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Sample records for valva mitral totalmente

  1. Estudo mesoscópico da valva mitral e do seu anel fibroso

    OpenAIRE

    Cavalcanti,Jennecy Sales; Oliveira,Eveline de Lucena; Godoi,Emanuelle Tenório A. M.; Santos,Laura Patrícia Ferreira; Silva,Viviane Xavier de Lima e; Oliveira,Micheline de Lucena

    1997-01-01

    OBJETIVO: Estudar o arranjo espacial dos elementos fibrosos que constituem os folhetos da valva mitral e do seu anel fibroso. MÉTODOS: Foram utilizados 20 corações adultos, de ambos os sexos, fixados em formol a 10%. Isolaram-se a valva mitral, juntamente com o anel fibroso, e uma pequena quantidade de tecido muscular ao seu redor. Parte desse material foi incluído em parafina, submetido a cortes seriados de 40µm de espessura e corados pelo tricrômio de Azan e pela resorcina-fucsina, e o rest...

  2. Plástica da valva mitral em portadores de febre reumática

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    Pomerantzeff Pablo M. A.

    1998-01-01

    Full Text Available Objetivo: Analisar os resultados tardios da plástica da valva mitral em pacientes reumáticos. Casuística e Métodos: Durante o período de março de 1980 a dezembro de 1997, 201 pacientes portadores de insuficiência mitral secundária a febre reumática foram submetidos à plástica da valva mitral, no Instituto do Coração do HCFMUSP. A idade média foi de 26,9 ± 15,4 anos e 59,7% dos pacientes eram do sexo feminino. Outros diagnósticos estavam presentes em 67,7% dos pacientes, sendo o mais freqüente a insuficiência tricúspide (31,3%. As técnicas de plástica da valva mitral foram: anel de Carpentier em 75 (37,3%, anuloplastia com tira posterior de pericárdio bovino em 68 (33,8%, anuloplastia posterior segmentar em 16 (7,9%, ressecção quadrangular da cúspide posterior com plicatura do anel correspondente em 11 (5,5%, ressecção de segmento da cúspide anterior em 6 (3%, anuloplastia tipo De Vega em 6 (3%, Kay em 5 (2,5%, Reed em 4 (2% e outras em 10 pacientes. Técnicas associadas de plástica foram empregadas em 94 (46,8% pacientes, sendo a mais freqüente o encurtamento de cordas (48 pacientes - 23,9%. Cirurgias associadas foram realizadas em 113 pacientes (56,2%. As curvas actuariais de Kaplan-Meier foram comparadas através de análise de regressão linear. Resultados: A mortalidade hospitalar foi de 4 (2,0% pacientes, e as causas de mortalidade foram a falência de múltiplos órgãos em 2 (50% pacientes e o baixo débito cardíaco em 2 (50%. No pós-operatório tardio, 83,9% dos pacientes se encontravam em classe funcional I (NYHA. A sobrevida actuarial foi de 93,9 ± 1,9% em 125 meses. Vinte e três pacientes foram reoperados no pós-operatório tardio, com um intervalo médio de 35,7 meses. A sobrevida livre de reoperação foi 43,3 ± 13,7% em 125 meses. Analisando-se separadamente os pacientes segundo a faixa etária, no grupo menor de 16 anos (Grupo 1 a sobrevida actuarial foi de 91,3 ± 3,8%, contra uma sobrevida de

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

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    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

  4. Transplante de valva mitral heteróloga: Nova alternativa cirúrgica: estudo clínico inicial

    OpenAIRE

    Vrandecic, Mário O; Gontijo Filho, Bayard; Fantini,Fernando Antônio; Silva,João Alfredo Paula E; Barbosa, Juscelino Teixeira; Gutierrez,Cristiana; Barbosa, Maurício R; Oliveira,Sérgio Almeida de; Morea, Mário

    1993-01-01

    A substituição da valva mitral tem sido realizada, nestes 30 anos, usando-se o modelo aórtico. Embora o resultado clínico, na maioria dos pacientes seja satisfatório, existem, restrições específicas, tanto entre as biopróteses, como nas próteses mecânicas. A experiência no tratamento dos tecidos biológicos, assim como a fabricação de substitutos valvares, há 2 décadas, tem permitido o desenvolvimento da valva mitral heteróloga. Este substituto mitral foi implantado em 38 pacientes, com a pres...

  5. Results of beating heart mitral valve surgery via the trans-septal approach Resultados da abordagem transeptal para a valva mitral com coração batendo

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    Tomas A Salerno

    2009-03-01

    Full Text Available OBJECTIVE: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls. METHODS: Between 2000 and 2007, 214 consecutive patients were operated upon utilizing beating heart technique for mitral valve surgery. The operation was performed via transseptal approach with the aorta unclamped, the heart beating, with normal electrocardiogram and in sinus rhythm. RESULTS: Mean age was 56.03 ± 13.93 years (range: 19-86 years; median: 56 years. There were 131 (61.2% males and 83 (38.8% females. Of the prostheses used, 108 (50.5% were biological, and 39 (18.2% were mechanical. Mitral repairs were performed in 67 (31.3% patients. Mean hospital stay was 17.4 ± 20.0 days (range: 3-135 days; median: 11 days. Intra-aortic balloon pump (IABP utilization was required in 12 (5.6% of 214 patients. One-month mortality was 7.4%, and re-operation for bleeding was needed in 15 (7% patients. CONCLUSIONS: Beating-heart mitral valve surgery is an option for myocardial protection in patients undergoing mitral valve surgery. This technique is facilitated by the trans-septal approach due to reduced aortic insufficiency and improved visualization of the mitral apparatus.OBJETIVO: A cirurgia da valva mitral pode ser feita via transatrial ou transeptal. Embora a transatrial seja a preferida, a via transeptal tem sido utilizada mais recentemente e tido um grande valor nas operações com o coração batendo. Mostramos a nossa experiência na cirurgia da valva mitral via transeptal com coração batendo e discutimos seus benefícios e problemas. MÉTODOS: Entre 2000 e 2007, 214 pacientes consecutivos foram operados com o coração batendo. A

  6. 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

  7. Reoperação da valva mitral minimamente invasiva sem pinçamento da aorta

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    Rodrigo Milani

    2013-09-01

    Full Text Available INTRODUÇÃO: Reoperações da valva mitral apresentam maior índice de complicações quando comparadas com a primeira cirurgia. Com o domínio das técnicas videoassistidas para as primeiras cirurgias da valva mitral, os casos de reoperações passaram a despertar interesse para esses procedimentos menos invasivos. OBJETIVO: Analisar os resultados e as dificuldades técnicas da retroca valvar mitral minimamente invasiva em 10 pacientes. MÉTODO: A circulação extracorpórea foi instalada por meio de colocação de cânulas femorais e cânula na veia jugular interna direita, conduzida em 28 graus de temperatura em fibrilação ventricular. Realizada toracotomia lateral direita com 5 a 6 cm no terceiro ou quarto espaço intercostal. Pericárdio foi descolado apenas na região do átrio esquerdo no ponto da atriotomia. A aorta não foi pinçada. RESULTADOS: Foram avaliados 10 pacientes com idade média de 56,9±10,5 anos. Quatro encontravam-se em ritmo de fibrilação atrial e 6 em ritmo sinusal. O tempo médio entre a primeira operação e a reoperações foi de 11 ± 3,43 anos. O EuroSCORE médio do grupo foi de 8,3 ± 1,82. O tempo médio de fibrilação ventricular e de circulação extracorpórea foi respectivamente 70,9 ± 17,66 min e 109,4 ± 25,37 min. O tempo médio de internamento foi de 7,6 ± 1,5 dias. Não houve óbitos nessa série. CONCLUSÃO: A reoperação da valva mitral pode ser feita por meio de técnicas menos invasivas com bons resultados imediatos e baixa morbimortalidade. Entretanto, esse tipo de cirurgia requer maior tempo de circulação extracorpórea, especialmente nos casos em que o paciente já tenha uma prótese. A presença de uma mínima insuficiência aórtica também torna esse procedimento tecnicamente mais desafiador.

  8. 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.

  9. Doença crônica da valva mitral em cães: avaliação clínica funcional e mensuração ecocardiográfica da valva mitral Chronic mitral valvular disease in dogs: assessment of functional clinical stage and echocardiographic measurement of the mitral valve

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    R.A.L. Muzzi

    2009-04-01

    Full Text Available Foram descritos os achados do exame físico em cães com degeneração mixomatosa crônica da valva mitral e mensurado o comprimento e a espessura das cúspides da valva mitral pelo exame ecocardiográfico. Utilizaram-se 81 cães de diferentes raças de pequeno a médio porte, com idade de 11,12± 2,51 anos e peso de 6,24kg± 3,19, dos quais 20 eram clinicamente normais (grupo-controle e 61 apresentavam evidências clínicas de cardiopatia. Os animais foram distribuídos em três classes distintas segundo a insuficiência cardíaca congestiva (grupos I, II e III, de acordo com os dados do histórico e dos sinais clínicos apresentados. Ao exame ecocardiográfico, avaliaram-se as medidas das cúspides da valva mitral, que não apresentaram diferença entre os cães do grupo I e II, embora estivessem anormais se comparadas às dos cães do grupo-controle. Nos animais do grupo III, as medidas das valvas avaliadas foram maiores que as dos cães dos grupos I e II. Foram observados nódulos com formato arredondado e, nos cães do grupo III, as cúspides estavam bastante alongadas e espessadas.Physical and echocardiographic aspects were studied in dogs with chronic mitral valvular disease. The length and thickness of the mitral valve leaflets were echocardiographically measured. Eighty-one dogs of small-medium breeds (mean of 6.24kg± 3.19, older than six years (11.12± 2.51 years were used. Twenty were clinically normal dogs (control group and 61 presented myxomatous degeneration of the mitral valve. The diseased dogs were categorized into three classes of congestive heart failure (I, II, and III groups according to the information on clinical manifestations. On the echocardiographic exam, the measurements of the mitral valve leaflets were evaluated and no diferences between dogs of groups I and II were found, though they were abnormal if compared with control group animals. Group III dogs presented measurements higher than those of animals of groups

  10. Hipermobilidade articular em pacientes com prolapso da valva mitral Hipermovilidad articular en pacientes con prolapso de la válvula mitral Joint hypermobility in patients with mitral valve prolapse

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    Simone Cavenaghi

    2009-09-01

    Full Text Available Estudos sobre hipermobilidade têm despertado grande interesse, nas últimas décadas, por estarem associados a disfunções músculo-esqueléticas, bem como a anormalidades em vários sistemas orgânicos - como, por exemplo, o prolapso da valva mitral. Neste contexto, buscou-se agrupar e atualizar os conhecimentos da relação entre a hipermobilidade articular e o prolapso da valva mitral. Segundo a literatura, estudos mostram que alterações genéticas na composição do colágeno parecem ser a principal causa desta relação.Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.

  11. Estudo mesoscópico da valva mitral e do seu anel fibroso Mesoscopic study of the mitral valve and its fibrous ring

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    Jennecy Sales Cavalcanti

    1997-10-01

    Full Text Available OBJETIVO: Estudar o arranjo espacial dos elementos fibrosos que constituem os folhetos da valva mitral e do seu anel fibroso. MÉTODOS: Foram utilizados 20 corações adultos, de ambos os sexos, fixados em formol a 10%. Isolaram-se a valva mitral, juntamente com o anel fibroso, e uma pequena quantidade de tecido muscular ao seu redor. Parte desse material foi incluído em parafina, submetido a cortes seriados de 40µm de espessura e corados pelo tricrômio de Azan e pela resorcina-fucsina, e o restante das peças dissecadas sob lupa estereoscópica, com ajuda de delicadas pinças e agulhas, para se observar a disposição dos feixes miocárdicos ao nível do anel mitral. RESULTADOS: Observou-se que o anel fibroso mitral era constituído por feixes colágenos de trajetória semicircular, envolvendo de forma incompleta o óstio atrioventricular, uma vez que era ausente na região ântero-medial do óstio. Verificou-se que os feixes miocárdicos ventriculares inseriam-se de forma oblíqua, na borda externa do anel, sendo que na região ântero-medial assumiam uma trajetória semicircular. Os folhetos da valva mitral eram constituídos de feixes colágenos dispostos, paralelamente, no sentido do maior eixo da válvula, recobertos pelo endocárdio atrial e ventricular. Os feixes colágenos, presentes na base dos folhetos valvares, praticamente se continuavam com os do anel fibroso. Observou-se, em alguns casos, a existência de delgados feixes miocárdios atriais no folheto valvar anterior, que praticamente eram restritos à região central das válvulas. CONCLUSÃO: Os folhetos da valva mitral e seu anel fibroso possuem uma continuidade estrutural, que demonstra que estes elementos funcionam de forma integrada no fechamento do óstio atrioventricular esquerdo durante a sístole ventricular, no que seria auxiliado pela redução do diâmetro do anel fibroso, através da contração dos feixes miocárdicos semicirculares que nele se inserem

  12. Transplante de valva mitral heteróloga: Nova alternativa cirúrgica: estudo clínico inicial Heterologous mitral valve transplant: New surgical technique: initial clinical trial

    OpenAIRE

    Vrandecic, Mário O; Bayard Gontijo Filho; Fernando Antônio Fantini; Silva,João Alfredo Paula E; Juscelino Teixeira Barbosa; Cristiana Gutierrez; Barbosa, Maurício R; Sérgio Almeida de Oliveira; Mário Morea

    1993-01-01

    A substituição da valva mitral tem sido realizada, nestes 30 anos, usando-se o modelo aórtico. Embora o resultado clínico, na maioria dos pacientes seja satisfatório, existem, restrições específicas, tanto entre as biopróteses, como nas próteses mecânicas. A experiência no tratamento dos tecidos biológicos, assim como a fabricação de substitutos valvares, há 2 décadas, tem permitido o desenvolvimento da valva mitral heteróloga. Este substituto mitral foi implantado em 38 pacientes, com a pres...

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

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    Álvaro Villela de Moraes

    1992-12-01

    Full Text Available A ecodopplercardiografia ocupa posição de destaque no diagnóstico das valvopatias, pois fornece dados sobre a anatomia valvar, a área estenótica, os gradientes pressóricos e o grau da regurgitação. Seu uso na cirurgia cardíaca, com a abordagem epicárdica, é bastante conhecido. O advento da abordagem transesofágica, por não interferir no campo operatório, facilitou a sua utilização. O objetivo deste trabalho foi estudar a utilidade da ETE nacirurgiada valva mitral. De julho de 1991 a janeiro de 1992, aecodopplercardiografia transesofágica (ETE monitorizou 198 cirurgias, das quais 65 foram sobre a valva mitral (VM. A idade variou de 8 a 62 anos e 42 pacientes eram do sexo feminino. A comissurotomia e papilarotomia (CP foi o procedimento mais freqüente em 28 pacientes (pts, seguido do implante de bioprótese (BP em 24 e da plastia (PL em 19. A ETE pré-operatória confirmou o diagnóstico da lesão mitral em todos os pts, tendo acrescentado informações quanto ao grau e direção da insuficiência mitral (IM em 8 dos 28 pts submetidos a CP. Modificou a orientação da abordagem da valva tricúspide em 9 oportunidades (3 por diagnosticar lesões não detectadas e 6 por evitar a abordagem desnecessária por melhor avaliação da lesão. Quanto aos pts submetidos a implante de BP, 6 já tinham próteses disfuncionantes, em 12 pts a BP foi implantada de imediato por decisão do cirurgião e, em 6 pts, a BP foi implantada após a detecção da presença de IM importante pós-correção. Quanto ao pts submetidos a PL, 12 tinham prolapso, 6 tinham insuficiência coronária e 1 era pós-operatório tardio de correção de defeito do septo atrioventricular. Em apenas 1 pt foi necessária nova CEC para nova plastia. A avaliação da tM pós CEC evidenciou 7 pts (10% com IM importante, sendo necessária nova CEC, e mostrou IM leve em 15 pts, moderada em 8 e importante em 1 onde não foi realizada nova CEC. A ETE é um método de grande

  14. Transplante de valva mitral heteróloga: Nova alternativa cirúrgica: estudo clínico inicial Heterologous mitral valve transplant: New surgical technique: initial clinical trial

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    Mário O Vrandecic

    1993-06-01

    Full Text Available A substituição da valva mitral tem sido realizada, nestes 30 anos, usando-se o modelo aórtico. Embora o resultado clínico, na maioria dos pacientes seja satisfatório, existem, restrições específicas, tanto entre as biopróteses, como nas próteses mecânicas. A experiência no tratamento dos tecidos biológicos, assim como a fabricação de substitutos valvares, há 2 décadas, tem permitido o desenvolvimento da valva mitral heteróloga. Este substituto mitral foi implantado em 38 pacientes, com a preservação da função ventricular. A idade média foi de 29 anos, predominando o sexo feminino (69%, e a etiologia reumática em 86%. A dupla lesão foi a mais freqüente (53%. A classificação funcional deste grupo engloba (47% em classe II e (53% em classe IV da NYHA. A técnica cirúrgica é reproduzível e proporcionou resultados clínicos satisfatórios durante 12 meses de evolução, demonstrando que a valva mitral heteróloga é o substituto natural, quando indicada a troca valvar. Houve uma reoperação em paciente que apresentou insuficiência mitral moderada, devido à desproporção entre a valva escolhida e o anel mitral bastante dilatado. Os resultados clínico, hematológico e ecocardiográfico têm sido extremamente gratificantes, durante o período de seguimento. O desenho mitral natural, aliado ao tratamento anticalcificante, é o que deve proporcionar melhor qualidade de vida e a durabilidade desejada.Mitral valve replacement has been performed for the last 30 years using an aortic designed valve, to fulfil specific requirements of the left ventricle. The clinical results obtained by such devices have been generally favorable, although specific restrictions are obvious because of their design. The knowledge and experience acquired by Biocor Laboratories in the last two decades, in production of biological heart valve substitutes, contributed positively to the research, development and manufacture of the heterologous

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

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    Carlos Manuel de Almeida Brandão

    2007-12-01

    Full Text Available OBJETIVO: O objetivo deste trabalho é apresentar os resultados clínicos tardios da plástica da valva mitral com a técnica do "Duplo Teflon". MÉTODOS: A plástica de "Duplo Teflon" consiste em técnica de reparo mitral com ressecção quadrangular da cúspide posterior, anuloplastia segmentar com plicatura do anel com de fios com "pledgets" sobre uma tira de Teflon, e sutura borda a borda da cúspide. Entre abril de 1994 e dezembro de 2003, 133 pacientes com diagnóstico de insuficiência mitral degenerativa com alongamento ou rotura de cordas da cúspide posterior foram submetidos à plástica com esta técnica. A idade média foi de 60,4 anos e 60,9% eram do sexo feminino. Quanto à avaliação clínica no pré-operatório, 29,3% dos pacientes estavam em classe funcional IV, 55,7% em classe III e 15,0% em classe II. Técnicas associadas de plástica mitral foram utilizadas em 15,2% dos pacientes, sendo a mais comum o encurtamento de cordas. Vinte e seis (19,5% pacientes foram submetidos a operações associadas. RESULTADOS: Houve um (0,75% óbito hospitalar. No período pós-operatório tardio, 95,5% dos sobreviventes estavam em classe funcional I. As taxas linearizadas de tromboembolismo, reoperação e óbito foram 0,9%, 0,3% e 0,6% pacientes/ano, respectivamente. A sobrevida atuarial em 10 anos foi de 94,1% ± 3,6%. As sobrevidas atuariais livre de tromboembolismo e reoperação foram de 97,3 ± 1,5% e 99,2 ± 0,8%, respectivamente. Não houve casos de endocardite ou hemólise. CONCLUSÃO: A plástica da valva mitral com a técnica do "Duplo Teflon" apresenta baixa morbi-mortalidade e boa evolução clínica tardia.OBJECTIVE: The purpose of this paper is to present the late clinical results of mitral valve repair with the "Double Teflon" technique. METHODS: "Double Teflon" technique consists of a quadrangular resection of the posterior leaflet, annulus plication with "pledgetted" stitches over a Teflon patch, and leaflet suture. Between

  16. Plástica da valva mitral com emprego do anel de Gregori-Braile: análise de 66 pacientes

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    CARVALHO Roberto Gomes de

    1998-01-01

    Full Text Available Tendo em vista as complicações decorrentes com uso das próteses valvares, maior tem sido o empenho em se conservar a valva mitral. Objetivo: O presente trabalho analisa a plástica da valva mitral com emprego do anel de Gregori-Braile em 66 pacientes operados consecutivamente entre outubro de 1989 a outubro de 1995. Casuística e Métodos: Quarenta e cinco (74,1% pacientes eram do sexo feminino e 17 (25,7% pacientes do masculino. A idade média foi de 32,9 anos. Moléstia reumática esteve presente na maioria dos casos (49 pacientes e insuficiência mitral em 38 (57,5% pacientes. O tempo de evolução foi de 2,560 meses/pacientes com média de 38,8 meses e o acompanhamento foi realizado em 64 (96,9% pacientes. Os métodos de avaliação foram: quadro clínico (GF, sopro sistólico no foco mitral (SSFM e estudo Dopplerecocardiográfico no período pré e pós-operatório. As técnicas empregadas sobre a valva mitral foram: implante do anel, mobilização das cúspides e cordas tendíneas e restrição da mobilidade valvar. Encurtamento das cordas tendíneas foi realizado em 44 (66,6% pacientes. Os procedimentos associados foram: redução do AE (8 casos, troca valvar aórtica (3 casos e cirurgia de Cox (3 casos. (1,5% uma paciente faleceu sete dias após a operação por tromboembolismo pulmonar. Resultados: Houve importante melhora do grau funcional após a operação. No pré-operatório 41 (62,1% pacientes estavam no GF III e 23 (34,8% pacientes no GF IV. Após a plástica, 53 (80,3% pacientes se encontravam no GF I e 8 (12,1% pacientes no GF II. O mesmo ocorreu com o SSFM, pois em 92,4% dos operados ele era ausente ou de + de intensidade. O GF e SSFM melhoraram de maneira significativa (p < 0,001. Quanto ao estudo Dopplerecocardiográfico, a média do diâmetro diastólico do VE era de 5,96 cm no PO (p < 0,001. A média do tamanho do AE era de 5,67 cm no pré e 4,65 cm no PO (p < 0,001. O diâmetro da aorta ascendente era de 2,97 cm no pr

  17. Mitral valve replacement with the preservation of the entire valve apparatus Substituição da valva mitral com preservação do aparato completo da valva

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    Ahmed A. Alsaddique

    2007-06-01

    Full Text Available OBJECTIVE: The papillary muscles and the chordae tendineae of both mitral leaflets contribute to the preservation of the left ventricular function. Most surgeons, however, routinely excise the anterior mitral leaflet. METHODS: In a group of nine patients, six of them underwent mitral valve replacement alone and three underwent both aortic and mitral valve replacements, all the mitral apparatus was preserved. All of these patients had mechanical valves using CarboMedics cardiac prosthesis (CarboMedics, Inc. Austin, Texas. RESULTS: There was no mortality. Postoperative echocardiographic assessment revealed maintained left ventricular function with no interference with the prosthetic leaflet mobility and no left ventricular outflow tract gradient. CONCLUSION: We believe that in most patients with long-standing mitral valve regurgitation, thinned out papillary muscles and elongated chordae tendineae that are not amenable to repair, valve replacement with the preservation of the entire native valve is possible and should be encouraged. This is especially valuable for those with depressed left ventricular function, who might otherwise suffer from left ventricular dysfunction in the long-term if the entire mitral valve apparatus were to be excised.OBJETIVO: Os músculos papilares e as cordas tendíneas de ambos folhetos mitral contribuem para a preservação da função ventricular esquerda. Muitos cirurgiões, entretanto, rotineiramente extirpar o folheto mitral anterior. MÉTODOS: Em um grupo de nove pacientes, seis deles foram submetidos à substituição da válvula mitral e três foram submetidos a substituições das válvulas mitral e aórtica, todos os aparatos mitrais foram preservados. Todos os pacientes tinham válvulas mecânicas implantadas usando próteses cardíacas CarboMedics (CarboMedics, Inc. Austin, Texas. RESULTADOS: Não houve mortalidade. A avaliação ecocardiográfica pós-operatória revelou a conservação da fun

  18. Técnicas reparadoras em crianças com anomalias congênitas da valva mitral: resultados clínicos tardios

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    LORIER Gabriel

    1998-01-01

    Full Text Available Fundamento: Malformações congênitas da valva mitral são lesões complexas. Em crianças e adolescentes, os anéis protéticos devem ser evitados. Desde 1975 não usamos anéis protéticos, empregando-se a técnica de Wooler nas anuloplastias. Objetivo: Análise da evolução clínica tardia após o tratamento cirúrgico das anomalias mitrais congênitas, com e sem malformações associadas, em crianças até 12 anos de idade, tratadas com técnicas reparadoras e reconstrutivas sem suporte anelar. Casuística e Métodos: Foram avaliados 21 pacientes operados entre 1975 e 1998. A média de idade foi de 4,67 ± 3,44 anos; sexo feminino em 47,6%; a insuficiência esteve presente em 57,1% (12 casos, estenose em 28,6% (6 casos e dupla lesão em 14,3% (3 casos. O tempo de perfusão foi 43,10 ± 9,50 min; tempo de isquemia 29,40 ± 10,50 min. O seguimento clínico na insuficiência foi feito em 12 pacientes com média de 41,52 ± 53,61 meses; no grupo de estenose em 4 pacientes com média de 46,39 ± 32,02 meses. Resultados: No grupo de insuficiência 10 pacientes estavam assintomáticos. Controle ecocardiográfico em 9 pacientes, (seguimento 37,17 ± 39,51 meses 6 pacientes apresentaram refluxo leve, 1 ausência de refluxo e 2 com refluxo moderado; 1 paciente foi reoperado aos 48 m após a primeira operação, sendo feita nova plastia. No grupo da estenose, 4 pacientes, todos assintomáticos, sendo 2 sem medicação, com seguimento ecocardiográfico, média 42,61 ± 30,59 meses, gradiente médio entre 8 e 12 mmHg. No grupo de dupla lesão, 1 paciente foi reoperado para implante de bioprótese aos 43 meses da primeira operação, 1 paciente aos 75 meses da operação encontrava-se em classe funcional II e a ecocardiografia mostrou estenose e insuficiência leve. Não foram relatados episódios de endocardite nem tromboembolismo. A mortalidade operatória foi de 9,5% (2 casos. Não houve mortalidade tardia. Conclusões: a estenose mitral apresenta

  19. Gene expression of endothelin receptors in replaced rheumatic mitral stenotic valves Expressão gênica de receptores de endotelina em valvas mitrais reumáticas estenóticas substituídas

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    Sydney Correia Leão

    2012-12-01

    Full Text Available OBJECTIVES: Rheumatic fever is a highly prevalent disease in Brazil, and it poses a major public health problem. It is the leading cause of acquired heart disease in childhood and adolescence. The aim of this study was to evaluate the gene expression of ET-3 and its receptors, in replaced rheumatic mitral valves. METHODS: We studied the gene expression of endothelin-3 (ET-3 and its receptors, endothelin receptor A and endothelin receptor B (ETr-A and ETr-B, in the rheumatic mitral valves of 17 patients who underwent valve replacement surgery. The samples also underwent a histological analysis. RESULTS: Our data showed that almost all patients, regardless of individual characteristics such as gender or age, expressed the endothelin receptor genes, but did not express the genes for ET-3. In quantitative analysis, the ETr-A/GAPDH mean ratio was 33.04 ± 18.09%; while the ETr-B/GAPDH mean ratio was 114.58 ± 42.30%. Regarding histopathological individual features, the frequency of fibrosis is 100%, 88.23% of mononuclear infiltrate, 52.94% of neovascularization, 58.82% of calcification and absence of ossification. CONCLUSION: The presence of receptors ETr-A and ETr-B in rheumatic mitral valves suggests its interaction with the system of circulating endothelins, particularly ETr-B (known for acting in the removal of excess endothelin detected in a greater proportion, which could explain the lack of expression of endothelin in rheumatic mitral valve, process to be elucidated.OBJETIVOS: A febre reumática é uma doença altamente prevalente no Brasil, e representa um importante problema de saúde pública. É a principal causa de cardiopatia adquirida na infância e adolescência. O objetivo deste estudo foi avaliar a expressão gênica de ET-3 e seus receptores, em valvas mitrais reumáticas substituídas. Métodos: Estudamos a expressão gênica de endotelina-3 (ET-3 e de seus receptores, receptor da endotelina A e receptor da endotelina B (ETr-A e

  20. Substituição da valva mitral por aloenxerto valvar aórtico preservado em glutaraldeído Mitral valve replacement with glutaraldehyde preserved aortic allografts

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    Claudio A Salles

    1994-03-01

    Full Text Available No período de setembro de 1984 a dezembro de 1992, 145 pacientes selecionados foram submetidos a substituição isolada de valva mitral, utilizando-se valvas aórticas de cadáver obtidas durante autopsia, processadas em glutaraldeído e montadas em suporte flexível de Celcon recoberto com Dacron. Os pacientes apresentavam idade média de 22,5 anos, variando de 5 a 77 anos e 79 (54,5% pacientes tinham idade igual ou inferior a 15 anos. Operações cardíacas prévias haviam sido, realizadas em 26 (18% pacientes e 20 (13,8% deles eram portadores de biopróteses de porco, pericárdico bovino ou dura-máter calcificadas. A mortalidade hospitalar (30 dias foi de 3 (2,1 % pacientes. A evolução tardia coletou 709 pacientes-ano de seguimento total, correspondendo a um seguimento médio de 5 anos por paciente e máximo de 9 anos e 5 meses. Segmento completo foi obtido em 130 (91,5% pacientes e parcial nos 12 pacientes restantes. Complicações relacionadas ao aloenxerto ocorreram em 48 pacientes, incluindo a fibrocalcificação, tromboembolismo, endocardite e escape para-valvar, correspondendo a uma incidência de 6,8% ± 0,9% por paciente-ano. A fibrocalcificação levando a disfunção valvar representou a principal complicação, presente em 37 pacientes com uma incidência de 5,2% ± 0,8% por paciente-ano. Todos os casos de calcificação ocorreram em pacientes com idade igual ou inferiora 15 anos, com um intervalo médio entre o implante valvar e a calcificação de 46 meses, variando de 14 a 100 meses. Reoperações foram realizadas em 44 pacientes com substituição da alobioprótese em 39, representando uma incidência de reoperações de 6,3% ± 0,9% por paciente-ano e uma incidência de substituição da alobioprótese de 5,5% ± 0,9% por paciente-ano. A principal causa da reoperação foi a calcificação, presente em 36 aloenxertos, sendo as outras causas representadas pela endocardite, escape para-valvar e insuficiência aórtica em

  1. Amplificação dos genes que codificam a endotelina-1 e seus receptores em valvas mitrais reumáticas Amplificación de los genes que codifican la endotelina-1 y sus receptores en válvulas mitrales reumáticas Amplification of the genes that codify endothelin-1 and its receptors in rheumatic mitral valves

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    Edmilson Bastos de Moura

    2010-07-01

    Full Text Available FUNDAMENTO: As cardiopatias são doenças de alta prevalência, sendo a cardite reumática uma doença de grande relevância em países em desenvolvimento. As alterações em câmaras cardíacas esquerdas se associam à disfunção endotelial, com aumento dos níveis de endotelina-1 (ET-1 e consequências sobre a circulação pulmonar, muitas vezes determinando a hipertensão pulmonar (HP. No entanto, a presença de ET-1 e seus receptores na própria valva mitral, promovendo alterações vasculares pulmonares e aumentando a deformação valvar reumática, ainda é um assunto não abordado na literatura. OBJETIVO: Determinar, mediante técnicas moleculares, a expressão dos genes da endotelina e dos seus receptores em valvas mitrais reumáticas. MÉTODOS: 27 pacientes submetidos à troca valvar mitral tiveram seu tecido valvar analisado, a fim de determinar a presença de genes de ET-1 e seus receptores A e B. Foram feitas análises histológica e molecular das valvas (divididas em fragmentos M1, M2 e M3 e colhidos dados clínicos e epidemiológicos dos pacientes. Foram divididos em três grupos: valvopatia mitral, mitroaórtica e pacientes reoperados. RESULTADOS: O estudo mostrou a manifestação do gene da ET-1 em 40,7% dos espécimes e de seu receptor A em todas as amostras, com manifestação minoritária do gene do receptor B (22,2%. CONCLUSÃO: Todos os pacientes expressaram a presença do gene do receptor A. Não houve diferença estatística quanto à gravidade da doença, expressa em classe funcional, e aos subgrupos estudados (valvopatas mitrais, mitroaórticos e pacientes reoperados, ou quanto à expressão dos genes da ET-1 e seus receptores entre os subgrupos estudados (valvopatas mitrais, mitroaórticos e pacientes reoperados.FUNDAMENTO: Las cardiopatías son enfermedades de alta prevalencia, siendo la carditis reumática una enfermedad de gran relevancia en países en desarrollo. Las alteraciones en cámaras cardíacas izquierdas

  2. 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

    Full Text Available OBJETIVO: Avaliar a geometria e a função do ventrículo esquerdo (VE após a troca mitral com tração e fixação dos papilares, em portadores de insuficiência cardíaca terminal com insuficiência mitral secundária. MÉTODO: Dos 20 pacientes avaliados, 70% eram homens, com idade média de 50,2 anos e 55% recebiam inotrópicos. A fração de ejeção (FEVE foi menor que 30% em todos; 85% estavam em classe funcional (CF IV. Dezoito receberam próteses de pericárdio bovino e dois, mecânicas. Os períodos considerados foram: 3, 6, 12 e 18 meses. As variáveis consideradas: volume sistólico do VE (VS, a FEVE, os diâmetros sistólico e diastólico finais (DSF e DDF e os volumes sistólico e diastólico finais (VSF e VDF. No estudo estatístico, empregou-se da análise de variância (AV e o teste de Friedmann (F. A sobrevida foi aferida pelo método de Kaplan-Meyer. RESULTADOS: Dois (10% faleceram no período imediato. A sobrevida no primeiro ano foi de 85%, no segundo, 44%, no terceiro, 44%, no quarto, 44% e no quinto, 44%. A comparação entre pré e 3 meses, empregando-se a AV, não revelou alteração significativa para o VS (p=0,086. Houve acréscimo da FEVE (p=0,008 e decréscimo do DDF (p=0,038; do DSF (p=0,008; do VDF (p=0,029 e do VSF (p=0,009. Os momentos pré, 3 e 6 meses, com o teste F, não revelaram alterações. Entre os momentos pré, 3 meses e final, empregando-se a AV, não houve significância. CONCLUSÃO: Há melhora da FEVE, dos VDF, VSF, DDF e DSF; até o terceiro mês. A partir de então, as variáveis permanecem estáveis.OBJECTIVE: This study aimed at evaluating results of mitral valve replacement using a new technique of complete chordae tendineae adjustment for left ventricular remodeling. METHODS: Twenty end-stage idiopathic dilated cardiomyopathy patients with severe functional mitral valve regurgitation underwent mitral valve replacement. Seventeen (85% were in functional class IV. Both anterior and posterior

  3. Avaliação da evolução da área das valvas mitral e tricúspide fetal com ultrassonografia tridimensional Assessment of the fetal mitral and tricuspid valves areas development by three-dimensional ultrasonography

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    Liliam Cristine Rolo

    2010-09-01

    Full Text Available OBJETIVO: avaliar as áreas das válvulas atrioventriculares (tricúspide e mitral de fetos normais por meio da ultrassonografia tridimensional (US3D utilizando o método STIC (spatiotemporal image correlation. MÉTODOS: realizou-se estudo de corte transversal com 141 mulheres entre a 18ª e a 33ª semana de gestação. As medidas dos volumes cardíacos foram obtidas por um transdutor volumétrico transabdominal acoplado ao aparelho Voluson 730 Expert. Utilizou-se como referência o plano de quatro câmaras com a ROI (região de interesse posicionada a partir dos ventrículos, sendo a área das valvas delimitada manualmente. Para conhecer a correlação das áreas valvulares com a idade gestacional, foram construídos diagramas de dispersão e calculou-se o coeficiente de correlação de Pearson (r. Foram calculadas médias, medianas, desvios padrão (DP, valores máximo e mínimo. Para se determinar intervalos de referência das áreas valvulares em função da idade gestacional, seguiu-se o modelo de regressão linear simples, utilizando o método de Altman, com nível de significância de pPURPOSE: to evaluate the areas of the atrioventricular valves (tricuspid and mitral of normal fetuses by the use of three-dimensional ultrasound (3DUS and the spatiotemporal image correlation (STIC method. METHODS: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r was calculated. Means, medians, standard deviations (SD and maximum and minimum values were calculated. The simple linear regression

  4. Tratamento cirúrgico da comunicação interventricular e rotura da parede livre do ventrículo esquerdo após infarto agudo do miocárdio e da disjunção atrioventricular após troca da valva mitral, empregando o dispositivo de isolamento ventricular (DIV:: estudo experimental

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    Rodrigo de Castro BERNARDES

    1997-01-01

    Full Text Available A rotura de parede livre do ventrículo esquerdo (VE e a comunicação interventricular (CIV por rotura de septo são dois eventos catastróficos que podem complicar a evolução do infarto agudo do miocárdio (IAM. A oportunidade do tratamento cirúrgico, o acesso à CIV e a técnica cirúrgica ideal para o tratamento desta complicação são muito discutidos na literatura (1-5. Os resultados, porém, são quase unânimes: alta taxa de mortalidade. A rotura da parede posterior do ventrículo esquerdo pós troca da valva mitral (disjunção atrioventricular não é uma complicação rara, sendo quase sempre fatal (6, 7. O objetivo de nosso trabalho é discutir a alternativa de tratamento cirúrgico destas graves lesões, sem o manuseio direto do músculo cardíaco friável, necrozado. Desenvolvemos e testamos em animais (carneiros o dispositivo de isolamento ventricular (DIV. No período de 12/7/95 a 10/1/96, operamos 12 carneiros adultos para o implante do DIV. No primeiro período de aprendizado da técnica de implante e de desenvolvimento da prótese, operamos 7 animais, sem sucesso. No segundo período operamos 5 animais, já com o DIV completamente desenvolvido e com a técnica cirúrgica já padronizada; obtivemos sucesso com todos os animais, sobrevivendo com bom débito cardíaco, constatado ao ecocardiograma e à ventriculografia. Após 20 dias de sobrevida, os animais foram submetidos a ventriculografia e ecocardiografia. Observamos o completo isolamento da cavidade ventricular com o emprego do DIV, obtendo o tratamento provisório destas graves lesões.The rupture of the ventricular free wall, and the ventricular septal rupture are two catastrophic events that can complicate the outcome of acute myocardial infarction. The opportunity to use surgical treatment, the access to the ventricular septal rupture as well as the ideal surgical technique are very much discussed in the literature but the results are almost unanimous: an elevated

  5. Homoenxerto mitral: uma realidade

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    Francisco Diniz Affonso da COSTA

    1998-07-01

    Full Text Available Fundamentos: A utilização de homoenxertos valvares aórticos criopreservados está associada a excelente qualidade de vida, com baixa morbidade e durabilidade satisfatória. Espera-se obter resultados semelhantes em posição mitral com o emprego de homoenxertos mitrais criopreservados. Objetivo: Avaliar os resultados imediatos e a curto prazo da substituição da valva mitral por homoenxerto mitral criopreservado. Casuística e Métodos: De julho/97 a fevereiro/98, 8 pacientes com média de idades de 40,3 ± 6,2 anos foram submetidos a substituição da valva mitral por homoenxerto mitral criopreservado. A técnica de implante consistiu de fixação látero-lateral dos músculos papilares, sutura anular contínua e anuloplastia com anel de Carpentier. Antes da alta, todos os pacientes realizaram ecocardiografia bidimensional com Doppler para análise da função valvar e ventricular. Os pacientes foram solicitados a retornar no primeiro mês e, subseqüentemente, a cada três meses de pós-operatório, para controles clínico e ecocardiográfico tardio. Resultados: Houve um óbito hospitalar de causa não relacionada ao enxerto. A avaliação ecocardiográfica antes da alta hospitalar demonstrou média das áreas valvares de 3,1 ± 0,6 cm2 e média dos gradientes médios de 3,5 ± 1,6 mmHg. A insuficiência valvar foi quantificada como inexistente ou trivial em 4 casos e leve em 3. A fração de ejeção de 57 ± 7% no pré-operatório foi adequadamente preservada no pós-operatório (62 ± 6%. Os níveis de hipertensão pulmonar regrediram significativamente de 87 ± 15 mmHg no pré-operatório para 48 ± 12 mmHg no pós-operatório. Houve também redução do tamanho da cavidade atrial esquerda de 61 ± 10 mm para 53 ± 7 mm. Nenhum paciente foi perdido do acompanhamento tardio. Após um tempo médio de seguimento de 4,1 ± 2,5 meses, os pacientes encontram-se funcionalmente bem e sem complicações pós-operatórias. O estudo ecocardiogr

  6. Fibroelastoma papilar de la válvula mitral

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    Fernando Reguillo

    2006-01-01

    Full Text Available Mujer de 59 años, que presentaba accidentes cerebrovasculares de repetición, de posible origen cardioembólico. Al realizar el estudio cardiológico, en el ecocardiograma transesofágico se detectó una masa de 7–8 mm dependiente de la valva anterior mitral, que ocasionaba una insuficiencia mitral leve (Fig. 1. Fue intervenida bajo circulación extracorpórea, por vía transeptal anterior auricular, extirpándose dicha masa y la base de implantación, cerrando el defecto de la valva mitral con puntos sueltos (Fig. 2. El postoperatorio fue normal, siendo dada de alta a los 7 días. La anatomía patológica demostró que se trataba de un fibroelastoma papilar.

  7. 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.

  8. Plástica mitral Mitral repair

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    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

  9. Anomalia de Ebstein: resultados com a reconstrução cônica da valva tricúspide

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    Silva José Pedro da

    2004-01-01

    Full Text Available OBJETIVO: Analisar os resultados de uma modificação técnica de plastia da valva tricúspide na anomalia de Ebstein. MÉTODOS: De novembro/1993 a agosto/2002, 21 pacientes com anomalia de Ebstein da valva tricúspide, com idades variando de 20 meses a 37 (média: 23 anos, foram submetidos a uma nova técnica de plastia da valva tricúspide, onde o megafolheto anterior tricúspide é desinserido da parede ventricular e do anel valvar, total, ou quase totalmente, transformando-o num cone, cujo vértice permanece fixo na ponta do ventrículo direito e cuja base é suturada ao verdadeiro anel tricúspide, inclusive na região septal, após o ajuste, com uma plicatura do anel, ao tamanho da base do cone. RESULTADOS: Houve um (4,7%, óbito hospitalar, causado por baixo débito cardíaco em portador de miocardiopatia causada pela hipóxia crônica. O tempo médio de seguimento foi de 4 anos e os ecocardiogramas recentes mostraram boa morfologia do ventrículo direito e valva tricúspide com discreta ou mínima insuficiência em 18 pacientes e moderada em 2. Em dois dos três portadores de feixe anômalo foi possível localizá-los e seccioná-los no ato cirúrgico. Não ocorreu bloqueio atrioventricular em nenhum dos pacientes. CONCLUSÃO: A técnica utilizada foi eficiente para a correção da insuficiência tricúspide e a restauração da morfologia do ventrículo direito, e aplicável para todos os tipos anatômicos de Ebstein, exceto o tipo D da classificação de Carpentier.

  10. Mitral stenosis (image)

    Science.gov (United States)

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

  11. Remodelação cirúrgica da valva aórtica Surgical remodeling of the aortic valve

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    Ronaldo D. FONTES

    2001-09-01

    Full Text Available OBJETIVO: Os autores analisam os resultados por eles obtidos com a utilização de técnica específica para a preservação da valva aórtica. CASUÍSTICA E MÉTODOS: Esse método consiste no emprego habitual da circulação extracorpórea com uso de hipotermia moderada e infusão de solução cardioplégica nos óstios coronários. Realiza-se ressecção da válvula não coronariana e une-se as comissuras correspondentes utilizando-se fio de Mersilene 2-0 ancorado em feltro de teflon, tornando a valva "bivalvulada". Procede-se por fim à aortorrafia convencional. Foram operados 15 pacientes, 9 do sexo masculino. A idade variou entre 12 e 78 anos. Quatro pacientes tinham diagnóstico de insuficiência aórtica isolada, 2 com dupla disfunção aórtica associada à insuficiência coronária, 2 com doença da aorta ascendente, 4 com insuficiência aórtica e mitral, 1 com dupla disfunção aórtica e mitral, e 2 com insuficiência aórtica e insuficiência coronária. RESULTADOS: Em 12 pacientes não houve insuficiência aórtica residual pós-operatória, e em 3 identificou-se insuficiência aórtica leve ou moderada. Três pacientes foram reoperados no pós-operatório tardio devido a insuficiência aórtica, tendo sido substituída a valva aórtica em 2. Quatro pacientes foram submetidos a estudo hemodinâmico e em 1 deles havia gradiente supravalvar de 20 mmHg. Nos outros 3 pacientes, o gradiente sistólico transvalvar foi de 0, 9 e 12 mmHg, respectivamente. Os 11 pacientes restantes foram avaliados somente através de ecocardiografia, a qual não demonstrou estenose. Não houve óbito imediato e houve 1 óbito tardio, após reoperação. Quatorze pacientes tiveram melhora da classe funcional, tanto imediata quanto tardiamente, e foram acompanhados durante período entre 30 dias e 24 meses, encontrando-se em classe funcional I ou II (NYHA. CONCLUSÃO: Os autores acreditam que o método seja uma alternativa para o tratamento cir

  12. 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

  13. 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.

  14. Resultados imediatos e tardios da valvoplastia mitral percutânea em pacientes com estenose mitral Immediate and late results of percutaneous mitral valve repair in patients with mitral stenosis

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    Luiz Francisco Cardoso

    2010-03-01

    Full Text Available FUNDAMENTO: A análise dos resultados imediatos e a longo prazo da valvoplastia mitral por catéter-balão (VMCB ainda são escassos na literatura, principalmente no contexto nacional. OBJETIVO: Avaliar os resultados imediatos e tardios dos pacientes submetidos à VMCB. MÉTODO: 330 pacientes consecutivos foram seguidos por 47 ± 36 meses (até 126 meses. Análises univariadas e multivariadas avaliaram os fatores relacionados ao sucesso do procedimento, à reestenose e aos eventos tardios (morte ou necessidade de nova intervenção na valva mitral. O método de Kaplan-Meier estimou a sobrevida livre de eventos. RESULTADOS: Houve sucesso do procedimento em 305 (92,4%. A anatomia valvar mitral foi o principal preditor de sucesso imediato do procedimento. Durante o seguimento, a reestenose ocorreu em 77 (23,3% pacientes e esteve associada a menor área valvar mitral e maior calcificação antes do procedimento. Ocorreram 67 eventos em um tempo médio de seguimento de 38 ± 26 meses. A probabilidade de sobrevida livre de eventos foi de 95 % em 1 ano, 75% aos 5 anos e 61% aos 10 anos. Os preditores de sobrevida livre de eventos foram: idade, escore ecocardiográfico e resultado imediato do procedimento. CONCLUSÃO: A VMCB é um procedimento efetivo, sendo que mais de 60% dos pacientes estiveram livres de eventos ao final do seguimento. A condição anatômica da valva mitral e a idade do paciente foram os melhores preditores da sobrevida livre de eventos e devem ser levados em consideração na seleção dos pacientes para VMCB.BACKGROUND: The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC are still lacking in literature, mainly in the national context. OBJECTIVE: To assess the immediate and late results of patients submitted to mitral valve repair by balloon catheter. METHOD: A total of 330 consecutive patients were followed-up by 47 ± 36 months (up to 126 months. Univariate and multivariate analyses

  15. Mitral valve prolapse

    Science.gov (United States)

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

  16. Anatomia da valva atrioventricular esquerda: I. As cúspides Anatomy of the left atrio-ventricular valve: I. The cusps

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    Antônio B. Prado Fortuna

    1988-12-01

    Full Text Available Os resultados de um estudo anatômico da valva atrioventricular esquerda, realizado em 30 corações aparentemente normais, conservados em formalina, são comparados aos dados da literatura, tendo por objetivo adequar a nomenclatura e os conceitos anatômicos clássicos aos atuais, baseados na ultra-sonografia e na prática cirúrgica corrente. O presente artigo tratará apenas das cúspides, sendo que os demais elementos anatômicos dessa valva atrioventricular esquerda fazem parte de uma "unidade aortoventricular", onde distinguimos a cúspide anterior, em continuidade com o trígono intervalvar e o anel aórtico, e um grupo de cúspides posteriores, em relação com a parede posterior do ventrículo esquerdo. A cúspide anterior está separada do grupo de cúspides posteriores, tanto no polo valvar superior como no inferior, por uma estrutura anatômica bem definida: a "lâmina juncional", superior e inferior, respectivamente. As cúspides do grupo posterior são designadas pela ordem numeral ordinal, a partir da lâmina juncional superior. Esta nomenclatura tem por objetivo destacar a cúspide como unidade funcional da valva e facilitar as referências ecocardiográficas e cirúrgicas, particularmente nos casos em que mais de 3 cúspides posteriores são encontradas.A review of the left atrio-ventricular valve anatomy is compared to a clinical oriented morphological study on 30 normal adult heart, preserved in formalin. The results will be presented in five separated sections: I. The cusps; II. The comissures; III. The chordae tendinae; IV. The papilary muscles; V. The valvar annulus. The present publication will deal with the cusps. The terms "left atrio-ventricular valve" and "cusps" are to be prefered to the more descriptive and traditional "mitral valve" and "leaflets". The anterior cusp, in continuity with the aortic annulus, and a group of posterior cusps, attached to the posterior left wall, are described. An ordinal numerical

  17. Percutaneous transvenous mitral commissurotomy in juvenile mitral ...

    African Journals Online (AJOL)

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

  18. Problem: Mitral Valve Regurgitation

    Science.gov (United States)

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

  19. Mitral valve regurgitation

    Science.gov (United States)

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

  20. Fijador con soporte y modificación de la valva de Balfour

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    Miguel Ángel Carrasco Molina

    1998-08-01

    Full Text Available Se describe y muestra un instrumento que fija la valva de Balfour en el hemiabdomen superior para su uso en múltiples operaciones, constituido por un fijador, un soporte y la modificación realizada a la valva de Balfour, y tiene como ventajas la garantía de una mejor realización de la técnica quirúrgica, la mejoría del campo operatorio y la eliminación de un ayudante en la mesa de operaciones. Este separador fue ideado para utilizarse en el hemiabdomen superior, no obstante puede emplearse en cualquier parte del abdomen. La propuesta ha sido utilizada en 30 pacientes y fue satisfactorio su empleo en todos éstos y aceptados por todos los cirujanos. Se presentó una complicación representada por un cuadro de neuritis intercostal en el paciente operado de neoplasia de curvatura esplénica del colon. Consideramos que por las ventajas que presenta el instrumento debe ser ampliado a otras unidades hospitalarias de CubaA surgical implement which fixes Balfour's valva to the upper hemiabdomen is described and shown for its using in other surgery. It is made up of a fixator, a bracket and the modification of Balfour's valva and it exhibits advantages such as: a better guaranteed surgical technique, improvement of surgical field and elimination of one assistant at surgery. This separator was devised to be used in the upper hemiabdomen but it may be employed in other abdomen sections. The proposed implement has been used in 30 patients with satisfactory outcome and accepted by all surgeons. A complication related to intercostal neuritis affected a patient who was operated from colon splenial curvature neoplasm. We consider that the advantages of this implement allows it to be extended to other hospitals in the country

  1. Cateteres venosos centrais totalmente implantáveis para quimioterapia: experiência com 793 pacientes

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    Esmálio Barroso de Oliveira

    Full Text Available OBJETIVO: estudar retrospectivamente os resultados obtidos com a implantação de cateteres totalmente implantáveis em pacientes submetidos à quimioterapia. MÉTODOS: foram colocados 815 cateteres totalmente implantáveis em 793 pacientes submetidos ao regime de quimioterapia preferencialmente utilizando-se a veia cefálica direita. Foram avaliadas as complicações precoces e tardias. RESULTADOS: a análise retrospectiva mostrou duração média dos cateteres de 339 dias. Em 733 (90% cateteres não se observou nenhuma complicação. Entre as complicações precoces observamos um pneumotórax, um mau posicionamento de cateter, uma punção arterial, um sangramento, um hemotórax e hemomediastino e seis hematomas na loja de implantação. Entre as complicações tardias, ocorreram 35 infecções relacionadas ao cateter, dez infecções no sítio cirúrgico, seis obstruções e 20 tromboses. Foram retirados 236 cateteres, 35 devido às complicações e 201 por final de tratamento. CONCLUSÃO: os cateteres totalmente implantáveis para quimioterapia são meios seguros para a administração de substâncias, em vista do baixo número de complicações observadas neste estudo.

  2. Mitral valve repair versus replacement

    Science.gov (United States)

    Keshavamurthy, Suresh; Gillinov, A. Marc

    2015-01-01

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

  3. Aneurisma subanular mitral: correção cirúrgica Submitral left ventricular aneurysm: surgical correction

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    Paulo M Pêgo-Fernandes

    1993-06-01

    Full Text Available O aneurisma subanular mitral é doença pouco conhecida em nosso país. Foi descrita, inicialmente, e é vista com maior freqüência na população negra das regiões sul e oeste da África. Parece relacionar-se a uma fraqueza da parede ventricular na área de implantação da cúspide posterior da valva mitral, levando à insuficiência dessa valva. É relatado o caso de homem de 20 anos, branco, com queixa de dispnéia e taquicardia. Foi internado devido a evolução para classe funcional IV. Após compensação clínica, apresentava, ainda, sopro sistólico (+++/++++ em área mitral. A radiografia de tórax mostrou aumento da área cardíaca (+++/++++ às custas de átrio e ventrículo esquerdo. O ecocardiograma, além do aumento dessas câmaras, revelou dilatação aneurismática na região posterior do ventrículo esquerdo, justa-valvar em relação à valva mitral, com sinais de incompetência severa, assim como a cineangiocardiografia. Submetido a cirurgia em 20/10/86, quando foi realizada ressecção do aneurisma, utilizando-se placas de pericárdio bovino para reconstrução. Foi feita, também, troca de valva mitral por válvula biológica. O paciente evoluiu bem, tendo recebido alta hospitalar no oitavo dia de pós-operatório. Atualmente, é assintomático, o ecocardiograma de controle revelou correção cirúrgica satisfatória.Submitral left ventricular aneurysm is a poorly known entity in our country; it has been described mainly in the southern and western African black populations. It appears to be related to a ventricular wall weakness in the area of implantation of the posterior mitral valve leaflet. A 20-year-old white man was admitted with complaints of dyspnea and palpitation. On admission he was in NYH A class IV. After medical treatment the cardiac area was very enlarged and there was a systolic murmur +++/++++. The twodimensional echocardiography as well as the angiocardiography revealed annular submitral left

  4. Mitral Valve Stenosis

    Science.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    Dorival Julio Della Togna

    2013-04-01

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

  6. Echocardiography of the mitral valve

    OpenAIRE

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

    2010-01-01

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

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

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    LinXiang Lu

    2016-01-01

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

  8. Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

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    Seong Lee

    2015-10-01

    Full Text Available Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, 47.7±9.7 years; 11 female and 4 male who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5±7 years. The mean preoperative Wilkins score was 9.4±2.6. Results: The mean mitral valve area obtained using planimetry increased from 1.16±0.16 cm2 to 1.62±0.34 cm2 (p=0.0001. The mean pressure half time obtained using Doppler ultrasound decreased from 202.4±58.6 ms to 152±50.2 ms (p=0.0001. The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4±4.0 mmHg to 5.8±1.5 mmHg (p=0.0021. There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39±16 months. The 5-year event-free survival was 56.16% (95% confidence interval, 47.467–64.866. Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

  9. 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.

  10. Defeito do anel fibroso mitral posterior com aneurisma de átrio esquerdo e insuficiência mitral: tratamento cirúrgico com sucesso Defect of the posterior mitral fibrous ring with left atrial aneurysm and mitral insufficiency: successful surgical treatment

    Directory of Open Access Journals (Sweden)

    Ronaldo Machado BUENO

    1999-10-01

    Full Text Available Aneurismas em átrio esquerdo são pouco comuns, podendo ocorrer na aurícula ou na parede do átrio esquerdo. Freqüentemente, são assintomáticos, podendo ocorrer arritmias, fenômenos tromboembólicos ou insuficiência cardíaca como complicação da sua evolução. Apresentamos paciente de 39 anos, do sexo feminino, com defeito do anel posterior da valva mitral levando a grande dilatação aneurismática da parede posterior do átrio esquerdo com insuficiência mitral. O diagnóstico foi feito pela radiografia de tórax (abaulamento de silhueta cardíaca esquerda e ecocardiograma (grande aneurisma do átrio esquerdo posteriormente à parede posterior do ventrículo esquerdo com insuficiência mitral. O estudo hemodinâmico sugeriu pseudo-aneurisma de ventrículo esquerdo. Submetida a tratamento cirúrgico com auxílio da circulação extracorpórea, realizou-se anuloplastia mitral e exclusão do aneurisma com reconstrução do assoalho do átrio esquerdo com retalho de pericárdio bovino. A paciente apresentou boa evolução pós-operatória, recebendo alta hospitalar no oitavo dia em boas condições clínicas.Atrial aneurysm is a rare condition and can be found on the atrial appendage or on the atrial wall. Most patients are asymptomatic, but arrhythmias, thromboembolism, and heart failure are common complications. We present a 39 years old female patient with posterior mitral ring defect causing a great aneurysm of the left posterior atrial wall with mitral insufficiency. The diagnosis was achieved by chest roentgenogram (marked prominence of the upper left heart border and echocardiography (great left atrial aneurysm behind the left posterior ventricular wall with mitral insufficiency. Left ventricular cineangiogram suggested the presence of a false aneurysm of the left ventricle. The patient subsequently underwent surgical treatment with cardiopulmonary bypass. Posterior mitral valve annuloplasty was performed with aneurysm exclusion

  11. Isolamento das veias pulmonares em pacientes com fibrilação atrial permanente secundária a valvopatia mitral Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease

    Directory of Open Access Journals (Sweden)

    Gustavo G. Lima

    2004-04-01

    Full Text Available OBJETIVO: Analisar a eficácia do isolamento cirúrgico das veias pulmonares para restabelecer ritmo sinusal em pacientes com fibrilação atrial secundária à doença mitral. MÉTODOS: 33 pacientes com indicação de correção cirúrgica da valva mitral e com fibrilação atrial permanente, foram submetidos ao isolamento cirúrgico das veias pulmonares, sendo 67% mulheres. Média de idade de 56,3±10 anos, classe funcional NYHA pré-operatória de 3,2±0,6, tamanho de átrio esquerdo de 5,5± 0,9 cm, fração de ejeção de 61,3±13%. A técnica cirúrgica consistiu de incisão circunferencial ao redor das 4 veias pulmonares, excisão do apêndice atrial esquerdo e de incisão perpendicular desde a borda inferior da incisão, isolando as veias pulmonares, até o ânulo da valva mitral. Arritmias precoces foram tratadas, agressivamente, com cardioversão. RESULTADOS: O seguimento médio foi de 23,9±17 meses e ocorreram 3 óbitos no pós-operatório. Dez pacientes necessitaram de cardioversão elétrica no pós-operatório; 87% apresentavam ritmo sinusal na última consulta e 33% estavam em uso de amiodarona. CONCLUSÃO: Isolamento das veias pulmonares associado à cirurgia da valva mitral é uma técnica efetiva e segura na manutenção de ritmo sinusal em pacientes com fribilação atrial permanente.OBJECTIVE: To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease. METHODS: Thirty-three (67% were women patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3±10 years, preoperative NYHA functional class was 3.2±0.6, left atrial size was 5.5±0.9 cm, and ejection fraction was 61.3±13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left

  12. Mitral Valve Prolapse

    Science.gov (United States)

    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... valve syndrome . What happens during MVP? Watch an animation of mitral valve prolapse When the heart pumps ( ...

  13. PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY ...

    African Journals Online (AJOL)

    Kateee

    2003-04-04

    Apr 4, 2003 ... G.O. Yonga, MBChB, MMed, Consultant Cardiologist, Hurlingham Heart Clinic, P.O. Box 76555, Nairobi and P. Bonhoeffer, Consultant Cardiologist and Director. Paediatric ... Standard left and right heart catheterisation for mitral valve disease. ... to severe rheumatic fever and also carries poorer prognosis.

  14. Mitral Valve Disease

    Science.gov (United States)

    ... clots, but they also are less durable than mechanical valves and may need to be replaced in the future. Like mitral valve repair, replacement can be done minimally invasively or with traditional open heart surgery. Your medical team will discuss the advantages ...

  15. 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

  16. Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada

    Directory of Open Access Journals (Sweden)

    HUEB Alexandre Ciappina

    2001-01-01

    Full Text Available OBJETIVO: O objetivo deste trabalho foi analisar o comportamento do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada (CMD. MATERIAL E MÉTODOS: Analisaram-se 68 corações humanos adultos, fixados, sendo 48 portadores de CMD de etiologia isquêmica ou idiopática, e 20 corações sem cardiopatia. Obteve-se imagens digitalizadas do perímetro do anel mitral, inserção da cúspide anterior e posterior e da porção fibrosa e muscular. Obteve-se também o perímetro interno do VE, distância do septo ao músculo papilar anterior e posterior, distância entre os músculos papilares, e extensão do septo interventricular. RESULTADOS: A análise dos resultados demonstrou proporcionalidade, tanto da porção fibrosa (r²= 0.98, quanto da porção muscular (r²= 0.99 do anel em relação ao grau de dilatação da valva mitral. A regressão linear revelou que o perímetro de inserção das cúspides anterior (r²= 0.96 e posterior (r² =0.98 também guardam relação de proporcionalidade. Observou-se que a dilatação do VE ocorre de forma global e esférica em seus segmentos. Não se observou relação de proporcionalidade entre o grau de dilatação do anel mitral e do VE. CONCLUSÃO: Ao contrário do que se pensava, na CMD de etiologia isquêmica ou idiopática, a dilatação do anel mitral ocorre de forma proporcional e não apenas na sua porção posterior. Não é o grau de dilatação do VE que determina o grau de dilatação do anel mitral pois eles ocorrem de forma independente. Estas observações abrem novas perspectivas para as técnicas de correção da insuficiência valvar mitral na CMD.

  17. Correção da origem anômala de artéria coronária esquerda com insuficiência mitral e hemólise mecânica Correction of anomalous origin of left coronary artery with mitral insufficiency and mechanical hemolisys

    Directory of Open Access Journals (Sweden)

    José Alberto Caliani

    2004-12-01

    Full Text Available Criança do sexo feminino, 2 meses de idade, apresentando quadro clínico de insuficiência cardíaca e sopro. Durante a investigação, foi realizado ecocardiograma e estudo cineangiocardiográfico que evidenciaram origem anômala da artéria coronária esquerda do tronco pulmonar e insuficiência mitral importante demonstrada ao doppler. A paciente foi submetida a tratamento cirúrgico com auxílio de circulação extracorpórea, que consistiu no reimplante da artéria coronária esquerda na aorta, associado à anuloplastia da valva mitral. No pós-operatório tardio, houve importante hemólise mecânica ocasionada pela plastia mitral. A paciente foi reoperada para remoção de retalho de pericárdio bovino. O ecocardiograma pós-operatório mostra insuficiência mitral leve e o paciente apresenta-se em classe funcional I (NYHA.A 2 months-old girl, presenting with heart failure and murmur was investigated using echocardiography and cardiac cathetherization revealing an anomalous left coronary artery origin from the pulmonary trunk and massive mitral regurgitation. The patient was submitted to surgery under cardiopulmonary bypass: the anomalous coronary was implanted in the aorta and the mitral valve repaired by annuloplasty. In the postoperative period the patient had important mechanical hemolysis caused by mitral annuloplasty. The patient underwent a second intervention to remove a piece of bovin pericardium. A postoperative echocardiogram revealed mild mitral insufficiency and the patient is free of symptoms.

  18. Hammock mitral valve: A rare case report

    Directory of Open Access Journals (Sweden)

    Veeresh F. Manvi

    2014-01-01

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

  19. 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.

  20. Cirurgia conservadora da endocardite bacteriana aguda da valva tricúspide Conservative operation for bacterial endocardites of the tricuspide valve

    Directory of Open Access Journals (Sweden)

    Iseu Affonso da Costa

    1988-08-01

    Full Text Available É relatado o caso de 1 paciente que apresentou endocardite aguda da valva tricúspide pós-aborto, cujo agente causal era o S. aureus. Como não houvesse resposta favorável ao tratamento antibiótico (gentamicina, vancomicina e oxacilina, optou-se pela intervenção, vinte dias após a internação. Foi praticada excisão de uma vegetação única e do tecido valvar adjacente, na comissura ântero-posterior e plicatura anular. O resultado foi favorável, com cura clínica. O exame ecocardiográfico confirmou a presença da vegetação no pré-operatório e o funcionamento conservado da valva, após a plastia. O tratamento cirúrgico, com retirada do tecido infectado e preservação da valva constitui uma alternativa aplicável a certos casos de endocardite aguda das valvas atrioventriculares.One case of acute bacterial endocarditis of the tricuspid valve caused by S. aureus and following a septic abortion is presented. Surgical treatment was indicated after failure of antibiotics. Operation consisted of excision of a large vegetation adherent to the anterior and posterior cusps at the commisure and of the affected valvar tissue. Annular plicature at the segment corresponding to the posterior cuspid was employed to maintain competence. Clinical result was very satisfactory with resolution of sepsis. Dopplerecocardiography revealed the presence of the vegetation before the operation and showed a small regurgitation after valvoplasty. Conservative operation upon the atrioventricular valves must be kept in mind as an alternative in the treatment of acute bacterial endocarditis.

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

    Directory of Open Access Journals (Sweden)

    Ahmet Seyfeddin Gurbuz

    2016-06-01

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

  2. Association Between Mitral Annular Calcium and Flail Mitral Leaflet in Degenerative Mitral Valve Disease.

    Science.gov (United States)

    Zemer Wassercug, Noa; Shapira, Yaron; Weisenberg, Daniel; Monakier, Daniel; Bental, Tamir; Sagie, Alik; Vaturi, Mordehay

    2015-07-01

    The aim of this study was to assess the association between mitral annular calcium (MAC) and flail mitral leaflets in a cohort of patients with degenerative mitral valve disease. A retrospective study was conducted of consecutive patients with degenerative mitral valve disease who underwent echocardiography at Rabin Medical Center from 2003 to 2012. Special focus was attended to the presence and grade of MAC and characterization of valve pathology (myxomatous vs nonmyxomatous, prolapse vs flail). Patients were excluded if they had undergone previous mitral valve surgery and/or had infective endocarditis. Multivariate logistic regressions were used to control for confounders. The study included 1,912 patients (60.8% men, mean age 63.8 ± 17.4 years) divided into 3 groups: 1,627 (86%) without MAC, 183 (10%) with either mild or moderate MAC, and 94 (5%) with severe MAC. The presence of flail leaflet was 27%, 30%, and 46% in these groups, respectively (p mitral leaflet with severe MAC versus no MAC was 1.76 (95% confidence interval 1.10 to 2.83, p = 0.019). In conclusion, this study demonstrates that degenerative mitral valve disease with severe MAC is significantly associated with flail mitral leaflet. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. 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.

  4. Mitral Valve Disease: a Comprehensive Review.

    Science.gov (United States)

    Harb, Serge C; Griffin, Brian P

    2017-08-01

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

  5. Quality of Life Score as a Predictor of Death in Dogs with Degenerative Mitral Valve Disease.

    Science.gov (United States)

    Strunz, Célia M C; Marcondes-Santos, Mário; Takada, Julio Yoshio; Fragata, Fernanda S; Mansur, Antônio de Pádua

    2017-04-01

    The knowledge of the variables predicting mortality is important in clinical practice and for therapeutic monitoring in mitral valve disease. To determine whether a quality of life score evaluated with the Functional Evaluation of Cardiac Health questionnaire would predict mortality in dogs with degenerative mitral valve disease (DMVD). Thirty-six client-owned dogs with mitral valve disease underwent clinical, laboratory, and echocardiographic evaluations at baseline and were monitored for 6 months. Cardiovascular death was the primary outcome. The 36 dogs were classified as survivors or nonsurvivors. Higher values of the following variables were obtained at baseline in the nonsurviving group (12 dogs): amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, plasma norepinephrine, heart rate, quality of life score, diastolic left ventricular internal dimension to aortic root ratio, systolic left ventricular internal dimension to aortic root ratio, and left atrium to aortic root ratio. NT-proBNP levels and quality life score were independently associated with death in the multivariable analysis. The quality life score was an independent variable for cardiac death in dogs with DMVD. This result is encouraging, as this score is easy to apply and does not require any technology, only a veterinarian and an observant owner. O conhecimento das variáveis preditoras de mortalidade é importante para a prática clínica e para o acompanhamento terapêutico na doença da valva mitral. Determinar se um escore de qualidade de vida avaliado com o Functional Evaluation of Cardiac Health poderia auxiliar na predição de mortalidade em cães com doença degenerativa da valva mitral (DDVM). Trinta e seis cães de estimação com doença valvar mitral foram submetidos a avaliação clínica, laboratorial e ecocardiográfica no início do estudo e monitorizados durante 6 meses. A morte cardiovascular foi o desfecho primário. Os 36 cães foram classificados como

  6. Recuperação por desbridamento manual da valva aórtica estenótica calcificada Manual debridement for repair in calcified aortic stenosis

    Directory of Open Access Journals (Sweden)

    Renato A. K Kalil

    1995-06-01

    Full Text Available Os autores analisam os resultados clínicos e evolução ecocardiográfica em uma série de pacientes em que foi possível recuperar a valva aórtica calcificada. Entre janeiro de 1993 e outubro de 1994, 31 pacientes foram considerados para recuperação valvar, sendo obtido sucesso imediato em 21. A etiologia era congênita em 8 e senil em 13 pacientes; o sexo masculino em 10 e feminino em 11 e as idades variaram de 44 a 78 anos (média ± DP = 63,8 ± 9,5 anos. Procedimentos associados foram 6 revascularizações miocárdicas e 1 comissurotomia mitral, com tempos de perfusão de 53,8 ± 21,4 min e de isquemia miocárdica de 33,7 ±12,1 min. O cálcio retirado com auxílio de pinças saca-cálcio usuais auxiliadas por aspiração e raspagem das válvulas. Em duas ocasiões as válvulas foram perfuradas e suturadas com Propilene 5-0. Comissurotomia com bisturi foi realizada, se necessário. Dezesseis pacientes foram avaliados por ecocardiograma no pós-operatório imediato ou após 6 m a 1 ano. Todos os casos estão em acompanhamento. Não houve mortalidade na fase hospitalar e 4,8% (1 caso na tardia. Não ocorreram complicações pós-operatórias significativas no período estudado, encontrando-se os pacientes em classe funcional I ou II. A avaliação ecocardiográfica mostrou gradiente instantâneo máximo na via de saída do VE de 90,7 ± 23,3 mmHg (média ± DP no exame pré-operatório e 33,0 ± 7,9 no pós-operatório (p A series of 21 patients submitted to mechanical debridement for treatment of calcified stenotic aortic valves is presented. There were 8 congenital and 13 senile valves, in 10 male and 11 female patients. Mean age 63.8 ± 9.5 (44 to 78 years. Six had also coronary bypass grafts and 1 mitral comissurotomy. Total perfusion time was 53.8 ± 21.4 min and ischemic time 33.7 ± 12.1 min. All patients had been followedup from 1 month to 2 years. In 16 a late echocardiographic evaluation was performed. There have been no early

  7. Effects of Dobutamine Infusion on Mitral Regurgitation.

    Science.gov (United States)

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

    1998-01-01

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

  8. Protocolo de difusão síncrona totalmente ordenada para aglomerados de alto desempenho

    OpenAIRE

    Daniel Cason

    2013-01-01

    Resumo: Protocolos de Difusão Totalmente Ordenada (DTO) constituem o núcleo de diversas soluções que dão suporte ao desenvolvimento de aplicações distribuídas tolerantes a falhas. O longo período no qual este problema vem sendo objeto de pesquisa e a quantidade de algoritmos que foram para ele propostos atestam, não só a sua importância, mas também a dificuldade de se obter soluções eficientes para DTO. Este trabalho apresenta um novo algoritmo de DTO, que explora a sincronia e a confiabilida...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  10. Modified Surgical Intervention for Extensive Mitral Valve Endocarditis and Posterior Mitral Annular Calcification

    Directory of Open Access Journals (Sweden)

    Gwan Sic Kim

    2016-02-01

    Full Text Available The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.

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

    Science.gov (United States)

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

    1990-05-01

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

  12. Anatomical challenges for transcatheter mitral valve intervention

    DEFF Research Database (Denmark)

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

    2016-01-01

    , most of these transcatheter mitral valve interventions are still in their early clinical or preclinical development phase. Challenges arising from the complex anatomy of the mitral valve and the interplay of the mitral apparatus with the left ventricle (LV) have contributed to a more difficult...

  13. Anatomical challenges for transcatheter mitral valve intervention

    DEFF Research Database (Denmark)

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

    2016-01-01

    system, most of these transcatheter mitral valve interventions are still in their early clinical or preclinical development phase. Challenges arising from the complex anatomy of the mitral valve and the interplay of the mitral apparatus with the left ventricle (LV) have contributed to a more difficult...

  14. Severe mitral regurgitation after radiotherapy.

    Science.gov (United States)

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

    2014-02-01

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

  15. Homoenxerto em cirurgia de valvas cardíacas: evidências para a prática da enfermagem perioperatória

    National Research Council Canada - National Science Library

    Flávia Martinelli Pelegrino; Fernanda Gaspar Torrati; Namie Okino Sawada; Cristina Maria Galvão

    2009-01-01

    ... revisão integrativa da literatura. As bases de dados selecionadas foram Medline e Lilacs e osdescritores de assunto utilizados foram: transplante homólogo, criopreservação e valvas cardíacas. Foramincluídos...

  16. Contemporary outcomes in reoperative mitral valve surgery.

    Science.gov (United States)

    Mehaffey, Hunter J; Hawkins, Robert B; Schubert, Sarah; Fonner, Clifford; Yarboro, Leora T; Quader, Mohammed; Speir, Alan; Rich, Jeff; Kron, Irving L; Ailawadi, Gorav

    2017-10-05

    Data suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes. All (11 973) open mitral valve cases were evaluated (2002-2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery. Of all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, pmitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era. Redo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Verificação da proporção divina da face em pacientes totalmente dentados

    OpenAIRE

    Marcia Regina Piccin

    1997-01-01

    Resumo: Esta pesquisa foi realizada com a finalidade de verificar a presençada "Proporção Divina" nos segmentos da face, por meio do método fotográfico, em pacientes dentados. A "Proporção Divina" já era utilizada desde a Antiga Grécia por escultores e arquitetos na confecção de suas obras, tendo sido estudada durante o Renascimento. Esta Proporção está presente não apenas nas artes plásticas, como também na natureza. A amostra deste estudo constituiu-se de 121 indivíduos totalmente dentados,...

  18. Robotically assisted mitral valve replacement.

    Science.gov (United States)

    Gao, Changqing; Yang, Ming; Xiao, Cangsong; Wang, Gang; Wu, Yang; Wang, Jiali; Li, Jiachun

    2012-04-01

    In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 ± 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 ± 21.9 minutes (range, 105-168) and 99.3 ± 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  19. TRAUMA VALVULAR MITRAL EN UN LACTANTE DURANTE LA VALVULOPLASTIA AÓRTICA Y SU TRATAMIENTO QUIRÚRGICO / Mitral valve trauma in an infant during aortic valvuloplasty and its surgical treatment

    Directory of Open Access Journals (Sweden)

    Francisco Díaz Ramírez

    2013-04-01

    Full Text Available Resumen: La valvuloplastia con globo es ampliamente aceptada como tratamiento de elección de la estenosis aórtica congénita en recién nacidos y lactantes. Las complicaciones por el procedimiento son bien conocidas pero el daño valvular mitral es infrecuente. Se presenta un paciente masculino, de siete meses de edad, con el diagnóstico de coartación de la aorta y estenosis valvular aórtica a quién se le realizó dilatación de ambas lesiones por cateterismo intervencionista. A las 20 horas del procedimiento se diagnosticó insuficiencia cardíaca grave secundaria a lesión de la valva anterior mitral. Se intervino quirúrgicamente de urgencia y se observó un desgarro en forma de hendidura desde el borde libre hasta el anillo, el cual se reparó y se realizó anuloplastia en la comisura lateral. En el postoperatorio inmediato evolucionó sin complicaciones y al año de seguimiento presenta insuficiencia valvular mitral leve sin signos de recoartación ni de estenosis valvular aórticas. / Abstract: Balloon valvuloplasty is widely accepted as the treatment of choice for congenital aortic stenosis in newborns and infants. Complications from the procedure are well known but mitral valve damage is rare. This is the case of a 7-month-old male patient with the diagnosis of coarctation of the aorta and aortic valve stenosis who underwent dilation of both lesions via catheterization. At 20 hours of the procedure a severe heart failure secondary to an injury of the anterior mitral valve was diagnosed. The patient underwent emergency surgery and a slit-like tear from the free edge to the annulus was observed, which was repaired and annuloplasty in the lateral commissure was performed. In the immediate postoperative period the patient progressed without complications and at one year follow up he shows mild valve regurgitation without evidence of recoarctation or aortic valve stenosis.

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

    Directory of Open Access Journals (Sweden)

    Claire Kelley

    2016-05-01

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

  1. 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.

  2. Folding mitral valvuloplasty without posterior leaflet resection for calcified mitral annulus

    Science.gov (United States)

    Smith, Craig R.; Stamou, Sotiris C.; Boeve, Theodore J.; Patzelt, Lawrence H.

    2012-01-01

    Mitral valve annular calcification has long been a challenge in repairing posterior mitral valve prolapse. Folding valvuloplasty of the posterior leaflet without resection provides a means of circumventing common procedural complications. This report demonstrates the success of folding valvuloplasty without resection in the treatment of mitral valve prolapse and severe annular calcification. PMID:22159235

  3. 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....

  4. Mitral valve regurgitation in twins

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  5. Percutaneous approaches to mitral valve disease

    National Research Council Canada - National Science Library

    Fassa, A-A; Himbert, D; Brochet, E; Bouleti, C; Vahanian, A

    2015-01-01

    Percutaneous approaches to mitral valve disease consist in modifications of existing surgical techniques, aiming to replicate the favourable outcomes of surgery, with less procedure-related risk, due...

  6. Avaliação anatômica da valva tricúspide Anatomic evaluation of the tricuspid valve

    Directory of Open Access Journals (Sweden)

    Fábio B Jatene

    1992-03-01

    Full Text Available O objetivo deste estudo é avaliar dados anatômicos da valva tricúspide e região adjacente que possam auxiliar em procedimentos diagnósticos e cirúrgicos. Em 101 corações humanos normais (84% do sexo masculino, 61 % do grupo étnico branco e com idades entre 9 e 86 anos (30,0 + 15,5, foram analisados os seguintes aspectos: número de cúspides; perímetro do anel tricúspide; distância intercomissural interna e externa; porcentagem de ocupação das cúspides no anel; largura das cúspides e área do triângulo de Koch. Esses aspectos foram relacionados com idade, sexo e grupo étnico. Em nosso material, 73% das valvas apresentavam três cúspides, 26% duas e 1% quatro. O perímetro do anel tricúspide variou de 79 mm a 158 mm(109,6 mm + 12,2 mm, sendo 9% maior no sexo masculino. Com relação à porcentagem de ocupação das cúspides no anel valvar, a cúspide anterior ocupou em média 48% do anel, a septal 36% e a posterior 16%. A área média do triângulo de Koch foi 167,79 mm² + 71,88 mm*, sendo 10% maior no grupo étnico não branco e em faixa etária superior a 30 anos. Em conclusão, valvas tricúspides normais apresentam variações estruturais relacionadas com sexo, idade e grupo étnico.The purpose of this study is to evaluate anatomic data of the tricuspid valve and adjacent area to help in diagnostic and surgical procedures. In 101 normal human fixed hearts (84% male; 61 % white ethnic group and mean age of 30.0 + 15.5 years old, we analysed: number of leaflets; tricuspid ring perimeter; size of leaflets and its occupation in ring perimeter; Koch's triangle area. These aspects were related with age, sex and ethnic group. There were 73% with three, in 26% with two and in 1% with four leaflets. The ring perimeter changed 79 to 158 mm (109.6 +12.2 and was larger (9% in man. Regarding the relative occupation on ring the anterior represented 48%, the septal 36% and the inferior 16% of occupation area in tricuspid ring. The mean

  7. Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.

    Science.gov (United States)

    Commeau, P; Grollier, G; Huret, B; Foucault, J P; Potier, J C

    1987-01-01

    Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:3620253

  8. Desafios técnicos e complicações da dupla substituição valvar na presença de anéis aórtico e mitral pequenos Technical challenges and complications of double valve replacement in the presence of small aortic and mitral annuli

    Directory of Open Access Journals (Sweden)

    Fernando A. Atik

    2006-12-01

    Full Text Available Mulher de 57 anos portadora de cardiopatia reumática com comprometimento das valvas aórtica e mitral foi submetida a uma substituição mitro-aórtica. A presença de anéis aórtico e mitral pequenos contribuiu para uma série de complicações intra-operatórias, como oclusão do óstio coronariano esquerdo e dissociação atrioventricular do tipo III. O sulco foi reparado com generoso enxerto autólogo pericárdico fresco de camada dupla sobreposto por uma prótese mecânica de duplo folheto. No pós-operatório, a paciente desenvolveu insuficiência respiratória prolongada, pneumonia, disfunção miocárdica temporária e insuficiência renal aguda. No final, ela recebeu alta sem problemas residuais.A 57 year old female with rheumatic heart disease affecting both aortic and mitral valves underwent double valve replacement. The presence of small aortic and mitral annuli contributed to a series of intraoperative complications: left coronary ostium occlusion and type III atrioventricular groove disruption. The latter was repaired with a generous fresh autologous pericardial double layer patch and implant of a bileaflet mechanical prosthesis over the patch. Postoperatively, the patient developed prolonged respiratory insufficiency and pneumonia, transient myocardial dysfunction and acute renal failure. She was eventually discharged home without residual defects.

  9. 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.

  10. Double orifice mitral valve; a coincidental finding

    NARCIS (Netherlands)

    Westendorp, Iris C. D.; de Bruin-Bon, H. A. C. M.; Hrudova, Jana

    2006-01-01

    A double orifice mitral valve (DOMV) represents a rare congenital malformation characterised by two valve orifices with two separate subvalvular apparatus. This case demonstrates the necessity of careful imaging of the mitral valve apparatus, not only in patients with atrioventricular septal

  11. 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

  12. 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...

  13. Mitral valve repair in acquired dextrocardia.

    Science.gov (United States)

    Elmistekawy, Elsayed; Chan, Vincent; Hynes, Mark; Mesana, Thierry

    2015-10-01

    Surgical correction of valvular heart disease in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve repair in a patient with acquired dextrocardia. Successful mitral valve repair was performed through a right lateral thoracotomy. We describe our surgical strategy and summarize the literature. © The Author(s) 2014.

  14. Mitral supravalvular ring: a case report

    Directory of Open Access Journals (Sweden)

    Testa Paola

    2005-08-01

    Full Text Available Abstract Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative diagnosis is difficult with transtoracic echo (TTE, angiography and magnetic resonance imaging (MRI. In this case, a 36-year-old male, was admitted to our Heart department: He experienced progressive dyspnea on effort and at rest. Diagnosis was made by transesophageal echocardiography which showed, on apical 4-chamber section, an anulare structure attached since a membrane to the atrial wall anterior mitral valve leaflet and just proximal to the posterior mitral leaflet. Pre-operative identification of the supravalvular mitral ring is the target for obtaining good surgical results. Cineangiography and MRI both failed in reaching this objective, whereas, transesophageal echocardiography is the best method to identify this congenital heart disease. Using TEE the identification is not only possible but also easier.

  15. Mitral stenosis before, during and after pregnancy

    Directory of Open Access Journals (Sweden)

    JW Roos-Hesselink

    2007-07-01

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

  16. Mitral Valve Repair: The Chordae Tendineae

    Directory of Open Access Journals (Sweden)

    Carlos-A Mestres

    2015-10-01

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

  17. 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.

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

    African Journals Online (AJOL)

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

  19. 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.

  20. Redução anular intermitente com plastia de Alfieri no tratamento da insuficiência mitral em crianças: resultados iniciais Intermittent annular reduction with Alfieri's repair in the treatment of mitral insufficiency in children: initial results

    Directory of Open Access Journals (Sweden)

    Moise Dalva

    2009-09-01

    Full Text Available OBJETIVO: A insuficiência mitral com indicação cirúrgica na faixa etária pediátrica deve ser tratada por meio de plastia sempre que possível, evitando-se os inconvenientes da substituição valvar. O objetivo deste trabalho é propor técnica de plastia mitral baseada em abordagem funcional e anatômica. MÉTODOS: Durante período de 13 meses, foram operadas oito crianças (idade de 2 a 12 anos, média de 6,37 ± 3,66 anos portadoras de insuficiência mitral com realização de anuloplastia anterior e posterior de forma intermitente, associadas à plastia de Alfieri (passagem de ponto entre as cúspides no ponto de maior regurgitação, formando valva mitral biorificial. RESULTADOS: Não houve óbito nesta série. Ecocardiografia de controle pós-operatório foi realizada em todos os pacientes, com insuficiência mitral discreta em três pacientes, e sem evidência de insuficiência em cinco pacientes. O tempo de permanência em unidade de terapia intensiva variou de 2 a 4 dias (2,5 ± 0,75, e o tempo de internação hospitalar variou de 5 a 8 dias (6,37 ± 1,06. CONCLUSÃO: Apesar do tamanho limitado da amostra, a opção proposta revelou-se eficaz na avaliação imediata do tratamento da insuficiência mitral isolada em crianças. O acompanhamento dos pacientes faz-se necessário para avaliação dos resultados em longo prazoOBJECTIVE: Mitral valve insufficiency must be treated by repair whenever as possible as it provides better results - especially within the pediatric population in order to avoid valve replacement inconvenients. The aim of this study is to describe mitral valve repair technique based on an anatomical and functional approach. METHODS: During a 13 months period, eight children (age ranged from 2 and 12 years old 6.37 ± 3.66 with mitral valve insufficiency underwent intermittent anterior and posterior annuloplasty associated with Alfieri's repair - performed by placing a stitch between the anterior and posterior

  1. Dura mater mitral and tricuspid bioprostheses: 30 years of follow-up Bioprótese de dura mater mitral e tricúspide: 30 anos de acompanhamento

    Directory of Open Access Journals (Sweden)

    Luiz Boro Puig

    2003-01-01

    livre de reoperação, 18,8% ± 7,5%. CONCLUSÕES: A bioprótese de dura-mater teve mais importante papel no tratamento de pacientes com lesão das valvas mitral e tricúspide. A baixa taxa de tromboembolismo e o longo período de seguimento sem disfunção valvar em vários pacientes são importantes características desta bioprótese.

  2. Valve reconstruction for congenital mitral valve disease.

    Science.gov (United States)

    Quinonez, Luis G; Del Nido, Pedro J

    2015-01-01

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

  3. Traumatic Mitral Valve and Pericardial Injury

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    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  4. Computer tomographic findings in mitral valve disease

    Energy Technology Data Exchange (ETDEWEB)

    Heuser, L.; Neufang, K.F.R.; Jansen, W.

    1984-04-01

    In 38 patients suffering from mitral valve disease the findings of cardiac CT scans were compared to the results of echocardiographic, standard roentgenographic, and cineangiocardiographic studies as well as to intraoperative and histological findings. CT proved to be superior to the other imaging modalities in detecting mitral calcifications and in demonstrating the morphological changes, but cannot replace cardiac catheterization as it does not yield haemodynamic data. The indication for CT in mitral valve disease therefore is restricted to cases with extremely enlarged left atria in which the other methods do not provide satisfactory visualization, and to patients with suspected intracavitary thrombus or tumor. 8 figs.

  5. 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.

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

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    Omar Ahmad Araji Tiliani

    2013-04-01

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

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

    Science.gov (United States)

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

    2011-07-01

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

  8. Atuação da enfermagem na utilização do catéter venoso totalmente implantável (CVTI

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    Rosemeire A. Mendes Lopes

    1993-06-01

    Full Text Available As autoras fizeram um levantamento de 41 casos de utilização do cateter venoso totalmente implantável usados para tratamento com drogas antineoplásicas. Descreveram os motivos que levaram o serviço a utilizar este sistema para infusão e analisaram sua utilização, seu controle e as intercorrências. Os resultados, embora tenham mostrado um índice de complicações de 29%, incluindo falhas na técnica de implantação e no manuseio, apresentaram um bom índice de aproveitamento, ou seja, 61%.

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

    African Journals Online (AJOL)

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

  10. Repair of Concomitant Double Orifice Mitral and Tricuspid Valves.

    Science.gov (United States)

    Saxena, Rachit; Talwar, Sachin; Gharde, Parag; Kumar, Manikala Vinod; Choudhary, Shiv Kumar

    2016-01-01

    The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old boy with double orifice mitral and tricuspid valves requiring surgical correction of hemodynamically significant mitral and tricuspid stenosis. © The Author(s) 2015.

  11. Echocardiographic anatomy of the mitral valve in healthy dogs and dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Wesselowski, S; Borgarelli, M; Menciotti, G; Abbott, J

    2015-06-01

    To further characterize the echocardiographic anatomy of the canine mitral valve apparatus in normal dogs and in dogs affected by myxomatous mitral valve disease (MMVD). Twenty-two normal dogs and 60 dogs with MMVD were prospectively studied. The length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet were measured in the control group and the affected group, as were the diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs). The dogs with MMVD were staged based on American College of Veterinary Internal Medicine (ACVIM) guidelines and separated into groups B1 and B2/C. All measurements were indexed to body weight based on empirically defined allometric relationships. There was a statistically significant relationship between all log10 transformed mitral valve dimensions and body weight. The AMVL, AMVW, AMVA, MVAd and MVAs were all significantly greater in the B2/C group compared to the B1 and control groups. The AMVW was also significantly greater in the B1 group compared to the control group. Interobserver % coefficient of variation (% CV) was mitral valve leaflet and the mitral valve annulus in the dog can be indexed to body weight based on allometric relationships. Preliminary reference intervals have been proposed over a range of body sizes. Relative to normal dogs, AMVL, AMVW, AMVA, MVAd and MVAs are greater in patients with advanced MMVD. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Avaliação funcional do apêndice atrial esquerdo ao ecocardiograma transesofágico antes e após valvotomia percutânea na estenose mitral Functional assessment of the left atrial appendage at transesophageal echocardiography before and after percutaneous valvotomy in the mitral stenosis

    Directory of Open Access Journals (Sweden)

    Solange Bernardes Tatani

    2005-06-01

    Full Text Available OBJETIVO: Avaliar os efeitos da abertura efetiva da valva mitral estenótica através da valvotomia percutânea por cateter balão na função do apêndice atrial esquerdo. MÉTODOS: Foram estudados 12 pacientes com estenose mitral sintomática, em ritmo sinusal, submetidos ao ecocardiograma transesofágico antes e após valvotomia percutânea por cateter balão efetiva. Em relação ao apêndice atrial esquerdo, foram analisadas ao Doppler pulsátil as velocidades máximas e respectivas integrais dos fluxos anterógrado e retrógrado, além da fração de ejeção calculada pela planimetria da área desta estrutura. RESULTADOS: Houve aumento significante das velocidades de fluxo anterógrado do apêndice atrial esquerdo após valvotomia percutânea por cateter balão (pré: média de 0,30 m/s; pós: média de 0,47 m/s; pOBJECTIVE: To assess the effects of the relief of the mitral stenosis by percutaneous ballon valvotomy in the function of the left atrial appendage. METHODS: Twelve patients with symptomatic mitral stenosis, in sinus rhythm, were studied. They were submitted to the transesophageal echocardiogram before and after effective percutaneous ballon valvotomy. Concerning the left atrial appendage, the peak flow velocities and the respective integral of the anterograde and retrograde flow, in addition to the ejection fraction calculated through the planimetry of the area of that structure, were analyzed at the pulsatile Doppler. RESULTS: There was a significant increase of the anterograde flow velocity of the left atrial appendage after percutaneous ballon valvotomy (pre: mean of 0.30 m/s; post: mean of 0.47 m/s; p<0.05 and their respective integrals. The same happened with the retrograde flow velocity (pre: mean of 0.35 m/s, post: mean of 0.53 m/s; p<0.05. There was a tendency of increase of the ejection fraction of the left atrial appendage after the procedure (pre: mean of 20%, post: mean of 31%; p=0.08. CONCLUSION: The effective

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

    Marchese, Nicola; Facciorusso, Antonio; Vigna, Carlo

    2015-12-01

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

  15. In vitro balloon dilatation of mitral valve stenosis: the importance of subvalvar involvement as a cause of mitral valve insufficiency

    NARCIS (Netherlands)

    Sadee, A. S.; Becker, A. E.

    1991-01-01

    To investigate the mechanism that increases the orifice area of the mitral valve during balloon dilatation 43 surgically excised intact rheumatic mitral valves were studied. The main pathological features were (a) fibrosis of mitral valve leaflets and commissures (10 valves); (b) fibrosis with

  16. Piezogenic pedal papules with mitral valve prolapse

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    Cihan Altin

    2016-01-01

    Full Text Available Piezogenic pedal papules (PPP are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases.

  17. The serpentine mitral valve and cerebral embolism

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    Ker James

    2011-02-01

    Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

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

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    Deniz Demir

    2014-06-01

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

  19. Rupture of mitral valve chordae in hypertrophic cardiomyopathy.

    Science.gov (United States)

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

    2015-04-01

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

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

    Science.gov (United States)

    Voilliot, Damien; Lancellotti, Patrizio

    2017-03-01

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

  1. 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.

  2. 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

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2002-01-01

    Full Text Available INTRODUÇÃO: O acesso cirúrgico por esternotomia mediana e atriotomia subseptal clássica pode, em certos casos, resultar em má exposição da valva mitral. Incisões atriais alternativas otimizam a exposição da valva mitral mas podem interferir na atividade elétrica atrial pós-operatória. OBJETIVO: Padronizar método para investigar a atividade elétrica atrial para emprego em estudos comparativos de diferentes atriotomias em cardiopatas sumetidos à cirurgia cardíaca. MÉTODOS: Análise com eletrocardiograma convencional e de 24 h (sistema Holter, pré e pós-operatória, e cardioestimulação epicárdica pós-operatória pelo método de Narula, em 10 pacientes submetidos à correção de valvopatias mitrais. RESULTADOS: No pré-op., os pacientes em ritmo sinusal apresentaram ectopias supraventriculares, com episódios de taquicardia supraventricular em 57% dos casos, "flutter" atrial em 10% e ritmo juncional em 10%. Todos apresentaram ectopias ventriculares, de baixa incidência em 70% dos casos, e taquicardia ventricular não sustentada foi detectada em 30% dos pacientes. No pós-operatório, houve 40% de novas arritmias supraventriculares (fibrilação atrial, ritmo juncional, ritmo atrial baixo e taquicardia supraventricular paroxística, mas não ocorreram arritmias ventriculares. No pós-op. a função do nó sinusal não se alterou, ocorreu redução significativa das ectopias supraventriculares, com reversão de FA para ritmo sinusal em 1 paciente, mas não houve redução significativa das ectopias ventriculares. O tempo de condução inter-atrial correlacionou-se com o tamanho do átrio esquerdo. CONCLUSÃO: A metodologia mostrou-se adequada e segura, e poderá ser empregada na comparação de diferentes incisões atriais para exposição valvar mitral.INTRODUCTION: The selection of the surgical approach to the mitral valve is a critical factor in obtaining good exposure and minimizing lesions of the surrounding structures

  3. Balloon expandable transcatheter heart valves for native mitral valve disease with severe mitral annular calcification.

    Science.gov (United States)

    Guerrero, Mayra; Urena, Marina; Pursnani, Amit; Wang, Dee D; Vahanian, Alec; O'Neill, William; Feldman, Ted; Himbert, Dominique

    2016-06-01

    Patients with mitral annular calcification (MAC) have high surgical risk for mitral valve replacement due to associated comorbidities and technical challenges related to calcium burden, precluding surgery in many patients. Transcatheter mitral valve replacement (TMVR) with the compassionate use of balloon expandable aortic transcatheter heart valves has been used in this clinical scenario. The purpose of this review was to summarize the early experience including successes and failures reported. TMVR might evolve into an acceptable alternative for selected patients with severe MAC who are not candidates for conventional mitral valve surgery. However, this field is at a very early stage and the progress will be significantly slower than the development of transcatheter aortic valve replacement due to the complexity of the mitral valve anatomy and its pathology. Optimizing patient selection process by using multimodality imaging tools to accurately measure the mitral valve annulus and evaluate the risk of left ventricular outflow tract obstruction is essential to minimize complications. Strategies for treating and preventing left ventricular outflow tract obstruction are being tested. Similarly, carefully selecting candidates avoiding patients at the end of their disease process, might improve the overall outcomes.

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

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

    2013-06-01

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

  6. 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.

  7. 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...

  8. Minimally Invasive Mitral Valve Surgery III

    Science.gov (United States)

    Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

    2016-01-01

    Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

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

    Science.gov (United States)

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

    2014-09-01

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

  10. Tricuspid valve dysplasia and Ebstein's anomaly in dogs: case report Displasia da valva tricúspide e anomalia de Ebstein em cães: relato de caso

    Directory of Open Access Journals (Sweden)

    M.G. Sousa

    2006-10-01

    Full Text Available Two cases of tricuspid valve dysplasia are reported. Dogs were presented for evaluation of weakness and ascites. In both cases, echocardiography disclosed tricuspid insufficiency and, in one of them, tricuspid leaflets also were displaced down into the right ventricle, substantiating Ebstein's anomaly. Medical therapy for congestive heart failure was initiated. One of the dogs suddenly died shortly after diagnosis was established. Although the other dog recovered much better initially, sudden death also occurred. Post-mortem examinations showed right atrioventricular enlargement, and thickened tricuspid leaflets. Clinical features, diagnostic methods and medical therapy are discussed in this paper.Dois casos de displasia da valva tricúspide são relatados neste trabalho. Os cães foram avaliados devido à fraqueza e presença de ascite. Em ambos os casos, o exame ecocardiográfico mostrou insuficiência tricúspide e, em um deles, a inserção dos folhetos da valva tricúspide encontrava-se deslocada para baixo do ventrículo direito, caracterizando a anomalia de Ebstein. A terapia medicamentosa para insuficiência cardíaca congestiva foi iniciada, mas um dos animais veio a óbito subitamente alguns dias após o diagnóstico. O outro cão, apesar de inicialmente ter apresentado melhora significativa do quadro clínico, apresentou morte súbita. A necropsia dos animais revelou dilatação atrioventricular direita e folhetos tricúspides espessados. As características clínicas, métodos de diagnóstico e terapia medicamentosa são discutidas neste artigo.

  11. Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática Surgical treatment of atrial fibrillation using bipolar radiofrequency ablation in rheumatic mitral disease

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    Leonardo Secchin Canale

    2011-12-01

    Full Text Available OBJETIVO: Avaliar a eficácia do tratamento cirúrgico da fibrilação atrial (FA utilizando ablação com radiofrequência bipolar durante cirurgia cardíaca de procedimentos mitrais de etiologia reumática. MÉTODOS: Foram avaliados, retrospectivamente, os prontuários e exames de 53 pacientes submetidos à cirurgia valvar mitral, com ou sem cirurgia tricúspide ou aórtica associada, em que foi realizada ablação de FA utilizando radiofrequência bipolar. Trinta e quatro (64% pacientes eram mulheres e a idade variou de 27 a 72 anos (média: 49,3 anos ± 10,7 anos. O tempo médio de FA relatado foi de 41 meses (variou de 3 a 192 meses. O tipo de FA apresentado foi: paroxística em oito pacientes, persistente em três, permanente em 42. O átrio esquerdo apresentava tamanho médio de 52,9 ± 8,5 mm. As cirurgias realizadas foram: 47 trocas de valva mitral e seis plastias mitrais. O seguimento eletrocardiográfico foi completo em 83% dos pacientes, ao final de 14 meses. Informações adicionais oriundas de Holter 24h foram exploradas. RESULTADOS: Ocorreram sete (13% óbitos per-operatórios e a sobrevida após 14 meses foi de 87%. Os ritmos cardíacos encontrados após um ano de cirurgia foram: sinusal em 25 (66% pacientes, FA em sete (18%, Flutter em cinco (13%, Juncional em um (3%. CONCLUSÃO: O uso de radiofrequência bipolar para tratamento de FA em pacientes submetidos à cirurgia valvar mitral de origem reumática é efetivo no controle da arritmia em 68% dos pacientes, após 14 meses.OBJECTIVE: To analyze the effectiveness of surgical treatment of atrial fibrillation (AF using bipolar radiofrequency ablation during mitral valve procedures of rheumatic etiology in heart surgery. METHODS: We retrospectively reviewed medical registries of 53 patients submitted to atrial ablation with bipolar radiofrequency energy during mitral valve surgery. Thirty four (64% patients were women and the age varied from 27 to 72 years old (average: 49.3 ± 10

  12. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons.

    Science.gov (United States)

    Silverman, Norman H

    2014-12-01

    I surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

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

    Science.gov (United States)

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

    2017-08-01

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

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

    Science.gov (United States)

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

    2016-02-15

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

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

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    Jagdish C. Mohan

    2016-09-01

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

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

    Science.gov (United States)

    Pant, Sadip; Grubb, Kendra J

    2017-11-27

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

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

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

    1993-02-01

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

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

    Science.gov (United States)

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

    2014-03-01

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

  19. 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.

  20. An unusual instance of mitral valve prolapse in endomyocardial fibrosis

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    Dalal J

    1978-01-01

    Full Text Available This is a report of an unusual case showing a mitral valve prolapse in the presence of a biventricular endomyocardial fibrosis (EMF. The EMF was strongly suspected on left ventricular angiography and later proved at autopsy. The prolapse of the mitral valve was detected at echocardiography. To the best of our knowledge this is the first report of a case of EMF associated with mitral valve prolapse.

  1. Anatomy of the Mitral Valve Apparatus – Role of 2D and 3D Echocardiography

    Science.gov (United States)

    Dal-Bianco, Jacob P.; Levine, Robert A.

    2013-01-01

    The mitral valve apparatus is a complex three–dimensional functional unit that is critical to unidirectional heart pump function. This review details the normal anatomy, histology and function of the main mitral valve apparatus components 1) mitral annulus, 2) mitral valve leaflets, 3) chordae tendineae and 4) papillary muscles. 2 and 3 dimensional Echocardiography is ideally suited to examine the mitral valve apparatus and has provided insights into the mechanism of mitral valve disease. An overview of standardized image acquisition and interpretation is provided. Understanding normal mitral valve apparatus function is essential to comprehend alterations in mitral valve disease and the rationale for repair strategies. PMID:23743068

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

    Science.gov (United States)

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

    2011-10-01

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

  3. 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.

  4. Numerical simulation of mitral valve function

    OpenAIRE

    Lau, K. D.

    2012-01-01

    In the mammalian heart there are four heart valves (HV), of which the largest is the mitral valve (MV). Key components in the circulatory system, correct HV function is vital to cardiovascular health. A tethered and asymmetric structure, the MV regulates unidirectional flow between the left atrium and left ventricle. MVfunction is divided between systole/closure, where theMVis required to sustain a pressure load ~120 mmHg whilst minimising flow reversal, and diastole/opening in wh...

  5. Reconstruction of aorto-mitral continuity with a handmade aorto-mitral bioprosthetic valve for extensive bivalvular endocarditis†

    OpenAIRE

    Tedoriya, Takeo; Hirota, Masanori; Ishikawa, Noboru; Omoto, Tadashi

    2012-01-01

    Surgical treatment is effective to exclude all infected tissue in patients with infective endocarditis. Although various techniques have been reported, it has remained a great challenge for patients with extensive infected regions. A patient with extensive bivalvular endocarditis including the aortic and mitral valve and aorto-mitral continuity is described. A handmade aorto-mitral bioprosthetic valve was created to reconstruct the defect after extensive debridement. The patient was discharge...

  6. Reconstruction of aorto-mitral continuity with a handmade aorto-mitral bioprosthetic valve for extensive bivalvular endocarditis†

    Science.gov (United States)

    Tedoriya, Takeo; Hirota, Masanori; Ishikawa, Noboru; Omoto, Tadashi

    2013-01-01

    Surgical treatment is effective to exclude all infected tissue in patients with infective endocarditis. Although various techniques have been reported, it has remained a great challenge for patients with extensive infected regions. A patient with extensive bivalvular endocarditis including the aortic and mitral valve and aorto-mitral continuity is described. A handmade aorto-mitral bioprosthetic valve was created to reconstruct the defect after extensive debridement. The patient was discharged on the 30th postoperative day without inflammatory signs. PMID:23169876

  7. Reconstruction of aorto-mitral continuity with a handmade aorto-mitral bioprosthetic valve for extensive bivalvular endocarditis.

    Science.gov (United States)

    Tedoriya, Takeo; Hirota, Masanori; Ishikawa, Noboru; Omoto, Tadashi

    2013-03-01

    Surgical treatment is effective to exclude all infected tissue in patients with infective endocarditis. Although various techniques have been reported, it has remained a great challenge for patients with extensive infected regions. A patient with extensive bivalvular endocarditis including the aortic and mitral valve and aorto-mitral continuity is described. A handmade aorto-mitral bioprosthetic valve was created to reconstruct the defect after extensive debridement. The patient was discharged on the 30th postoperative day without inflammatory signs.

  8. Pulmonary hypertension in rheumatic mitral stenosis revisited.

    Science.gov (United States)

    Pourafkari, L; Ghaffari, S; Ahmadi, M; Tajlil, A; Aslanabadi, N; Nader, N D

    2017-12-01

    In patients with mitral stenosis (MS), pulmonary hypertension (PH) is a significant contributor to the associated morbidity. We aimed to study factors associated with the presence of significant PH (sPH) and whether incorporating body surface area (BSA) in the mitral valve area (MVA) would improve the predictive value of the latter. The medical records of 558 patients with severe MS undergoing percutaneous balloon mitral commissurotomy were evaluated over a period of 8 years. Factors associated with the presence of significant PH (sPH) defined as mPAP ≥ 40 mm Hg were examined. A total of 558 patients (423 women) were enrolled. Overall, 153 (27%) patients had sPH. Patients with sPH were similar to the rest of the subjects in terms of demographics, body habitus, blood group, and incidence of atrial fibrillation. Among echocardiographic findings, absolute MVA, indexed MVA, and mean transmitral valve gradient were associated with the presence of sPH. Transmitral valve gradient during right heart catheterization had the highest area under the curve for an association with sPH. Age, gender, heart rhythm, and blood group were not associated with the presence of sPH in severe MS. The predictive value of the indexed MVA for the presence of sPH was not higher than that of absolute MVA.

  9. Robotic mitral valve replacement for severe rheumatic mitral disease: perioperative technique, outcomes, and early results.

    Science.gov (United States)

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

    2014-01-01

    We report a case series of robotic mitral valve replacement in patients with severe rheumatic mitral disease. From March 2010 to June 2013, a total of 63 patients underwent robotic cardiac procedures. Robotic procedures were performed using the da Vinci Si surgical systems (Intuitive Surgical, Inc, Sunnyvale, CA USA). Eighteen of the patients (28.5%) underwent robotic mitral valve replacement. Rheumatic disease was the underlying pathology in all patients. The mean (SD) follow-up period was 18 (10) months. The mean (SD) age and EuroSCORE of the patients were 51.2 (11) years and 4.1% (4%), respectively. Seven patients (38.8%) had an additional cardiac procedure. No operative and hospital mortality were observed. The mean (SD) cross-clamp time and cardiopulmonary bypass time were 116 (30) and 178 (54) minutes, the mean (SD) drainage was 430 (350) mL, the mean intubation time was 9.4 (7) hours, the rate of patients extubated within 6 hours or less was 94.4%, and the mean (SD) intensive care unit stay time was 30 (12) hours. Sixteen of the patients (88.8%) were discharged from the intensive care unit within the first 24 hours postoperatively. During the intensive care unit stay, one patient (5.5%) needed inotropic support. There was one early reoperation for bleeding (5.5%), one (5.5%) intensive care unit readmission, and one (5.5%) hospital readmission observed. During the midterm follow-up, there was no mortality and no need for reoperation or reintervention. Robotic mitral valve replacement for severe rheumatic mitral disease is technically feasible. Early results are encouraging. Patient selection criteria for robotic mitral valve surgery may be expanded to include valve replacements.

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

    Directory of Open Access Journals (Sweden)

    Cláudio Henrique Fischer

    1998-12-01

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

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

    Science.gov (United States)

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

    2009-05-19

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

  12. 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

  13. Manejo médico-quirúrgico del fibroelastoma papilar de la válvula mitral, diagnosticado durante la gestación

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    Nestor Pereira

    2012-07-01

    Full Text Available El Fibroelastoma papilar es una neoplasia cardiaca benigna, poco frecuente cuya incidencia es menor a 0,0017%. Se diagnostica como hallazgo ecocardiográfico, o estudios post mortem. La mayoría cursan asintomáticos, sin embargo, presentan como complicación, la formación de émbolos. Este tumor no muestra preferencia por edad ni sexo, pero si por sitio anatómico, con características morfológicas bien definidas. Femenina, de 27 años, gestante, con antecedentes de extrasístoles ventriculares desde el año 2002 y referida al Servicio de Cardiología por presentar ictus. El ecocardiograma transesofágico, muestra masa con configuración de “anémona” en válvula mitral, adosada a la cara auricular de la valva anterior, de 7 x 7mm, e insuficiencia mitral trivial por Doppler color. Se decide resección quirúrgica. El estudio histopatológico del espécimen biopsico concluye como Fibroelastoma papilar. El Fibroelastoma papilar tiene presentación clínica variable, desde asintomático hasta causar la muerte por obstrucción valvular o embolismo periférico. Las manifestaciones clínicas más frecuentes son disnea, sincope, dolor torácico y arritmias. La resección de la tumoración es el tratamiento de elección aunado al cambio valvular si es necesario y, en algunos casos, la resección del endotelio cardiaco y posterior reparación de la zona. Reportamos el manejo médico-quirúrgico del primer caso de fibroelastoma papilar informado en el IAHULA. Palabras clave: Fibroelastoma papilar, válvula mitral, gestación. Medical management surgical papillary fibroelastoma mitral valve diagnosed during pregnancy Abstract The papillary fibroelastoma is a benign cardiac neoplasm, uncommon, occurring in less than 0.0017%. It is diagnosed incidentally by echocardiography or postmortem studies. Most asymptomatic for, however, present as a complication, the formation or emboli. This tumor shows no preference for age or sex, but by anatomical site

  14. Tensión de límite elástico en monocristales de circonia totalmente estabilizada con alto contenido en óxido de itrio

    Directory of Open Access Journals (Sweden)

    Gallardo, A.

    2001-04-01

    Full Text Available The yield stress of cubic stabilized zirconia single crystals with yttria concentrations between 24 to 32 mol % has been studied for temperatures of 1400 °C by compression experiments on the <112> crystalographic axis at constant compressive strain rate. The yield stress reaches a value of 300 MPa, remaining constant for the higher concentration studied, and being also independent of the annealing time in air. The plastic behavior is discussed in terms of the interaction of dislocations with the free yttrium defects.

    Se ha estudiado la tensión de dominio plástico en aire, en monocristales de circonia totalmente estabilizada con contenido en óxido de itrio entre 24 y 32 mol %, a velocidades de deformación constante y temperatura de 1.400 °C. Los monocristales se deformaron por compresión uniaxial en el eje correspondiente a la dirección cristalográfica <112>. La tensión de límite elástico obtenida es de 300 MPa, permaneciendo constante para las concentraciones estudiadas superiores y siendo independiente de tratamientos térmicos en aire. Se discute el comportamiento plástico en función de la interacción de las dislocaciones con los defectos de itrio libres.

  15. Validação de procedimentos operacionais padrão no cuidado de enfermagem de pacientes com cateter totalmente implantado

    Directory of Open Access Journals (Sweden)

    Rita Paiva Pereira Honório

    2011-10-01

    Full Text Available Os protocolos de assistência são recursos tecnológicos importantes na prática de saúde e devem ser validados, para adquirirem credibilidade científica na prática profissional. O objetivo desta pesquisa foi validar os itens de proposta de procedimentos operacionais padrão (POPs quanto à punção, heparinização e curativo do cateter totalmente implantado, por meio da análise de conceito proposta por Hoskins. O estudo se deu em duas etapas. Na primeira, elaborou-se um formulário para validação dos POPs. Na segunda, avaliou-se o conteúdo dos POPs por peritos. As sugestões versaram sobre reformulação da redação; acréscimo de ações, tornando-o mais claro e abrangente; a ordem dos passos dos procedimentos; e o material para a adequação do instrumento. Constatou-se a necessidade de outros estudos que direcionem os profissionais, principalmente, quanto à heparinização dos cateteres e à troca do primeiro curativo após punção, no sentido de uniformizar condutas embasadas em evidências científicas seguras.

  16. 149. Reparación valvular mitral en endocarditis

    Directory of Open Access Journals (Sweden)

    J. Rodríguez-Roda Stuart

    2010-01-01

    Conclusiones: Con la suficiente experiencia en reparación mitral, la reparación de la válvula mitral con endocarditis se puede realizar con una baja mortalidad quirúrgica además de aportar las ventajas de conservar la válvula nativa con una baja tasa de reoperación.

  17. Joint hypermobility syndrome and mitral valve prolapse in panic disorder.

    Science.gov (United States)

    Gulpek, Demet; Bayraktar, Erhan; Akbay, Sebnem Pirildar; Capaci, Kazým; Kayikcioglu, Meral; Aliyev, Emil; Soydas, Cahide

    2004-09-01

    The purpose of this study is to test the association between joint hypermobility syndrome (JHS) and panic disorder (PD) and to determine whether mitral valve prolapse (MVP) modifies or accounts in part for the association. A total of 115 subjects are included in this study in three groups. Group I (n = 42): panic disorder patients with MVP. Group II (n = 35): panic disorder patients without mitral valve prolapse. Group III (n = 38): control subjects who had mitral valve prolapse without any psychiatric illness. Beighton criteria were used to assess joint hypermobility syndrome. Two-dimensional and M-mode echocardiography was performed on each subject to detect mitral valve prolapse. Joint hypermobility syndrome was found in 59.5% of panic disorder patients with mitral valve prolapse, in 42.9% of patients without mitral valve prolapse and in 52.6% of control subjects. Beighton scores was 4.93 +/- 2.97 in group I, 4.09 +/- 2.33 in group II, and 4.08 +/- 2.34 in group III. There was no significant difference between groups according to Beighton scores. We did not detect a statistically significant relationship between panic disorder and joint hypermobility syndrome. Mitral valve prolapse and joint hypermobility syndrome are known to be etiologically related and we suggest that mitral valve prolapse affects the prevalence of joint hypermobility syndrome in the panic disorder patients.

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

    African Journals Online (AJOL)

    Ibrahim Eldaghayes

    2017-11-02

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

  19. 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...

  20. Optimized strategies for the management of Mitral Valve Disease

    NARCIS (Netherlands)

    Jansen, R.

    2017-01-01

    Mitral valve disease is one of the most prevalent valvular heart diseases. This thesis aims to investigate and optimize the management of mitral valve disease, focusing on the improvement of current diagnostic and treatment strategies. Two central questions are discussed: 1) how can we optimize

  1. Anomalous pulmonary venous drainage associated with mitral valve disease

    NARCIS (Netherlands)

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

    1969-01-01

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

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

    Science.gov (United States)

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

    2016-03-26

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

  3. Closed Mitral Valvotomy-a Life Saving Procedure in Facility ...

    African Journals Online (AJOL)

    DELL

    Acquired Mitral valve stenosis is the sequela of rheumatic heart disease due to rheumatic fever which is commonly seen in developing countries and no longer in developed countries1,2,3,4,5,6. Definitive treatment for rheumatic mitral valve stenosis is valve replacement which can be either mechanical or biological.

  4. Avaliação das concentrações séricas de adiponectina e sua correlação com obesidade e endocardiose de valva mitral em cães

    OpenAIRE

    Fabrício Lorenzini Aranha Machado

    2012-01-01

    A obesidade é definida como acúmulo excessivo de gordura corpórea, derivada de um desequilíbrio crônico entre energia ingerida e gasta. Neste desequilíbrio estão relacionados fatores como estilo de vida (dieta e atividade física), alterações neuro-endócrinas e fatores hereditários (MARQUES-LOPES et al., 2004). A obesidade não acomete apenas seres humanos, tornando-se um elemento importante de estudos e pesquisas, inclusive em animais de companhia como cães e gatos. O diagnóstico da obesidade ...

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

    Directory of Open Access Journals (Sweden)

    Boccardi Lidia

    2010-07-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  7. Manejo do cateter venoso central totalmente implantado em pacientes oncológicos: revisão integrative Manejo del catéter venoso central totalmente implantado en pacientes oncológicos: revisión integrativa Management of totally implanted catheter in patients with cancer: an integrative review

    Directory of Open Access Journals (Sweden)

    Christiane Inocêncio Vasques

    2009-10-01

    Full Text Available O cateter totalmente implantado é amplamente utilizado durante o tratamento de pacientes com câncer e é capaz de minimizar complicações decorrentes da terapia intravenosa periférica. Assim, buscou-se identificar os cuidados de enfermagem relacionados ao manuseio de cateter totalmente implantado nesses pacientes. Para tanto, realizou-se revisão integrativa da literatura que resultou na análise de 15 artigos. O conhecimento produzido está direcionado para o tempo de permanência do cateter, complicações inerentes ao uso, manuseio do dispositivo, percepção do paciente em relação ao cateter e informações ao paciente. Além de demonstrar a complexidade da assistência de enfermagem no manuseio desses dispositivos, os achados podem auxiliar, igualmente, os profissionais que não atuam em oncologia, na aplicação de conhecimentos na prática clínica.El catéter totalmente implantado es ampliamente utilizado durante el tratamiento de pacientes con cáncer y es capaz de minimizar las complicaciones consecuentes de la terapia intravenosa periférica. Así, en este trabajo, se buscó identificar los cuidados de enfermería relacionados a la manipulación del catéter totalmente implantado en esos pacientes. Para tal efecto, se realizó una revisión integrativa de la literatura dando como resultado el análisis de 15 artículos. El conocimiento producido está orientado hacia el tiempo de permanencia del catetér, complicaciones inherentes al uso, manipulación del dispositivo, informaciones y percepción del paciente en relación al catéter. Aparte de demostrar la complejidad de la asistencia de enfermería en la manipulación de esos dispositivos, los hallazgos pueden auxiliar, igualmente, a los profesionales que no actúan en oncología, en la aplicación de conocimientos en la práctica clínica.Totally implanted catheter, which is effective in deceasing complications related to peripheral intravenous therapy, is widely used in

  8. Influência da operação de Cox no tratamento da fibrilação atrial em valvopatia mitral reumática: análise comparativa de resultados imediatos e tardios

    Directory of Open Access Journals (Sweden)

    Marcelo B. Jatene

    1998-04-01

    Full Text Available Este estudo visa avaliar a operação de Cox no tratamento da fibrilação atrial (FA de etiologia reumática em pacientes (pts portadores de valvopatia mitral. No período de julho 1991 a junho 1994, 55 pts valvopatas mitrais reumáticos (35 dupla lesão e 19 estenose e FA associada foram operados. A média de idades era de 51,5 anos (16 a 74 a, 47 femininos. Todos se encontravam no pré-operatório em ICC CF III ou IV. Segundo o tipo de operação, foram identificados dois grupos: G I - 20 pts submetidos a operação da valva mitral e operação de Cox para tratamento da FA e G II - 35 pts operados apenas da valva mitral. Eco pré-operatório mostrou diâmetro de átrio esquerdo semelhante em G I e G II (5,35 e 5,57 mm; p = 0,779. Em 24 pts a valva mitral foi substituída por bioprótese de pericárdio bovino e preservada em 31. Observaram-se 3 óbitos hospitalares, sendo 1 no G I. Detectou-se FA na UTI em 82,4% dos pts do G II, mantida em 76,5% em período de evolução de 37,7 meses; no G I, 21,1% dos pts apresentaram FA na UTI, mantida em 5,3% em período de evolução de 37,4 meses (p = 0,0001. Seis (20,6% pts do G II apresentaram no pós-operatório episódios de embolia sistêmica (em FA e um paciente apresentou episódio de embolia pulmonar, contra nenhum episódio detectado nos pacientes do G I (p = 0,041. Em conclusão, a operação de Cox mostrou-se eficaz no controle tardio da FA e prevenção de embolia, com baixa morbimortalidade, devendo ser considerada como opção nos portadores de FA associada à valvopatia mitral.The aim of this study is to evaluate the influence of the Maze Procedure in the treatment of rheumatic atrial fibrillation (AF in patients with mitral valve disease (MVD. Between July 91 and June 94, 55 patients with rheumatic MVD (35 double dysfunction and 19 stenosis and associated AF were operated on. The mean age was 51 yrs and 47 were female. All pts were in FC (NYHA III or IV pre operatively. The patients were

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

    Science.gov (United States)

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

    2017-08-08

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

  10. 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...

  11. ECG-gated multi-detector row CT for assessment of mitral valve disease: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Willmann, Juergen K.; Roos, Justus E.; Hilfiker, Paul R.; Marincek, Borut; Weishaupt, Dominik [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Kobza, Richard; Jenni, Rolf; Luescher, Thomas F. [Clinic of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Lachat, Mario [Clinic of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-11-01

    Our objective was to evaluate applicability and image quality of contrast-enhanced, retrospectively ECG-gated multi-detector row CT (MDCT) for visualization of anatomical details of the mitral valve and its apparatus, and to determine the value of MDCT for diagnosing abnormal findings of the mitral valve. Twenty consecutive patients with mitral valve disease underwent MDCT preoperatively. Two readers assessed visibility of the mitral valve annulus, mitral valve leaflets, tendinous cords, and papillary muscles by using a four-point Likert grading scale. Abnormal mitral valve findings [thickening of the mitral valve leaflets, presence of mitral annulus calcification (MAC), and calcification of the valvular leaflets] were compared with preoperative echocardiography and intraoperative findings. Visibility of the mitral valve annulus and mitral valve leaflets was good or excellent in 15 patients (75%) and in 19 patients (95%) for papillary muscles. The MDCT yielded a 95-100% agreement compared with echocardiography and surgery with regard to the assessment of mitral valve leaflet thickening and the presence of calcifications of the mitral valve annulus or mitral valve leaflets. Intermodality agreement between MDCT and echocardiography was excellent with regard to classification of mitral valve leaflet thickness ({kappa}=1.00) and good regarding classification of MAC thickness ({kappa}=0.73). Contrast-enhanced, retrospectively ECG-gated MDCT allows good to excellent visualization of anatomical details of the mitral valve and its apparatus, and demonstrates good agreement with echocardiography and surgery in diagnosing mitral valve abnormalities. (orig.)

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

    OpenAIRE

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

    2000-01-01

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

  13. 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.

  14. Resultado clínico tardio da anuloplastia mitral sem suporte em crianças e adolescentes Late outcome of unsupported annuloplasty as surgical treatment of mitral insufficiency in children and adolescents

    Directory of Open Access Journals (Sweden)

    Solange Bordignon

    1996-12-01

    Full Text Available O resultado clínico pós-operatório (p.o. tardio da reconstrução da valva mitral sem suporte em crianças e adolescentes é analisado através da observação de uma série de 70 pacientes operados. Objetivou-se acompanhar a evolução clínica tardia após o tratamento de insuficiência mitral pelas técnicas reparadoras nos pacientes em fase de crescimento, avaliar a eficácia, a durabilidade e a reprodutibilidade do procedimento, bem como morbidade e mortalidade nas fases hospitalar e tardia. Consideraram-se, ainda, os resultados em relação à etiologia da doença e as causas de falha do método. De 1977 a 1995, foram operados 70 pacientes, sendo 36 casos do sexo feminino e 34 do masculino. A média de idade foi de 12,4 ± 4,8 anos (6m a 18a. Houve predomínio da etiologia reumática (71,4% sobre a congênita (18,6%, a degeneração mixomatosa (8,6% e a infecciosa (1,4%. A classe funcional pré-operatória era 11 em 32 (45,7% casos, 111 em 18 (25,7% casos e IV em 20 (28,6% casos. A técnica cirúrgica utilizada foi a anuloplastia simples tipo Wooler isolada em 58 (82,9% casos e associada a encurtamento de cordoalha em 12(17,1%. Em 21 (30% pacientes foram realizados procedimentos associados. O período de acompanhamento foi de 7 m a 17 anos, no p.o. A mortalidade hospitalar foi 4,3%. Regurgitação mitral foi descrita no intra-operatório em 21,4%. Sopro sistólico de regurgitação mitral residual foi notado em 35 (49,9% pacientes, a maioria sem repercussão hemodinâmica. A classe funcional pós-operatória foi I em 73,9%, II em 21,7% e III em 4,4%. As curvas de análise atuarial mostraram aos 5 e 10 anos, respectivamente, probabilidade de sobrevida global de 89% e 79% e estimativa de permanecer livre de eventos cirúrgicos no período de 87% e 61 % no grupo total, 88% e 56% no grupo de etiologia reumática e 91 % no grupo de etiologia congênita para 5 e 10 anos. A insuficiência mitral pode ser tratada efetivamente por anuloplastia

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

    Science.gov (United States)

    Goldstone, Andrew B; Woo, Y Joseph

    2016-11-01

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

  16. Estenosis mitral por mixoma auricular izquierdo

    Directory of Open Access Journals (Sweden)

    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.

  17. Chronic ischemic mitral regurgitation – adiagnostic and therapeutic challenge

    Directory of Open Access Journals (Sweden)

    Jana Ambrožič

    2014-02-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  19. Robotic Excision of a Papillary Fibroelastoma of the Mitral Chordae.

    Science.gov (United States)

    Arsalan, Mani; Smith, Robert L; Squiers, John J; Wang, Alex; DiMaio, J Michael; Mack, Michael J

    2016-06-01

    Papillary fibroelastomas of the mitral chordae tendineae are rare, primary benign tumors. They are either incidentally diagnosed during echocardiography or discovered after transient ischemic attack, stroke, or myocardial infarction. Removal of papillary fibroelastomas should be considered, given the increased risk for embolization causing cerebrovascular accident or mortality in patients with echocardiographic evidence of papillary fibroelastoma not undergoing surgical procedures. Although fibroelastoma removal can be performed in most cases without disrupting mitral valve competency, sternotomy and minithoracotomy are the typical approaches for excision. Herein, we report the first robotic excision of a mitral chord papillary fibroelastoma. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Early outcome of minimally invasive mitral valve surgery

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    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.

  1. Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study.

    Science.gov (United States)

    Chivasso, Pierpaolo; Bruno, Vito D; Farid, Shakil; Malvindi, Pietro Giorgio; Modi, Amit; Benedetto, Umberto; Ciulli, Franco; Abu-Omar, Yasir; Caputo, Massimo; Angelini, Gianni D; Livesey, Steve; Vohra, Hunaid A

    2017-11-20

    An increasing number of octogenarians are referred to undergo mitral valve surgery for degenerative disease, and percutaneous approaches are being increasingly used in this subgroup of patients. We sought to determine the survival and its predictors after Mitral valve Surgery in Octogenarians (MiSO) in a multicenter UK study of high-volume specialized centers. Pooled data from 3 centers were collected retrospectively. To identify the predictors of short-term composite outcome of 30 days mortality, acute kidney injury, and cerebrovascular accident, a multivariable logistic regression model was developed. Multiple Cox regression analysis was performed for late mortality. Kaplan-Meier curves were generated for long-term survival in various subsets of patients. Receiver operating characteristic analysis was done to determine the predictive power of the logistic European System for Cardiac Operative Risk Evaluation. A total of 247 patients were included in the study. The median follow-up was 2.9 years (minimum 0, maximum 14 years). A total of 150 patients (60.7%) underwent mitral valve repair, and 97 patients (39.3%) underwent mitral valve replacement. Apart from redo cardiac surgery (mitral valve repair 6 [4%] vs mitral valve replacement 11 [11.3%], P = .04) and preoperative atrial fibrillation (mitral valve repair 79 [52.6%] vs mitral valve replacement 34 [35.1%], P mitral valve repair group (10.2 ± 11.8 vs 13.7 ± 15.2 in mitral valve replacement; P = .07). No difference was found between groups for duration of cardiopulmonary bypass and aortic crossclamp times. The 30-day mortality for the whole cohort was 13.8% (mitral valve repair 4.7% vs mitral valve replacement 18.6%; P mitral valve replacement (OR, 7.7; 95% CI, 4.04-14.9; P mitral valve repair vs mitral valve replacement: 89.9% vs 70.7% at 1 year, 69.6% vs 54% at 5 years, and 51.8% vs 35.5% at 10 years; P = .0005). Cox proportional hazard model results showed mitral valve replacement (hazard

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

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    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.

  3. Rotational accuracy of all-ceramic restorations on ceraone components = Liberdade rotacional de restaurações totalmente cerâmicas sobre componentes ceraone

    Directory of Open Access Journals (Sweden)

    Webster, Jacqueline

    2005-01-01

    Full Text Available Objetivo: Este estudo avaliou a desadaptação interna de sistemas cerâmicos em prótese sobre implantes em relação à liberdade rotacional das restaurações após várias cocções da porcelana. Materiais e métodos: Foram analisados três sistemas cerâmicos: Procera AllCeram, In-Ceram e CeraOne sobre análogo e intermediário CeraOne. A liberdade rotacional foi medida com um dispositivo acoplado a um relógio comparador em quatro tempos: fase de coifa, após aplicação do corpo da porcelana e glaze, e após duas queimas adicionais. Os dados foram analisados por testes de Friedman, de Kruskal-Wallis e de Wilcoxon, a = 0,01. Resultados: As médias de liberdade rotacional em graus foram: 0,08 para In-Ceram/Análogo; 1,64 para Procera/ Intermediário; 1,72 para CeraOne/Intermediário; 1,88 para CeraOne/Análogo e 1,97 para Procera/Análogo. O sistema In-Ceram sobre o análogo apresentou níveis de liberdade rotacional dez a vinte vezes menores que CeraOne e Procera. Não houve diferença entre as fases de confecção da restauração para In-Ceram. O comportamento de CeraOne e Procera foi similar, com aumento da liberdade rotacional sobre intermediário e análogo com a progressão da confecção da restauração. A liberdade rotacional sobre intermediário foi menor que sobre análogo. Conclusão: A liberdade rotacional variou em função da etapa do processo de fabricação dependendo do sistema totalmente cerâmico

  4. Herniorrafia inguinal laparoscópica totalmente extraperitoneal: vinte e sete complicações graves após 4565 operações consecutivas

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    Alberto Meyer

    Full Text Available OBJETIVO: identificar e avaliar as complicações do tratamento da hérnia inguinal com a colocação de tela totalmente extraperitoneal. MÉTODOS: Foram incluídos, em uma série consecutiva de 4565 reparos de hérnia laparoscópica, pacientes que haviam sido submetidos ao procedimento TEP entre janeiro de 2001 e janeiro de 2011. Os critérios de inclusão foram: diagnóstico com hérnia inguinal sintomática, incluindo recorrência após correção de hérnia inguinal e cirurgia prévia em abdômen inferior e pelve. Todos os pacientes > 18 anos de idade. Pacientes com hérnia encarcerada na urgência foram excluídos do estudo. RESULTADOS: Um total de 4565 hérnias foram incluídas no estudo. Ocorreram 27 complicações graves (0,6%: 12 hemorragias (0,25%, duas lesões da bexiga (0,04%, cinco oclusões (0,11%, quatro perfurações intestinais (0,09%, uma lesão da veia ilíaca (0,02%, uma lesão do nervo femoral (0,02%, duas lesões dos vasos deferentes (0,04% e dois óbitos (0,02% (embolia pulmonar, peritonite. CONCLUSÃO: A taxa de complicações com o procedimento TEP é baixa. Correção de hérnia laparoscópica é uma técnica reprodutível e confiável. Em nossa experiência, existem contraindicações para o procedimento de TEP. A técnica TEP deve ser minuciosa para evitar complicações intraoperatórias (diatermia bipolar. As complicações podem ocorrer mesmo após o cirurgião ter adquirido experiência substancial.

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

    Science.gov (United States)

    Mazurkiewicz, Łukasz; Rużyłło, Witold; Chmielak, Zbigniew; Opalińska-Ciszek, Ewa; Janas, Jadwiga; Hoffman, Piotr; Hryniewiecki, Tomasz; Grzybowski, Jacek

    2017-01-01

    Atrial (ANP) and B-type (BNP) natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload. To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV) and to investigate factors associated with endpoints. 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) cm 2 , 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. The PBMV was successful in all cases. After the procedure MVA increased (1.18-1.78 cm 2 , p 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). Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure.

  6. 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

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

    Science.gov (United States)

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

    2012-07-01

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

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

    Science.gov (United States)

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

    2010-05-01

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

  9. Can percutaneous mitral balloon valvuloplasty reduce ongoing inflammation in patients with rheumatic mitral stenosis?

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    Fatih Uzun

    2015-09-01

    Full Text Available Objective: In the pathophysiology of rheumatic heart valve disease, chronic systemic inflammatory process plays an important role. In this study, we aimed to investigate whether the percutaneous transluminal mitral balloon valvuloplasty (PTMV has any effect on the chronic systemic inflammatory response in patients with rheumatic mitral stenosis (RMS. Methods: In this study, we used neutrophil to lymphocyte ratio (NLR, which is a simply available and inexpensive biomarker of systemic inflammatory response, to evaluate the level of inflammation. A total of 41 consecutive patients with severe RMS undergoing successful PTMV were included in the study. Laboratory assessments of all patients by the measuring of NLR before and after the PTMV procedure were performed. Results: Before and after the PTMV, the mean lymphocyte counts were found 2.1±0.6 x103 /µL and 1.9±0.6 x103 / µL (p=0.01, and the mean leukocyte counts were 4.8±1.4 x103 /µL and 4.4±1.3 x103 /µL (p=0.069 respectively. NLR values were determined as 2.7 ± 1.0 and 2.2 ± 0.8. After the PTMV, there was a significant decrease in NLR in patients with rheumatic mitral stenosis patients (p=0.001. In the correlation analysis, there was significant negative correlation between the mitral valve area and NLR (p= 0.004- r=0.440, and there was significant positive correlation between left atrial diameter and NLR (p=0.028 r=0.344. Conclusion: This study showed significant decrease in NLR after PTMV in patients with RMS, which means reduced inflammation after PTMV. Larger studies are needed to confirm the results.

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

    Science.gov (United States)

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

    1985-01-01

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

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

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    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.

  12. Diagnosis of mitral valve prolapse by X-ray CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Masuda, Yoshiaki; Inagaki, Yoshiaki

    1986-12-01

    To evaluate the usefulness of enhanced X-ray CT and gating magnetic resonance imaging (MRI) for diagnosing mitral valve prolapse, three patients with this abnormality and several controls were examined by these two methods. The mitral valve was not recognized by X-ray CT except a few cases with thickened mitral valve. However, MRI could demonstrate clearly the mitral leaflets and annulus in many subjects. In transverse MR imaging of the subjects without valvular disease, the closed mitral valve showed V-shaped appearance in the left ventricle during systole. In a patient with marked mitral valve prolapse, MRI revealed buckling of the posterior mitral leaflet into the left atrium, and in two other patients with mild mitral valve prolapse, MRI demonstrated displacement of coaptation of the anterior leaflet toward the left atrium. These results suggest MRI is a useful method for diagnosing mitral valve prolapse.

  13. [Intraoperative transesophageal echocardiography in patients undergoing robotic mitral valve replacement].

    Science.gov (United States)

    Wang, Yao; Gao, Changqing; Xiao, Cangsong; Yang, Ming; Wang, Gang; Wang, Jiali; Shen, Yansong

    2012-12-01

    To retrospectively assess the value of intraoperative transesophageal echocardiography (TEE) during robotic mitral valve (MV) replacement. Intraoperative TEE was performed in 21 patients undergoing robotic MV replacement for severe rheumatic mitral stenosis between November 2008 and December 2010. During the procedure, TEE was performed to document the mechanism of rheumatic mitral stenosis (leaflet thickening and calcification, commissural fusion or chordal fusion) before cardiopulmonary bypass (CPB). During the establishment of peripheral CPB, TEE was used to guide the placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. Accuracy of TEE was 100% for rheumatic mitral stenosis. All the cannuli in the SVC, IVC and AAO were located in the correct position. In all patients, TEE confirmed successful procedure. TEE is useful in the assessment of robotic MV replacement.

  14. Balloon valvuloplasty for severe mitral valve stenosis in pregnancy

    African Journals Online (AJOL)

    . Commerford, B. Levetan. Balloon Valvuloplasties for severe mitral stenosis were performed on 11 ... 140 patients each year with cardiac disease - an incidence of 0.5%. ... Department of Medicine, Groote Schuur Hospital and University of.

  15. Double orifice mitral valve in rheumatic heart disease.

    Science.gov (United States)

    Choudhury, Partha P; Chaturvedi, Vivek

    2014-01-01

    A 55-year-old female, presented to our outpatient department with complaints of dyspnea on exertion, NYHA grade II for 7 years, which had progressed to NYHA Grade III in the past 6 months. An echocardiogram done showed severe mitral stenosis with mitral valve fused in the middle to create an appearance of 2 separate valves (complete bridge type) with 2 separate turbulent jets of flow across these valves. No other congenital anomaly was seen. Due to presence of severe subvalvular disease, she was sent for elective mitral valve replacement. This case demonstrates that a careful analysis of the subvalvular apparatus of the mitral valve is needed before making a decision for definitive treatment of this condition.

  16. Mitral valve prolapse in Zaria: clinical and echocardiographic features

    African Journals Online (AJOL)

    . The commonest prolapsing leaflet was the anterior mitral valve leaflet found in 80% of the cases. Eight patients (80%) had classical MVP and the remaining two had non-classical MVP. There were significant difference between those with ...

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

    Science.gov (United States)

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

    2002-01-01

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

  18. [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.

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

    Science.gov (United States)

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

    2016-05-25

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

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

    Science.gov (United States)

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

    2017-01-01

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

  1. Mitral valve disease in pregnancy: outcomes and management

    OpenAIRE

    Tsiaras, Sarah; Poppas, Athena

    2009-01-01

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

  2. Robotic mitral valve surgery: overview, methodology, results, and perspective

    Science.gov (United States)

    2016-01-01

    Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author’s series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the “heart team” approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. PMID:27942486

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

    Science.gov (United States)

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

    2017-06-09

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

  4. 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.

  5. Extensive infective endocarditis of the aortic root and the aortic-mitral continuity: a mitral valve sparing approach†.

    Science.gov (United States)

    Tomšic, Anton; Schneider, Adriaan W; Palmen, Meindert; van Brakel, Thomas J; Versteegh, Michel I M; Klautz, Robert J M

    2017-06-01

    Severe cases of infective endocarditis (IE) of the aortic valve can cause aortic root destruction and affect the surrounding structures, including the aortic-mitral continuity, the anterior mitral valve leaflet and the roof of the left atrium. Reconstruction after resection of all infected tissue remains challenging. We describe our surgical approach and the mid-term results. Between January 2004 and December 2015, 35 patients underwent surgery for extensive IE of the aortic valve with destruction of the aortic root, the aortic-mitral continuity and the mitral valve. Mean age was 60.4 ± 13.7; 26/35 (74%) patients had prosthetic valve endocarditis. Four patients were in critical preoperative state. Median EuroSCORE II was 18.0% [interquartile range (IQR) 11.0-26.7]. Aortic root replacement was performed in 32 (91%) patients. The remaining patients underwent aortic valve replacement. Reconstruction of the aortic-mitral continuity and the roof of the left atrium were performed using a folded pericardial patch. In 28 patients (80%), mitral valve repair was performed. Postoperative mechanical circulatory support, acute kidney failure and surgical re-exploration were seen in 5 (16%), 10 (31%) and 4 (13%) patients, respectively. Early survival rate was 77% (27 patients). During a median follow-up of 29.8 months (IQR 6.4-62.9), 7 (26%) patients required reintervention (3-42 months after surgery); 4 were due to mitral incompetence, early in our experience. Extensive IE of the aortic root with destruction of the surrounding tissues remains a complex disease with high morbidity and mortality rates. Our technique allows native mitral valve preservation but is technically challenging.

  6. Relação anatômica entre a porção posterior do ânulo mitral e as artérias coronárias: implicações no tratamento cirúrgico Anatomical relashionship between the posterior mitral valve annulus and the coronary arteries: implications to operative treatment

    Directory of Open Access Journals (Sweden)

    Clodualdo J. N. Pessa

    2004-12-01

    Full Text Available OBJETIVO: Este trabalho objetivou analisar a relação anatômica entre o ânulo da valva atrioventricular esquerda (mitral, a artéria circunflexa e a artéria posterior do ventrículo esquerdo, relacionando a distância entre as estruturas citadas ao padrão de dominância coronariano. MÉTODO: Foram estudados 85 corações humanos, previamente fixados em solução de formaldeido a 10%. Inicialmente, avaliou-se o padrão de dominância coronariana. A seguir, realizou-se atriotomia e ventriculotomia esquerdas na parede posterior do coração, a partir das veias pulmonares em direção ao ápice cardíaco, seccionando-se o ânulo mitral. Removeu-se a parede atrial ao nível do ânulo, em toda a porção da cúspide posterior. Sobre o ânulo foram demarcados cinco pontos: 1 - comissural anterior, 2 - entre o comissural anterior e o ponto médio posterior do ânulo, 3 - ponto médio posterior do ânulo, 4 - entre o ponto médio posterior do ânulo e o comissural posterior, 5 - comissural posterior. Nestes pontos foi medida a distância entre as estruturas com um paquímetro eletrônico. RESULTADOS: Padrão de dominância direita foi observado em 81,17% dos casos, circulação balanceada em 16,47% e dominância esquerda em 2,35%. Nos corações que apresentaram dominância direita observou-se que a região de maior proximidade entre o ânulo e as estruturas vasculares foi a comissural anterior, 3,996 ± 1,865mm, enquanto a região de menor proximidade foi a comissural posterior, medindo 7,78 ± 2,615mm. CONCLUSÃO: Este estudo propiciou melhor compreensão da relação anatômica entre a valva mitral e as artérias coronárias adjacentes, podendo auxiliar o cirurgião na diminuição de complicações cirúrgicas.OBJECTIVE: This work aimed to analyze the anatomical relationship among the mitral annulus, the circumflex artery and the posterior left ventricular artery, correlating the distance among the structures mentioned to the pattern of coronary

  7. Nova técnica: translocação aórtica e pulmonar com preservação da valva pulmonar New technique: aortic and pulmonary translocation with preservation of pulmonary valve

    Directory of Open Access Journals (Sweden)

    Gláucio Furlanetto

    2010-03-01

    Full Text Available Realizamos com sucesso novo procedimento cirúrgico, em duas crianças portadoras de transposição das grandes artérias associada a comunicação interventricular e obstrução da via de saída do ventrículo esquerdo. A cirurgia consiste na realização de translocação aórtica com a valva aórtica e as artérias coronárias para o ventrículo esquerdo, após a ampliação da via de saída desse ventrículo e da comunicação interventricular com pericárdio autólogo fixado em glutaraldeído, associada à translocação do tronco pulmonar para o ventrículo direito, conservando integralmente a valva pulmonar.We applied successfully, a new surgical technique, in two children with transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, that utilized aortic translocation with the aortic valve and the coronary arteries to the left ventricle, after correction of left outflow tract obstruction and correction of the ventricular septal defect, associated to pulmonary root translocation to the right ventricle, conserving integrally the pulmonary valve.

  8. 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.

  9. 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.

  10. Totally endoscopic mitral valve repair using a robotic-controlled atrial retractor.

    Science.gov (United States)

    Smith, J Michael; Stein, Hubert; Engel, Amy M; McDonough, Sarah; Lonneman, Lindsey

    2007-08-01

    Our aim was to assess the feasibility of totally endoscopic robotic mitral valve surgery using a novel atrial retractor manipulated by a fourth arm da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA). Eighteen patients with mitral valve disease underwent totally endoscopic mitral valve surgery using the retractor. It was inserted in the second or third intercostal space just lateral to the sternum, and it was manipulated at the robotic console for dynamic exposure of the valve structures. Mitral valve repair procedures were feasible in all patients with the robotic-controlled atrial retractor providing superior exposure of the mitral valve anatomy. The time until satisfactory exposure of the mitral valve was noticeably decreased with the robotic retractor. All patients were discharged home in sinus rhythm and transesophageal echocardiography revealed competent mitral valves. The EndoWrist atrial retractor (Intuitive Surgical Inc) facilitated complex totally endoscopic mitral valve surgery, including concomitant procedures, regardless of pathology with excellent clinical outcomes.

  11. 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)....

  12. 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

    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

  13. Standard transthoracic echocardiography and transesophageal echocardiography views of mitral pathology that every surgeon should know

    Science.gov (United States)

    Tan, Timothy C.

    2015-01-01

    The mitral valve is the most commonly diseased heart valve and the prevalence of mitral valve disease increases proportionally with age. Echocardiography is the primary diagnostic imaging modality used in the assessment of patients with mitral valve disease. It is a noninvasive method which provides accurate anatomic and functional information regarding the mitral valve and can identify the mechanism of mitral valve pathology. This is especially useful as it may guide surgical repair. This is increasingly relevant given the growing trend of patients undergoing mitral valve repair. Collaboration between cardiac surgeons and echocardiographers is critical in the evaluation of mitral valve disease and for identification of complex valvular lesions that require advanced surgical skill to repair. This article will provide an overview of transthoracic and transesophageal assessment of common mitral valve pathology that aims to aid surgical decision making. PMID:26539350

  14. 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.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-11-27

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

  17. 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.

  18. Artificial intelligence in mitral valve analysis.

    Science.gov (United States)

    Jeganathan, Jelliffe; Knio, Ziyad; Amador, Yannis; Hai, Ting; Khamooshian, Arash; Matyal, Robina; Khabbaz, Kamal R; Mahmood, Feroze

    2017-01-01

    Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

  19. Electrocardiographic Changes in Mitral Valve Prolapse Syndrome

    Directory of Open Access Journals (Sweden)

    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.

  20. 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.

  1. 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)....

  2. Bedside percutaneous transseptal mitral commissurotomy under sole transthoracic echocardiographic guidance in a critically ill patient.

    Science.gov (United States)

    Trehan, Vijay K; Nigam, Arima; Mukhopadhyay, Saibal; Yusuf, Jamal; UmaMahesh, C R; Gupta, Mohit D; Girish, Menahalli Palleda; Sharma, Manish

    2006-04-01

    Percutaneous transvenous mitral commissurotomy is an effective and safe alternative to surgical treatment, in selected patients of rheumatic mitral stenosis. It is usually performed under fluoroscopic guidance in the catheterization laboratory. We report the successful performance of emergency mitral commissurotomy by the Inoue balloon at bedside under sole transthoracic echocardiographic guidance in a critically ill patient.

  3. 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.

  4. Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification: Results From the First Multicenter Global Registry.

    Science.gov (United States)

    Guerrero, Mayra; Dvir, Danny; Himbert, Dominique; Urena, Marina; Eleid, Mackram; Wang, Dee Dee; Greenbaum, Adam; Mahadevan, Vaikom S; Holzhey, David; O'Hair, Daniel; Dumonteil, Nicolas; Rodés-Cabau, Josep; Piazza, Nicolo; Palma, Jose H; DeLago, Augustin; Ferrari, Enrico; Witkowski, Adam; Wendler, Olaf; Kornowski, Ran; Martinez-Clark, Pedro; Ciaburri, Daniel; Shemin, Richard; Alnasser, Sami; McAllister, David; Bena, Martin; Kerendi, Faraz; Pavlides, Gregory; Sobrinho, Jose J; Attizzani, Guilherme F; George, Isaac; Nickenig, George; Fassa, Amir-Ali; Cribier, Alain; Bapat, Vinnie; Feldman, Ted; Rihal, Charanjit; Vahanian, Alec; Webb, John; O'Neill, William

    2016-07-11

    This study sought to evaluate the outcomes of the early experience of transcatheter mitral valve replacement (TMVR) with balloon-expandable valves in patients with severe mitral annular calcification (MAC) and reports the first large series from a multicenter global registry. The risk of surgical mitral valve replacement in patients with severe MAC is high. There are isolated reports of successful TMVR with balloon-expandable valves in this patient population. We performed a multicenter retrospective review of clinical outcomes of patients with severe MAC undergoing TMVR. From September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR with compassionate use of balloon-expandable valves. Mean age was 73 ± 13 years, 66% were female, and mean Society of Thoracic Surgeons score was 14.4 ± 9.5%. The mean mitral gradient was 11.45 ± 4.4 mm Hg and the mean mitral area was 1.18 ± 0.5 cm(2). SAPIEN valves (Edwards Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%, SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%. Technical success according to Mitral Valve Academic Research Consortium criteria was achieved in 46 (72%) patients, primarily limited by the need for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract obstruction with hemodynamic compromise. Mean mitral gradient post-procedure was 4 ± 2.2 mm Hg, paravalvular regurgitation was mild or absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular = 12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data available were in New York Heart Association functional class I or II at 30 days (n = 25). TMVR with balloon-expandable valves in patients with severe MAC is feasible but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options. Copyright

  5. 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.

  6. Implante transapical de valva aórtica: resultados de uma nova prótese brasileira Transapical aortic valve implantation: results of a brazilian prosthesis

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2010-09-01

    Full Text Available OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, levando à contraindicação do procedimento, apesar dos sintomas. O implante minimamente invasivo transcateter de valva aórtica parece ser uma alternativa, reduzindo a morbi-mortalidade. O objetivo deste estudo foi o desenvolvimento e implante de nova prótese para implante transcateter. MÉTODOS: Após desenvolvimento em animais, uma prótese transcateter, balão-expansível foi utilizada em 14 casos de alto risco. O EuroSCORE médio foi de 43,7%. Quatro pacientes apresentavam disfunção de biopróteses e o restante, estenose aórtica calcificada. Todos os pacientes eram sintomáticos. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Com o uso de minitoracotomia esquerda, as próteses foram implantadas através do ápice ventricular, sob estimulação ventricular de alta frequência ou choque hemorrágico controlado, após valvoplastia aórtica. Foram realizados controles clínicos e ecocardiográficos seriados. RESULTADOS: A correta liberação da prótese foi possível em 13 casos. Uma conversão ocorreu. Não houve mortalidade operatória. O gradiente de pico médio pós-implante foi de 25 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual não significativa esteve presente em 71% dos casos, nenhuma significativa. Não ocorreu complicação vascular periférica. Não houve necessidade de marcapasso definitivo. Um caso de acidente vascular cerebral ocorreu. A mortalidade geral foi de 42%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é um procedimento possível com esta nova prótese. O comportamento hemodinâmico foi satisfatório. São necessários estudos de longo prazo e com maior poder amostral, no intuito de determinar a real eficácia e indicação do

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  9. Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical Mitral Valve.

    Science.gov (United States)

    Park, Byungjoon; Sung, Kiick; Park, Pyo Won

    2018-01-25

    This study aimed to evaluate the safety and feasibility of transaortic mitral pannus removal (TMPR).Methods and Results:Between 2004 and 2016, 34 patients (median age, 57 years; 30 women) with rheumatic disease underwent pannus removal on the ventricular side of a mechanical mitral valve through the aortic valve during reoperation. The median time interval from the previous surgery was 14 years. TMPR was performed after removal of the mechanical aortic valve (n=21) or diseased native aortic valve (n=11). TMPR was performed in 2 patients through a normal aortic valve. The mitral transprosthetic mean pressure gradient (TMPG) was ≥5 mmHg in 11 patients, including 3 with prosthetic valve malfunction. Prophylactic TMPR was performed in 23 patients. There were no early deaths. Concomitant operations included 22 tricuspid valve surgeries (13 replacements, 15 repairs) and 32 aortic valve replacements (24 repeats, 8 primary). The mean gradient in patients who had mitral TMPG ≥5 mmHg was significantly decreased from 6.46±1.1 to 4.37±1.17 mmHg at discharge (Pvalve malfunction was apparent on last echocardiography. TMPR is a safe and effective procedure for patients with malfunction or stenosis of a mechanical mitral valve and may be considered an alternative approach in patients with pannus overgrowth in such valves.

  10. Plastica mitral com anel maleavel de pericardio bovino

    OpenAIRE

    Marco Antonio Volpe

    1997-01-01

    Resumo: No final da década de 50, realizou-se a primeira tentativa de corrigir a insuficiência mitral pura por anuloplastia. Desde então, numerosas técnicas têm sido propostas na correção das valvopatias. O presente trabalho mostra os resultados obtidos com doentes submetidos a uma variedade de plástica mitral. A técnica consiste em medir o perímetro da cúspide anterior e implantar uma prótese flexível de pericárdio bovino, com esta medida, para reforço e conformação do anel mitral posterior....

  11. Percutaneous mitral valve edge-to-edge repair

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  12. 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.

  13. Transjugular balloon mitral valvotomy in a patient with severe kyphoscoliosis

    Directory of Open Access Journals (Sweden)

    George Joseph

    2016-09-01

    Full Text Available Balloon mitral valvotomy (BMV performed by the conventional transfemoral approach can be difficult or even impossible in the presence of structural impediments such as severe kyphoscoliosis, gross cardiac anatomic distortion and inferior vena caval anomalies. A 25-year-old woman with severe thoracolumbar kyphoscoliosis due to poliomyelitis presented with symptomatic rheumatic mitral valve stenosis. After the failure of transfemoral BMV, the procedure was attempted from the right jugular access, using a modified septal puncture technique. The left atrium was entered from the jugular access and the mitral valve was crossed and dilated successfully using over the wire balloon technique. Transjugular BMV is an effective alternative in patients with kyphoscoliotic spine that preclude transfemoral approach. The detailed technique used for the procedure, its advantages as well as the other percutaneous treatment options are also discussed.

  14. Mitral valve mechanics following posterior leaflet patch augmentation

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  15. Simulation and skills training in mitral valve surgery.

    Science.gov (United States)

    Joyce, David L; Dhillon, Tanvir S; Caffarelli, Anthony D; Joyce, Daniel D; Tsirigotis, Dimitrios N; Burdon, Thomas A; Fann, James I

    2011-01-01

    Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score. Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency. Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement. Published by Mosby, Inc.

  16. 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.

  17. Unnatural milieu: Thrombus after transcatheter mitral valve replacement.

    Science.gov (United States)

    Khan, Jaffar M; Lederman, Robert J

    2017-08-01

    What the article teaches Transcatheter heart valve thrombosis in the mitral position causes increased valve gradients, valve dysfunction, and symptoms, and may be associated with lack of therapeutic anticoagulation. How it will impact practice Anticoagulation with a vitamin K antagonist should be considered in all patients undergoing transcatheter mitral valve replacement. What new research/study would help answer the question posed Efficacy, optimal duration, and safety of anticoagulation therapy, balancing reduced thrombosis against increased bleeding risk, needs to be assessed in larger cohort studies and prospective trials. © 2017 Wiley Periodicals, Inc.

  18. Energy dynamics of the intraventricular vortex after mitral valve surgery.

    Science.gov (United States)

    Nakashima, Kouki; Itatani, Keiichi; Kitamura, Tadashi; Oka, Norihiko; Horai, Tetsuya; Miyazaki, Shohei; Nie, Masaki; Miyaji, Kagami

    2017-09-01

    Mitral valve morphology after mitral valve surgery affects postoperative intraventricular flow patterns and long-term cardiac performance. We visualized ventricular flow by echocardiography vector flow mapping (VFM) to reveal the impact of different mitral valve procedures. Eleven cases of mechanical mitral valve replacement (nine in the anti-anatomical and two in the anatomical position), three bioprosthetic mitral valve replacements, and four mitral valve repairs were evaluated. The mean age at the procedure was 57.4 ± 17.8 year, and the echocardiography VFM in the apical long-axis view was performed 119.9 ± 126.7 months later. Flow energy loss (EL), kinetic pressure (KP), and the flow energy efficiency ratio (EL/KP) were measured. The cases with MVR in the anatomical position and with valve repair had normal vortex directionality ("Clockwise"; N = 6), whereas those with MVR in the anti-anatomical position and with a bioprosthetic mitral valve had the vortex in the opposite direction ("Counterclockwise"; N = 12). During diastole, vortex direction had no effect on EL ("Clockwise": 0.080 ± 0.025 W/m; "Counterclockwise": 0.083 ± 0.048 W/m; P = 0.31) or KP ("Clockwise": 0.117 ± 0.021 N; "Counterclockwise": 0.099 ± 0.057 N; P = 0.023). However, during systole, the EL/KP ratio was significantly higher in the "Counterclockwise" vortex than that in the "Clockwise" vortex (1.056 ± 0.463 vs. 0.617 ± 0.158; P = 0.009). MVP and MVR with a mechanical valve in the anatomical position preserve the physiological vortex, whereas MVR with a mechanical valve in the anti-anatomical position and a bioprosthetic mitral valve generate inefficient vortex flow patterns, resulting in a potential increase in excessive cardiac workload.

  19. Minimally invasive mitral valve repair in osteogenesis imperfecta.

    Science.gov (United States)

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

    2017-10-01

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

  20. 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.

  1. 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.

  2. Artificial intelligence in mitral valve analysis

    Directory of Open Access Journals (Sweden)

    Jelliffe Jeganathan

    2017-01-01

    Full Text Available Background: Echocardiographic analysis of mitral valve (MV has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA. Three examiners analyzed three end-systolic (ES frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both. Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

    Little, Sherard G

    2014-12-01

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

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

    Science.gov (United States)

    2011-01-01

    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. PMID:21942971

  6. 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.

  7. Mitral valve repair for congenital mitral valve disease: impact of the use of a biodegradable annuloplasty ring.

    Science.gov (United States)

    Yakub, Mohd Azhari; Sivalingam, Sivakumar; Dillon, Jeswant; Matsuhama, Minoru; Latiff, Haifa Abdul; Ramli, Mohd Faizal

    2015-03-01

    This study compares the midterm results of mitral valve repair using the biodegradable ring versus repair with non-ring annuloplasty techniques for congenital mitral valve disease in young children where it was not possible to use standard commercial rings. Between February 2006 and November 2011, 68 patients underwent mitral valve repair for congenital mitral valve disease. Thirty-nine (57%) patients underwent concomitant annuloplasty using the biodegradable ring (group A) and 29 (43%) patients using non-ring annuloplasty techniques (group B). The median age of repair was 2 years (range 1 month to 14 years). There were no hospital deaths or major postoperative morbidity. At a median follow-up of 3.8 years (range, 2 months to 5.1 years), overall survival at 5 years was 97% ± 3% for group A and 88% ± 8% for group B (p = 0.29). Freedom from valve failure was 90% ± 7% in group A and 74% ± 9% in group B (p = 0.026). The freedom from reoperation was 100% in group A and 84% ± 9% in group B (p = 0.04). The mean transmitral gradients were 4.3 ± 1.8 mm Hg in group A and 4.2 ±1.7 mm Hg in group B (p = 0.77). Mitral valve repair using the biodegradable ring for congenital mitral valve disease was superior compared with non-ring annuloplasty repair. Excellent survival benefit, freedom from reoperation, and valve failure without significant elevation of transmitral gradients, suggests its important role in young children with smaller annular sizes where standard commercial rings are not available or recommended. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Echocardiographic assessment of long-term hemodynamic characteristics of mechanical mitral valve prostheses with different mitral valvular diseases.

    Science.gov (United States)

    Zhu, Xiliang; Li, Qian; Tang, Hong; Xiao, Xijun

    2017-03-01

    Mitral stenosis (MS) and mitral insufficiency (MI) have different pre-operative hemodynamic characteristics. However, it is unclear if there are differences in long-term echocardiographic characteristics of MS and MI patients after mechanical mitral valve replacement. This study is to compare long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients. From January 2003 to January 2009, a total of 199 consecutive patients were recruited in this study. Patients were classified as group MS (n = 123) and MI (n = 76) according to the manifestation of mitral valvular disease. The mean age for patients was 50.1 ± 10.5 years and follow-up time was 7.2 ± 2.0 years. The MS after operation were more likely to experience atrial fibrillation (p = 0.002). The New York Heart Association (NYHA) class in MI showed a greater improvement (p = 0.006) than in MS. The left ventricular end-diastolic dimension (LVEDD) (p = 0.010) and stroke volume (SV) (p = 0.000) in MI were still larger than that in MS patients. These differences did not disappear with time after operation. The long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients are significantly different. Over a long-term follow up, MI patients still have a larger LVEDD and SV than MS, and associated with a greater improvement of NYHA class.

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

    Science.gov (United States)

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

    2017-05-01

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

  10. A meta-analysis of minimally invasive versus conventional mitral valve repair for patients with degenerative mitral disease

    Science.gov (United States)

    Gupta, Sunil; Chandrakumar, David; Nienaber, Thomas A.; Indraratna, Praveen; Ang, Su C.; Phan, Kevin; Yan, Tristan D.

    2013-01-01

    Background Minimally invasive mitral valve surgery through a mini-thoracotomy approach was developed in the mid-1990s as an alternative to conventional sternotomy, but with reduced trauma and quicker recovery. However, technical demands and a paucity of comparative data have thus far limited the widespread adoption of minimally invasive mitral valve repair (MIMVR). Previous meta-analyses have grouped various surgical techniques and underlying valvular disease aetiologies together for comparison. The present study aimed to compare the clinical outcomes of MIMVR versus conventional mitral valve repair in patients with degenerative mitral valve disease. Methods A systematic review of the current literature was performed through nine electronic databases from January 1995 to July 2013 to identify all relevant studies with comparative data on MIMVR versus conventional mitral valve surgery. Measured endpoints included mortality, stroke, renal failure, wound infection, reoperation for bleeding, aortic dissection, myocardial infarction, atrial fibrillation, readmission within 30 days, cross clamp time, cardiopulmonary bypass time and durations of intensive care unit (ICU) stay and overall hospitalization. Echocardiographic outcomes were also assessed when possible. Results Seven relevant studies were identified according to the predefined study selection criteria, including one randomized controlled trial and six retrospective studies. Meta-analysis of clinical outcomes did not identify any statistically significant differences between MIMVR and conventional mitral valve repair. The duration of ICU stay was significantly shorter for patients who underwent MIMVR, but this did not translate to a shorter hospitalization period. Patients who underwent MIMVR required longer cross clamp time as well as cardiopulmonary bypass time. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes. Pain-related outcomes was assessed in one study and reported

  11. Molecular evaluation of the great vessels of patients with bicuspid aortic valve disease Análise molecular dos grandes vasos da base em portadores de valva aórtica bicúspide

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    Mauro Paes Leme

    2003-06-01

    Full Text Available PURPOSE: Bicuspid aortic valve (BAV is associated with increased prevalence of annulo-aortic ectasia, dissection and ascending aortic aneurysm. This study was undertaken to compare the amount of fibrillin-1 and elastin in the media of great vessels of patients with bicuspid and tricuspid aortic valve disease. METHOD: Tissue samples of ascending aorta and pulmonary artery were obtained from 22 patients with bicuspid aortic valve disease (BAV and 17 patients with tricuspid aortic valve disease (TAV, including 6 normal valves from the transplant program. Indirect immunofluorescence and computerized image analyses were used to quantify fibrillin-1 and elastin of the media of the arteries. The results were expressed as the mean integrated optical density (IOD. RESULTS: In the ascending aorta, the IOD for fibrillin-1 was 15 ± 8 in the BAV group and 24 ± 7 in the TAV group (p = 0.001. In the pulmonary artery, the IOD for fibrillin-1 was 18 ± 10 in the BAV group and 25 ± 9 in the TAV group (p = 0.07. In respect to the elastin measurements of the aorta, the specific IOD was 34 ± 13 in the BAV group and 29 ± 14 in the TAV group. In the pulmonary artery the IOD for elastin was 30 ± 12 in the BAV group and 29 ± 14 in the TAV group (p = 0.34. CONCLUSIONS: Patients with BAV were found to have less fibrillin-1 in the ascending aorta and pulmonary artery than patients with TAV. These findings may explain aortic root dilation and ascending aortic dissection in patients with BAV disease.OBJETIVO: A valva aórtica bicúspide (VAB está associada a maior prevalência de ectasia anulo-aórtica, aneurisma e dissecção da aorta ascendente. Este estudo investigou a quantidade de fibrilina-1 e elastina nos grandes vasos de portadores de VAB. MÉTODO:Amostras de tecidos foram colhidas da aorta ascendente e tronco da artéria pulmonar de 22 portadores de VAB e 16 portadores de valva aórtica tricúspide (VAT submetidos a cirurgia cardíaca, incluindo seis

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

    Science.gov (United States)

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

    2017-10-24

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

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

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

    2016-11-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

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    Christos Rammos

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

  16. CHORDAE TENDINEAE FREQUENCY IN THE MITRAL VALVE OF SANTA INÊS SHEEP (Ovis Aries, Linnaeus 1758 FREQUÊNCIA DE CORDAS TENDÍNEAS DA VALVA MITRAL DO CORAÇÃO DE OVINOS (Ovis aries, LINNAEUS 1758 DA RAÇA SANTA INÊS

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    Fábio Ferreira de Queiroz

    2009-12-01

    Full Text Available

    The aim of this work is to investigate the frequency of tendinous cords in the left atrioventricular valve complex (LAVC of the heart of sheeps of the Santa Inês breed. The experiments involved 40 hearts prepared in 10% formalin solution and dissected for the retreat of LVC. The LAVC was analyzed for tendinous cords counting and the total of these cords in each heart varied from 10 to 27 and the total oriented to the commissure of valve varied from two to five cords, all coming from papilar sub-auricular and papilar sub-atrial muscles. Higher frequency was observed in hearts with three cords that were oriented to commissure. The results suggest no anatomic standardization in the amount of tendinous cords in the heart of the sheep of the Santa Inês.

    Keywords:  Frequency, heart, morphology, sheep, tendinous cords.
    Este trabalho teve como objetivo investigar a frequência de cordas tendíneas no complexo valvar atrioventricular esquerdo (CVAE do coração de ovinos da raça Santa Inês. Os ensaios foram realizados em quarenta órgãos preparados com a utilização de solução de formol a 10% e dissecados para a retirada do CVAE, classificando-se e quantificando-se as cordas tendíneas, cujo número variou de 10 a 27, bem como as que se orientavam à comissura entre as válvulas, variando em número de duas a cinco cordas, saindo dos músculos papilares subauricular e subatrial. Corações com três cordas que se orientavam à comissura apresentaram maior frequência. Os resultados sugerem a inexistência de uma padronização anatômica na quantidade de cordas tendíneas no coração do ovino da raça Santa Inês.

    Palavra-chaveS: Cordas tendíneas, coração, frequência, morfologia, ovino.

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

    OpenAIRE

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

    1985-01-01

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

  18. Cardiogenic shock – a look at acute functional mitral incompetence

    African Journals Online (AJOL)

    Functional causes of acute mitral incompetence. Leaflet perforation or chordae tendineae rupture from endocarditis. Dilated cardiomyopathy leads to leaflet tethering. Chordal rupture in myxomatous valvular disease. Acute ischaemic akinesis of wall segments and papillary muscle dysfunction. Papillary muscle rupture due ...

  19. MitraClip para el reparo de insuficiencia mitral severa

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    Celin Malkun

    2016-11-01

    Conclusiones: Se reporta el primer caso de implante de MitraClip para el manejo de la IM severa, en la ciudad de Barranquilla, siendo la segunda ciudad de Colombia, después de Cali, donde se implanta este tipo de dispositivos para el reparo de la insuficiencia mitral severa.

  20. 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.

  1. 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.

  2. 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...

  3. Percutaneous transvenous mitral commissurotomy in a case of situs ...

    African Journals Online (AJOL)

    Situs inversus with dextrocardia is a rare congenital disorder. There is rare coincidence of rheumatic ... The patient had dyspnea on exertion of NYHA class III with initial mitral valve area of 0.8 cm2 and severe pulmonary arterial hypertension with PA systolic pressure of 106 mmHg. Femoral vein access was performed from ...

  4. 65. A female neonate with unguarded mitral valve orifice

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    Ayed Shati

    2015-10-01

    Conclusion: This case raises many questions regarding embryologic cardio genesis, specifically the association of pulmonary atresia, transposition of the great vessels, and unguarded mitral valve orifice. What is the optimal surgical technique in such a patient and does left ventricle exclusion impair right ventricular function?

  5. Surgical treatment of congenital mitral stenosis: medium-term results

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    Atik Fernando A.

    2003-01-01

    Full Text Available OBJECTIVE: For a cohort of patients with congenital mitral stenosis (CMS, to determine: patient outcomes, predictors of valve repairability and predictors of durability of valve repair. METHODS: From 1989 and 2002, 23 patients underwent surgical treatment of CMS, excluding those with common atrioventricular canal, and univentricular forms. The median age at operation was 15.5 months (range 2-204, and the median body weight was 11 Kg (range 4.5-51.6. Seventeen patients (73.9% had associated anomalies, including Shone's complex in nine (39.1% and pulmonary hypertension in 14 (60.9%. Mitral stenosis was severe in 14 patients (60.9% and moderate in the remaining (median trans-mitral gradient of 16 mmHg, range 8.5-32. Mitral valve repair was performed in 18 patients (78.3%, and valve replacement in five (21.7%. Repair techniques included papillary muscle splitting (n=10, excision of supravalvular ring (n=9 and commissurotomy (n=8. Twelve patients (52.2% required associated procedures. RESULTS: There were no early and late deaths at a mean follow-up of 58.5 ± 46.7 months (range 1-156. Mean hospital stay was 12.7 ± 8.2 days. There were no significant factors associated with unsuccessful valve repair. Actuarial freedom from reoperation at five years was 67.1% (CI 95%: 56.8% to 77.4%. The mitral valve repair group required reoperation in eight patients (44.4% (two early and six late, as opposed to one (20% in the replacement group. The presence of preoperative pulmonary hypertension was significantly related (p<0.005 to higher reoperation rates. All but two the followed patients are presently in functional class I and the echocardiography has shown less than 2+ mitral stenosis and/or regurgitation. CONCLUSION: Reoperations were the most important cause of morbidity at the medium-term follow-up of CMS. Preoperative pulmonary hypertension may predict the need for reoperation after mitral valve repair, which is the procedure of choice in CMS.

  6. Papel del ecocardiograma en la reparación mitral

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    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.

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

    Science.gov (United States)

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

    2005-06-01

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

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

    Science.gov (United States)

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

    2008-02-01

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

  9. Relation of Mitral Valve Surgery Volume to Repair Rate, Durability, and Survival.

    Science.gov (United States)

    Chikwe, Joanna; Toyoda, Nana; Anyanwu, Anelechi C; Itagaki, Shinobu; Egorova, Natalia N; Boateng, Percy; El-Eshmawi, Ahmed; Adams, David H

    2017-04-24

    Degenerative mitral valve repair rates remain highly variable, despite established benefits of repair over replacement. The contribution of surgeon-specific factors is poorly defined. This study evaluated the influence of surgeon case volume on degenerative mitral valve repair rates and outcomes. A mandatory New York State database was queried and 5,475 patients were identified with degenerative mitral disease who underwent mitral valve operations between 2002 and 2013. Mitral repair rates, mitral reoperations within 12 months of repair, and survival were analyzed using multivariable Cox modeling and restricted cubic spline function. Median annual surgeon volume of any mitral operations was 10 (range 1 to 230), with a mean repair rate of 55% (n = 20,797 of 38,128). In the subgroup of patients with degenerative disease, the mean repair rate was 67% (n = 3,660 of 5,475), with a range of 0% to 100%. Mean repair rates ranged from 48% (n = 179 of 370) for surgeons with total annual volumes of ≤10 mitral operations to 77% (n = 1,710 of 2,216) for surgeons with total annual volumes of >50 mitral operations (p mitral valve disease (adjusted odds ratio [OR]: 1.13 for every additional 10 mitral operations; 95% confidence interval [CI]: 1.10 to 1.17; p mitral operations annually; and improved 1-year survival (adjusted hazard ratio: 0.95 for every additional 10 operations; 95% CI: 0.92 to 0.98; p = 0.001). For surgeons with a total annual volume of ≤25 mitral operations, repair rates were higher (63.8%; n = 180 of 282) if they operated in the same institution as a surgeon with total annual mitral volumes of >50 and degenerative mitral valve repair rates of >70%, compared with surgeons operating in the other institutions (51.3%; n = 580 of 1,130) (adjusted OR: 1.79; 95% CI: 1.24 to 2.60; p mitral repair rates, but also freedom from reoperation, and survival. The data from this study support the guideline's concept of reference referral to experienced mitral

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

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    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.

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

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    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.

  12. 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 quantifie...

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

    Science.gov (United States)

    van Rensburg, Annari; Doubell, Anton

    2017-01-01

    The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P = 0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P abnormal papillary muscles (P = 0.002) and an additional chord or tendon in the left ventricle cavity (P = 0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect. PMID:28515127

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

    Science.gov (United States)

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

    2014-01-01

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

  15. A mitral annulus tracking approach for navigation of off-pump beating heart mitral valve repair.

    Science.gov (United States)

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

    2015-01-01

    To develop and validate a real-time mitral valve annulus (MVA) tracking approach based on biplane transesophageal echocardiogram (TEE) data and magnetic tracking systems (MTS) to be used in minimally invasive off-pump beating heart mitral valve repair (MVR). The authors' guidance system consists of three major components: TEE, magnetic tracking system, and an image guidance software platform. TEE provides real-time intraoperative images to show the cardiac motion and intracardiac surgical tools. The magnetic tracking system tracks the TEE probe and the surgical tools. The software platform integrates the TEE image planes and the virtual model of the tools and the MVA model on the screen. The authors' MVA tracking approach, which aims to update the MVA model in near real-time, comprises of three steps: image based gating, predictive reinitialization, and registration based MVA tracking. The image based gating step uses a small patch centered at each MVA point in the TEE images to identify images at optimal cardiac phases for updating the position of the MVA. The predictive reinitialization step uses the position and orientation of the TEE probe provided by the magnetic tracking system to predict the position of the MVA points in the TEE images and uses them for the initialization of the registration component. The registration based MVA tracking step aims to locate the MVA points in the images selected by the image based gating component by performing image based registration. The validation of the MVA tracking approach was performed in a phantom study and a retrospective study on porcine data. In the phantom study, controlled translations were applied to the phantom and the tracked MVA was compared to its "true" position estimated based on a magnetic sensor attached to the phantom. The MVA tracking accuracy was 1.29 ± 0.58 mm when the translation distance is about 1 cm, and increased to 2.85 ± 1.19 mm when the translation distance is about 3 cm. In the study on

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

    Science.gov (United States)

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

    2014-03-01

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

  17. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques.

    Science.gov (United States)

    Koprivanac, Marijan; Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

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

    Science.gov (United States)

    Maher, Kevin O; Tweddell, James S

    2016-08-01

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

  19. 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

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

    Directory of Open Access Journals (Sweden)

    Gomes Walter J.

    2002-01-01

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

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

    Science.gov (United States)

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

    2018-02-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

    OpenAIRE

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

    2013-01-01

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

  4. Robotic tissue tracking for beating heart mitral valve surgery.

    Science.gov (United States)

    Yuen, Shelten G; Vasilyev, Nikolay V; del Nido, Pedro J; Howe, Robert D

    2013-12-01

    The rapid motion of the heart presents a significant challenge to the surgeon during intracardiac beating heart procedures. We present a 3D ultrasound-guided motion compensation system that assists the surgeon by synchronizing instrument motion with the heart. The system utilizes the fact that certain intracardiac structures, like the mitral valve annulus, have trajectories that are largely constrained to translation along one axis. This allows the development of a real-time 3D ultrasound tissue tracker that we integrate with a 1 degree-of-freedom (DOF) actuated surgical instrument and predictive filter to devise a motion tracking system adapted to mitral valve annuloplasty. In vivo experiments demonstrate that the system provides highly accurate tracking (1.0 mm error) with 70% less error than manual tracking attempts. Copyright © 2010 Elsevier B.V. All rights reserved.

  5. Patient-reported outcomes after aortic and mitral valve surgery

    DEFF Research Database (Denmark)

    Borregaard, Britt; Ekholm, Ola; Riber, Lars

    2017-01-01

    , cross-sectional study (DenHeart). Patient-reported outcome measures included: Short-Form-12, Hospital Anxiety and Depression Scale, EuroQol-5D-5L, HeartQol and Edmonton Symptom Assessment System. Demographic and clinical information was obtained from national registers. RESULTS: Of 354 patients (65% men......, mean age: 68 years), 79% underwent aortic valve surgery. Patients who had undergone aortic valve surgery had more symptoms of anxiety compared with patients who had undergone mitral valve surgery (34% vs 17%, p=0.003, Hospital Anxiety and Depression Scale anxiety cut-off score of eight). Being female...... Analogue Scale. Age and comorbidity were not associated with patient-reported outcomes. CONCLUSION: Patients who had undergone aortic valve and mitral valve surgery did not significantly differ in patient-reported health at discharge, except for symptoms of anxiety. Being female was the only characteristic...

  6. Papel del ecocardiograma en la reparación mitral

    OpenAIRE

    Moñivas, Vanessa; Mingo, Susana; Cobo, Marta; Beltrán, Paula; Ramis, Sebastian; Castedo, Evaristo

    2010-01-01

    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...

  7. Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery

    National Research Council Canada - National Science Library

    Clotario Neptali Carrasco Cueva; Maiara dosSantos Rocha; Carlos Mauricio Cardeal Mendes; Luiz Antonio Rodrigues deFreitas; Jose Augusto Baucia; Roberto Badaro

    2013-01-01

    ...: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested...

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

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Afsoon Fazlinezhad

    2016-02-01

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

  11. 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.

  12. A Hybrid Double Access for Transcatheter Mitral Valve-In-Valve Implantation.

    Science.gov (United States)

    Pagnotta, Paolo; Mennuni, Marco G; Ferrante, Giuseppe; Ornaghi, Diego; Bragato, Renato; Cappai, Antioco; Presbitero, Patrizia

    2015-06-01

    We present a case of hybrid mitral valve-in valve implantation. The planned transapical approach failed due to the inability to cross the degenerated stenotic mitral bioprosthesis. An alternative strategy was performed: first, an anterograde crossing of mitral stenosis, and then, a guidewire externalization through the apex by using a snare. To our knowledge, this is the first described case of double approach mitral valve-in valve implantation. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-02-01

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

  14. 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.

  15. Mixoma atrial gigante simulando estenose mitral grave em paciente jovem

    Directory of Open Access Journals (Sweden)

    Eric Paiva Vilela

    2010-10-01

    Full Text Available Homem de 20 anos, previamente hígido, com quadro clínico de dispneia paroxística noturna e cansaço aos médios esforços com evolução em torno de dez dias, apresentou, ao exame ecocardiográfico, mixoma em átrio esquerdo funcionando como estenose mitral grave.

  16. Myocardial imaging artifacts caused by mitral valve annulus calcification

    Energy Technology Data Exchange (ETDEWEB)

    Wagoner, L.E.; Movahed, A.; Reeves, W.C. (East Carolina Univ. School of Medicine, Greenville, NC (USA))

    1991-02-01

    Knowledge of imaging artifact of myocardial perfusion studies with thallium-201 is critical for improving the diagnostic accuracy of coronary artery disease. Three patients are described who underwent exercise or pharmacologic stress thallium-201 imaging studies and had a moderate, fixed myocardial perfusion defect (scar) involving the posterolateral and inferoposterior walls of the left ventricle. This was an imaging artifact caused by a heavily calcified mitral valve annulus.

  17. 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.

  18. Mycoplasma pneumoniae and Chlamydia pneumoniae in calcified nodules of aortic stenotic valves Mycoplasma pneumoniae e Chlamydia pneumoniae nos focos de calcificação de valva aórtica estenótica

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes HIGUCHI

    2002-07-01

    Full Text Available Aortic Valve Stenosis (AVS has been explained as an atherosclerotic process of the valve as they often exhibit inflammatory changes with infiltration of macrophages, T lymphocytes and lipid infiltration. The present study investigated whether the bacteria Chlamydia pneumoniae (CP and Mycoplasma pneumoniae (MP, detected previously in atherosclerotic plaques, are also present in AVS. Ten valves surgically removed from patients with AVS were analyzed by immunohistochemistry, in situ hybridization, and electron microscopy. The mean and standard deviation of the percentage areas occupied by CP antigens and MP - DNA were respectively 6.21 +/- 5.41 and 2.27 +/- 2.06 in calcified foci; 2.8 +/- 3.33 and 1.78+/- 3.63 in surrounding fibrotic areas, and 0.21 +/- 0.17 and 0.12 +/- 0.13 in less injured parts of the valve. There was higher amount of CP and MP in the calcified foci and in the surrounded fibrosis than in more preserved valvular regions. In conclusion, the fact that there were greater amounts of CP and MP in calcification foci of AVS favors the hypothesis that AS is not an inevitable degenerative process due to aging, but rather that it may be a response to the presence of these bacteria, similarly to the morphology detected in atherosclerosis damage.Estenose da Valva Aórtica (EVA tem sido considerada como um processo aterosclerótico das valvas pois elas freqüentemente exibem alterações inflamatórias com acúmulo de macrófagos e linfócitos T, bem como infiltração de lípides. O presente estudo investigou se as bactérias Chlamydia pneumoniae (CP e Mycoplasma pneumoniae (MP, detectadas previamente em placas ateroscleróticas, estavam presentes na EVA. Dez valvas removidas cirúrgicamente de pacientes com EVA foram analisadas pela imunohistoquímica, hibridização in situ e microscopia eletrônica. A média e desvio padrão das porcentagens de área ocupadas por antígenos de CP e de DNA do MP foram respectivamente de 6,21 +/- 5,41 e 2

  19. Tetralogy of Fallot with rheumatic mitral stenosis: A case report

    Directory of Open Access Journals (Sweden)

    Sai Krishna Cheemalapati

    2008-04-01

    Full Text Available Abstract Introduction Rheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India. Tetralogy of Fallot is the most common congenital heart disease with survival to adulthood. Infective endocarditis accounts for 4% of admissions to a specialized unit for adult patients with a congenital heart lesion. This report is unique in that a severe stenotic lesion of the mitral valve, probably of rheumatic aetiology, was noted in an adult male with Tetralogy of Fallot. Case presentation An unusual association of rheumatic mitral stenosis in an adult Indian male patient aged 35 years with Tetralogy of Fallot and subacute bacterial endocarditis of the aortic valve is presented. Conclusion In this case report the diagnostic implications, hemodynamic and therapeutic consequences of mitral stenosis in Tetralogy of Fallot are discussed. In addition, the morbidity and mortality of infective endocarditis in adult patients with congenital heart disease are summarized. The risk of a coincident rheumatic process in patients with congenital heart disease is highlighted and the need for careful attention to this possibility during primary and follow-up evaluation of such patients emphasized.

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

    Science.gov (United States)

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

    2011-04-12

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

  1. Flow-Induced Mitral Leaflet Motion in Hypertrophic Cardiomyopathy

    Science.gov (United States)

    Meschini, Valentina; Mittal, Rajat; Verzicco, Roberto

    2017-11-01

    Hypertrophic cardiomyopathy (HCM) is considered the cause of sudden cardiac death in developed countries. Clinically it is found to be related to the thickening of the intra-ventricular septum combined with elongated mitral leaflets. During systole the low pressure, induced by the abnormal velocities in the narrowed aortic channel, can attract one or both the mitral leaflets causing the aortic obstruction and sometimes instantaneous death. In this paper a fluid structure interaction model for the flow in the left ventricle with a native mitral valve is employed to investigate the physio-pathology of HCM. The problem is studied using direct numerical simulations of the Navier-Stokes equations with a two-way coupled structural solver based on interaction potential approach for the structure dynamics. Simulations are performed for two different degrees of hypertrophy, and two values of pumping efficiency. The leaflets dynamics and the ventricle deformation resulting from the echocardiography of patients affected by HCM are well captured by the simulations. Moreover, the procedures of leaflets plication and septum myectomy are simulated in order to get insights into the efficiency and reliability of such surgery.

  2. Mechanotransduction Mechanisms in Mitral Valve Physiology and Disease Pathogenesis.

    Science.gov (United States)

    Pagnozzi, Leah A; Butcher, Jonathan T

    2017-01-01

    The mitral valve exists in a mechanically demanding environment, with the stress of each cardiac cycle deforming and shearing the native fibroblasts and endothelial cells. Cells and their extracellular matrix exhibit a dynamic reciprocity in the growth and formation of tissue through mechanotransduction and continuously adapt to physical cues in their environment through gene, protein, and cytokine expression. Valve disease is the most common congenital heart defect with watchful waiting and valve replacement surgery the only treatment option. Mitral valve disease (MVD) has been linked to a variety of mechano-active genes ranging from extracellular components, mechanotransductive elements, and cytoplasmic and nuclear transcription factors. Specialized cell receptors, such as adherens junctions, cadherins, integrins, primary cilia, ion channels, caveolae, and the glycocalyx, convert mechanical cues into biochemical responses via a complex of mechanoresponsive elements, shared signaling modalities, and integrated frameworks. Understanding mechanosensing and transduction in mitral valve-specific cells may allow us to discover unique signal transduction pathways between cells and their environment, leading to cell or tissue specific mechanically targeted therapeutics for MVD.

  3. Resolution of massive left atrial appendage thrombi with rivaroxaban before balloon mitral commissurotomy in severe mitral stenosis: A case report and literature review.

    Science.gov (United States)

    Li, Yuechun; Lin, Jiafeng; Peng, Chen

    2016-12-01

    Data on nonvitamin K antagonist oral anticoagulant being used for the treatment of LAA thrombi are limited only in nonvalvular atrial fibrillation. There are no data on the antithrombotic efficacy and safety of nonvitamin K antagonist oral anticoagulant in the resolution of left atrial appendage (LAA) thrombi in patients with rheumatic mitral stenosis. A 49-year-old woman with known rheumatic mitral stenosis and atrial fibrillation was referred for percutaneous transvenous mitral commissurotomy because of progressive dyspnea on exertion over a period of 3 months. Transesophageal echocardiography (TEE) demonstrated a large LAA thrombus protruding into left atria cavity before the procedure. Direct factor Xa (FXa) inhibitor rivaroxaban (20 mg/d) was started for the patient. After 3 weeks of rivaroxaban treatment TEE showed a relevantly decreased thrombus size, and a complete thrombus resolution was achieved after 5 weeks of anticoagulant therapy with the FXa inhibitor. To the best of our knowledge, this is the first documented case of large LAA thrombus resolution with nonvitamin K antagonist oral anticoagulant in severe mitral stenosis, and in which percutaneous transvenous mitral commissurotomy was performed subsequently. The report indicated that rivaroxaban could be a therapeutic option for mitral stenosis patients with LAA thrombus. Further study is required before the routine use of rivaroxaban in patients with rheumatic mitral stenosis and atrial fibrillation.

  4. 3D printed mitral valve models: affordable simulation for robotic mitral valve repair.

    Science.gov (United States)

    Premyodhin, Ned; Mandair, Divneet; Ferng, Alice S; Leach, Timothy S; Palsma, Ryan P; Albanna, Mohammad Z; Khalpey, Zain I

    2018-01-01

    3D printed mitral valve (MV) models that capture the suture response of real tissue may be utilized as surgical training tools. Leveraging clinical imaging modalities, 3D computerized modelling and 3D printing technology to produce affordable models complements currently available virtual simulators and paves the way for patient- and pathology-specific preoperative rehearsal. We used polyvinyl alcohol, a dissolvable thermoplastic, to 3D print moulds that were casted with liquid platinum-cure silicone yielding flexible, low-cost MV models capable of simulating valvular tissue. Silicone-moulded MV models were fabricated for 2 morphologies: the normal MV and the P2 flail. The moulded valves were plication and suture tested in a laparoscopic trainer box with a da Vinci Si robotic surgical system. One cardiothoracic surgery fellow and 1 attending surgeon qualitatively evaluated the ability of the valves to recapitulate tissue feel through surveys utilizing the 5-point Likert-type scale to grade impressions of the valves. Valves produced with the moulding and casting method maintained anatomical dimensions within 3% of directly 3D printed acrylonitrile butadiene styrene controls for both morphologies. Likert-type scale mean scores corresponded with a realistic material response to sutures (5.0/5), tensile strength that is similar to real MV tissue (5.0/5) and anatomical appearance resembling real MVs (5.0/5), indicating that evaluators 'agreed' that these aspects of the model were appropriate for training. Evaluators 'somewhat agreed' that the overall model durability was appropriate for training (4.0/5) due to the mounting design. Qualitative differences in repair quality were notable between fellow and attending surgeon. 3D computer-aided design, 3D printing and fabrication techniques can be applied to fabricate affordable, high-quality educational models for technical training that are capable of differentiating proficiency levels among users.

  5. Value of Robotically Assisted Surgery for Mitral Valve Disease

    Science.gov (United States)

    Mihaljevic, Tomislav; Koprivanac, Marijan; Kelava, Marta; Goodman, Avi; Jarrett, Craig; Williams, Sarah J.; Gillinov, A. Marc; Bajwa, Gurjyot; Mick, Stephanie L.; Bonatti, Johannes; Blackstone, Eugene H.

    2014-01-01

    Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotic surgery mitigate high technology costs. Design Clinical cohort study comparing costs of robotic vs. three contemporaneous conventional surgical approaches for degenerative mitral disease. Surgery was performed from 2006–2011, and comparisons were based on intent-to-treat, with propensity-matching used to reduce selection bias. Setting Large multi-specialty academic medical center. Participants 1,290 patients aged 57±11 years, 27% women, underwent mitral repair for regurgitation from posterior leaflet prolapse. Robotic surgery was used in 473, complete sternotomy in 227, partial sternotomy in 349, and anterolateral thoracotomy in 241. Three propensity-matched groups were formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiology, and echocardiographic measurements: robotic vs. sternotomy (n=198 pairs) vs. partial sternotomy (n=293 pairs) vs. thoracotomy (n=224 pairs). Interventions Mitral valve repair. Main Outcome Measures Cost of care, expressed as robotic capital investment, maintenance, and direct technical hospital cost, and benefit of care, based on differences in recovery time. Results Median cost of care for robotically assisted surgery exceeded the cost of alternative approaches by 27% (−5%, 68%), 32% (−6%, 70%), and 21% (−2%, 54%) (median [15th, 85th percentiles]) for complete sternotomy, partial sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: median 35 days for robotic surgery, 49 for complete sternotomy, 56 for partial sternotomy, and 42 for anterolateral thoracotomy. Resulting net differences in cost of robotic surgery vs. the three

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

    Science.gov (United States)

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

    2002-11-01

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

  7. Mitral valve repair-related hemolysis: a report of two cases

    NARCIS (Netherlands)

    Bruinsma, G. J. B. B.; Bredee, J. J.; de Mol, B. A. J. M.

    1997-01-01

    Two patients are described who suffered from progressive intravascular hemolysis following different kinds of reconstructive surgery of the mitral valve. Within the context of increasing numbers of operations aimed to preserve the mitral valve, the importance and difficulty of prompt recognition and

  8. 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

  9. Surgery for rheumatic mitral valve disease in sub-saharan African ...

    African Journals Online (AJOL)

    Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral ...

  10. Rupture of Sinus of Valsalva Aneurysm Associated with Left Ventricular Noncompaction and Mitral Valve Prolapse

    Directory of Open Access Journals (Sweden)

    Sinan Aydoğdu

    2011-08-01

    Full Text Available We report a 27-year-old patient with ruptured sinus Valsalva aneurysm (SVA, left ventricular noncompaction and mitral valve prolapse. Whether the coexistence of ruptured SVA, left ventricular noncompaction and mitral valve prolapse is coincidental or due to a defect in a common developmental pathway requires further research.

  11. An isolated cleft of the anterior leaflet of mitral valve in an infant: a ...

    African Journals Online (AJOL)

    McRoy

    echocardiographic and surgical/postmortem findings in mitral cleft.[11]Congenital cleft malformation in an otherwise normal mitral valve usually presents with concomitant cardiac defects, mainly an atrial septal defect, and Down's syndrome is the commonst common noncardiac anomaly.[12]. It is known that its association ...

  12. 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...

  13. Mitral Valve Prolapse in Dar-es-Salaam, Tanzania: Clinical and ...

    African Journals Online (AJOL)

    Background: Mitral Valve Prolapse is a common, usually a benign disease. If recognized early, it has a good prognosis and saves the doctor and patients from embarrassing mismanagement. Broad Objective: To determine the prevalence of Mitral Valve Prolapse among patients referred to our cardiac clinic with provisional ...

  14. Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease

    NARCIS (Netherlands)

    Geuzebroek, Guillaume S. C.; van Amersfoorth, Shirley C. M.; Hoogendijk, Mark G.; Kelder, Johannes C.; van Hemel, Norbert M.; de Bakker, Jacques M. T.; Coronel, Ruben

    2012-01-01

    Objective: Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation + mitral valve disease or with lone atrial fibrillation and compared it with

  15. An isolated cleft of the anterior leaflet of mitral valve in an infant: a ...

    African Journals Online (AJOL)

    International Journal of Medicine and Biomedical Research ... The cardiac failure was treated but he represented with recurrent heart failure upto three times within six months. ... Conclusion: Isolated cleft of the mitral valve commonly presents with mitral incompetence and eventual heart failure as in our patient.

  16. PREDICTION OF BLOOD FLOW VELOCITY AND LEAFLET DEFORMATION VIA 2D MITRAL VALVE MODEL

    Directory of Open Access Journals (Sweden)

    M.A.H. Mohd Adib

    2012-06-01

    Full Text Available In the mitral valve, regional variations in structure and material properties combine to affect the biomechanics of the entire valve. From previous studies, we know that the mitral valve leaflet tissue is highly extensible. A two-dimensional model of the mitral valve was generated using an Arbitrary Lagrangian-Eulerian (ALE mesh. A simple approximation of the heart geometry was used and the valve dimensions were based on actual measurements made. Valve opening and closure was simulated using contact equations. The objective of this study was to investigate and predict flow and leaflet phenomena via a simple 2D mitral valve model based on the critical parameter of blood. Two stages of mitral valves analysis were investigated: the systolic and diastolic stages. The results show a linear correlation between the mitral valve leaflet rigidity and the volume of backflow. Additionally, the simulation predicted mitral valve leaflet displacement during closure, which agreed with the results of our previous data analysis and the results for blood flow velocity during systole condition through the mitral valve outlet, as reported in the medical literature. In conclusion, these computational techniques are very useful in the study of both degenerative valve disease and failure of prostheses and will be further developed to investigate heart valve failure and subsequent surgical repair.

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

    Science.gov (United States)

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

    2017-07-27

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

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Satoko Yokoyama

    2017-11-01

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

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

    Science.gov (United States)

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

    2006-11-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  2. 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. Copyright © 2010 Wiley Periodicals, Inc.

  3. 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

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

    Science.gov (United States)

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

    2017-12-13

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

  5. Combined aortic root replacement and mitral valve surgery: The quest to preserve both valves.

    Science.gov (United States)

    Javadikasgari, Hoda; Roselli, Eric E; Aftab, Muhammad; Suri, Rakesh M; Desai, Milind Y; Khosravi, Mitra; Cikach, Frank; Isabella, Monica; Idrees, Jay J; Raza, Sajjad; Tappuni, Bassman; Griffin, Brian P; Svensson, Lars G; Gillinov, A Marc

    2017-05-01

    Coexisting aortic root and mitral valve pathology is increasingly recognized among patients undergoing surgery. We characterized the pathology and surgical outcomes of patients with combined aortic root and mitral disease. From 1987 to 2016, 118 patients (age 52.40 ± 17.71 years) underwent concomitant aortic root and mitral procedures (excluding aortic stenosis, endocarditis, and reoperations). Aortic root pathologies included degenerative aneurysm (94%) and aortic dissection (6%). The aortic valve was bicuspid in 15% of patients and had normally functioning tricuspid leaflets in 23% of patients. Marfan syndrome was present in 34 patients (29%). Degenerative mitral disease predominated (78%). Mitral procedures were repair (86%) and replacement (14%), and root procedures were valve-preserving root reimplantation (36%), Bentall procedure (47%), and homograft root replacement (17%). In the last 10 years, the combination of valve-preserving root reimplantation and mitral repair has increased to 50%. Kaplan-Meier and competing risk analyses were used to estimate survival and reoperation. There were 2 (1.7%) operative deaths with survival of 79% and 71% at 10 and 15 years, respectively, and reoperation rates of 4.7% and 12% after 5 and 10 years, respectively. There were no operative deaths in patients with combined valve-preserving root reimplantation and mitral repair, with survival of 89% and reoperation rate of 7.8% at 10 years. Among patients with Bentall/homograft and mitral operation, survival was 73% and reoperation was 9.8% at 10 years. In patients with aortic root and mitral pathology, combined surgical risk is low and valve durability is high. When possible, valve-preserving root reimplantation and mitral repair should be considered to avoid prosthesis degeneration, anticoagulation, and lifestyle limitations. Copyright © 2017. Published by Elsevier Inc.

  6. Predicting Acute Kidney Injury Following Mitral Valve Repair.

    Science.gov (United States)

    Chang, Chih-Hsiang; Lee, Cheng-Chia; Chen, Shao-Wei; Fan, Pei-Chun; Chen, Yung-Chang; Chang, Su-Wei; Chen, Tien-Hsing; Wu, Victor Chien-Chia; Lin, Pyng-Jing; Tsai, Feng-Chun

    2016-01-01

    Acute kidney injury (AKI) after cardiac surgery is associated with short-term and long-term adverse outcomes. Novel biomarkers have been identified for the early detection of AKI; however, examining these in every patient who undergoes cardiac surgery is prohibitively expensive. Society of Thoracic Surgeons (STS) and Age, Creatinine, and Ejection Fraction (ACEF) scores have been proven to predict mortality in bypass surgery. The aim of this study was to determine whether these scores can be used to predict AKI after mitral valve repair. Between January 2010 and December 2013, 196 patients who underwent mitral valve repair were enrolled. The clinical characteristics, outcomes, and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined using the Kidney Disease Improving Global Outcome 2012 clinical practice guidelines for AKI. A total of 76 patients (38.7%) developed postoperative AKI. The STS renal failure (AUROC: 0.797, P < .001) and ACEF scores (AUROC: 0.758, P < .001) are both satisfactory tools for predicting all AKI. The STS renal failure score exhibited superior accuracy compared with the ACEF score in predicting AKI stage 2 and 3. The overall accuracy of both scores was similar for all AKI and AKI stage 2 and 3 when the cut-off points of the STS renal failure and ACEF scores were 2.2 and 1.1, respectively. In conclusion, the STS renal failure score can be used to accurately predict stage 2 and 3 AKI after mitral valve repair. The ACEF score is a simple tool with satisfactory power in screening patients at risk of all AKI stages. Additional studies can aim to determine the clinical implications of combining preoperative risk stratification and novel biomarkers.

  7. Mitral valve annular downsizing forces: implications for annuloplasty device development.

    Science.gov (United States)

    Jensen, Morten O; Honge, Jesper L; Benediktsson, Jon A; Siefert, Andrew W; Jensen, Henrik; Yoganathan, Ajit P; Snow, Teresa K; Hasenkam, J Michael; Nygaard, Hans; Nielsen, Sten L

    2014-07-01

    Mitral valve repair with annulus downsizing is a popular surgical procedure for functional mitral regurgitation. We investigated the effects of externally applied downsizing on the observed in-plane forces and valvular dimensions. Five animals were included in an acute porcine study. Three traction sutures were anchored at the right fibrous trigone (T) and suspended across the annulus for externalization at the P1, P2, and P3 annular segments. The annulus was downsized with the sutures in controlled increments while measuring the tension force in the sutures. Downsizing percentages ranged from a 2% to 32% reduction of the T-P distances. Sonomicrometry was used to measure the resulting valvular dimensions. No difference in force was found between the P1, P2, and P3 segments across all levels of downsizing. The peak forces at 32% downsizing were 1.2 ± 0.9 N, 1.5 ± 1.0 N, and 0.8 ± 0.2 N for the T-P1, T-P2, and T-P3 segments, respectively. The maximum total suture forces in the mitral plane during downsizing increased from 0.12 ± 0.03 N to 3.5 ± 1.3 N (P downsizing (0%-32%) from 5 ± 3 mm to 1 ± 1 mm (P downsizing increased in-plane traction suture forces and has a significant influence on the in-plane biomechanics. These results have implications for device design in terms of mechanical strength requirements and can be used to supplement boundary conditions for computational left heart models. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  8. Decellularized mitral valve in a long-term sheep model.

    Science.gov (United States)

    Iablonskii, Pavel; Cebotari, Serghei; Ciubotaru, Anatol; Sarikouch, Samir; Hoeffler, Klaus; Hilfiker, Andres; Haverich, Axel; Tudorache, Igor

    2018-01-29

    The objective of this study was to evaluate surgical handling, in vivo hemodynamic performance and morphological characteristics of decellularized mitral valves (DMVs) in a long-term sheep model. Ovine mitral valves were decellularized using detergents and β-mercaptoethanol. Orthotopic implantations were performed in 6-month-old sheep (41.3 ± 1.2 kg, n = 11) without annulus reinforcement. Commercially available stented porcine aortic valves [biological mitral valve (BMV), n = 3] were implanted conventionally and used as controls. Valve function was evaluated by transoesophageal echocardiography and explants were investigated by a routine bright field microscopy and immunofluorescent histology. During implantation, 2 DMVs required cleft closure of the anterior leaflet. All valves were competent on water test and early postoperative transoesophageal echocardiography. Six animals (DMV, n = 4; BMV, n = 2) survived 12 months. Six animals died within the first 4 months due to valve-related complications. At 12 months, transoesophageal echocardiography revealed severe degeneration in all BMVs. Macroscopically, BMV revealed calcification at the commissures and leaflet insertion area. Histological examination showed sporadic cells negative for endothelial nitric oxide synthase, von Willebrand factor and CD45 on their surface. In contrast, DMV showed no calcification or stenosis, and the regurgitation was trivial to moderate in all animals. Fibrotic hardening occurred only along the suture line of the valve annulus, immunostaining revealed collagen IV covering the entire leaflet surface and a repopulation with endothelial cells. Surgical implantation of DMV is feasible and results in good early graft function. Additional in vivo investigations are required to minimize the procedure-related complications and to increase the reproducibility of surgical implantation. Degenerative profile of allogeneic DMV is superior to commercially available

  9. Mycobacterium goodii endocarditis following mitral valve ring annuloplasty.

    Science.gov (United States)

    Parikh, Rohan B; Grant, Matthew

    2017-03-21

    Mycobacterium goodii is an infrequent human pathogen which has been implicated in prosthesis related infections and penetrating injuries. It is often initially misidentified as a gram-positive rod by clinical microbiologic laboratories and should be considered in the differential diagnosis. We describe here the second reported case of M. goodii endocarditis. Species level identification was performed by 16S rDNA (ribosomal deoxyribonucleic acid) gene sequencing. The patient was successfully treated with mitral valve replacement and a prolonged combination of ciprofloxacin and trimethoprim/sulfamethoxazole. Confirmation of the diagnosis utilizing molecular techniques and drug susceptibility testing allowed for successful treatment of this prosthetic infection.

  10. 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.

  11. Mitral valve morphology assessed by three-dimensional transthoracic echocardiography in healthy dogs and dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Menciotti, G; Borgarelli, M; Aherne, M; Wesselowski, S; Häggström, J; Ljungvall, I; Lahmers, S M; Abbott, J A

    2017-04-01

    To assess differences in morphology of the mitral valve (MV) between healthy dogs and dogs affected by myxomatous mitral valve disease (MMVD) using real-time transthoracic three-dimensional echocardiography (RT3DE). Thirty-four were normal dogs and 79 dogs were affected by MMVD. Real-time transthoracic three-dimensional echocardiography mitral datasets were digitally recorded and analyzed using dedicated software. The following variables were obtained and compared between healthy dogs and dogs with MMVD at different stages: antero-posterior annulus diameter, anterolateral-posteromedial annulus diameter, commissural diameter, annulus height, annulus circumference, annulus area, anterior leaflet length, anterior leaflet area, posterior leaflet length, posterior leaflet area, non-planar angle, annulus sphericity index, tenting height, tenting area, tenting volume, the ratio of annulus height and commissural diameter. Dogs with MMVD had a more circular MV annulus compared to healthy dogs as demonstrated by an increased annulus sphericity index (p=0.0179). Affected dogs had a less saddle-shaped MV manifest as a decreased annulus height to commissural width ratio (p=0.0004). Tenting height (pdogs. Real-time transthoracic three-dimensional echocardiography analysis demonstrated that dogs affected by MMVD had a more circular and less saddle-shaped MV annulus, as well as reduced tenting height area and volume, compared to healthy dogs. Multiple variables differed between dogs at different stages of MMVD. Diagnostic and prognostic utility of these variables, and the significance of these changes in the pathogenesis and natural history of MMVD, require further attention. Copyright © 2017 Elsevier B.V. All rights reserved.

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

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    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.

  13. A review of the use of cardiac computed tomography for evaluating the mitral valve before and after mitral valve repair

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    Kim, Jong Hun; Choi, Jong Bum [Dept. of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju (Korea, Republic of); Kim, Eun Young; Jin, Gong Yong [Dept. of Radiology, Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences of Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2017-09-15

    The role of cardiac computed tomography (CT) for evaluating the mitral valve (MV) has been limited since echocardiography is the main method of evaluation. However, recent advances in cardiac CT have enable detailed evaluation of the anatomy and geometry of the MV. We describe assessments of the anatomy and coaptation geometric parameters of normal MVs, and also review repair of diseased/damaged MV. We also discuss pre- and post-surgical imaging of MV pathology using cardiac CT and various CT images. We found that cardiac CT could be used as an alternative imaging modality to echocardiography for pre-operative MV evaluation and to predict clinical outcomes following repair.

  14. Substituição valvar isolada com próteses metálicas St. Jude Medical em posição aórtica ou mitral: seguimento de médio prazo Sustitución valvular aislada con prótesis metálicas St. Jude Medical en posición aórtica o mitral: seguimiento de medio plazo Isolated mitral and aortic valve replacement with the St. Jude Medical valve: a midterm follow-up

    Directory of Open Access Journals (Sweden)

    Alfredo José Rodrigues

    2009-09-01

    Full Text Available FUNDAMENTO: Em nosso meio as próteses valvares biológicas predominam, considerando-se as dificuldades relacionadas à anticoagulação, mesmo em pacientes jovens, a despeito da necessidade de repetidas operações devido à degeneração das próteses biológicas. OBJETIVO: Apresentar a evolução em médio prazo de pacientes submetidos à substituição da valva mitral ou aórtica por prótese valvar mecânica St. Jude. MÉTODOS: Foi analisada retrospectivamente a evolução dos pacientes operados entre janeiro de 1995 e dezembro de 2003 e seguidos até dezembro de 2006. RESULTADOS: Cento e sessenta e oito pacientes receberam prótese valvar mitral e 117, aórtica. A idade média de ambos os grupos foi de 45 anos. Entre os mitrais, 75% tinham até 55 anos e 65% eram mulheres. Entre os aórticos, 66% tinham até 55 anos e 69% eram homens. Considerando-se apenas mortes relacionadas às próteses valvares, a sobrevida foi de 85,6% para os mitrais e de 88,7% para os aórticos (p=0,698. Entre os mitrais, 97% estavam livres de reoperação, e entre os aórticos 99% (p=0,335. Quanto aos eventos tromboembólicos, a porcentagem de pacientes livres foi de 82% entre os mitrais e de 98% entre os aórticos (p=0,049, e para os eventos hemorrágicos foi de 71% e 86% respectivamente (0,579. Quanto à ocorrência de endocardite, 98 % entre os mitrais e 99% entre os aórticos estavam livres ao final de 10 anos (p=0,534. CONCLUSÃO: Nossa experiência com próteses metálicas St. Jude em uma população predominantemente jovem confirma o bom desempenho desta prótese, em acordo com outras experiências publicadas.FUNDAMENTO: En nuestro medio, las prótesis valvulares biológicas predominan, teniendo en cuenta las dificultades relacionadas a la anticoagulación, incluso en pacientes jóvenes, pese a la necesidad de repetidas operaciones debido a la degeneración de las prótesis biológicas. OBJETIVO: Presentar la evolución en medio plazo de pacientes sometidos

  15. Real-time three-dimensional transthoracic echocardiography for predicting mitral annuloplasty ring size.

    Science.gov (United States)

    Labib, Dina O; Heshmat, Hussien; Gaafar, Ahmed H; Salah, Maged; Mahdy, Soliman G

    2014-09-01

    Despite advances in mitral valve repair techniques, including robotic surgeries, few studies are available on predicting mitral annuloplasty ring size using echocardiography. Furthermore, these studies either had limited accuracy or else required the use of three-dimensional transesophageal echocardiography (3D-TEE), an expensive and semi-invasive tool. The study aim was to predict the mitral annuloplasty ring size preoperatively using real-time, three-dimensional transthoracic echocardiography (RT3D-TTE), which is a cheaper, non-invasive technique. This prospective study included 47 consecutive patients scheduled for elective mitral valve surgery. All participants underwent preoperative RT3D-TTE. The mitral annular transverse diameter during early systole and the maximum height of the A2 scallop were measured in the multiplanar reconstruction mode. The surgeon, who was blinded to the echocardiographic measurements, also measured these two variables intraoperatively. A Pearson correlation coefficient was used to assess the association between the echocardiographic and operative measurements. A linear regression analysis was used to predict the annuloplasty ring size. A total of 34 patients (72.3%) underwent mitral valve repair. The echocardiographic measurements of the mitral annular transverse diameter were well correlated with the operative measurements (r = 0.64, p robotic procedures are performed.

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

    Science.gov (United States)

    Bhattacharya, Shamik; He, Zhaoming

    2015-01-01

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

  17. How safe is it to train residents to perform mitral valve surgery?

    Science.gov (United States)

    Gabriel, Joseph; Göbölös, László; Miskolczi, Szabolcs; Barlow, Clifford

    2016-11-01

    A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients undergoing mitral valve surgery] are [postoperative morbidity and mortality outcomes] acceptable when patients are operated on by [residents]? Four hundred and twenty-three were identified from the search strategy. Six articles selected as best evidence were tabulated. All current published evidence, encompassing open and minimally invasive mitral valve repair in addition to mitral valve replacement, supports the involvement of trainees in mitral procedures. Although trainees may experience longer aortic cross-clamp and cardiopulmonary bypass times than specialist surgeons, they are not associated with significantly worse perioperative or postoperative outcomes in comparable mitral procedures. Important factors in the viability of mitral valve training and its quality include the volume of cases per institution and the expertise of the supervising surgeon, and these remain largely unexplored. Overall, mitral valve surgery remains a valuable potential training opportunity, one which is perhaps underexploited. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

    Science.gov (United States)

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

    2011-01-01

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

  19. Loss of olfactory cell adhesion molecule reduces the synchrony of mitral cell activity in olfactory glomeruli.

    Science.gov (United States)

    Borisovska, Maria; McGinley, Matthew J; Bensen, AeSoon; Westbrook, Gary L

    2011-04-15

    Odours generate activity in olfactory receptor neurons, whose axons contact the dendritic tufts of mitral cells within olfactory bulb glomeruli. These axodendritic synapses are anatomically separated from dendrodendritic synapses within each glomerulus. Mitral cells within a glomerulus show highly synchronized activity as assessed with whole-cell recording from pairs of mitral cells. We examined glomerular activity in mice lacking the olfactory cell adhesion molecule (OCAM). Glomeruli in mice lacking OCAM show a redistribution of synaptic subcompartments, but the total area occupied by axonal inputs was similar to wild-type mice. Stimulation of olfactory nerve bundles showed that excitatory synaptic input to mitral cells as well as dendrodendritic inhibition was unaffected in the knockout. However, correlated spiking in mitral cells was significantly reduced, as was electrical coupling between apical dendrites. To analyse slow network dynamics we induced slow oscillations with a glutamate uptake blocker. Evoked and spontaneous slow oscillations in mitral cells and external tufted cells were broader and had multiple peaks in OCAM knockout mice, indicating that synchrony of slow glomerular activity was also reduced. To assess the degree of shared activity between mitral cells under physiological conditions, we analysed spontaneous sub-threshold voltage oscillations using coherence analysis. Coherent activity was markedly reduced in cells from OCAM knockout mice across a broad range of frequencies consistent with a decrease in tightly time-locked activity. We suggest that synchronous activity within each glomerulus is dependent on segregation of synaptic subcompartments.

  20. Ruptura traumática de la válvula mitral

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    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.

  1. Dendritic branching of olfactory bulb mitral and tufted cells: regulation by TrkB.

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    Fumiaki Imamura

    2009-08-01

    Full Text Available 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.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.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.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-12-18

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

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

    Directory of Open Access Journals (Sweden)

    Vera T. M Borges

    2011-01-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

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

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    Li Zong-Xiao

    2012-04-01

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

  7. Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy

    Science.gov (United States)

    Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.

    2002-01-01

    Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

  8. Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional Minimally invasive aortic valve replacement: a comparison of results with the traditional technique

    Directory of Open Access Journals (Sweden)

    André Luiz Tyszka

    2004-03-01

    Full Text Available OBJETIVO: As cirurgias cardíacas minimamente invasivas foram desenvolvidas para proporcionarem, através de acessos limitados, menores traumas, melhores resultados estéticos e diminuição nos custos hospitalares com a mesma segurança das cirurgias tradicionais. O estudo teve como objetivo comparar os resultados peri-operatórios dos pacientes submetidos à troca de valva aórtica por meio dos acessos minimamente invasivo e convencional. MÉTODO: Doze pacientes consecutivamente submetidos à troca de valva aórtica isolada por acesso minimamente invasivo, a partir de junho de 2002, tiveram seus dados pré-operatórios, operatórios e pós-operatórios imediatos comparados com os 12 pacientes anteriormente operados na mesma instituição submetidos ao mesmo tipo de operação, porém com acesso convencional. O acesso minimamente invasivo utilizado foi a hemiesternotomia mediana superior e a instalação da CEC foi através da canulação da aorta ascendente e do átrio direito, semelhante à técnica tradicional. RESULTADOS: Os dados demográficos foram semelhantes nos dois grupos de pacientes. Não houve diferença significativa entre os tempos de isquemia, de CEC e do tempo total do procedimento. O tamanho da incisão da pele foi significativamente menor no grupo minimamente invasivo. No pós-operatório, embora tenham sido menores os tempos de ventilação mecânica e o tempo total de permanência hospitalar, estes dados não mostraram diferença significativa. A morbidade pós-cirúrgica foi semelhante entre os dois grupos. CONCLUSÕES: Esta abordagem oferece adequada exposição das estruturas necessárias para uma segura troca valvar e com o mesmo instrumental utilizado na cirurgia tradicional podemos oferecer as vantagens de um acesso menos invasivo com a mesma eficiência da cirurgia tradicional sem acrescentar riscos aos nossos pacientes.OBJECTIVE: Minimally invasive cardiac surgeries are approaches used to reduce trauma, to give

  9. Mitral valve prolapse: association with bizarre behavior, a confusional state, and aphasia.

    Science.gov (United States)

    Schatz, R E; Chandraratna, P A

    1982-06-01

    A 30-year-old man was admitted to the hospital with a history of sudden onset of bizarre behavior and difficulty in speaking that initially was attributed to drug intoxication. Examination disclosed a confused young man with receptive and expressive aphasia. A late systolic murmur was heard in the mitral area and echocardiography confirmed the presence of mitral valve prolapse. A computed tomographic scan of the head and cerebral angiography showed abnormalities consistent with an infarct of the left temporo-occipital region. Since no other predisposing factors were present, this patient's stroke was probably related to mitral valve prolapse.

  10. [Large mitral annulus myxoma presenting with syncope: Report of one case].

    Science.gov (United States)

    Vega, Julián; Gabrielli, Luigi; Olivares, Gabriel; Córdova, Samuel; Méndez, Manuel; González, Rodrigo

    2016-12-01

    We report a 23-year-old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication.

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

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed

    2016-05-01

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

  12. Ecocardiografía en la valvulopatía mitral

    OpenAIRE

    Rodríguez,Leonardo

    2005-01-01

    La ecocardiografía se ha convertido en el método principal para la evaluación de las enfermedades valvulares. En el caso de la valvulopatía mitral, el ecocardiograma provee información detallada acerca de la anatomía y función ventricular. El uso de este método nos ha permitido el ahondar en el conocimiento de los mecanismos que participan en la génesis de insuficiencia mitral. El eco no sólo nos permite detectar la presencia de insuficiencia mitral sino también cuantificar su severidad, la c...

  13. Asimetría bilateral de la forma de las valvas y posición espacial en matrices del chorito Perumytilus purpuratus (Lamarck, 1819 (Bivalvia: Mytilidae Bilateral asymmetry of shell shape and spatial position in matrices of the mussel Perumytilus purpuratus (Lamarck, 1819 (Bivalvia: Mytilidae

    Directory of Open Access Journals (Sweden)

    CAROLINA BRIONES

    2005-03-01

    Full Text Available De las distintas formas de la asimetría bilateral, la asimetría direccional (AD ha recibido considerablemente menos atención en la literatura que la asimetría fluctuante (AF. Si bien existen buenos ejemplos de AD conspicua en algunos grupos de moluscos (e.g., Ostreidae y Pectinidae, para otros como los mitílidos la AD no ha sido reportada. En matrices del chorito Perumytilus purpuratus de tres localidades del intermareal rocoso de Chile norte y central, comparando individuos de los estratos superior e inferior, y usando dos índices de forma de la valva, reportamos evidencia de AD en relación con la forma de las valvas, tendiendo la derecha a ser consistentemente más elongada que la valva izquierda. Sin embargo, no solo en estratos inferiores de la matriz los choritos tienden a tener valvas menos elongadas sino que también tienden a ser más asimétricas, en relación con el estrato superior. Los resultados sugieren que el cambio de forma y de asimetría podría estar siendo modulado por la densidad o la estratificación. Las explicaciones causales de este fenómeno están abiertas a la investigaciónIn the literature, less attention has been paid to the study of directional asymmetry (DA than fluctuating asymmetry (FA. Although there are good examples of DA in mollusks (e.g., Ostreidae and Pectinidae, for some taxa, such as mussels, DA has not been reported. We examined asymmetry in two shell shape traits of the mussel Perumytilus purpuratus, in the rocky intertidal zone of three localities in central and northern Chile. We compared shell asymmetry between mussels occupying different positions in the matrices or mussel beds (i.e., upper versus lower stratum. We observed shell shape DA for mussels occupying both strata, with the right valve being consistently less elongated than the left valve. However, for individuals in the lower strata the mussel valves tended to be more elongated, and also more asymmetrical, relative to mussels from

  14. Evaluation of plain radiograph in mitral stenosis related to hemodynamics

    Energy Technology Data Exchange (ETDEWEB)

    Choe, Ku Ok; Suh, Jung Ho; Park, Chang Yun; Choi, Byung So [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1973-04-15

    Mitral stenosis, the most frequent heart disease in adult, showed relatively characteristic pulmonary findings in plain chest X-ray. In recent years the knowledge of the altered physiology of hemodynamics could offer considerable amount of hemodynamic barrier in plain chest. But the value of several parameters was still controversial. In this study a variety of roentgen signs were related to physiologic data and those were acquired by the cardiac catheterization in total of 67 cases of mitral stenosis. 1. Correlation of DPA/DHT ratio (Diameter of pulmonary arterial segment/ Diameter of hemithorax X 100) to hemodynamic data; The pulmonary arterial segments was dilated by two factors, the one was pulmonary blood flow and the other the blood pressure within it. In mitral stenosis, the cardiac output was decreased to quite uniform level, hence measurement of pulmonary arterial segment might be valuable. The correlation coefficient of DPA/ DHT ratio to hemodynamic data were as follows: 0.54 to mean pulmonary artery pressure, 0.32 to pulmonary capillary wedge pressure, -0.37 to mitral valvular area and 0.07 to pulmonary vascular resistance. No significant difference was noted in between pure mitral stenosis and mitral stenosis associated with other valvular disease. 2. Correlation of diameter of right descending pulmonary artery to hemodynamic data: The measurement was made near the first bifurcation of right descending pulmonary artery at its widest point. Pulmonary vascular pattern was best correlated (r=0.71). Another had rough correlation: 0.05 to mean pulmonary artery pressure, 0.31 to pulmonary capillary wedge pressure, -0.44 to mitral valvular area in correlation coefficient. No pulmonary arterial hypertension was observed in the cases diameter of less than 12 mm, but all except two cases had pulmonary hypertension in which diameter exceeded 16 mm. According to increase of the mean pulmonary arterial pressure, the same increment in pressure increased change

  15. Effect of obstructive sleep apnea on mitral valve tenting.

    Science.gov (United States)

    Pressman, Gregg S; Figueredo, Vincent M; Romero-Corral, Abel; Murali, Ganesan; Kotler, Morris N

    2012-04-01

    Obstructive apneas produce high negative intrathoracic pressure that imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no obstructive sleep apnea (OSA; AHI <15) and moderate/severe OSA (AHI ≥15). Mitral valve tenting height and area, left ventricular (LV) long and short axes, and LV end-diastolic volume were measured in addition to tissue Doppler parameters. Comparisons of measurements at baseline and follow-up between and within groups were obtained; correlations between absolute changes (Δ) in echocardiographic parameters were also performed. After a mean follow-up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 to 1.28 ± 0.17 cm, p = 0.001) in moderate/severe OSA as did tenting area (2.30 ± 0.41 to 2.66 ± 0.60 cm(2), p = 0.0002); Δtenting height correlated with ΔLV end-diastolic volume (rho 0.43, p = 0.01) and Δtenting area (rho 0.35, p = 0.04). In patients with mild/no OSA there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 to 2.31 ± 0.43 cm(2), p = 0.05). Septal tissue Doppler early diastolic wave decreased (8.04 ± 2.49 to 7.10 ± 1.83 cm/s, p = 0.005) in subjects with moderate/severe OSA but not in in those with mild/no OSA. In conclusion, in patients with moderate/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2009-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2016-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Diane Elegino-Steffens

    2012-01-01

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

  20. 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).

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    Roux Emmanuel

    2009-02-01

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

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

    OpenAIRE

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

    2009-01-01

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

  5. Mitral valve replacement in a case of dextrocardia with situs solitus.

    Science.gov (United States)

    Okamura, Homare; Yamaguchi, Atsushi; Adachi, Koichi; Adachi, Hideo

    2010-11-01

    Cardiac surgery in patients with a positional anomaly of the heart is technically challenging, and very few reports exist of such surgery in patients with dextrocardia. A 73-year-old woman in whom dextrocardia with situs solitus had been diagnosed at a young age, presented with palpitation and shortness of breath due to significant mitral valve insufficiency. Cardiopulmonary bypass (CPB) was initiated through aortic, superior vena cava, and inferior vena cava cannulae. The use of a heart positioner simplified and made safe the initiation of CPB. A left-sided left atriotomy provided excellent exposure of the mitral valve, and mitral valve replacement (MVR) was safely performed with a 25 mm St. Jude Medical mechanical prosthesis. The postoperative course was uneventful. In patients with dextrocardia requiring cardiac surgery, it is important to consider the appropriate surgical strategy. Approaching the mitral valve through a left-sided left atrial incision seems to provide excellent exposure for MVR.

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

    Science.gov (United States)

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

    2017-01-17

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

  7. Prosthetic mitral valve thrombosis in pregnancy: from thrombolysis to anticoagulation.

    Science.gov (United States)

    Cardoso, Gonçalo; Aguiar, Carlos; Andrade, Maria João; Patrício, Lino; Freire, Isabel; Serrano, Fátima; Anjos, Rui; Mendes, Miguel

    2015-01-01

    Pregnant women with mechanical prosthetic heart valves are at increased risk for valve thrombosis. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss. Bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns. We report a case of mitral prosthetic valve thrombosis in early pregnancy, which was successfully treated with streptokinase. Ten years later, the same patient had an uneventful pregnancy, throughout which acenocoumarol was maintained. With this case we review the prevention (with oral anticoagulant therapy) and treatment of prosthetic valve thrombosis during pregnancy, which is important for both obstetrician and cardiologist. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Valved stent for off-pump mitral valve replacement

    OpenAIRE

    Ma, L.(School of Physics, Shandong University, Shandong, China)

    2004-01-01

    Résumé Objectif : Evaluer un remplacement de valve mitrale hors-pompe avec des stents valvés Méthode: Des homografts préservés dans du glutaraldehyde ont été suturés dans une prothèse tubulaire avant d'être soudés à deux stents Z en nitinol pour créer deux couronnes auto- extensibles. A) Nous avons testé la valve in vitro en utilisant un circuit pulsatile fermé (mock loop) ayant de débuter les expériences sur les porcs. (n=8, 46 .0± 4.3 kg : B). L'oreillette gauche a été exposée p...

  9. 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.

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

    Science.gov (United States)

    Mohan, Jagdish C; Shukla, Madhu; Mohan, Vishwas; Sethi, Arvind

    Congenital anomaly wherein the mitral valve leaflets are directly attached to the papillary muscle(s) (PM) with or without short under-developed chords is rarely reported in adults. Patients with two PMs with an intervening fibrous bridge have also been included under this head in previous studies. Echocardiography enables accurate evaluation of the morphology and function of valve leaflets, chordae tendineae, and PM. This report describes a series of six patients aged 56-84 years who had abnormal mitral valve with a large solitary and anomalously inserted PM seen over a period of 3 years. Only those patients who had a single pillar or bridge-like PM and either absent tendinous chords or small under-developed chords were included in the analysis. Among 9600 consecutive echocardiograms performed, six patients met the criteria of an abnormal mitral valve with solitary large PM. Two patients underwent mitral valve replacement with partial excision of the PM wherein echocardiographic observations were confirmed. The patients were previously followed with the diagnosis of hypertrophic cardiomyopathy (3) and rheumatic mitral valve disease (3). Multi-planar reconstruction of 3D echocardiographic images provided incremental value in assessing the detailed patho-anatomy of PMs in these cases. In adult patients, a high index of suspicion is required to detect congenital mitral stenosis/regurgitation with large solitary PM (resembling a parachute mitral valve) which may masquerade as hypertrophic cardiomyopathy or rheumatic mitral valve disease. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

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

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    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.

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

    Science.gov (United States)

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

    2005-03-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

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

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    Bovenzi Francesco

    2009-12-01

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

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

    Science.gov (United States)

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

    2013-09-30

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

  16. Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty.

    Science.gov (United States)

    Bernal, José M; Pontón, Alejandro; Diaz, Begoña; Llorca, Javier; García, Iván; Sarralde, J Aurelio; Gutiérrez-Morlote, Jesús; Pérez-Negueruela, Carolina; Revuelta, José M

    2010-05-04

    We examined predictors of early and very long-term outcome after combined mitral and tricuspid valve repair for rheumatic disease. Between 1974 and 2002, 153 consecutive patients (mean age, 46.0+/-13.2 years) underwent combined mitral and tricuspid valve repair for rheumatic disease. Mitral disease was predominantly stenosis (82.3%); 100% of patients had organic tricuspid valve disease, predominantly with regurgitation (53.6%) or some degree of tricuspid stenosis (46.4%). Mitral repair included commissurotomy in 132 patients (86.3%) associated with a flexible annuloplasty in 108. Tricuspid valve repair included flexible annuloplasty in 68 patients (44.4%) and suture annuloplasty in 20 patients (13.1%) combined with tricuspid commissurotomy in 62 patients (42.5%). Thirty-day mortality was 5.9%. Late mortality was 60.1%. The median follow-up was 15.8 years (interquartile range, 6 to 19 years). Follow-up was 97.9% complete. Age>65 years was the only predictor of late mortality. Kaplan-Meier survival probability was 74.4% at 10 years and 57.0% at 15 years. Sixty-three patients required valve reoperation (mitral valve, 59; tricuspid valve, 38). Predictors of valve reoperations were either mitral or tricuspid commissurotomy without associated prosthetic ring annuloplasty. At 20 years, Kaplan-Meier freedom from reoperation was 48.5+/-5.1%. Combined mitral and tricuspid valve repair in rheumatic disease showed satisfactory early results. Long-term results were poor because of high mortality and a high number of valve-related reoperations. The use of prosthetic ring annuloplasty was significantly associated with a reduced incidence of both mitral and tricuspid valve reoperations.

  17. Drug-Induced by Systemic Lupus Erythematosus Presenting as Recurrent Pericardial Effusion After Mitral Valve Repair

    OpenAIRE

    Aghigh Haydari; Feridoun Sabzi; Samsam Dabiri; Alireza Poormotaabed

    2017-01-01

    We report a patient presented with recurrent pericardial effusion caused by drug-induced systemic lupus Erythematosus (SLE) following mitral valve repair. The surgery was complicated by hemiparesis and convulsion in early postoperative period. The patient had been received carbamazepine for a paroxysmal seizure that occurred following mitral valve repair. The post operative computed tomography showed embolic stroke and its sequel (seizure) that treated with carbamazepine. In the 3rd month of ...

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

    Science.gov (United States)

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

    2015-04-17

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

  19. Mitral valve m-mode echo in complete heart block with atrial tachycardia

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    Kalathingathodika Sajeer

    2013-01-01

    Full Text Available We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple ′a′ waves corresponding to atrial tachycardia rate.

  20. Effect of Losartan on Mitral Valve Changes After Myocardial Infarction.

    Science.gov (United States)

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

    2017-09-05

    After myocardial infarction (MI), mitral valve (MV) tethering stimulates adaptive leaflet growth, but counterproductive leaflet thickening and fibrosis augment mitral regurgitation (MR), doubling heart failure and mortality. MV fibrosis post-MI is associated with excessive endothelial-to-mesenchymal transition (EMT), driven by transforming growth factor (TGF)-β overexpression. In vitro, losartan-mediated TGF-β inhibition reduces EMT of MV endothelial cells. This study tested the hypothesis that profibrotic MV changes post-MI are therapeutically accessible, specifically by losartan-mediated TGF-β inhibition. The study assessed 17 sheep, including 6 sham-operated control animals and 11 with apical MI and papillary muscle retraction short of producing MR; 6 of the 11 were treated with daily losartan, and 5 were untreated, with flexible epicardial mesh comparably limiting left ventricular (LV) remodeling. LV volumes, tethering, and MV area were quantified by using three-dimensional echocardiography at baseline and at 60 ± 6 days, and excised leaflets were analyzed by histopathology and flow cytometry. Post-MI LV dilation and tethering were comparable in the losartan-treated and untreated LV constraint sheep. Telemetered sensors (n = 6) showed no significant losartan-induced changes in arterial pressure. Losartan strongly reduced leaflet thickness (0.9 ± 0.2 mm vs. 1.6 ± 0.2 mm; p losartan-treated sheep. Profibrotic changes of tethered MV leaflets post-MI can be modulated by losartan without eliminating adaptive growth. Understanding the cellular and molecular mechanisms could provide new opportunities to reduce ischemic MR. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Robotic mitral valve repair for degenerative posterior leaflet prolapse.

    Science.gov (United States)

    Javadikasgari, Hoda; Suri, Rakesh M; Tappuni, Bassman; Lowry, Ashley M; Mihaljevic, Tomislav; Mick, Stephanie; Gillinov, A Marc

    2017-01-01

    Robotic mitral valve (MV) repair is the least invasive surgical approach to the MV and provides unparalleled access to the valve. We sought to assess technical aspects and clinical outcomes of robotic MV repair for isolated posterior leaflet prolapse by examining the first 623 such cases performed in a tertiary care center. We reviewed the first 623 patients (mean age 56±9.7 years) with isolated posterior leaflet prolapse who underwent robotic primary MV repair from 01/2006 to 11/2013. All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. MV repair was attempted in all patients; 622 (99.8%) underwent MV repair and only 1 (0.2%) converted to replacement. After an initial attempt at robotic MV repair, 8 (1.3%) patients were converted to sternotomy as a result of management of residual mitral regurgitation (n=3), bleeding (n=1), difficulties with surgical exposure (n=2), aortic valve injury (n=1), and aortic dissection (n=1). Intraoperative post-repair echocardiography confirmed that all patients left the operating room with MR graded as mild or less, and pre-discharge echocardiography confirmed mild or less MR in 573 (99.1%). There was no hospital death, sternal wound infection, or renal failure. Seven (1.1%) patients suffered a stroke, 11 (1.8%) patients underwent re-exploration for bleeding, and 111 (19%) experienced new-onset atrial fibrillation. The mean intensive care unit length of stay and hospital length of stay were 29±17 hours and 4.6±1.6 days, respectively. At a large tertiary care referral center, robotic MV repair for posterior prolapse is associated with zero mortality, infrequent operative morbidity, and near 100% successful repair. The combination of a patient selection algorithm and increased experience improved clinical outcomes and procedural efficiency.

  2. Association between Body Mass Index and Mitral Valve Prolapse

    Directory of Open Access Journals (Sweden)

    Malihe Mojaver Borabadi

    2016-03-01

    Full Text Available Introduction: Body mass index (BMI can affect cardiac morphology; however, the relationship between BMI and valvular heart diseases has not been thoroughly evaluated. This study aimed to determine the relationship between BMI and mitral valve prolapse (MVP as one of the most common valve diseases worldwide. It can help us to better understand pathophysiology of this common disease. Materials and Methods: In this descriptive study we enrolled 200 patients with isolated MVP. This patient was referred from 2014 to 2015 to our cardiology clinic in Mashhad, Iran, with chief complaint of chest pain, dyspnea, and palpitation. patients underwent transthoracic echocardiography. We document the patients’ height, weight, and demographics data. BMI distribution was categorized as higher and lower than 18.5 kg/m2. Chi- square and independent samples t-test were performed using SPSS version 19 to analyze the data. Results: The results showed that 92 (46% and 108 (54% of the samples were male and female, respectively, and their mean age was 24.29±3.75 years. Most of the patients(n=110 had low BMI (55% of the patients had BMI lower than 18.5 kg/m2. Left atrial and ventricular diameters had a significant relationship with BMI of all the underweight patients(n=110 (P=0.026 and 0.032, respectively. The main complaints were chest pain (n=55,50% and dyspnea (n=58,64.44% in the patients with low and normal BMI, respectively. Conclusion: Symptoms and echocardiographic features in MVP patients vary with BMI. While mitral valve annulus diameter was the same in both BMI groups, the results showed that left atrial and ventricular diameters in the underweight patients were less than those with normal BMI.

  3. Dynamic heart phantom with functional mitral and aortic valves

    Science.gov (United States)

    Vannelli, Claire; Moore, John; McLeod, Jonathan; Ceh, Dennis; Peters, Terry

    2015-03-01

    Cardiac valvular stenosis, prolapse and regurgitation are increasingly common conditions, particularly in an elderly population with limited potential for on-pump cardiac surgery. NeoChord©, MitraClipand numerous stent-based transcatheter aortic valve implantation (TAVI) devices provide an alternative to intrusive cardiac operations; performed while the heart is beating, these procedures require surgeons and cardiologists to learn new image-guidance based techniques. Developing these visual aids and protocols is a challenging task that benefits from sophisticated simulators. Existing models lack features needed to simulate off-pump valvular procedures: functional, dynamic valves, apical and vascular access, and user flexibility for different activation patterns such as variable heart rates and rapid pacing. We present a left ventricle phantom with these characteristics. The phantom can be used to simulate valvular repair and replacement procedures with magnetic tracking, augmented reality, fluoroscopy and ultrasound guidance. This tool serves as a platform to develop image-guidance and image processing techniques required for a range of minimally invasive cardiac interventions. The phantom mimics in vivo mitral and aortic valve motion, permitting realistic ultrasound images of these components to be acquired. It also has a physiological realistic left ventricular ejection fraction of 50%. Given its realistic imaging properties and non-biodegradable composition—silicone for tissue, water for blood—the system promises to reduce the number of animal trials required to develop image guidance applications for valvular repair and replacement. The phantom has been used in validation studies for both TAVI image-guidance techniques1, and image-based mitral valve tracking algorithms2.

  4. Mitral valve resistance determines hemodynamic consequences of severe rheumatic mitral stenosis and immediate outcomes of percutaneous valvuloplasty.

    Science.gov (United States)

    Sanati, Hamidreza; Zolfaghari, Reza; Samiei, Niloufar; Rezaei, Yousef; Chitsazan, Mitra; Zahedmehr, Ali; Shakerian, Farshad; Kiani, Reza; Firouzi, Ata; Rezaei Tabrizi, Reza

    2017-02-01

    The mitral valve area (MVA) poorly reflects the hemodynamic status of (MS). In this study, we compared the MVA with mitral valve resistance (MVR) with regard to the determination of hemodynamic consequences of MS and the immediate outcomes of percutaneous balloon mitral valvuloplasty (PBMV). In a prospective study, 36 patients with severe rheumatic MS with left ventricular ejection fraction (LVEF) >50% were evaluated. They underwent transthoracic echocardiography (TTE) and catheterization. The MVA was measured by two-dimensional planimetry and pressure half-time (PHT), and the MVR was calculated using the equation: 1333 × transmitral pressure gradient mean transmitral diastolic flow rate. The patients' mean age was 47.8±10.5 years. MVR ≥140.6 dynes·s/cm5 detected systolic pulmonary arterial pressure (sPAP) >55 mm Hg with a sensitivity of 100% and a specificity of 74%. The sensitivity and specificity of MVA<0.75 cm2 to discriminate elevated sPAP were 81% and 89%, respectively. PHT ≥323.5 mseconds had a sensitivity of 78% and a specificity of 96% to detect an elevated sPAP. To predict a successful PBMV, preprocedural MVR ≥106.1 dynes·s/cm5 had a sensitivity of 100% and a specificity of 67% (area under the curve [AUC]=0.763; 95% confidence interval [CI]=0.520-1.006; P=.034); preprocedural MVA <0.95 cm2 had a sensitivity of 78% and a specificity of 73% (AUC=0.730; 95% CI=0.503-0.956; P=.065); and preprocedural PHT ≥210.5 mseconds had a sensitivity of 73% and a specificity of 78% (AUC=0.707; 95% CI=0.474-0.941; P=.095). MVR seems to be more accurate than MVA in determining the hemodynamic consequences of severe MS as determined by sPAP. In addition, preprocedural MVR detected successful PBMVs. © 2017, Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2017-12-08

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

  6. Use of fully covered self-expanding metal stents for the management of benign biliary conditions Utilización de prótesis metálicas autoexpandibles totalmente recubiertas en procesos biliares benignos

    Directory of Open Access Journals (Sweden)

    J. García-Cano

    2010-09-01

    pequeños y proporcionar, al abrirse completamente, diámetros grandes para el drenaje biliar. Su utilización en procesos benignos ha estado muy limitada, fundamentalmente por la dificultad en su extracción. Presentamos nuestra experiencia inicial con una PMAB totalmente recubierta (Wallflex para tratar patología benigna de la vía biliar. Pacientes y métodos: en un estudio descriptivo prospectivo se insertaron por CPRE prótesis de 8 mm de diámetro y 4, 6 u 8 cm de longitud, cuando se consideró que para el drenaje biliar eran precisos diámetros superiores a 10 french (3,3 mm. Las prótesis se retiraron también por endoscopia varios meses después según se consideró oportuno clínicamente. Resultados: se insertaron 20 PMAB. Los motivos fueron: gran fístula biliar intrahepática tras cirugía de quiste hidatídico (1, perforación del área papilar por esfinterotomía endoscópica (2, recanalización de prótesis no recubiertas insertadas en procesos benignos (3, estenosis benignas (7, coledocolitiasis múltiples y de gran tamaño con afilamiento-estenosis del colédoco distal que no pudieron extraerse (7. En todos los casos se logró un drenaje biliar satisfactorio y no se produjeron complicaciones por la inserción. Las prótesis se extrajeron con facilidad a los 132 días de media (36-270. La resolución completa de los procesos se obtuvo en 14 pacientes (70%. Conclusiones: en nuestra experiencia inicial, la prótesis Wallflex biliar totalmente recubierta pudo extraerse sin complicaciones tras permanecer en el colédoco hasta una media de más cuatro meses, por lo que podría utilizarse en el tratamiento de procesos biliares benignos.

  7. Valvuloplastia mitral percutánea de emergencia en un paciente con edema pulmonar refractario

    Directory of Open Access Journals (Sweden)

    Alejandra I. de Zubiría

    2018-01-01

    Full Text Available La estenosis mitral usualmente es causada por fiebre reumática. A pesar de ser una patología poco frecuente en los países desarrollados, es prevalente en los países en vía de desarrollo, donde aproximadamente dos tercios de la población mundial vive, haciendo de esta condición, una enfermedad valvular común. Es importante considerar la estenosis mitral en el diagnóstico diferencial de los pacientes con edema agudo de pulmón cardiogénico refractario y la valvuloplastia mitral percutánea de emergencia como el tratamiento definitivo. Se presenta el caso de un paciente femenino de 21 años, con edema agudo de pulmón cardiogénico refractario, secundario a estenosis mitral muy severa de origen reumático, tratado con valvuloplastia percutánea con balón de urgencia. Se realiza una revisión sobre la estenosis mitral y se examina el tratamiento con especial énfasis en los casos publicados en la literatura de valvuloplastia mitral percutánea de emergencia.

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

    Science.gov (United States)

    Martin, Randolph P

    2013-11-01

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

  9. A meta-analysis of robotic vs. conventional mitral valve surgery.

    Science.gov (United States)

    Cao, Christopher; Wolfenden, Hugh; Liou, Kevin; Pathan, Faraz; Gupta, Sunil; Nienaber, Thomas A; Chandrakumar, David; Indraratna, Praveen; Yan, Tristan D

    2015-07-01

    The present study is the first meta-analysis to compare the surgical outcomes of robotic vs. conventional mitral valve surgery in patients with degenerative mitral valve disease. A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic vs. conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalization and duration of intensive care unit (ICU) stay. Echocardiographic outcomes were assessed when possible. Six relevant retrospective studies with comparative data for robotic vs. conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalization and ICU stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. Current evidence on comparative outcomes of robotic vs. conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety.

  10. Increased expression of endothelin B receptor in static stretch exposed porcine mitral valve leaflets

    DEFF Research Database (Denmark)

    Pedersen, Lotte Gam; Zhao, J.; Yang, J.

    2007-01-01

    The aim of this study was to evaluate the effect of mechanical stretch on the expression of ET-1 and ETA- and ETB-receptors in porcine mitral valve leaflets. Leaflet segments from 10 porcine mitral valves were exposed to a static stretch load of 1.5 N for 3.5 h in buffer at 37oC together with mat...... of the pathogenesis of myxomatous mitral valve disease.......The aim of this study was to evaluate the effect of mechanical stretch on the expression of ET-1 and ETA- and ETB-receptors in porcine mitral valve leaflets. Leaflet segments from 10 porcine mitral valves were exposed to a static stretch load of 1.5 N for 3.5 h in buffer at 37oC together...... 1.37 and 2.70) vs. median 1.56 (quartiles 1.38 and 2.17, P=0.03) whereas the mRNA expression of ETA-receptors (P=0.90) and ET-1 (P=0.51) remained unchanged. Stretch increased the expression of ETB-receptors in porcine mitral valve leaflets. The finding could lead to a better understanding...

  11. Repair Strategies Based on Pathological Characteristics of the Rheumatic Mitral Valve in Chinese Patients.

    Science.gov (United States)

    Tiange, Luo; Xu, Meng

    2017-06-28

    We aimed to clarify the pathological characteristics of rheumatic mitral valve disease in Chinese individuals, as well as to determine the appropriate rheumatic mitral valve repair strategy according to such characteristics. We obtained detailed statistics regarding the pathological characteristics of patients who underwent mitral valve repair or replacement for rheumatic disease during the past year at our centre. The outcomes of different repair techniques were compared. Multivariate logistic regression analyses were used to identify predictive factors for successful rheumatic mitral valve repair. Between August 2015 and August 2016, 163 patients underwent rheumatic mitral valve repair (77 cases) or replacement (61 cases) at our centre. Although the prevalence of pathological lesions was typically high, the prevalence of severe lesions was low in the leaflets and high in the commissure and subvalvular apparatus (more than one-third of all lesions in these areas). Commissurotomy (97.40%) and leaflet thinning (84.42%) were performed most frequently. On multivariate logistic regression analysis, pathological score >17.5 (odds ratio [OR] for success, 0.049; pmitral valve repair. Lesions of the commissure and subvalvular apparatus are the main pathological features in Chinese patients with rheumatic mitral valve disease. The commissure processing technique is beneficial in most such patients. Copyright © 2017 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.

  12. Association of altered collagen content and lysyl oxidase expression in degenerative mitral valve disease.

    Science.gov (United States)

    Purushothaman, K-Raman; Purushothaman, Meerarani; Turnbull, Irene C; Adams, David H; Anyanwu, Anelechi; Krishnan, Prakash; Kini, Annapoorna; Sharma, Samin K; O'Connor, William N; Moreno, Pedro R

    Collagen cross-linking is mediated by lysyl oxidase (LOX) enzyme in the extracellular matrix (ECM) of mitral valve leaflets. Alterations in collagen content and LOX protein expression in the ECM of degenerative mitral valve may enhance leaflet expansion and disease severity. Twenty posterior degenerative mitral valve leaflets from patients with severe mitral regurgitation were obtained at surgery. Five normal posterior mitral valve leaflets procured during autopsy served as controls. Valvular interstitial cells (VICs) density was quantified by immunohistochemistry, collagen Types I and III by picro-sirius red staining and immunohistochemistry, and proteoglycans by alcian blue staining. Protein expression of LOX and its mediator TGFβ1 were quantified by immunofluorescence and gene expression by PCR. VIC density was increased, structural Type I collagen density was reduced, while reparative Type III collagen and proteoglycan densities were increased (Pvalves. These changes were associated with a reduction in LOX (Pmitral valve leaflets. Observed changes in Type I and III collagen densities in Degenerative Mitral Valve Disease may be secondary to alterations in LOX protein expression, contributing to disorganization of ECM and disease severity. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Intraoperative measurements on the mitral apparatus using optical tracking: a feasibility study

    Science.gov (United States)

    Engelhardt, Sandy; De Simone, Raffaele; Wald, Diana; Zimmermann, Norbert; Al Maisary, Sameer; Beller, Carsten J.; Karck, Matthias; Meinzer, Hans-Peter; Wolf, Ivo

    2014-03-01

    Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves. During reconstructive surgery the judgement of mitral valve geometry and subvalvular apparatus is mandatory in order to choose for the appropriate repair strategy. To date, intraoperative analysis of mitral valve is merely based on visual assessment and inaccurate sizer devices, which do not allow for any accurate and standardized measurement of the complex three-dimensional anatomy. We propose a new intraoperative computer-assisted method for mitral valve measurements using a pointing instrument together with an optical tracking system. Sixteen anatomical points were defined on the mitral apparatus. The feasibility and the reproducibility of the measurements have been tested on a rapid prototyping (RP) heart model and a freshly exercised porcine heart. Four heart surgeons repeated the measurements three times on each heart. Morphologically important distances between the measured points are calculated. We achieved an interexpert variability mean of 2.28 +/- 1:13 mm for the 3D-printed heart and 2.45 +/- 0:75 mm for the porcine heart. The overall time to perform a complete measurement is 1-2 minutes, which makes the method viable for virtual annuloplasty during an intervention.

  14. Paediatric Melody® mitral valve replacement in acute endocarditis - alternative surgical-hybrid technique.

    Science.gov (United States)

    Haponiuk, Ireneusz; Chojnicki, Maciej; Jaworski, Radosław; Steffens, Mariusz; Paczkowski, Konrad; Szofer-Sendrowska, Aneta; Paśko-Majewska, Marta; Gierat-Haponiuk, Katarzyna; Romanowicz, Anna; Szymanowicz, Wiktor

    2017-01-01

    Acute endocarditis (AE) is still rare disease in the paediatric population; nevertheless, the children suffering from AE usually need heart valve repair or replacement in emergency settings. We present a case of emergency mitral valve replacement with the use of Melody balloon expandable stented bioprosthesis in a two-year-old patient with AE and subsequent mitral (bicuspid) valve incompetence after aggressive infective destruction with the symptoms of critical multi-organ failure. The patient, with a history of rapid deterioration after two-week-long septicaemia in the course of AE, was operated urgently after initial antibiotic treatment because of huge vegetations into the mitral valve orifice. A Melody TVP 22 valve was expanded over a 16-mm TyShak balloon and implanted into a mitral position (Melody-MVR) with good result. Based on current knowledge concerning heart valve reconstructions and institutional experience, we conclude that infected mitral valve in children should be primarily repaired; nevertheless, the Melody valve could be reasonably con-sidered as a mitral prosthesis in such conditions.

  15. Development of off-pump mitral valve replacement in a porcine model.

    Science.gov (United States)

    Gillespie, Matthew J; Aoki, Chikashi; Takebayashi, Satoshi; Shimaoka, Toru; McGarvey, Jeremy R; Gorman, Robert C; Gorman, Joseph H

    2015-04-01

    We describe our initial experience with on-bypass and off-bypass (off-pump) mitral valve replacement with the modified version of our novel catheter-based sutureless mitral valve (SMV) technology, which was developed to atraumatically anchor and seal in the mitral position. The SMV is a self-expanding device consisting of a custom designed nitinol framework and a pericardial leaflet valve mechanism. For the current studies, our original device was modified (SMV2) to reduce the delivery profile and to allow for controlled deployment while still maintaining the key principles necessary for atraumatic anchoring and sealing in the mitral valve position. Ten Yorkshire pigs underwent successful SMV2 device implantation through a left atriotomy (on-pump, n = 6; off-pump, n = 4). Echocardiography and angiography revealed excellent left ventricular systolic function, no significant perivalvular leak, no mitral valve stenosis, no left ventricular outflow tract obstruction, and no aortic valve insufficiency. Postmortem examination demonstrated that the SMV2 devices were anchored securely. This study demonstrates the feasibility and short-term success of off-pump mitral valve replacement using a novel, catheter-based device in a porcine model. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Direct measurements of nitric oxide release in relation to expression of endothelial nitric oxide synthase in isolated porcine mitral valves

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Olsen, Lisbeth Høier; Aasted, Bent

    2007-01-01

    The aim of this study was to measure the direct release of nitric oxide (NO) from the porcine mitral valve using a NO microelectrode. Furthermore, the expression and localization of endothelial nitric oxide synthase (eNOS) in the mitral valve was studied using immunohistochemistry, Western blotti...... techniques for investigations into the role of local NO release in mitral valve diseases.......The aim of this study was to measure the direct release of nitric oxide (NO) from the porcine mitral valve using a NO microelectrode. Furthermore, the expression and localization of endothelial nitric oxide synthase (eNOS) in the mitral valve was studied using immunohistochemistry, Western blotting...... and RT-PCR. Results show that bradykinin increases NO release from mitral valves (¿Bradykinin: 33.71 ± 10.41 nM NO, P

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

    Directory of Open Access Journals (Sweden)

    Mitsomoy Michel Francklyn

    2013-03-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    Science.gov (United States)

    Coutinho, Gonçalo F; Antunes, Manuel J

    2017-11-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

  1. Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification.

    Science.gov (United States)

    El Sabbagh, Abdallah; Eleid, Mackram F; Matsumoto, Jane M; Anavekar, Nandan S; Al-Hijji, Mohammed A; Said, Sameh M; Nkomo, Vuyisile T; Holmes, David R; Rihal, Charanjit S; Foley, Thomas A

    2018-01-23

    Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR). Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result. 3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model. 3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction. © 2018 Wiley Periodicals, Inc.

  2. Three-dimensional proximal flow convergence automatic calculation for determining mitral valve area in rheumatic mitral stenosis.

    Science.gov (United States)

    Sampaio, Francisco; Ladeiras-Lopes, Ricardo; Almeida, João; Fonseca, Paulo; Fontes-Carvalho, Ricardo; Ribeiro, José; Gama, Vasco

    2017-07-01

    Management of patients with mitral stenosis (MS) depends heavily on the accurate quantification of mitral valve area (MVA) using echocardiography. All currently used two-dimensional (2D) methods have limitations. Estimation of MVA using the proximal isovelocity surface area (PISA) method with real time three-dimensional (3D) echocardiography may circumvent those limitations. We aimed to evaluate the accuracy of 3D direct measurement of PISA in the estimation of MVA. Twenty-seven consecutive patients (median age of 63 years; 77.8% females) with rheumatic MS were prospectively studied. Transthoracic and transesophageal echocardiography with 2D and 3D acquisitions were performed on the same day. The reference method for MVA quantification was valve planimetry after 3D-volume multiplanar reconstruction. A semi-automated software was used to calculate the 3D flow convergence volume. Compared to MVA estimation using 3D planimetry, 3D PISA showed the best correlation (rho=0.78, PPISA (rho=0.26, P=.203). Bland-Altman analysis revealed a good agreement for MVA estimation with 3D PISA (mean difference -0.03 cm2 ; limits of agreement (LOA) -0.40-0.35), in contrast to wider LOA for 2D methods: CE (mean difference 0.02 cm2 , LOA -0.56-0.60); PHT (mean difference 0.31 cm2 , LOA -0.32-0.95); 2D PISA (mean difference -0.03 cm2 , LOA -0.92-0.86). MVA estimation using 3D PISA was feasible and more accurate than 2D methods. Its introduction in daily clinical practice seems possible and may overcome technical limitations of 2D methods. © 2017, Wiley Periodicals, Inc.

  3. Proximal flow convergence method by three-dimensional color Doppler echocardiography for mitral valve area assessment in rheumatic mitral stenosis.

    Science.gov (United States)

    de Agustin, Jose Alberto; Mejia, Hernan; Viliani, Dafne; Marcos-Alberca, Pedro; Gomez de Diego, Jose Juan; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; Perez de Isla, Leopoldo

    2014-08-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has important technical limitations for mitral valve orifice area (MVA) assessment in mitral stenosis (MS), mainly the geometric assumptions of PISA shape and the requirement of an angle correction factor. Single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions or the requirement of an angle correction factor. The aim of this study was to validate this method in patients with rheumatic MS. Sixty-three consecutive patients with rheumatic MS were included. MVA was assessed using the transthoracic 2D and 3D PISA methods. Planimetry of MVA (2D and 3D) and the pressure half-time method were used as reference methods. The 3D PISA method had better correlations with the reference methods (with 2D planimetry, r = 0.85, P PISA method (with 2D planimetry, r = 0.63, P PISA method was observed. A high percentage (30%) of patients with nonsevere MS by 3D planimetry were misclassified by the 2D PISA method as having severe MS (effective regurgitant orifice area PISA method had 94% agreement with 3D planimetry. Good intra- and interobserver agreement for 3D PISA measurements were observed, with intraclass correlation coefficients of 0.95 and 0.90, respectively. MVA assessment using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method. Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Flow-mediated vasodilation measurements in Cavalier King Charles Spaniels with increasing severity of myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Løwert, Charlotte Klostergaard; Zois, Nora Elisabeth

    2012-01-01

    Cardiovascular disease is associated with endothelial dysfunction in humans and studies of plasma biomarkers suggest that dogs with myxomatous mitral valve disease (MMVD) might also have endothelial dysfunction....

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

    Science.gov (United States)

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

    2018-02-01

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

  7. Three-Dimensional Echocardiographic Assessment of Changes in Mitral Valve Geometry After Valve Repair

    Science.gov (United States)

    Mahmood, Feroze; Subramaniam, Balachundhar; Gorman, Joseph H.; Levine, Robert M.; Gorman, Robert C.; Maslow, Andrew; Panzica, Peter J.; Hagberg, Robert M.; Karthik, Swaminathan; Khabbaz, Kamal R.

    2011-01-01

    Background Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair. Methods We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared. Results Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 ±14 versus 146 ± 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings. Conclusions Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity. PMID:19932245

  8. Early Outcomes After Mitral Valve Repair vs. Replacement in the Elderly: A Propensity Matched Analysis.

    Science.gov (United States)

    Farid, Shakil; Ladwiniec, Andrew; Hernández-Sánchez, Jules; Povey, Hannah; Caruana, Edward; Ali, Ayyaz; Moorjani, Narain; Irons, Joanne; Ring, Liam; Abu-Omar, Yasir

    2017-12-05

    To compare early outcomes of mitral valve repair versus replacement in elderly patients with degenerative mitral valve disease. A retrospective review of prospectively collected clinical data of patients over 75 years of age, who underwent mitral valve surgery for degenerative disease, between 2010 and 2013, was carried out. Those undergoing mitral valve repair and replacement were propensity matched to adjust for baseline clinical differences. A total 260 patients were identified: mitral valve repair was undertaken in 145 and replacement in 115 patients. After propensity matching, 78 patients were included in each group. In the entire, unmatched population, in-hospital mortality was significantly higher in those undergoing replacement compared with those undergoing repair (9.6% vs 1.4%, p=0.003). In-hospital death occurred in six (7.7%) of the propensity matched replacement group and none in the repair group (p=0.012). Amongst the propensity matched groups, probability of survival at 1, 2 and 3 years were 0.94, 0.90 and 0.86 respectively for the repair group and 0.85, 0.77 and 0.69 for the replacement group: the HR for death between replacement and repair is 2.5 (1.2-5.4), p=0.012. Within the limitations imposed by retrospective analyses, our study demonstrates that, in elderly patients with degenerative disease of the mitral valve, repair is associated with improved short-term and mid-term outcomes compared with mitral valve replacement. Copyright © 2017 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.

  9. New insights into mitral valve dystrophy: a Filamin-A genotype-phenotype and outcome study.

    Science.gov (United States)

    Le Tourneau, Thierry; Le Scouarnec, Solena; Cueff, Caroline; Bernstein, Daniel; Aalberts, Jan J J; Lecointe, Simon; Mérot, Jean; Bernstein, Jonathan A; Oomen, Toon; Dina, Christian; Karakachoff, Matilde; Desal, Hubert; Al Habash, Ousama; Delling, Francesca N; Capoulade, Romain; Suurmeijer, Albert J H; Milan, David; Norris, Russell A; Markwald, Roger; Aikawa, Elena; Slaugenhaupt, Susan A; Jeunemaitre, Xavier; Hagège, Albert; Roussel, Jean-Christian; Trochu, Jean-Noël; Levine, Robert A; Kyndt, Florence; Probst, Vincent; Le Marec, Hervé; Schott, Jean-Jacques

    2017-09-06

    Filamin-A (FLNA) was identified as the first gene of non-syndromic mitral valve dystrophy (FLNA-MVD). We aimed to assess the phenotype of FLNA-MVD and its impact on prognosis. We investigated the disease in 246 subjects (72 mutated) from four FLNA-MVD families harbouring three different FLNA mutations. Phenotype was characterized by a comprehensive echocardiography focusing on mitral valve apparatus in comparison with control relatives. In this X-linked disease valves lesions were severe in men and moderate in women. Most men had classical features of mitral valve prolapse (MVP), but without chordal rupture. By contrast to regular MVP, mitral leaflet motion was clearly restricted in diastole and papillary muscles position was closer to mitral annulus. Valvular abnormalities were similar in the four families, in adults and young patients from early childhood suggestive of a developmental disease. In addition, mitral valve lesions worsened over time as encountered in degenerative conditions. Polyvalvular involvement was frequent in males and non-diagnostic forms frequent in females. Overall survival was moderately impaired in men (P = 0.011). Cardiac surgery rate (mainly valvular) was increased (33.3 ± 9.8 vs. 5.0 ± 4.9%, P disease with complex phenotypic expression which can influence patient management. FLNA-MVD has unique features with both MVP and paradoxical restricted motion in diastole, sub-valvular mitral apparatus impairment and polyvalvular lesions in males. FLNA-MVD conveys a substantial lifetime risk of valve surgery in men.

  10. [Indication for mitral valve interventions: Development of a quality indicator for external hospital quality assurance].

    Science.gov (United States)

    Köster, Christina; Schorbach, Lena; Wrede, Stephanie; Meyer, Sven; Kazmaier, Tonia; Szecsenyi, Joachim

    2017-11-01

    The indication for a mitral valve intervention is an important patient-relevant parameter for the assessment of process quality and the comparison of healthcare providers. In this article, we describe the development of a corresponding quality indicator for an external hospital quality assurance (QA) procedure in Germany. An expert panel was set up by the aQua Institute to assist with the development of a QA procedure for mitral valve interventions and the associated quality indicators. In a comprehensive, systematic literature and evidence research, the American and European guidelines were identified as the best evidence available. Especially the more current American guideline formed the basis on which a quality indicator dealing with the correct indication for a mitral valve intervention was developed. The developed quality indicator assesses the proportion of patients for whom an indication for a mitral valve intervention was determined in compliance with guideline recommendations. The indicator differentiates between surgical and catheter-based procedures. To determine whether or not the indication was correct, different medical parameters are included, such as, for example, type of mitral valve defect, etiology of the disease, severity of symptoms, valve morphology (e. g., mitral valve area), valve hemodynamics and comorbidity, which healthcare providers have to document. The documentation for the developed quality indicator is considerable. Nonetheless, its relevance is undeniable because it allows the user to determine whether a surgical or catheter-based mitral valve intervention was necessary and performed according to guideline recommendations. In the first year of its implementation, this indicator should be evaluated for further improvement and simplification of assessment. Copyright © 2017. Published by Elsevier GmbH.

  11. Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach.

    Science.gov (United States)

    Mihos, Christos G; Pineda, Andrés M; Davila, Hector; Larrauri-Reyes, Maiteder C; Santana, Orlando

    2015-01-01

    Combined mitral and tricuspid valve surgery is associated with an increased perioperative morbidity and mortality. We evaluated the outcomes of a less invasive right minithoracotomy approach in patients undergoing primary or reoperative double-valve surgery. We retrospectively evaluated 132 consecutive patients with mitral and tricuspid valve disease who underwent double-valve surgery via a right minithoracotomy at our institution between January 2009 and April 2014. The cohort included 81 female (61%) and 51 male (39%) patients, with a mean ± SD age of 67 ± 13 years. The mean ± SD preoperative left ventricular ejection fraction, mitral regurgitation grade, and creatinine were 53% ± 12%, 3.8 ± 0.6, and 1.26 ± 1.17, respectively. The patients underwent primary (88%) or reoperative (12%) mitral and tricuspid valve surgery, which consisted of 88 mitral repairs (67%), 44 mitral replacements (33%), 131 tricuspid repairs (99%), and 1 tricuspid replacement (1%). Postoperatively, there were 6 cases of acute kidney injury (5%), 6 reoperations for bleeding (5%), 4 cerebrovascular accidents (3%), and 12 cases of atrial fibrillation (9%). The median intensive care unit length of stay and total hospital lengths of stay were 61 hours (interquartile range, 43-112 hours) and 8 days (interquartile range, 6-13 days), respectively. The in-hospital mortality was 4%. Actuarial survival at 1 and 5 years was 93% and 88%, respectively. In patients undergoing primary or reoperative mitral and tricuspid valve surgery, a right minithoracotomy approach is associated with a low perioperative morbidity and good midterm survival.

  12. Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery

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    Alexandre Visconti Brick

    Full Text Available Abstract Objective To evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods: We studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results: 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%, congestive heart failure (70%, and previous episodes of acute pulmonary edema (27%. Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion: Surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8% after 60 months of follow-up.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  14. Implante transcateter de valva aórtica: resultados atuais do desenvolvimento e implante de um nova prótese brasileira Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis

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    Diego Felipe Gaia

    2011-09-01

    Full Text Available OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, contraindicando o procedimento. O implante minimamente invasivo transcateter de valva aórtica parece ser alternativa, reduzindo a morbimortalidade. A avaliação dos resultados clínicos, segurança e eficácia do procedimento são o objetivo desse estudo. MÉTODOS: Uma prótese transcateter, balão expansível foi utilizada em 33 casos de alto risco. EuroScore médio foi de 39,30% e STS score de 30,28%. Oito pacientes apresentavam disfunção de bioprótese e o restante, estenose aórtica calcificada. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Através de minitoracotomia esquerda, as próteses foram implantadas pelo ápice ventricular, sob estimulação de alta frequência ou choque hemorrágico. Foram realizados controles clínicos e ecocardiográficos. RESULTADOS: A correta liberação da prótese foi possível em 30 casos. Três conversões ocorreram. A mortalidade operatória foi de um caso e a mortalidade em 30 dias, 18,18%. O gradiente médio reduziu de 43,58 para 10,54 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual esteve presente em 30,30% dos pacientes. Ocorreu uma complicação vascular periférica e um caso de bloqueio atrioventricular total. Um paciente apresentou acidente vascular cerebral. A mortalidade em 30 dias foi de 18,18%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é procedimento seguro e com resultados de médio prazo satisfatórios. São necessários estudos de longo prazo com maior poder amostral no intuito de determinar resultado hemodinâmico, qualidade de vida e sobrevida em longo prazoOBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication

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

    Directory of Open Access Journals (Sweden)

    Roya Sattarzadeh

    2018-01-01

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

  16. The role of visual and direct force feedback in robotics-assisted mitral valve annuloplasty.

    Science.gov (United States)

    Currie, Maria E; Talasaz, Ali; Rayman, Reiza; Chu, Michael W A; Kiaii, Bob; Peters, Terry; Trejos, Ana Luisa; Patel, Rajni

    2017-09-01

    The objective of this work was to determine the effect of both direct force feedback and visual force feedback on the amount of force applied to mitral valve tissue during ex vivo robotics-assisted mitral valve annuloplasty. A force feedback-enabled master-slave surgical system was developed to provide both visual and direct force feedback during robotics-assisted cardiac surgery. This system measured the amount of force applied by novice and expert surgeons to cardiac tissue during ex vivo mitral valve annuloplasty repair. The addition of visual (2.16 ± 1.67), direct (1.62 ± 0.86), or both visual and direct force feedback (2.15 ± 1.08) resulted in lower mean maximum force applied to mitral valve tissue while suturing compared with no force feedback (3.34 ± 1.93 N; P forces on cardiac tissue during robotics-assisted mitral valve annuloplasty suturing, force feedback may be required. Copyright © 2016 John Wiley & Sons, Ltd.

  17. [Left atrial appendage in rheumatic mitral valve disease: The main source of embolism in atrial fibrillation].

    Science.gov (United States)

    García-Villarreal, Ovidio A; Heredia-Delgado, José A

    To demonstrate that surgical removal of the left atrial appendage in patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation decreases the possibility of stroke. This also removes the need for long-term oral anticoagulation after surgery. A descriptive, prospective, observational study was conducted on 27 adult patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation, who had undergone mitral valve surgery and surgical removal of the left atrial appendage. Oral anticoagulation was stopped in the third month after surgery. The end-point was the absence of embolic stroke. An assessment was also made of postoperative embolism formation in the left atrium using transthoracic echocardiography. None of the patients showed embolic stroke after the third post-operative month. Only one patient exhibited transient ischaemic attack on warfarin therapy within the three postoperative months. Left atrial thrombi were also found in 11 (40.7%) cases during surgery. Of these, 6 (54.5%) had had embolic stroke, with no statistical significance (P=.703). This study suggests there might be signs that the left atrial appendage may be the main source of emboli in rheumatic mitral valve disease, and its resection could eliminate the risk of stroke in patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function.

    Science.gov (United States)

    Malaspinas, Iliona; Petak, Ferenc; Chok, Lionel; Perrin, Anne; Martin, Anne-Laure; Beghetti, Maurice; Habre, Walid

    2016-10-01

    To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair. Perioperative measurements in a prospective, consecutive cross-sectional study. University hospital, tertiary care teaching hospital The study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency. Input impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model. Relating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; pMitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-05-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2008-02-01

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

  2. Vasovagal tonus index in dog with myxomatous mitral valve disease

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    Bruna C. Brüler

    Full Text Available ABSTRACT: The vasovagal tonus index (VVTI is a useful and assessable index, obtained from standard ECG recordings, that is used to estimate heart rate variability (HRV, and may provide valuable information regarding the likelihood of progression into congestive heart failure (CHF. In this paperwork, we investigated how the vasovagal tonus index (VVTI behaves in dogs with naturally-occurring myxomatous mitral valve disease (MMVD Electrocardiographic (ECG recordings and echocardiographic data of 120 patients diagnosed with MMVD were reviewed. The VVTI was calculated from twenty consecutive RR intervals for each dog enrolled in the study. Lower VVTI values were found in MMVD patients in American College of Veterinary Internal Medicine (ACVIM stage C compared with stages B1 and B2. Values were also lower in patients with severe cardiac remodeling. When a cut-off value of 6.66 is used, VVTI was able to discriminate MMVD patients in stage C from B1 and B2 dogs with a sensitivity of 70 per cent and a specificity of 77 per cent. MMVD dogs in which VVTI is lower than 6.66 are 30% more likely to develop congestive heart failure (CHF.

  3. Mitral and aortic valvular flow: quantification with MR phase mapping

    DEFF Research Database (Denmark)

    Søndergaard, Lise; Thomsen, C; Ståhlberg, F

    1992-01-01

    When magnetic resonance phase mapping is used to quantitate valvular blood flow, the presence of higher-order-motion terms may cause a loss of phase information. To overcome this problem, a sequence with reduced encoding for higher-order motion was used, achieved by decreasing the duration of the...... mapping is also valid for pathologic conditions. Phase mapping may be used as a noninvasive clinical tool for flow quantification in heart valve disease....... of the flow-encoding gradient to 2.2 msec. Tested on a flow phantom simulating a severe valvular stenosis, the sequence was found to be robust for higher-order motion within the clinical velocity range. In eight healthy volunteers, mitral and aortic volume flow rates and peak velocities were quantified...... by means of phase mapping and compared with results of the indicator-dilution technique and Doppler echocardiography, respectively. Statistically significant correlations were found between phase mapping and the other two techniques. Similar studies in patients with valvular disease indicate that phase...

  4. Mitral valve repair [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Alberto Pozzoli

    2016-06-01

    Full Text Available Mitral regurgitation (MR is the most common valvular heart disease in the Western world. The MR can be either organic (mainly degenerative in Western countries or functional (secondary to left ventricular remodeling in the context of ischemic or idiopathic dilated cardiomyopathy. Degenerative and functional MR are completely different disease entities that pose specific decision-making problems and require different management. The natural history of severe degenerative MR is clearly unfavorable. However, timely and effective correction of degenerative MR is associated with a normalization of life expectancy. By contrast, the prognostic impact of the correction of functional MR is still debated and controversial. In this review, we discuss the optimal treatment of both degenerative and functional MR, taking into account current surgical and percutaneous options. In addition, since a clear understanding of the etiology and mechanisms of valvular dysfunction is important to guide the timing and choice of treatment, the role of the heart team and of echo imaging in the management of MR is addressed as well.

  5. Pregnancy Outcome after Mechanical Mitral Valve Replacement: A Prospective Study

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    Niloufar Samiei

    2015-10-01

    Full Text Available Background: Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis.Methods: In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old were studied. Patients were divided into two groups: group I (n = 43 received Warfarin throughout the pregnancy, while group II (n = 10 received Heparin in the first trimester and then Warfarin until the 36th week.Results: Thirty-two (60.4% pregnancies resulted in live births, whereas 18 (34% abortions, 2 (3.8% stillbirths, and one (1.9% maternal death occurred. In group I, there were 26 (60.5% live births, one (2.3% stillbirth, and 15 (34.9% abortions. In group II, there were 6 (60% live births, one (10% stillbirth, and 3 (30% abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7% of the pregnancies in group I and 50% of those in group II (p value = 0.001 were without complications. There were no congenital malformations in the two groups.Conclusion: Fetal outcome was almost the same between the Warfarin and Heparin regimens. In maternal outcome, the Warfarin regimen is safer than Heparin.  

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

    Science.gov (United States)

    Başpinar, Osman; Karaaslan, Sevim; Oran, Bülent

    2005-09-01

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

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

    Science.gov (United States)

    Cremer, S E; Singletary, G E; Olsen, L H; Wallace, K; Häggström, J; Ljungvall, I; Höglund, K; Reynolds, C A; Pizzinat, N; Oyama, M A

    2014-01-01

    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 [5HT] in platelet-rich plasma (PRP), platelet-poor plasma (PPP), mitral valve leaflets (MV), and left ventricular myocardium (LV). Forty-five dogs comprised 4 plasma groups of Cavalier King Charles Spaniels (CKCS) or non-CKCS, either healthy (CON) or MMVD affected: CKCS CON (n = 12); non-CKCS CON (n = 8); CKCS MMVD (n = 14); non-CKCS MMVD (n = 11). Twenty-four dogs comprised 3 tissue groups: MMVD (n = 8); other-HD (heart disease) (n = 7); non-HD, extracardiac disease (n = 9). High-performance liquid chromatography measured PRP, PPP, MV, and LV [5HT]. Platelet-rich plasma platelet [5HT] was greater in CKCS CON (1.83 femtograms/platelet [fg/plt]; range, 0.20-4.76; P = .002), CKCS MMVD (1.58 fg/plt; range, 0.70-4.03; P = .005), and non-CKCS MMVD (1.72 fg/plt; range, 0.85-4.44; P = .003) versus non-CKCS CON (0.92 fg/plt; range, 0.63-1.30). There was no group difference in PPP [5HT]. MV [5HT] was significantly higher in MMVD (32.4 ng/mg; range, 8.4-106.7) versus non-HD (3.6 ng/mg; range, 0-28.3; P = .01) and LV [5HT] was significantly higher in MMVD (11.9 ng/mg; range, 4.0-104.8) versus other-HD (0.9 ng/mg; range, 0-10.1; P = .011) and non-HD (2.5 ng/mg; range, 0-6.9; P = .001). Platelet [5HT] was highest in healthy CKCS and both MMVD groups, but plasma [5HT] showed no group differences. Tissue [5HT] was highest in MV and LV of MMVD-affected dogs, suggesting altered 5HT signaling as a potential feature of MMVD. Interactions of platelet, valvular, and myocardial 5HT signaling warrant further investigation. Copyright © 2014 by the American College of Veterinary Internal Medicine.

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Science.gov (United States)

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

    2013-02-15

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

  10. Troca de valva com a prótese valvar modelo Omnicarbon: seguimento clínico de 10 anos Valve replacement with the Omnicarbon valve prosthesis: a 10-year follow-up

    Directory of Open Access Journals (Sweden)

    Santiago Florez

    2005-05-01

    Full Text Available OBJETIVO: Estudar retrospectivamente os resultados de 264 pacientes submetidos à implementação cirúrgica de válvula modelo Omnicarbon entre abril 1985 e maio 1995. MÉTODOS: No momento da cirurgia, a média de idade dos pacientes que receberam essa prótese mecânica era de 57±11 anos. As válvulas modelo Omnicarbon foram colocadas em posição aórtica em 36% dos casos, na posição mitral em 44% dos casos, e nas duas posições em 20% dos casos. O seguimento clínico foi feito cuidadosamente, com a maioria dos pacientes submetidos ao exame físico em nossa clínica. Levando em conta o histórico do caso, os cardiologistas faziam perguntas aos pacientes sobre as complicações relacionadas à válvula. RESULTADOS: O seguimento acumulado dos pacientes foi de 1291 anos, com média de seguimento de 5,4 anos. A sobrevida após 10 anos foi de 79,4±3,9%, incluindo todas as causas de morte e os casos de mortalidade precoce. As complicações relatadas durante os 11 anos de estudo incluem: tromboembolismo (0,1 %, hemorragia (0,4%, endocardite (0,2%, e insuficiência não-estrutural (1,2%. Não foram detectadas anemia hemolítica, trombose valvar, ou insuficiência estrutural durante esse longo período de estudo. A capacidade funcional desses pacientes foi avaliada subjetivamente pelo sistema de classificação da NYHA. Com o tempo de seguimento maior do que 5 anos em média, nossos pacientes que receberam a válvula modelo Omnicarbon se encontram na classe I ou II da NYHA. CONCLUSÃO: As próteses mecânicas modelo Omnicarbon apresentam um bom desempenho clínico por até 10 anos, tanto em posição aórtica quanto mitral. Os resultados indicam uma baixa incidência de tromboembolismo e complicações hemorrágicas.OBJECTIVE: We retrospectively examined the outcomes of 264 patients who underwent consecutive Omnicarbon valve implantation surgery between April 1985 and May 1995. METHODS: At the time of surgery, patients who received this

  11. 63. Experiencia inicial con el nuevo anillo Sorin Memo-3D en la reparación valvular mitral compleja

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    R. García Fuster

    2010-01-01

    Conclusiones: A la luz de los primeros datos clinicoecocardiográficos, el anillo Sorin Memo-3D se ha mostrado seguro y eficaz en la corrección de la insuficiencia mitral de etiología variada, especialmente en pacientes sometidos a reparación mitral compleja.

  12. 103. Reparación valvular mitral en un caso de endocarditis trombótica no bacteriana

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    R. Manrique

    2012-04-01

    Conclusiones: La reparación valvular mitral es un procedimiento eficaz y seguro en la insuficiencia mitral aguda en pacientes con endocarditis trombótica no bacteriana. Permite evitar un riesgo adicional asociado al uso de prótesis mecánicas en pacientes con riesgo tromboembólico elevado.

  13. Mid-term outcomes of congenital mitral valve surgery: Shone's syndrome is a risk factor for death and reintervention.

    Science.gov (United States)

    Sughimoto, Koichi; Konstantinov, Igor E; d'Udekem, Yves; Brink, Johann; Zannino, Diana; Brizard, Christian P

    2017-11-01

    To study the recent trends and outcomes of congenital mitral valve surgery in children. From 2008 to 2014, 84 procedures in 66 consecutive patients (41 procedures in 31 patients with mitral stenosis and 43 procedures in 35 patients with mitral regurgitation) were retrospectively evaluated. The mean age at surgery was 4.3 ± 5.4 years, and 27 patients (41%) were neonates or infants. Seven (11%) patients died during the follow-up period of 3.2 ± 2.3 years and 5 (71%) were mitral valve replacements were performed in 8 patients, including 1 pulmonary valve homograft, 3 Contegra conduits of 12 mm thickness in the intra-annular position and 6 mechanical valves. Shone's syndrome, dysplastic valve, a need for valve replacement and age valve replacement and age mitral valve dysplasia was a significant risk factor for reoperation or death. The 5-year rate of freedom from death or reoperation in neonates or infants was 55% and that in patients aged >1 year was 88% (P = 0.003). An age of mitral valve dysplasia and a need for mitral valve replacement were associated with a higher incidence of death or reoperation. Primary mitral valve replacement or univentricular strategy may have to be considered for symptomatic neonates with Shone's syndrome.

  14. Transseptal transcatheter mitral valve-in-valve: A step by step guide from preprocedural planning to postprocedural care.

    Science.gov (United States)

    Guerrero, Mayra; Salinger, Michael; Pursnani, Amit; Pearson, Paul; Lampert, Mark; Levisay, Justin; Russell, Hyde; Feldman, Ted

    2017-05-30

    Transcatheter mitral valve replacement has been successfully performed with the use of aortic transcatheter heart valves in hundreds of patients worldwide with severe dysfunction of a degenerated mitral bioprosthesis and high surgical risk for repeat operation. The delivery approach in the vast majority of the mitral valve-in-valve procedures has been transapical. Although the transseptal approach may be more technically challenging, it is less invasive and may be preferred by patients. Data from case series and a large international registry suggest that patients treated with transseptal mitral valve-in-valve have faster recovery, more improvement in left ventricular ejection fraction and possibly lower mortality compared with patients treated with transapical approach. A prospective clinical trial, the MITRAL trial (Mitral Implantation of TRAnscatheter vaLves) is evaluating the safety and feasibility of transvenous transseptal mitral valve-in-valve. The experience from this trial has allowed us to improve our procedural approach. In anticipation of a wider adoption of the transseptal approach for mitral valve-in-valve, we describe our current method step-by-step from planning the procedure through postprocedural management. This is an evolving technique that has changed with experience and the transition to newer generation transcatheter heart valve devices. We discuss the use of cardiac computed tomography for planning the procedure including transseptal puncture and valve size selection, provide procedural and technical tips, and discuss postprocedural care. © 2017 Wiley Periodicals, Inc.

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

    NARCIS (Netherlands)

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

    1990-01-01

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

  16. Increased nitric oxide release and expression of endothelial and inducible nitric oxide synthases in mildly changed porcine mitral valve leaflets

    DEFF Research Database (Denmark)

    Moesgaard, Sophia Gry; Olsen, Lisbeth Høier; Viuff, Birgitte

    2007-01-01

    NOS) in relation to early local changes in porcine mitral valves. Methods: A histological evaluation of mitral valve leaflets from slaughter pigs and sows was made, and the expression of eNOS and iNOS protein measured using immunohistochemistry. Furthermore, mRNA levels of eNOS and iNOS were measured using real...

  17. Increased nitric oxide release and expression of endothelial and inducible nitric oxide synthases in mildly changed porcine mitral valve leaflets

    DEFF Research Database (Denmark)

    Moesgaard, Sophia G; Olsen, Lisbeth H; Viuff, Birgitte M

    2007-01-01

    NOS) in relation to early local changes in porcine mitral valves. METHODS: A histological evaluation of mitral valve leaflets from slaughter pigs and sows was made, and the expression of eNOS and iNOS protein measured using immunohistochemistry. Furthermore, mRNA levels of eNOS and iNOS were measured using real...

  18. Plastia mitral cirúrgica em crianças com febre reumática

    OpenAIRE

    Silva, Andréa Rocha e; Herdy, Gesmar Volga Haddad; Vieira,Alan Araujo; Simões, Luiz Carlos

    2009-01-01

    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-operatór...

  19. Mitral valve prolapse in Cavalier King Charles spaniel: a review and case study.

    Science.gov (United States)

    Hyun, Changbaig

    2005-03-01

    A 5 year-old spayed female Cavalier King Charles Spaniel was presented after a 3- to 5-day onset of severe respiratory distress. The dog also had a history of several episodes of syncope prior to presentation. A comprehensive diagnostic investigation revealed a midsystolic click sound on cardiac auscultation, signs of left sided cardiac enlargement in ECG and thoracic radiography, mitral valvular leaflet protrusion into left the atrium, decreased E-point-to septal separation (EPSS) and mitral regurgitated flow in echocardiography, all of which are characteristic signs of mitral valvular prolapse. After intensive care with diuretics [corrected] and a vasodilator with oxygen supplement, the condition of the dog was stabilized. The dog was then released and is being medicated with angiotensin converting enzyme (ACE) inhibitor with regular follow-up.

  20. Total Chordal Sparing Mitral Valve Replacement in Rheumatic Disease: A Word of Caution.

    Science.gov (United States)

    Kessel, Samuel M; Hawkins, Robert B; Yarboro, Leora T; Ailawadi, Gorav

    2017-07-01

    Total chordal preservation is the standard for mitral valve replacement to maintain long-term left ventricular geometry. Whereas it is appropriate for functional and degenerative mitral regurgitation, the role of chordal sparing in rheumatic valve disease is less well understood, with limited evidence supporting total chordal sparing. Inasmuch as this autoimmune disease affects the subvalvular apparatus in addition to the leaflets, it can be expected to continue after surgical repair. Here we present 2 patients who experienced adverse events associated with total chordal sparing mitral replacement as a result of disease progression with rapid fibrous growth causing inflow obstruction and early prosthetic valve failure. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  2. 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...

  3. Scleroderma and Mitral Stenosis: A New Cardiac Involvement or an Association by Chance

    Directory of Open Access Journals (Sweden)

    Ahmadreza Zarifian

    2016-01-01

    Full Text Available Systemic Sclerosis (SSc is an autoimmune disorder with unknown etiology, which presents with vascular lesions and fibrosis of the skin and internal organs. Cardiac, renal, and pulmonary involvements are major causes of death in systemic sclerosis. Although a major cause of scleroderma deaths is cardiac failure, scleroderma rarely causes valvular disease. We report the case of a 48-year-old woman with severe mitral stenosis who was diagnosed with scleroderma 6 months before. Echocardiographic assessments had revealed no clinical manifestation of heart involvement in her previous visits. We used cardiac surgical treatment with successful outcome. The present case confirms the data from the currently available literature, indicating that mitral valve involvement in systemic sclerosis is a rare occurrence. Awareness of this uncommon association and adequate management to prevent complications of the underlying disease are prerequisites for successful mitral valve repair or replacement in such patients.

  4. Reparación valvular mitral en un caso de endocarditis de Libman-Sacks

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    Eduardo Bernabeu

    2012-07-01

    Full Text Available La endocarditis de Libman-Sacks es una forma de endocarditis no bacteriana asociada a los pacientes con lupus eritematoso sistémico (LES. Aunque con frecuencia cursa de forma asintomática, en ocasiones es causa de insuficiencia cardíaca grave. Presentamos un caso de reparación valvular mitral en una paciente aquejada de esta infrecuente entidad, que debutó clínicamente con un edema agudo de pulmón secundario a insuficiencia mitral masiva. La reparación valvular mitral puede ser un procedimiento eficaz y seguro, que permite evitar el riesgo adicional asociado al uso de prótesis valvulares en estos pacientes con riesgo trombótico elevado.

  5. Intense Microbubbles Mimicking Mobile Thrombus in a Patient with Prosthetic Mitral Valve

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    Fatma Yılmaz Coşkun

    2017-06-01

    Full Text Available Microbubbles have been presumed as gaseous emboli, which originate during mechanical heart valve closure, but are not seen in bioprosthetic valves. In this report, we presented a cluster of microbubbles mimicking mobile thrombus in a patient with mechanical mitral valve prosthesis. A 30-year-old female with a history of implanted mechanical valve at the mitral position underwent a routine examination. She was asymptomatic and her physical examination was unremarkable. Transthoracic echocardiography showed a mobile thrombus-like mass on the ventricular side of the prosthetic mitral valve moving into the left ventricular outflow tract. However, close examination of images indicated that the mass was in fact intense microbubbles mimicking thrombus. Intense mobile microbubbles can be misdiagnosed as a mobile thrombus. We recommend and underscore the importance of detailed echocardiographic examination in case of mobile mass to avoid misdiagnosis in patients with mechanical heart valves.

  6. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Pomerantzeff Pablo Maria Alberto

    1999-01-01

    Full Text Available A forty eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR was implanted. The patient did well in the late follow-up and is now in NYHA Class I .

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    2014-11-01

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

  9. Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

    Science.gov (United States)

    Mahmood, Feroze; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Chen, Tzong-Huei; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal

    2014-01-01

    Background and aim of the study Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR). Methods A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters. Results Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9% p <0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 62%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter. Conclusion The mitral annulus undergoes significant geometric changes immediately after AVR Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve. PMID:23409347

  10. Long-axis fractional shortening and mitral annulus motion in dogs

    Directory of Open Access Journals (Sweden)

    Marlos Gonçalves Sousa

    2016-10-01

    Full Text Available Ventricular systolic dynamics involves the contraction of transverse and longitudinal myocardial fibers. Unfortunately, only the activity of the transverse myocardial fibers is foreseen by the standard systolic echocardiographic parameters. Although strain and strain rate have been used to assess the radial, circumferential and longitudinal planes of cardiac contraction, such analysis requires advanced equipment which is not always available in veterinary medicine. On the contrary, some unusual parameters may be recorded via standard methodology, allowing for the specific evaluation of left ventricular longitudinal contractility. In this study, the longitudinal contractile activity was evaluated using the long-axis fractional shortening and the mitral annulus motion, which were compared with several standard echocardiographic parameters in 14 beagles, including seven with asymptomatic mitral valve disease. The long-axis fractional shortening was positively correlated with both the mitral annulus motion and the end-diastolic left-ventricular diameter. Also, a significant correlation was found to exist between the mitral annulus motion and the left-ventricular end-diastolic diameter, which is likely supportive of its preload dependency. Even though no difference was documented in either mitral annulus motion or long-axis fractional shortening between healthy dogs and dogs with mitral valve disease, the latter only included animals with minimal cardiac remodeling, with no overt compromise of systolic function. Since it is possible to obtain these two parameters with any echocardiographic equipment, their inclusion in the routine exam would probably add information regarding the activity of the longitudinal myocardial fibers, whose functional deterioration supposedly occurs prior to the impairment of transverse fibers.

  11. In-vivo mitral annuloplasty ring transducer: implications for implantation and annular downsizing.

    Science.gov (United States)

    Siefert, Andrew W; Touchton, Steven A; McGarvey, Jeremy R; Takebayashi, Satoshi; Rabbah, Jean Pierre M; Jimenez, Jorge H; Saikrishnan, Neelakantan; Gorman, Robert C; Gorman, Joseph H; Yoganathan, Ajit P

    2013-09-27

    Mitral annuloplasty has been a keystone to the success of mitral valve repair in functional mitral regurgitation. Understanding the complex interplay between annular-ring stresses and left ventricular function has significant implications for patient-ring selection, repair failure, and patient safety. A step towards assessing these challenges is developing a transducer that can be implanted in the exact method as commercially available rings and can quantify multidirectional ring loading. An annuloplasty ring transducer was developed to measure stresses at eight locations on both the in-plane and out-of-plane surfaces of an annuloplasty ring's titanium core. The transducer was implanted in an ovine subject using 10 sutures at near symmetric locations. At implantation, the ring was observed to undersize the mitral annulus. The flaccid annulus exerted both compressive (-) and tensile stresses (+) on the ring ranging from -3.17 to 5.34 MPa. At baseline hemodynamics, stresses cyclically changed and peaked near mid-systole. Mean changes in cyclic stress from ventricular diastole to mid-systole ranged from -0.61 to 0.46 MPa (in-plane direction) and from -0.49 to 1.13 MPa (out-of-plane direction). Results demonstrate the variability in ring stresses that can be introduced during implantation and the cyclic contraction of the mitral annulus. Ring stresses at implantation were approximately 4 magnitudes larger than the cyclic changes in stress throughout the cardiac cycle. These methods will be extended to ring transducers of differing size and geometry. Upon additional investigation, these data will contribute to improved knowledge of annulus-ring stresses, LV function, and the safer development of mitral repair techniques. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  14. Changes in Mitral Valve Annular Geometry After Repair: Saddle-Shaped Versus Flat Annuloplasty Rings

    Science.gov (United States)

    Mahmood, Feroze; Gorman, Joseph H.; Subramaniam, Balachundhar; Gorman, Robert C.; Panzica, Peter J.; Hagberg, Robert C.; Lerner, Adam B.; Hess, Philip E.; Maslow, Andrew; Khabbaz, Kamal R.

    2011-01-01

    Background Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. Methods Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the “Image Arena” software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. Results Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. Conclusions Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings. PMID:20868816

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

    Science.gov (United States)

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

    2018-01-03

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

  16. Outcomes after mitral valve repair: A single-center 16-year experience.

    Science.gov (United States)

    Tatum, James M; Bowdish, Michael E; Mack, Wendy J; Quinn, Adrienne M; Cohen, Robbin G; Hackmann, Amy E; Barr, Mark L; Starnes, Vaughn A

    2017-09-01

    To evaluate outcomes after mitral valve repair. Between May 1999 and June 2015, 446 patients underwent mitral valve repair. Isolated mitral valve annuloplasty was excluded. A total of 398 (89%) had degenerative valve disease. Mean follow-up was 5.5 ± 3.8 years. Postoperative echocardiograms were obtained in 334 patients (75%) at a mean of 24.3 ± 13.7 months. Survival was 97%, 96%, 95%, and 94% at 1, 3, 5, and 10 years. Risk factor analysis showed age >60 years and nondegenerative etiology predict death (hazard ratio, 2.91; 95% confidence interval, 1.06-8.02, P = .038; and hazard ratio, 1.87; 95% confidence interval, 1.16-3.02, P = .010, respectively). Considering competing risks due to mortality, the cumulative incidence of reoperation was 2.8%, 4.2%, 5.1%, and 9.6% at 1, 3, 5, and 10 years. Competing risk proportional hazard survival regression identified nondegenerative etiology and previous cardiac surgery as predictors of reoperation, and posterior repair was protective (all P mitral regurgitation (2 or more grades) with mortality as a competing risk was 4.7%, 10.5%, 21.0%, and 35.8% at 1, 3, 5, and 10 years. Patients with previous sternotomy, repair or coronary artery bypass grafting, and concurrent tricuspid valve procedure or isolated anterior leaflet repair were more likely to develop progression of mitral regurgitation (all P valve intervention predicted MR progression. Mitral valve repair has excellent outcomes. Our results demonstrate failures appear to occur less in those who undergo posterior leaflet repair. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  17. Pulmonary blood volume measured by RI angiocardiography. Comparison between mitral valve disease and other diseases

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Kazuo (Fukushima Medical Coll. (Japan))

    1982-08-01

    RI angiocardiography (RACG) was performed in 81 patients with heart disease without congestive heart failure at the time, and the results were compared between the groups with mitral valve disease and other diseases. Cardiac output (CO) and pulmonary mean transit time (PMTT) were compared with the results from the dye dilution method in the same patients. PMTT directly measured by RACG was also compared with the peak to peak time (P-PT). P-PT was expressed as the distance from the right to the left peak time in radiocardiography (RCG). There were good correlations between the CO and PMTT obtained from the RI method and those of the dye dilution method (r = 0.90, r = 0.84). The relationship between PMTT and P-PT in mitral valve disease was different from that of other diseases. The average value of PMTT was 5.2 +- 1.0 seconds, and pulmonary blood volume (PBV) was 315 +- 57 ml/m/sup 2/ in the control group. The PBV values were markedly increased in patients with mitral stenosis (558 +- 132 ml/m/sup 2/) and mitral regurgitation (444 +- 119 ml/m/sup 2/), and were slightly increased in aortic valve disease, congenital shunt disease and cardiomyopathy. The patients with ischemic heart disease had normal PBV. In mitral valve disease, the direct method using PMTT of RACG is more accurate than the presumption method using P-PT of RCG. The determination of PBV by this method is very important to observe hemodynamic states in mitral valve disease.

  18. Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration

    Directory of Open Access Journals (Sweden)

    Pablo Maria Alberto Pomerantzeff

    1999-09-01

    Full Text Available OBJECTIVE - To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS - Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1±11.8 years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients - 12.7%. In 20 (16.9% patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients. RESULTS - Immediate mortality was 0.9% (one patient. Long-term rates for thromboembolism, endocarditis, re-operation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8±8.6% over 12 years; survival free from re-operation was 91.8±4.3%, free from endocarditis was 99.2±0.8% and free from thromboembolism was 99.2±0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA, with a complete follow-up in 89.7% of the patients. CONCLUSION - Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.

  19. Cambio valvular mitral, aórtico o mitro-aórtico en pacientes con baja fracción de eyección Mitral, aortic or mitral-aortic valvular replacement in patients with low ejection fraction

    Directory of Open Access Journals (Sweden)

    Jaime Calderón

    2006-10-01

    Full Text Available La decisión de someter a cambio valvular a un paciente con disfunción ventricular moderada a severa, es motivo de controversia debido a las complicaciones y los malos resultados a corto y largo plazo. El objetivo de este estudio fue evaluar los resultados quirúrgicos en los pacientes con baja fracción de eyección pre-quirúrgica sometidos a cambio valvular mitral aórtico o mitro-aórtico. En este tipo de pacientes se puede obtener una aceptable sobrevida libre de sintomas. La clase funcional IV de la New York Heart Association incrementa la mortalidad temprana y tardía. La marcada reducción de la fracción de eyección preoperatoria, no debe considerse como una contraindicación para cambio valvular.The decision to submit patients with moderate to severe ventricular dysfunction to valvular replacements is subject to controversy because complications and the adverse outcomes in short and long-term. The aim of this study was to evaluate the outcomes in mitral or aortic valve replacements or combined aortic and mitral valve replacements in patients with preoperative low left ventricular ejection fraction. Good symptomatic relief and acceptable overall survival can be obtained in patients with systolic dysfunction and valvular disease. Preoperative NYHA class IV increases early and late mortality. A marked ejection fraction reduction should not be considered a contraindication for valvular replacement.

  20. Atrial fibrillation in pure rheumatic mitral valvular disease is expression of an atrial histological change.

    Science.gov (United States)

    Alessandri, N; Tufano, F; Petrassi, M; Alessandri, C; Di Cristofano, C; Della Rocca, C; Gallo, P

    2009-01-01

    Some of theories try to explain the insurgence of atrial fibrillation (AF) in patients with acute articular rheumatism (AAR). These theories remind the close relation between AF and left atrium, or with valvular vitium degree, or monophasic action potential and histological cardiac structure. In 15 years of work in the academic Department of Heart and Big Vessels in Rome, the Authors studied 243 patients with mitral valvular disease post AAR before and after surgical manoeuvres. Patients were divided in order to monitor atrium and ventricle morphological and functional modifications of the valve according to cardiac rhythm. Patients classification was based on surgical therapy adopted, kind of mitral disease and cardiac rhythm. An histological examination was performed, only in patients treated with valvular replacement. During the operation an histological examination in an atrial tissue fragment was performed. 243 patients with mitral valvular disease post AAR with indication in valvular adjustment were studied. The whole population was treated with mitral transcutaneous valvuloplasty (Group B--130 patients) or with mitral valve replacement surgery (Group A--113 patients). These two groups were divided: in Gr.A in Gr.A1 and Gr.A2, and Gr.B in Gr.B1 and Gr.B2, according to cardiac rhythm (sinus rhythm iSR, AF). These subgroups were also divided in Gr.A1SR, Gr.A1AF; Gr.A2SR, Gr.A2AF; Gr.A3SR, Gr.A3AF, according to mitralic disease's kind (stenosis, stenosis/regurgitation, regurgitation). A complex screening were exerted to all patients using echocardio-doppler technology. Morphological parameters of atrium and ventricle, and functional parameters of mitral valve, aorta and tricuspid were evaluated. In Gr.A group patients during the operation were execute a bioptic sampling from left atrium and a consecutive histological valuation. In Gr.A1 mitral valve area (MtVA) arises smaller (p0.05). Left atrium volume arises elder in patients in AF than in patients in SR

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

    Science.gov (United States)

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

    2017-10-01

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

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  3. Real-world outcomes of surgery for native mitral valve endocarditis.

    Science.gov (United States)

    Toyoda, Nana; Itagaki, Shinobu; Egorova, Natalia N; Tannous, Henry; Anyanwu, Anelechi C; El-Eshmawi, Ahmed; Adams, David H; Chikwe, Joanna

    2017-12-01

    Consensus guidelines recommend repair over replacement for the surgical treatment of active native mitral valve infective endocarditis. However, contemporary practice and long-term outcome data are limited. Multivariable Cox regression was used to compare outcomes of 1970 patients undergoing isolated primary mitral valve repair (n = 367, 19%) or replacement (n = 1603, 81%) for active infective endocarditis between 1998 and 2010 in New York and California states. The primary outcome was long-term survival. Secondary outcomes were recurrent endocarditis and mitral reoperation. Median follow-up time was 6.6 years (range 0-12), and last follow-up date was December 31, 2015. Mitral valve repair rates increased from 10.7% to 19.4% over the study period (P < .001). Patients undergoing mitral repair were younger (55 ± 15 vs 57 ± 15 years, P = .005), less likely to have congestive heart failure (46.3% vs 57.1%, P < .001), and less likely to have staphylococcal infections (21.3% vs 32.0%, P < .001). Twelve-year survival was 68.8% (95% confidence interval [CI], 62.5%-74.3%) after mitral repair, versus 53.5% (95% CI, 50.6%-56.4%) after replacement (adjusted hazard ratio, 0.71; 95% CI, 0.57-0.88; P = .002). Mitral repair was associated with lower rate of recurrent endocarditis at 12 years than replacement (4.7% [95% CI, 2.8%-7.2%] vs 9.5% [95% CI, 8.0-11.1%]; P = .03), and similar rate of reoperation (9.1% [95% CI, 6.2%-12.8%] vs 8.6% [95% CI, 7.1%-10.4%]; P = .12). In active endocarditis, mitral valve repair is associated with better survival and lower risk of recurrent infection compared with valve replacement and should be the surgery of choice when feasible. Copyright © 2017. Published by Elsevier Inc.

  4. The prevalence of mitral valve prolapse in patients with Down's syndrome: implications for dental management.

    Science.gov (United States)

    Barnett, M L; Friedman, D; Kastner, T

    1988-10-01

    Eighty-three noninstitutionalized patients with Down's syndrome, aged 9 to 55 years, were randomly selected to receive echocardiograms. Forty-one patients had echocardiographic findings indicative of mitral valve prolapse, and 15 of these patients lacked associated auscultatory findings. Because mitral valve prolapse can predispose patients to bacterial endocarditis after bacteremia-producing dental procedures, these findings suggest that if auscultatory findings alone are used, a significant number of patients with Down's syndrome who are at risk for endocarditis may not be currently identified in the course of routine clinical practice.

  5. Implante de marcapasso definitivo em gestante portadora de valvopatia mitral reumática

    OpenAIRE

    Esper, Rodrigo Barbosa; Furtado, Remo Holanda de Mendonça; Tarasoutchi, Flávio; Spina, Guilherme Sobreira; Grinberg, Max; Ávila, Walkiria Samuel

    2009-01-01

    Descrevemos um caso raro de implante de marcapasso definitivo em gestante, portadora de valvopatia mitral reumática, previamente submetida à valvoplastia percutânea por cateter-balão. A paciente apresentava bloqueio atrioventricular de grau avançado, de causa não-reversível, sintomático e manifesto no 3º trimestre da gestação. We describe a rare case of permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease previously undergoing percutaneous balloon valvul...

  6. Heart rate and heart rate variability in dogs with different degrees of myxomatous mitral valve disease

    DEFF Research Database (Denmark)

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

    2011-01-01

    HEART RATE AND HEART RATE VARIABILITY IN DOGS WITH DIFFERENT DEGREES OF MYXOMATOUS MITRAL VALVE DISEASE. CE Rasmussen1, T Falk1, NE Zois1, SG Moesgaard1, HD Pedersen2, J Häggström3 and LH Olsen1. 1. Department of Basic Animal and Veterinary Sciences, Faculty of Life Sciences, University of Copenh......HEART RATE AND HEART RATE VARIABILITY IN DOGS WITH DIFFERENT DEGREES OF MYXOMATOUS MITRAL VALVE DISEASE. CE Rasmussen1, T Falk1, NE Zois1, SG Moesgaard1, HD Pedersen2, J Häggström3 and LH Olsen1. 1. Department of Basic Animal and Veterinary Sciences, Faculty of Life Sciences, University...

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

    Science.gov (United States)

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

    2011-08-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  9. A novel approach to in vivo mitral valve stress analysis.

    Science.gov (United States)

    Xu, Chun; Brinster, Clay J; Jassar, Arminder S; Vergnat, Mathieu; Eperjesi, Thomas J; Gorman, Robert C; Gorman, Joseph H; Jackson, Benjamin M

    2010-12-01

    Three-dimensional (3-D) echocardiography allows the generation of anatomically correct and time-resolved geometric mitral valve (MV) models. However, as imaged in vivo, the MV assumes its systolic geometric configuration only when loaded. Customarily, finite element analysis (FEA) is used to predict material stress and strain fields rendered by applying a load on an initially unloaded model. Therefore, this study endeavors to provide a framework for the application of in vivo MV geometry and FEA to MV physiology, pathophysiology, and surgical repair. We hypothesize that in vivo MV geometry can be reasonably used as a surrogate for the unloaded valve in computational (FEA) simulations, yielding reasonable and meaningful stress and strain magnitudes and distributions. Three experiments were undertaken to demonstrate that the MV leaflets are relatively nondeformed during systolic loading: 1) leaflet strain in vivo was measured using sonomicrometry in an ovine model, 2) hybrid models of normal human MVs as constructed using transesophageal real-time 3-D echocardiography (rt-3DE) were repeatedly loaded using FEA, and 3) serial rt-3DE images of normal human MVs were used to construct models at end diastole and end isovolumic contraction to detect any deformation during isovolumic contraction. The average linear strain associated with isovolumic contraction was 0.02 ± 0.01, measured in vivo with sonomicrometry. Repeated loading of the hybrid normal human MV demonstrated little change in stress or geometry: peak von Mises stress changed by MV deformed minimally during isovolumic contraction, as measured by the mean absolute difference calculated over the surfaces of both leaflets between serial MV models: 0.53 ± 0.19 mm. FEA modeling of MV models derived from in vivo high-resolution truly 3-D imaging is reasonable and useful for stress prediction in MV pathologies and repairs.

  10. Análise do tratamento cirúrgico da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2010-12-01

    Full Text Available OBJETIVO: Análise comparativa dos resultados imediatos e tardios da reconstrução da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica. MÉTODOS: No período de novembro de 2002 a setembro de 2009, 164 pacientes com idade média de 54 ± 15 anos, sendo 115 do sexo masculino, foram submetidos ao tratamento cirúrgico da raiz da aorta. Foram 125 tubos valvulados e 39 reconstruções da raiz da aorta com preservação da valva aórtica. Dezesseis por cento dos pacientes eram portadores de síndrome de Marfan e 4,3% apresentavam valva aórtica bivalvulada. Cento e quarenta e quatro (88% pacientes foram acompanhados durante tempo médio de seguimento de 41,1 ± 20,8 meses. RESULTADOS: A mortalidade hospitalar total foi de 4,9%; sendo 5,6% nas operações com tubo valvulado e 2,6% nas preservações da valva aórtica (POBJECTIVE: Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. METHODS: From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations. Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88% were followed for a mean period of 41.1 ± 20.8 months. RESULTS: The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05. There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1 nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29. The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001, (95% CI = 82% - 95% P = 0.03 and (95% CI = 81% - 95%, P = 0.03. Multivariate analysis

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

    Science.gov (United States)

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

    2017-04-01

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

  12. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses

    Directory of Open Access Journals (Sweden)

    Harish Ramakrishna

    2015-01-01

    Full Text Available Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.

  13. Endocarditis fatal con localización mitral producida por Erysipelothrix rhusiopathiae Fatal mitral valve endocarditis by Erysipelothrix rhusiopathiae

    Directory of Open Access Journals (Sweden)

    G.V. Vallespi

    2005-06-01

    Full Text Available Se describe un caso fatal de endocarditis en válvula mitral por Erysipelothrix rhusiopathiae, en un paciente varón de 45 años con antecedentes de etilismo crónico y sin contacto previo con animales. Presentaba un síndrome febril prolongado con poliartralgias, pérdida de peso y dolor en región lumbar y miembros inferiores. Los hemocultivos (2/2 fueron positivos a las 48 hs. de incubación y en el examen directo se observaron bacilos gram-positivos pleomórficos. En el subcultivo en agar sangre ovina al 5% desarrollaron colonias puntiformes con alfa hemólisis, catalasa y oxidasa negativas, PYR y LAP positivas y con producción de H2S en medio TSI. La cepa aislada fue identificada como E. rhusiopathiae de acuerdo a la metodología convencional y confirmada con API Coryne. El cuadro se asumió como una probable endocarditis demostrada mediante un ecocardiograma transtorácico. Se comenzó el tratamiento endovenoso con ampicilina y gentamicina. El paciente evolucionó favorablemente y se tornó afebril, sin embargo falleció a los 19 días de internación por edema agudo de pulmón. La prueba de sensibilidad por E-test demostró resistencia a vancomicina y gentamicina y sensibilidad a penicilina y cefotaxima. Es importante valorar los aislamientos de bacilos gram-positivos pleomórficos, catalasa y oxidasa negativos y realizar la prueba de producción de SH2 en el medio TSI. La resistencia a vancomicina ayuda a la identificación y permite establecer una correcta terapia antimicrobiana. Si bien se considera que las infecciones por E. rhusiopathiae son de carácter ocupacional, el contacto con cerdos u otros animales puede no ser evidente.A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis is described in a 45 years old male, with a history of chronic alcohol abuse and without animals contact. He presented intermittent fever, polyarthralgia, weight loss, and low back pain. In blood cultures (2 bottles, gram

  14. A simplified proximal isovelocity surface area method for mitral valve area calculation in mitral stenosis: not requiring angle correction and calculator

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    Omer Yiginer

    2011-08-01

    Full Text Available Aim To simplify proximal isovelocity surface area (PISA method for mitral valve area (MVA calculation that does not necessitate the usage of a calculator and angle correction, and to compare values estimated using this novel method with the values obtained by the conventional PISA, planimetry and pressure half-time (PHT methods.Methods We evaluated patients with a wide range of mitral stenosis (MS severity. The MVA was measured by the methods of PHT (MVA PHT, planimetry (MVApl, conventional PISA (MVAC-PISA and the novel method of simple PISA (MVAS-PISA. Application of simple PISA was performed subsequently by division of the peak mitral inflow velocity by four; measurement of the radius by adjusting the aliasing velocity to this value; square of the radius gives the MVAS-PISA. Results Twenty patients were enrolled in the study. Peak and mean pressure gradients of patients were 20 ± 6 mmHg and 10±4 mmHg,respectively. The average values of MVApl, MVAPHT, MVAC-PISA, and MVA S-PISA were 1,54±0,41, 1,65±0,40, 1,58±0,42, 1,57 ± 0,44 cm2, respectively. MVAS-PISA had a strong correlation with the MVAC-PISA, MVApl and MVAPHT . Furthermore, there was no signi- ficant difference between simple PISA and the other methods. The agreement between planimetry and simple PISA methods for detecting severe mitral stenosis (MVA<1.5 cm2 determined by ROC analysis was very good with a sensitivity and specificity of 100 % and 92%, respectively. Conclusion Simple PISA is a user friendly method which does not take time and gives simple and correct results. If the diagnostic power of the technique is proven by more comprehensive studies, it can supersede the conventional PISA method.

  15. Effects of Mechanical Ventilation on Heart Geometry and Mitral Valve Leaflet Coaptation During Percutaneous Edge-to-Edge Mitral Valve Repair.

    Science.gov (United States)

    Patzelt, Johannes; Zhang, Yingying; Seizer, Peter; Magunia, Harry; Henning, Andreas; Riemlova, Veronika; Patzelt, Tara A E; Hansen, Marc; Haap, Michael; Riessen, Reimer; Lausberg, Henning; Walker, Tobias; Reutershan, Joerg; Schlensak, Christian; Grasshoff, Christian; Simon, Dan I; Rosenberger, Peter; Schreieck, Juergen; Gawaz, Meinrad; Langer, Harald F

    2016-01-25

    This study sought to evaluate a ventilation maneuver to facilitate percutaneous edge-to-edge mitral valve repair (PMVR) and its effects on heart geometry. In patients with challenging anatomy, the application of PMVR is limited, potentially resulting in insufficient reduction of mitral regurgitation (MR) or clip detachment. Under general anesthesia, however, ventilation maneuvers can be used to facilitate PMVR. A total of 50 consecutive patients undergoing PMVR were included. During mechanical ventilation, different levels of positive end-expiratory pressure (PEEP) were applied, and parameters of heart geometry were assessed using transesophageal echocardiography. We found that increased PEEP results in elevated central venous pressure. Specifically, central venous pressure increased from 14.0 ± 6.5 mm Hg (PEEP 3 mm Hg) to 19.3 ± 5.9 mm Hg (PEEP 20 mm Hg; p 4.9 mm at PEEP of 10 mm Hg resulted in a significant reduction of PMVR procedure time (152 ± 49 min to 116 ± 26 min; p = 0.05). In this study, we describe a novel ventilation maneuver improving mitral valve coaptation length during the PMVR procedure, which facilitates clip positioning. Our observations could help to improve PMVR therapy and could make nonsurgical candidates accessible to PMVR therapy, particularly in challenging cases with functional MR. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Concomitant mitral valve surgery with aortic valve replacement: a 21-year experience with a single mechanical prosthesis

    Directory of Open Access Journals (Sweden)

    Sidhu Pushpinder

    2007-05-01

    Full Text Available Abstract Background Long-term survival for combined aortic and mitral valve replacement appears to be determined by the mitral valve prosthesis from our previous studies. This 21-year retrospective study assess long-term outcome and durability of aortic valve replacement (AVR with either concomitant mitral valve replacement (MVR or mitral valve repair (MVrep. We consider only a single mechanical prosthesis. Methods Three hundred and sixteen patients underwent double valve replacement (DVR (n = 273 or AVR+MVrep (n = 43, in the period 1977 to 1997. Follow up of 100% was achieved via telephone questionnaire and review of patients' medical records. Actuarial analysis of long-term survival was determined by Kaplan-Meier method. The Cox regression model was used to evaluate potential predictors of mortality. Results There were seventeen cases (5.4% of early mortality and ninety-six cases of late mortality. Fifteen-year survival was similar in both groups at 44% and 57% for DVR and AVR+MVrep respectively. There were no significant differences in valve related deaths, anticoagulation related complications, or prosthetic valve endocarditis between the groups. There were 6 cases of periprosthetic leak in the DVR group. Sex, pre-operative mitral and aortic valve pathology or previous cardiac surgery did not significantly affect outcome. Conclusion The mitral valve appears to be the determinant of survival following double valve surgery and survival is not significantly influenced by mitral valve repair.

  17. Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease: A retrospective study.

    Science.gov (United States)

    Zhai, Junyu; Wei, Lai; Huang, Ben; Wang, Chunsheng; Zhang, Hongqiang; Yin, Kanhua

    2017-06-01

    The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study.In the MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 ± 2.18 minutes) was significantly longer than that in the control group (112 patients; 36.05 ± 1.40 minutes) (P mitral valve disease, is associated with less trauma and a faster recovery. It is a better choice for treating simple rheumatic mitral valve disease.

  18. Dopaminergic modulation of mitral cell activity in the frog olfactory bulb: a combined radioligand binding-electrophysiological study

    Energy Technology Data Exchange (ETDEWEB)

    Duchamp, A.; Moyse, E.; Delaleu, J.-C.; Coronas, V.; Duchamp-Viret, P. [Laboratoire de Physiologie Neurosensorielle, Universite Claude Bernard and CNRS, F69622 Villeurbanne (France)

    1997-04-28

    Dopamine content in the amphibian olfactory bulb is supplied by interneurons scattered among mitral cells in the external plexiform/mitral cell layer. In mammals, dopamine has been found to be involved in various aspects of bulbar information processing by influencing mitral cell odour responsiveness. Dopamine action in the bulb depends directly on the localization of its receptor targets, found to be mainly of the D{sub 2} type in mammals. The present study assessed, in the frog, both the anatomical localization of D{sub 2}-like, radioligand-labelled receptors of dopamine and the in vivo action of dopamine on unitary mitral cell activity in response to odours delivered over a wide range of concentrations. The [{sup 125}I]iodosulpride-labelled D{sub 2} binding sites were visualized on frozen sagittal sections of frog brains by film radioautography. The sites were found to be restricted to the external plexiform/mitral cell layer; other layers of the olfactory bulb were devoid of specific labelling. Electrophysiological recordings of mitral unit activity revealed that dopamine or its agonist apomorphine induced a drastic reduction of spontaneous firing rate of mitral cells in most cases without altering odour intensity coding properties of these cells. Moreover, pre-treatment with the D{sub 2} antagonist eticlopride blocked the dopamine-induced reduction of mitral cell spontaneous activity.In the frog olfactory bulb, both anatomical localization of D{sub 2}-like receptors and functional data on dopamine involvement in information processing differ from those reported in mammals. This suggests a phylogenetic evolution of dopamine action in the olfactory bulb. In the frog, anatomical data perfectly corroborate electrophysiological results, together strongly suggesting a direct action of dopamine on mitral cells. In a physiologically operating system, such an action would result in a global improvement of signal-to-noise ratio. (Copyright (c) 1997 Elsevier Science B

  19. Valve Repair Is Superior to Replacement in Most Patients With Coexisting Degenerative Mitral Valve and Coronary Artery Diseases.

    Science.gov (United States)

    Javadikasgari, Hoda; Gillinov, A Marc; Idrees, Jay J; Mihaljevic, Tomislav; Suri, Rakesh M; Raza, Sajjad; Houghtaling, Penny L; Svensson, Lars G; Navia, José L; Mick, Stephanie L; Desai, Milind Y; Sabik, Joseph F; Blackstone, Eugene H

    2017-06-01

    For mitral regurgitation (MR) from degenerative mitral disease in patients with coexisting coronary artery disease, the appropriate surgical strategy remains controversial. From 1985 to 2011, 1,071 adults (age 70 ± 9.3 years, 77% men) underwent combined coronary artery bypass grafting and either mitral valve repair (n = 872, 81%) or replacement (n=199, 19%) for degenerative MR. Propensity matching (177 patient pairs, 89% of possible matches) was used to compare early outcomes and time-related recurrence of MR after mitral valve repair, mitral valve reoperation, and mortality. Risk factors for death were identified with multivariable, multiphase hazard-function analysis. Patients undergoing valve replacement were older, with more valve calcification and a higher prevalence of preoperative atrial fibrillation and heart failure (all p < .0001). Among matched pairs, mitral replacement versus repair was associated with higher hospital mortality (5.0% vs 1.0%, p = .0001) and more postoperative renal failure (7.0% vs 3.2%, p = .01), reexplorations for bleeding (6.0% vs 3.1%, p = .05), and respiratory failure (14% vs 4.7%, p < .0001). Of matched patients undergoing repair, 18% had MR above 3+ by 5 years. Mitral valve durability was similar between matched groups, but survival at 15 years was 18% after replacement versus 52% after repair. Nomograms from the multivariable equation revealed that in 94% of cases, 10-year survival was calculated to be higher after repair than after replacement. In patients with coexisting degenerative mitral valve and coronary artery diseases, mitral valve repair is expected to confer a long-term survival advantage over replacement despite some recurrence of MR. When feasible, it is the procedure of choice for these patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Fluid-structure interaction in the left ventricle of the human heart coupled with mitral valve

    Science.gov (United States)

    Meschini, Valentina; de Tullio, Marco Donato; Querzoli, Giorgio; Verzicco, Roberto

    2016-11-01

    In this paper Direct Numerical Simulations (DNS), implemented using a fully fluid-structure interaction model for the left ventricle, the mitral valve and the flowing blood, and laboratory experiments are performed in order to cross validate the results. Moreover a parameter affecting the flow dynamics is the presence of a mitral valve. We model two cases, one with a natural mitral valve and another with a prosthetic mechanical one. Our aim is to understand their different effects on the flow inside the left ventricle in order to better investigate the process of valve replacement. We simulate two situations, one of a healthy left ventricle and another of a failing one. While in the first case the flow reaches the apex of the left ventricle and washout the stagnant fluid with both mechanical and natural valve, in the second case the disturbance generated by the mechanical leaflets destabilizes the mitral jet, thus further decreasing its capability to penetrate the ventricular region and originating heart attack or cardiac pathologies in general.

  1. Left ventricular pseudoaneurysm found after mitral valve replacement performed 30 years earlier.

    Science.gov (United States)

    Castilla, Elena; Gato, Manuel; Ruiz, José Ramón

    2010-03-01

    Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier.

  2. Clinical significance of markers of collagen metabolism in rheumatic mitral valve disease.

    Science.gov (United States)

    Banerjee, Tanima; Mukherjee, Somaditya; Ghosh, Sudip; Biswas, Monodeep; Dutta, Santanu; Pattari, Sanjib; Chatterjee, Shelly; Bandyopadhyay, Arun

    2014-01-01

    Rheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value marker (AUC = 0.95; 95% CI = 0.91-0.99; p459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.

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

    Science.gov (United States)

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

    2014-04-01

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

  4. 74. Reparación Con Neocuerdas en Distintos Tipos de Prolapso Mitral

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    R. García Fuster

    2012-04-01

    Conclusiones: la reparación con neocuerdas se ha mostrado versátil y eficaz en un grupo variado de prolapsos de la válvula mitral. La técnica empleada evita la resección de tejido y mantiene la movilidad de ambos velos, logrando un resultado funcional excelente.

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

    DEFF Research Datab