mitral valve leaflet or focal involvement of the anterior mitral valve leaflet is most amenable to mitral valve repair, whereas patients with extensive involvement of the anterior leaflet or incomplete closure of the valve are more suitable for valve replacement. Echocardiography is the recognized investigation of choice for heart valve disease evaluation and assessment. However, the technique is depended on operator experience and on patient's hemodynamic profile, and may not always give optimal diagnostic views of mitral valve dysfunction. Cardiac catheterization is related to common complications of an interventional procedure and needs a hemodynamic laboratory. Cardiac magnetic resonance (MRI seems to be a useful tool which gives details about mitral valve anatomy, precise point of valve damage, as well as the quantity of regurgitation. Finally, despite of its higher cost, cardiac MRI using cine images with optimized spatial and temporal resolution can also resolve mitral valve leaflet structural motion, and can reliably estimate the grade of regurgitation.

  3. Surgical interventions in patients undergoing percutaneous balloon mitral valvotomy : a retrospective analysis of anaesthetic considerations.

    Directory of Open Access Journals (Sweden)

    Tempe Deepak

    2004-01-01

    Full Text Available Between 1990 and 2000, 5499 balloon mitral valvotomies were performed at GB Pant Hospital. Amongst these, 45 patients required surgical intervention, which form the basis of this report. There were 18 males and 27 females with the mean age of 26.5+/-8.3 years and weight of 42.9+/-7.39 kg. Thirty-five patients underwent open-heart surgery and 10 closed-heart surgery. Twenty-five patients developed acute severe mitral regurgitation during balloon mitral valvotomy and required emergency open-heart surgery. Morphine based anaesthetic technique with careful attention to haemodynamic monitoring was used in these patients. All patients required a high inotropic support to terminate the cardiopulmonary bypass. The closed-heart surgical procedures included emergency exploration for cardiac tamponade (4, exploration + closed mitral valvotomy (4, and elective closed mitral valvotomy (2. The overall mortality was 9%, which is much higher than the reported mortality for elective mitral valve replacement. Morphine based anaesthetic technique is useful in these patients. Adequate oxygenation, vasodilators, inotropes and diuretics are required for preoperative stabilisation of patients who develop acute mitral regurgitation, while those who develop cardiac tamponade need volume replacement along with inotropes and immediate surgical decompression of the tamponade.

  4. Ruptura traumática de la válvula mitral

    Directory of Open Access Journals (Sweden)

    Bernardo Romero

    2010-01-01

    Full Text Available Presentamos dos pacientes que sufrieron un accidente de tráfico con resultado de traumatismo de la válvula mitral. En el primer caso, al cuarto día del accidente, se diagnosticó insuficiencia mitral masiva por ruptura de la cabeza del músculo papilar anterolateral, con versión completa de los segmentos A1 y P1, procediéndose a reparación quirúrgica al mes del accidente, siendo la válvula mitral estructuralmente normal. En el segundo caso, el diagnóstico se hizo a los 10 días del accidente. Se trataba de una insuficiencia mitral grave por ruptura de cuerdas del velo posterior. La reparación quirúrgica se llevó a cabo a los 2 meses y medio del accidente. En este caso la válvula mitral era, además, degenerativa. En ambos casos la cirugía consistió en reparación valvular mitral. Se revisa la ruptura traumática de la válvula mitral.

  5. Repeated mitral valve replacement in a patient with extensive annular calcification

    Directory of Open Access Journals (Sweden)

    Kitamura Tadashi

    2011-11-01

    Full Text Available Abstract Background Mitral valve replacement in the presence of severe annular calcification is a technical challenge. Case report A 47-year-old lady who had undergone mitral and aortic valve replacement for rheumatic disease 27 years before presented with dyspnea. At reoperation, extensive mitral annular calcification was hindering the disc motion of the Starr-Edwards mitral prosthesis. The old prosthesis was removed and a St Jude Medical mechanical valve was implanted after thorough annular debridement. Postoperatively the patient developed paravalvular leak and hemolytic anemia, subsequently undergoing reoperation three days later. The mitral valve was replaced with an Edwards MIRA valve, with a bulkier sewing cuff, after more aggressive annular debridement. Although initially there was no paravalvular leak, it recurred five days later. The patient also developed a small cerebral hemorrhage. As the paravalvular leak and hemolytic anemia gradually worsened, the patient underwent reoperation 14 days later. A Carpentier-Edwards bioprosthetic valve with equine pericardial patches, one to cover the debrided calcified annulus, another as a collar around the prosthesis, was used to eliminate paravalvular leak. At 7 years postoperatively the patient is doing well without any evidence of paravalvular leak or structural valve deterioration. Conclusion Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification.

  6. Creep-rupture reliability analysis

    Science.gov (United States)

    Peralta-Duran, A.; Wirsching, P. H.

    1985-01-01

    A probabilistic approach to the correlation and extrapolation of creep-rupture data is presented. Time temperature parameters (TTP) are used to correlate the data, and an analytical expression for the master curve is developed. The expression provides a simple model for the statistical distribution of strength and fits neatly into a probabilistic design format. The analysis focuses on the Larson-Miller and on the Manson-Haferd parameters, but it can be applied to any of the TTP's. A method is developed for evaluating material dependent constants for TTP's. It is shown that optimized constants can provide a significant improvement in the correlation of the data, thereby reducing modelling error. Attempts were made to quantify the performance of the proposed method in predicting long term behavior. Uncertainty in predicting long term behavior from short term tests was derived for several sets of data. Examples are presented which illustrate the theory and demonstrate the application of state of the art reliability methods to the design of components under creep.

  7. Achilles tendon rupture in atypical patient populations.

    Science.gov (United States)

    Kingsley, Peter

    2016-03-01

    Rupture of the Achilles tendon is a significant injury, and the likelihood of a good recovery is directly associated with early diagnosis and appropriate referral. Such injuries are commonly assessed and identified by practitioners working in 'minors' areas of emergency departments or urgent care settings. The literature frequently describes rupture of the Achilles tendon as 'typically sport-related' affecting 'middle-aged weekend warriors', but this aetiology accounts for only about 70% of such injuries. Factors such as the natural ageing process, obesity and use of some commonly prescribed medications, can increase the risk of developing a tendinopathy and subsequent rupture, often from a seemingly insignificant incident. However, research suggests that injuries in this patient population are more likely be missed on first examination. This article describes risk factors that should alert clinicians to the possibility of Achilles tendon rupture in 'atypical' patient populations.

  8. Spontaneous splenic rupture in typhoid fever.

    OpenAIRE

    Ali, G; Kamili, M. A.; Rashid, S; Mansoor, A; Lone, B. A.; Allaqaband, G. Q.

    1994-01-01

    Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.

  9. Right Diaphragm Spontaneous Rupture: A Surgical Approach

    Directory of Open Access Journals (Sweden)

    Duilio Divisi

    2011-01-01

    Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.

  10. Cognitive frames in psychology: demarcations and ruptures.

    Science.gov (United States)

    Yurevich, Andrey V

    2009-06-01

    As there seems to be a recurrent feeling of crisis in psychology, its present state is analyzed in this article. The author believes that in addition to the traditional manifestations that have dogged psychology since it emerged as an independent science some new features of the crisis have emerged. Three fundamental "ruptures" are identified: the "horizontal" rupture between various schools and trends, the "vertical" rupture between natural science and humanitarian psychology, and the "diagonal" rupture between academic research and applied practice of psychology. These manifestations of the crisis of psychology have recently been compounded by the crisis of its rationalistic foundations. This situation is described in terms of the cognitive systems in psychology which include meta-theories, paradigms, sociodigms and metadigms.

  11. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    .3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related...... to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION: Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour...... is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study....

  12. Micromechanical properties and collagen composition of ruptured human achilles tendon

    DEFF Research Database (Denmark)

    Hansen, Philip; Kovanen, Vuokko; Hölmich, Per

    2013-01-01

    The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive.......The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive....

  13. Quadriceps tendon rupture through a superolateral bipartite patella.

    Science.gov (United States)

    Woods, G William; O'Connor, Daniel P; Elkousy, Hussein A

    2007-10-01

    We report a case of a quadriceps tendon rupture through a bipartite patella. Although quadriceps tendon ruptures and patella fractures are common, rupture through a bipartite patella fragment is rare. This case was managed similar to a quadriceps rupture with an excellent result.

  14. Aortic ruptures in seat belt wearers.

    Science.gov (United States)

    Arajärvi, E; Santavirta, S; Tolonen, J

    1989-09-01

    Several investigations have indicated that rupture of the thoracic aorta is one of the leading causes of immediate death in victims of road traffic accidents. In Finland in 1983, 92% of front-seat passengers were seat belt wearers on highways and 82% in build-up areas. The mechanisms of rupture of the aorta have been intensively investigated, but the relationship between seat belt wearing and injury mechanisms leading to aortic rupture is still largely unknown. This study comprises 4169 fatally injured victims investigated by the Boards of Traffic Accident Investigation of Insurance Companies during the period 1972 to 1985. Chest injuries were recorded as the main cause of death in 1121 (26.9%) victims, 207 (5.0%) of those victims having worn a seat belt. Aortic ruptures were found at autopsy in 98 victims and the exact information of the location of the aortic tears was available in 68. For a control group, we analyzed 72 randomly chosen unbelted victims who had a fatal aortic rupture in similar accidents. The location of the aortic rupture in unbelted victims was more often in the ascending aorta, especially in drivers, whereas in seat belt wearers the distal descending aorta was statistically more often ruptured, especially in right-front passengers (p less than 0.05). The steering wheel predominated statistically as the part of the car estimated to have caused the injury in unbelted victims (37/72), and some interior part of the car was the most common cause of fatal thoracic impacts in seat belt wearers (48/68) (p less than 0.001). The mechanism of rupture of the aorta in the classic site just distal to the subclavian artery seems to be rapid deceleration, although complex body movements are also responsible in side impact collisions. The main mechanism leading to rupture of the ascending aorta seems to be severe blow to the bony thorax. This also often causes associated thoracic injuries, such as heart rupture and sternal fracture. Injuries in the ascending

  15. Assessment of mitral valve reserve capacity before and after percutaneous balloon valvuloplasty with isoproterenol stress echocardiography

    Institute of Scientific and Technical Information of China (English)

    LIU Pin-ming; FU Xiang-yang; L(U) Jun-hao; WU Qun; Yang Fu-qing

    2002-01-01

    Objective: To explore whether successful valvuloplasty increases mitral valve reserve capacity in patients with mitral stenosis. Methods: Thirty-eight patients with pure rheumatic mitral stenosis underwent isoproterenol stress echocardiography before and after successful percutaneous balloon valvuloplasty. The mitral valve area (by direct planimetry of two-dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography)were measured at rest and under isoproterenol infusion to achieve heart rate of different stages. Results :Between the measurements before and after valvuloplasty, significant differences were observed in the mitral valve area (0. 91±0.28 vs 1.87±0.23 cm2, P<0.01), mean transmitral pressure gradient (12.5±6.3 vs 3. 9±1.9 mmHg, P<0. 01) and cardiac output (3.93±1.44 vs 4. 73±1.01 L/min, P<O. 05) at rest. Before valvuloplasty, the mean transmitral pressure gradient increased significantly (P<0. 01) as heart rate increased, but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05). In contrast, there was a significant increase after valvuloplasty in the mean transmitral pressure gradient (P<0. 01), but both mitral valve area and cardiac output further increased (both P<0. 01) as beart rate increased. Moreover, valvuloplasty decreased the mean transmitral pressure gradient at peak heart rate from 23.0 ±4. 5 to 7.75 ±2. 30 mmHg (P<0.01) under submaximal stress. Conclusion:Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve reserve capacity in patients with mitral stenosis, which is conspicuously manifested under condition of hemodynamic stress.Stress echocardiography provides a safe, feasible and non-invasive means of assessing the reserve capacity.

  16. Dendritic branching of olfactory bulb mitral and tufted cells: regulation by TrkB.

    Directory of Open Access Journals (Sweden)

    Fumiaki Imamura

    Full Text Available BACKGROUND: Projection neurons of mammalian olfactory bulb (OB, mitral and tufted cells, have dendrites whose morphologies are specifically differentiated for efficient odor information processing. The apical dendrite extends radially and arborizes in single glomerulus where it receives primary input from olfactory sensory neurons that express the same odor receptor. The lateral dendrites extend horizontally in the external plexiform layer and make reciprocal dendrodendritic synapses with granule cells, which moderate mitral/tufted cell activity. The molecular mechanisms regulating dendritic development of mitral/tufted cells is one of the unsolved important problems in the olfactory system. Here, we focused on TrkB receptors to test the hypothesis that neurotrophin-mediate mechanisms contributed to dendritic differentiation of OB mitral/tufted cells. PRINCIPAL FINDINGS: With immunohistochemical analysis, we found that the TrkB neurotrophin receptor is expressed by both apical and lateral dendrites of mitral/tufted cells and that expression is evident during the early postnatal days when these dendrites exhibit their most robust growth and differentiation. To examine the effect of TrkB activation on mitral/tufted cell dendritic development, we cultured OB neurons. When BDNF or NT4 were introduced into the cultures, there was a significant increase in the number of primary neurites and branching points among the mitral/tufted cells. Moreover, BDNF facilitated filopodial extension along the neurites of mitral/tufted cells. SIGNIFICANCE: In this report, we show for the first time that TrkB activation stimulates the dendritic branching of mitral/tufted cells in developing OB. This suggests that arborization of the apical dendrite in a glomerulus is under the tight regulation of TrkB activation.

  17. 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.

  18. Blunt cardiac rupture in a toddler

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    Peep Talving

    2016-08-01

    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  19. Valvoplastia mitral percutânea de urgência em gestante Emergency percutaneous balloon mitral valvoplasty in a pregnant woman

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    Luiz A. Gubolino

    1997-07-01

    Full Text Available Gestante com 33 anos na 28ª semana e sinais de óbito fetal foi admitida em caráter de urgência com quadro de edema pulmonar agudo secundário à estenose mitral grave. Com o insucesso do tratamento medicamentoso intensivo, a paciente foi submetida à valvoplastia mitral percutânea de emergência com melhora imediata. O agravamento subseqüente do quadro, atribuído ao óbito fetal, foi tratado através parto cesáreo com melhora clínica considerável. A paciente teve alta hospitalar no 10º dia, e 11 meses após o procedimento, encontra-se em classe funcional I, sem uso de medicação e com sinais ecocardiográficos de estenose mitral leve (área valvar: 2,0 cm².We report the case of a 33-year-old woman in the 28th week of pregnancy and with signs of fetal death, admitted to hospital in an emergency due to pulmonary edema secondary to severe mitral valve stenosis. Intensive medical treatment was unsuccessful and the patient was submitted to an emergency percutaneous balloon mitral valvoplasty with prompt clinical improvement. Subsequent clinical deterioration secondary to fetal death was managed by cesarean section resulting in clinical estabilization. The patient was discharged 10 days after admission and at 11 months after the procedure she had mild symptons without drug therapy and echocardiographic signs of mild residual mitral stenosis (mitral valve area: 2,0cm².

  20. Percutaneous mitral valve repair for chronic ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study in an ovine model.

    Science.gov (United States)

    Daimon, Masao; Shiota, Takahiro; Gillinov, A Marc; Hayase, Motoya; Ruel, Marc; Cohn, William E; Blacker, Steven J; Liddicoat, John R

    2005-05-03

    Although surgical annuloplasty is the standard repair for ischemic mitral regurgitation (IMR), its application is limited by high morbidity and mortality. Using 2D and real-time 3D echocardiography in an ovine model of chronic IMR, we evaluated the geometric impact and short-term efficacy of a percutaneous transvenous catheter-based approach for mitral valve (MV) repair using a novel annuloplasty device placed in the coronary sinus. Six sheep developed IMR 8 weeks after induced posterior myocardial infarction. An annuloplasty device optimized to reduce anterior-posterior (A-P) mitral annular dimension and MR was placed percutaneously in the coronary sinus. Mitral annular A-P and commissure-commissure dimensions and MV tenting area (MVTa) in 3 parallel A-P planes (medial, central, and lateral) were assessed by real-time 3D echocardiography with 3D software. The annuloplasty device reduced MR jet area from 5.4+/-2.6 to 1.3+/-0.9 cm2 (P<0.01), mitral annular A-P dimension in both systole and diastole (24.3+/-2.5 to 19.7+/-2.4 mm; P<0.03; 31.0+/-3.9 to 24.7+/-2.1 mm; P<0.001), and MVTa at mid systole in all 3 planes (153+/-46 to 93+/-24 mm2, P<0.01; 140+/-47 to 88+/-23 mm2, P<0.03; and 103+/-23 to 87+/-26 mm2, P<0.03). Percutaneous coronary sinus-based mitral annuloplasty reduces chronic IMR by reducing mitral annular A-P diameter and MVTa. This suggests the potential clinical application of a new nonsurgical therapeutic approach in patients with IMR.

  1. A ventriculotomia apical esquerda para tratamento cirúrgico da estenose mitral congênita The surgical treatment of congenital mitral stenosis through a left ventriculotomy

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    Miguel Barbero-Marcial

    1991-12-01

    Full Text Available Entre junho de 1987 e outubro de 1990, nove pacientes consecutivos, portadores de estenose mitral congênita (EMC foram submetidos a correção cirúrgica. Sete tinham valva mitral em paráquedas e dois, outras formas complexas de estenoses. Em todos, a via de abordagem foi a ventriculotomia apical esquerda, sendo dividido, primeiramente, o músculo papilar; depois, as cordas e, finalmente, as cúspides. As lesões associadas foram corrigidas prévia ou simultaneamente. Todos os pacientes tiveram boa evolução imediata. Houve um óbito tardio não relacionado. O estudo ecocardiográfico seriado pós-operatório mostrou adequada função ventricular esquerda. Conclui-se que esta via é de escolha para tratar lesões estenóticas congênitas complexas da valva mitral.From June 1987 to October 1990, nine patients with congenital mitral stenosis (CMS underwent surgical correction through an apical left ventriculotomy. Seven patients had parachute mitral valve and two had other forms of CMS. The surgical treatment of the mitral valve apparatus starts from below: first the papillary muscle is split and the cordae are divided and fenestrated. Then, the commissurotomies were performed through the ventricles aspect of the mitral valve. Associated anomalies were corrected simultaneously. There was no in-hospital death and only one late death (nonrelated. The echocardiography showed non significant residual stenosis and normal global function of the left ventricle. In conclusion, the appical left ventriculotomy is a good approach for treatment of CMS.

  2. Coronary fistula associated with double mitral valve disease. A case report.

    Science.gov (United States)

    Ayala, F; Badui, E; Murillo, H; Almazán, A; Madrid, R; Solorio, S; Verdín, R; Monroy, V

    1996-01-01

    The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.

  3. 2. Minimally invasive mitral valve surgery why do you take the risks?

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    A. Attia

    2016-07-01

    Full Text Available During recent years, minimally invasive mitral valve surgery (MIMVS become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female, age 35 ± 12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6 ± 0.7. Mean ejection fraction was 50 ± 8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%, or direct aortic cannulation (42 of 70, 25%. Aortic cross-clamp used in (66 of 70, 94.2%. Without aortic cross-clamp in (4 of 70, 5.7%, mitral valve repair has been done in (52 of 70, 74.2%, mitral valve replacement (18 of 70, 25.7%. Concomitant procedures included AF ablation (24 of 70, 34.2%, and tricuspid valve repair (33 of 70, 47.1%. No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5% during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95 ± 35 and 250 ± 74 min, respectively. 4 patients (5.7% underwent reexploration for bleeding and (57 of 70, 81.4% did not receive any blood transfusions. Six patients (8.5% sustained face oedema. Mean length of hospital stay was 7 ± 3.8 days. 18 patients (25.7% did not feel any interest regarding

  4. Double-Orifice Mitral Valve in an Eight-Year-Old Boy.

    Science.gov (United States)

    Segreto, Antonio; De Salvatore, Sergio; Chiusaroli, Alessandro; Bizzarri, Federico; Van Wyk, Cornelius; Congiu, Stefano

    2015-07-01

    The case is described of an eight-year-old boy who required an operation for moderate mitral regurgitation due to a double-orifice mitral valve (DOMV). The DOMV, which was clearly demonstrated by transthoracic echocardiography, had a central fibrous bridge. Mitral valve repair using a 5/0 Prolene suture placed at the level of the superior commissure of each hole to stabilize the valve, and ring annuloplasty with Edwards Physio ring, was successfully performed. Intraoperative real-time transesophageal echocardiography showed the repaired DOMV to be without regurgitation or stenosis.

  5. Valva mitral heteróloga sem suporte: resultados clínicos a médio prazo Heterologous mitral stentless valve: mid-term clinical results

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    Mario O Vrandecic

    1996-09-01

    Full Text Available OBJETIVO: O uso da prótese mitral porcina sem suporte ("Stentless" propicia manutenção das características de fluxo e contratilidade do ventrículo esquerdo. No presente estudo, são analisados os resultados a médio prazo com o uso desse substituto valvar. CASUÍSTICA E MÉTODOS: No período de março de 1992 a dezembro de 1995, 108 pacientes foram submetidos a implante de valva mitral "Stentless". A idade variou de 11 a 65 anos (média 35,22 ± 14,98. A etiologia predominante foi a doença reumática (94 casos, seguida da disfunção de bioprótese mitral (6, degeneração mixomatosa (5, endocardite infecciosa (2 e lesão isquêmica (1. Vinte e seis (24,1% tinham estenose mitral, 24 (22,2% insuficiência mitral e 58 (53,7% dupla lesão. Operações cardíacas prévias haviam sido realizadas em 21,3% dos pacientes. Procedimentos associados foram necessários em 10 (9,3% casos. RESULTADOS: A mortalidade hospitalar foi de 6,5% (7 pacientes; em apenas 1 caso a endocardite precoce foi relacionada à valva. Dos 101 restantes, 3 foram reoperados, 2 devido a erro na medida da valva e 1 devido a deiscência da fixação ao músculo papilar. Com 2 pacientes perdidos no seguimento, 96 foram seguidos por 3,2 a 45 meses. No seguimento tardio ocorreram 6 óbitos devidos a: endocardite (1, infarto agudo do miocárdio (1, pancreatite (1, acidente vascular cerebral (1 e reoperações para retroca valvar (2. Foram reoperados tardiamente 12 pacientes, 8 devido a insuficiência mitral (1 óbito, 2 devido a diminuição da área valvar mitral e 2 a endocardite profética (1 óbito. Atualmente, 80 pacientes têm sido avaliados trimestralmente. Os estudos ecodopplercardiográficos têm mostrado 63 pacientes com valvas funcionalmente normais, 15 com insuficiência mitral discreta e estável e 2 com redução da área valvar. Com exceção destes 2 últimos pacientes, todos os outros têm mostrado melhora da função ventricular esquerda, com redução dos volumes

  6. Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral Evaluation of atrial electrical activity in patients operated on mitral valve disease

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    Cesar Augusto Ferreira

    2002-01-01

    . The classical right lateral subseptal access may sometimes provide difficult exposure, so that alternative approaches are used whose effects on atrial electrical activity are contradictory. OBJECTIVE:To standardize an investigative method to evaluate heart electrical activity post-op. METHODS: Ten consecutive adult patients with mitral valve disease were operated on. Surface electrocardiogram and continuous electrocardiographic monitoring (Holter system pre and post-op., and epicardical cardioestimulation post-op. were used to study cardiac electric activity. RESULTS: There was no mortality. All patients with sinus rhythm presented supraventricular ectopia, with episodes of supraventricular tachycardia in 57%, atrial flutter in 10%, and junctional rhythm in 10%. All patients presented ventricular ectopia, with a low incidence in 70% of them and with unsustained ventricular tachycardia in 30%. During the postoperative period there was a 40% rate of new supraventricular arrhythmias (atrial fibrillation, junctional rhythm, low atrial rhythm, and paroxistic supraventricular tachycardia, with no ventricular arrhythmias. Post-op. sinus node function was preserved. There was a significant reduction of supraventricular ectopia, with reversal of atrial fibrillation to sinus rhythm in one patient. Although there was a significant reduction in left atrium size post-op, P wave duration, as well as ventricular ectopia rate remained unchanged. Interatrial conduction time correlated with left atrium size measured pre and post-op. CONCLUSION: The methods proved useful to evaluate atrial electric activity in patients operated upon by the classic subseptal access, thus permitting future comparisons with other surgical approaches to the mitral valve.

  7. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial

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    Verleisdonk Egbert-Jan MM

    2007-11-01

    Full Text Available Abstract Background We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture. Methods/Design At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month. Discussion By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial. Trial registration ISRCTN50141196

  8. Substituição da valva mitral com tração dos músculos papilares em pacientes com miocardiopatia dilatada Mitral valve replacement with chordae tendineae preservation, traction and fixation in end-stage dilated cardiomyopathy

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    Fabio Antonio Gaiotto

    2007-03-01

    leaflets of the mitral valve were divided to obtain 4 pillars of chordae tendineae. These were displaced with traction toward the left atrium and anchored between the mitral annulus and a valvular prosthesis. To evaluate the left ventricular remodeling, Doppler echocardiography was performed. For statistical analysis, variance analysis and the Friedman's test were employed. RESULTS: Two (10% early deaths occurred. Kaplan-Meyer showed survival at one year post-operative was 85%, 2 years it was 44%, at 3 years 44%, at 4 years 44% and at 5 years it was 44%. In the 48- and 54-month follow-ups, the McNemar test showed improvement in the functional class (p<0.001. In the third month of follow-up, variance analysis showed improvement in the ejection fraction (p=0.008 and reductions of the end diastolic diameter (p=0.038, end systolic diameter (p=0.008, end systolic volume (p=0.029 and end diastolic volume (p=0.009. No statistical differences were noted in the systolic volume. Comparing pre-operative and third- and six-month follow-ups, the Friedman test showed no statistical differences for all studied variables. Variance analyses between pre, three-month and final evaluations showed no significant differences. CONCLUSION: This technique of mitral valve replacement improved the left ventricle ejection fraction and decreased the end diastolic and systolic diameters and the end systolic diastolic volumes up to the third month of follow-up. From then on the variables stabilized.

  9. Percutaneous Transcatheter Mitral Valve Replacement: Patient-specific Three-dimensional Computer-based Heart Model and Prototyping.

    Science.gov (United States)

    Vaquerizo, Beatriz; Theriault-Lauzier, Pascal; Piazza, Nicolo

    2015-12-01

    Mitral regurgitation is the most prevalent valvular heart disease worldwide. Despite the widespread availability of curative surgical intervention, a considerable proportion of patients with severe mitral regurgitation are not referred for treatment, largely due to the presence of left ventricular dysfunction, advanced age, and comorbid illnesses. Transcatheter mitral valve replacement is a promising therapeutic alternative to traditional surgical valve replacement. The complex anatomical and pathophysiological nature of the mitral valvular complex, however, presents significant challenges to the successful design and implementation of novel transcatheter mitral replacement devices. Patient-specific 3-dimensional computer-based models enable accurate assessment of the mitral valve anatomy and preprocedural simulations for transcatheter therapies. Such information may help refine the design features of novel transcatheter mitral devices and enhance procedural planning. Herein, we describe a novel medical image-based processing tool that facilitates accurate, noninvasive assessment of the mitral valvular complex, by creating precise three-dimensional heart models. The 3-dimensional computer reconstructions are then converted to a physical model using 3-dimensional printing technology, thereby enabling patient-specific assessment of the interaction between device and patient. It may provide new opportunities for a better understanding of the mitral anatomy-pathophysiology-device interaction, which is of critical importance for the advancement of transcatheter mitral valve replacement.

  10. Surgical Treatment of Mitral Valve Regurgitation in Dilated Cardiomyopathy.

    Science.gov (United States)

    Calafiore, Antonio M.; Mauro, Michele Di; Gallina, Sabina; Yassin, Ibrahim M.; Shaheen, Yousry A.; Canosa, Carlo; Iacò, Angela L.; Mazzei, Valerio

    2004-01-01

    Abstract Background: Mitral valve (MV) surgery for dilated cardiomyopathy (DCM) was proposed at the beginning of the 1990s, and its effectiveness has been confirmed by many studies. The aim of this study is to evaluate long-term survival and the functional results of our experience with MV surgery for DCM. Methods: From January 1990 to October 2002, MV surgery for DCM was performed in 91 patients (64 ischemic, 27 idiopathic). DCM was defined as in our previous reports. Patients with organic MV disease, severe right ventricle dilatation with impaired function, or severe renal or hepatic failure were excluded from the study. MV annuloplasty was performed in 64 patients, and 27 patients underwent a MV replacement. Results: The 30-day mortality rate was 4.4% (4 patients). The probability of being alive at 5 years was 78.4% +/- 4.3% and was higher in patients who underwent MV repair (81.4% +/- 4.5%) than in patients who underwent replacement operation (66.7% +/- 9.1%), even if the P value was not statistically significant. After a mean follow-up period of 27 +/- 30 months, the New York Heart Association (NYHA) class decreased from 3.5 +/- 0.7 to 2.1 +/- 0.6 in the 69 survivors ( P stroke volume or ejection fraction. Some degree of functional mitral regurgitation (FMR) was present in all but 8 of the patients who underwent repair. The analysis of these patients showed that all of the patients who had no residual MR had a mitral valve coaptation depth (MVCD) of 10 mm or less and had a better functional result. Conversely, the MVCD was shorter in patients who had no or mild (1/4) residual MR than in patients who had a residual MR >1/4. NYHA class was lower in patients with no or up to 1/4 residual MR, showing that the purpose of the procedure is the reduction or elimination of FMR, which is the determinant of the clinical result. Conclusions: Long-term results in our patients are satisfying. FMR can be crucial for achieving a higher effectiveness of a combined strategy to

  11. Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction

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    Shah Ashish S

    2009-08-01

    Full Text Available Abstract We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.

  12. Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral Infected aneurysm of brachial artery after mitral valve infective endocarditis

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    Heraldo Guedis Lobo Filho

    2011-03-01

    Full Text Available Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

  13. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  14. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    OpenAIRE

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  15. [Percutaneus Suture of Achilles Tendon Rupture--Operation for Beginners?].

    Science.gov (United States)

    Prokop, A; Dolezych, R; Chmielnicki, M

    2016-02-01

    Acute rupture of the Achilles tendon is the most common tendon injury, with an incidence of 30/100,000 population. With the Dresden instruments, operative tendon suture can be standardised and is safe, quick and minimally invasive. With post-operative functional therapy in a walking boot, very good clinical results can be achieved. Is this operation suitable as an educational procedure and is its performance still economic? Between 1 January 2007 and 31 December 2013, 212 patients with acute rupture of the Achilles tendon were operated using the Dresden instruments. There were 167 males and 45 females, with an average age of 46 years. 99 operations were performed by trainees, 46 by attending surgical staff, and 57 by a senior surgeon. With the trainees, the mean duration of the operation was 29:53 minutes, and with the attending staff 29:10 minutes (n. s., p > 0.1). The rate of complications (re-rupture, infection, and sural nerve damage) was 5/99 (5 %) for the trainees, 4/46 (8.7 %) for the attending staff, and 3/57 (5.3 %) for the senior surgeon. A total cost analysis yielded a total operative cost of 445.76 € for outpatient surgery. With a billed sum of 490.11 €, net income of 44.35 € per case is generated. In patients with reasonable indications for 2-day short inpatient treatment, total treatment cost was 3232.70 €. Percutaneous suture of the Achilles tendon with the Dresden instruments is a standardised and cost-effective surgical procedure. It is suitable as a "beginner's" procedure that can be performed quickly, safely, and cost-effectively. Georg Thieme Verlag KG Stuttgart · New York.

  16. 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.

  17. The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs. replacement?

    Science.gov (United States)

    Maisano, Francesco; Alfieri, Ottavio; Banai, Shmuel; Buchbinder, Maurice; Colombo, Antonio; Falk, Volkmar; Feldman, Ted; Franzen, Olaf; Herrmann, Howard; Kar, Saibal; Kuck, Karl-Heinz; Lutter, Georg; Mack, Michael; Nickenig, Georg; Piazza, Nicolo; Reisman, Mark; Ruiz, Carlos E; Schofer, Joachim; Søndergaard, Lars; Stone, Gregg W; Taramasso, Maurizio; Thomas, Martyn; Vahanian, Alec; Webb, John; Windecker, Stephan; Leon, Martin B

    2015-07-07

    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 the transcatheter intervention armamentarium. Recently, the feasibility of transcatheter mitral valve implantation in native non-calcified valves has been reported in very high-risk patients. Acknowledging the lack of scientific evidence to date, it is difficult to predict what the ultimate future role of transcatheter mitral valve interventions will be. The purpose of the present report is to review the current state-of-the-art of mitral valve intervention, and to identify the potential future scenarios, which might benefit most from the transcatheter repair and replacement devices under development.

  18. Saddle-Shaped Annuloplasty Improves Leaflet Coaptation in Repair for Ischemic Mitral Regurgitation

    NARCIS (Netherlands)

    Bouma, Wobbe; Aoki, Chikashi; Vergnat, Mathieu; Pouch, Alison M.; Sprinkle, Shanna R.; Gillespie, Matthew J.; Mariani, Massimo A.; Jackson, Benjamin M.; Gorman, Robert C.; Gorman, Joseph H.

    2015-01-01

    Background. Current repair results for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings are characterized by high IMR recurrence rates. Current annuloplasty rings treat annular dilatation, but they do little to improve (and may actually exacerbate) leaflet tethering. New saddle

  19. 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).

  20. Surgical treatment of anterior mitral valve prolapse using artificial chordae loop

    Institute of Scientific and Technical Information of China (English)

    LI Ji-yong; ZHOU Qi-wen; ZHANG Jian-qun; ZHANG Fu-en; HE Yi-hua

    2010-01-01

    @@ Artificial chordae replacement with expanded polytetrafluoroethylene (ePTFE; Gore-Tex, W.L.Gore and Associates Inc., Flagstaff, AZ, USA) is an established technique for mitral valve repair with excellent long-term results.