Sample records for mitral regurgitation methods

  1. Quantitation of mitral regurgitation.

    PubMed

    Topilsky, Yan; Grigioni, Francesco; Enriquez-Sarano, Maurice

    2011-01-01

    Mitral regurgitation (MR) is the most frequent valve disease. Nevertheless, evaluation of MR severity is difficult because standard color flow imaging is plagued by considerable pitfalls. Modern surgical indications in asymptomatic patients require precise assessment of MR severity. MR severity assessment is always comprehensive, utilizing all views and methods. Determining trivial/mild MR is usually easy, based on small jet and flow convergence. Specific signs of severe MR (pulmonary venous flow systolic reversal or severe mitral lesion) are useful but insensitive. Quantitative methods, quantitative Doppler (measuring stroke volumes) and flow convergence (aka PISA method), measure the lesion severity as effective regurgitant orifice (ERO) and volume overload as regurgitant volume (RVol). Interpretation of these numbers should be performed in context of specific MR type. In organic MR (intrinsic valve lesions) ERO ? 0.40 cm(2) and RVol ? 60 mL are associated with poor outcome, while in functional MR ERO ? 0.20 cm(2) and RVol ? 30 mL mark reduced survival. While MR assessment should always be comprehensive, quantitative assessment of MR provides measures that are strongly predictive of outcome and should be the preferred approach. The ERO and RVol measured by these methods require interpretation in causal context to best predict outcome and determine MR management. PMID:22041039

  2. Anterior leaflet augmentation for ischemic mitral regurgitation

    Microsoft Academic Search

    Edward H Kincaid; Robert D Riley; Michael H Hines; John W Hammon; Neal D Kon

    2004-01-01

    BackgroundMitral valve repair improves survival and quality of life in patients with ischemic mitral regurgitation (MR). Although many repair methods exist for this condition, the ideal approach remains unknown. The purpose of this study is to describe a simple technique for repair of ischemic MR that addresses the pathophysiology of tethered leaflets and to report its early results.

  3. Percutaneous Mitral Annuloplasty for Functional Mitral Regurgitation

    PubMed Central

    Schofer, Joachim; Siminiak, Tomasz; Haude, Michael; Herrman, Jean P.; Vainer, Jindra; Wu, Justina C.; Levy, Wayne C.; Mauri, Laura; Feldman, Ted; Kwong, Raymond Y.; Kaye, David M.; Duffy, Stephen J.; Tübler, Thilo; Degen, Hubertus; Brandt, Mathias C.; Van Bibber, Rich; Goldberg, Steve; Reuter, David G.; Hoppe, Uta C.

    2014-01-01

    Background Functional mitral regurgitation (FMR), a well-recognized component of left ventricular remodeling, is associated with increased morbidity and mortality in heart failure patients. Percutaneous mitral annuloplasty has the potential to serve as a therapeutic adjunct to standard medical care. Methods and Results Patients with dilated cardiomyopathy, moderate to severe FMR, an ejection fraction <40%, and a 6-minute walk distance between 150 and 450 m were enrolled in the CARILLON Mitral Annuloplasty Device European Union Study (AMADEUS). Percutaneous mitral annuloplasty was achieved through the coronary sinus with the CARILLON Mitral Contour System. Echocardiographic FMR grade, exercise tolerance, New York Heart Association class, and quality of life were assessed at baseline and 1 and 6 months. Of the 48 patients enrolled in the trial, 30 received the CARILLON device. Eighteen patients did not receive a device because of access issues, insufficient acute FMR reduction, or coronary artery compromise. The major adverse event rate was 13% at 30 days. At 6 months, the degree of FMR reduction among 5 different quantitative echocardiographic measures ranged from 22% to 32%. Six-minute walk distance improved from 307±87 m at baseline to 403±137 m at 6 months (P<0.001). Quality of life, measured by the Kansas City Cardiomyopathy Questionnaire, improved from 47±16 points at baseline to 69±15 points at 6 months (P<0.001). Conclusions Percutaneous reduction in FMR with a novel coronary sinus–based mitral annuloplasty device is feasible in patients with heart failure, is associated with a low rate of major adverse events, and is associated with improvement in quality of life and exercise tolerance. PMID:19597051

  4. Echocardiographic assessment of ischemic mitral regurgitation.

    PubMed

    Dudzinski, David M; Hung, Judy

    2014-01-01

    Ischemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Echocardiographic diagnosis and assessment of ischemic mitral regurgitation are critical to gauge its adverse effects on prognosis and to attempt to tailor rational treatment strategy. There is no single approach to the echocardiographic assessment of ischemic mitral regurgitation: standard echocardiographic measures of mitral regurgitation severity and of LV dysfunction are complemented by assessments of displacement of the papillary muscles and quantitative indices of mitral valve deformation. Development of novel approaches to understand mitral valve geometry by echocardiography may improve understanding of the mechanism, clinical trajectory, and reparability of ischemic mitral regurgitation. PMID:25416497

  5. Surgical Treatment of Moderate Ischemic Mitral Regurgitation

    PubMed Central

    Smith, P.K.; Puskas, J.D.; Ascheim, D.D.; Voisine, P.; Gelijns, A.C.; Moskowitz, A.J.; Hung, J.W.; Parides, M.K.; Ailawadi, G.; Perrault, L.P.; Acker, M.A.; Argenziano, M.; Thourani, V.; Gammie, J.S.; Miller, M.A.; Pagé, P.; Overbey, J.R.; Bagiella, E.; Dagenais, F.; Blackstone, E.H.; Kron, I.L.; J., D.; Rose, E.A.; Moquete, E.G.; Jeffries, N.; Gardner, T.J.; O’Gara, P.T.; Alexander, J.H.; Michler, R.E.

    2015-01-01

    BACKGROUND Ischemic mitral regurgitation is associated with increased mortality and morbidity. For surgical patients with moderate regurgitation, the benefits of adding mitral-valve repair to coronary-artery bypass grafting (CABG) are uncertain. METHODS We randomly assigned 301 patients with moderate ischemic mitral regurgitation to CABG alone or CABG plus mitral-valve repair (combined procedure). The primary end point was the left ventricular end-systolic volume index (LVESVI), a measure of left ventricular remodeling, at 1 year. This end point was assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank. RESULTS At 1 year, the mean LVESVI among surviving patients was 46.1±22.4 ml per square meter of body-surface area in the CABG-alone group and 49.6±31.5 ml per square meter in the combined-procedure group (mean change from baseline, ?9.4 and ?9.3 ml per square meter, respectively). The rate of death was 6.7% in the combined-procedure group and 7.3% in the CABG-alone group (hazard ratio with mitral-valve repair, 0.90; 95% confidence interval, 0.38 to 2.12; P = 0.81). The rank-based assessment of LVESVI at 1 year (incorporating deaths) showed no significant between-group difference (z score, 0.50; P = 0.61). The addition of mitral-valve repair was associated with a longer bypass time (P<0.001), a longer hospital stay after surgery (P = 0.002), and more neurologic events (P = 0.03). Moderate or severe mitral regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%, P<0.001). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year. CONCLUSIONS In patients with moderate ischemic mitral regurgitation, the addition of mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did not show a clinically meaningful advantage of adding mitral-valve repair to CABG. Longer-term follow-up may determine whether the lower prevalence of mitral regurgitation translates into a net clinical benefit. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.) PMID:25405390

  6. Percutaneous intervention for mitral regurgitation.

    PubMed

    Sarraf, Mohammad; Feldman, Ted

    2015-04-01

    Percutaneous treatment of mitral regurgitation (MR) is a promising alternative for patients with functional MR (FMR) who are not appropriate for surgery and are not responding to optimal medical therapy and cardiac resynchronization therapy. Unlike degenerative MR, where repair therapy is clearly preferred, the optimal approach for FMR has not been defined. Challenges for novel mitral repair devices are to demonstrate safety and superior efficacy to medical management in higher risk patients. Transcatheter mitral valve replacement is emerging as a feasible therapy, but requires significant additional clinical trials to define its place in treating heart failure related to MR. PMID:25834973

  7. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

    Microsoft Academic Search

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

    2008-01-01

    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

  8. Mitral regurgitation quantification by cardiovascular magnetic resonance: a comparison of indirect quantification methods.

    PubMed

    Polte, Christian L; Bech-Hanssen, Odd; Johnsson, Åse A; Gao, Sinsia A; Lagerstrand, Kerstin M

    2015-08-01

    Quantification of mitral regurgitation (MR) using cardiovascular magnetic resonance can be achieved by three indirect methods. The aims of the study were to determine their agreement, observer variability and effect on grading MR severity. The study comprised 16 healthy volunteers and 36 MR patients. Quantification was performed using the 'standard' [left ventricular stroke volume (LVSV)-aortic forward flow (AoFF)], 'volumetric' [LVSV-right ventricular stroke volume (RVSV)] and 'flow' method [mitral inflow (MiIF)-AoFF]. In healthy volunteers without MR, LVSV was larger than AoFF (mean difference ±SD: 12 ± 6 ml, P < 0.0001). Only small differences were found between LVSV-RVSV (3 ± 6 ml) and MiIF-AoFF (1 ± 5 ml). In patients, mitral regurgitant volumes (MRVs)/fractions (MRFs) were larger (P < 0.0001) using the 'standard' method (90 ± 31 ml/51 ± 11 %) compared with the 'volumetric' (76 ± 30 ml/42 ± 11 %) and 'flow' method (70 ± 32 ml/44 ± 15 %). Inter-observer variability was lowest for the 'flow' and highest for the 'volumetric' method, while intra-observer variability was similar for all three methods. In 29 operated patients with severe MR, MRVs were above the guideline threshold (?60 ml) in 100, 86 and 83 % of the cases, and MRFs were above the threshold (?50 %) in 76, 32 and 48 % of the cases, when using the 'standard', 'volumetric' and 'flow' method respectively. In conclusion, the choice of method can affect the grading of MR severity and thereby eventually the clinical decision-making and timing of surgery. PMID:26001380

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

    PubMed Central

    Gabriel, Ruvin S; Kerr, Andrew J; Raffel, Owen C; Stewart, Ralph A; Cowan, Brett R; Occleshaw, Christopher J

    2008-01-01

    Purpose In mitral valve prolapse, determining whether the valve is suitable for surgical repair depends on the location and mechanism of regurgitation. We assessed whether cardiovascular magnetic resonance (CMR) could accurately identify prolapsing or flail mitral valve leaflets and regurgitant jet direction in patients with known moderate or severe mitral regurgitation. Methods CMR of the mitral valve was compared with trans-thoracic echocardiography (TTE) in 27 patients with chronic moderate to severe mitral regurgitation due to mitral valve prolapse. Contiguous long-axis high temporal resolution CMR cines perpendicular to the valve commissures were obtained across the mitral valve from the medial to lateral annulus. This technique allowed systematic valve inspection and mapping of leaflet prolapse using a 6 segment model. CMR mapping was compared with trans-oesophageal echocardiography (TOE) or surgical inspection in 10 patients. Results CMR and TTE agreed on the presence/absence of leaflet abnormality in 53 of 54 (98%) leaflets. Prolapse or flail was seen in 36 of 54 mitral valve leaflets examined on TTE. CMR and TTE agreed on the discrimination of prolapse from flail in 33 of 36 (92%) leaflets and on the predominant regurgitant jet direction in 26 of the 27 (96%) patients. In the 10 patients with TOE or surgical operative findings available, CMR correctly classified presence/absence of segmental abnormality in 49 of 60 (82%) leaflet segments. Conclusion Systematic mitral valve assessment using a simple protocol is feasible and could easily be incorporated into CMR studies in patients with mitral regurgitation due to mitral valve prolapse. PMID:18400088

  10. A novel fully automated method for mitral regurgitant orifice area quantification???

    PubMed Central

    Moraldo, Michela; Bergamini, Corinna; Malaweera, Anura S.N.; Dhutia, Niti M.; Pabari, Punam A.; Willson, Keith; Baruah, Resham; Manisty, Charlotte; Davies, Justin E.; Xu, Xiao Y.; Hughes, Alun D.; Francis, Darrel P.

    2013-01-01

    Background Effective regurgitant orifice area (EROA) in mitral regurgitation (MR) is difficult to quantify. Clinically it is measured using the proximal isovelocity surface area (PISA) method, which is intrinsically not automatable, because it requires the operator to manually identify the mitral valve orifice. We introduce a new fully automated algorithm, (“AQURO”), which calculates EROA directly from echocardiographic colour M-mode data, without requiring operator input. Methods Multiple PISA measurements were compared to multiple AQURO measurements in twenty patients with MR. For PISA analysis, three mutually blinded observers measured EROA from the four stored video loops. For AQURO analysis, the software automatically processed the colour M-mode datasets and analysed the velocity field in the flow-convergence zone to extract EROA directly without any requirement for manual radius measurement. Results Reproducibility, measured by intraclass correlation (ICC), for PISA was 0.80, 0.83 and 0.83 (for 3 observers respectively). Reproducibility for AQURO was 0.97. Agreement between replicate measurements calculated using Bland-Altman standard deviation of difference (SDD) was 21,17 and 17mm2for the three respective observers viewing independent video loops using PISA. Agreement between replicate measurements for AQURO was 6, 5 and 7mm2for automated analysis of the three pairs of datasets. Conclusions By eliminating the need to identify the orifice location, AQURO avoids an important source of measurement variability. Compared with PISA, it also reduces the analysis time allowing analysis and averaging of data from significantly more beats, improving the consistency of EROA quantification. AQURO, being fully automated, is a simple, effective enhancement for EROA quantification using standard echocardiographic equipment. PMID:22217482

  11. Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation.

    PubMed Central

    Tribouilloy, C; Shen, W F; Slama, M A; Dufossé, H; Choquet, D; Marek, A; Lesbre, J P

    1991-01-01

    OBJECTIVE--To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the regurgitant fraction in patients with mitral regurgitation. PATIENTS AND METHODS--Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The regurgitant fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS--In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean regurgitant fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived regurgitant fraction (45.8 (19.2)%) accorded closely with the regurgitant fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION--Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation. Images PMID:1747280

  12. The echocardiographic assessment of functional mitral regurgitation.

    PubMed

    Ray, Simon

    2010-12-01

    Functional mitral regurgitation (MR) is common, clinically important, and mechanistically complex. Its assessment by echocardiography can be challenging, and particular care is needed in the quantification of severity. Echocardiographers need to be aware of the potential limitations of flow convergence and vena contracta methods in assessing severity and alert to the prognostic importance of even moderate functional MR. Three-dimensional echocardiography has the potential to improve both the understanding of the mechanisms of functional MR and the accuracy of its quantification. PMID:21078834

  13. Blood cyst of the anterior mitral leaflet causing severe mitral regurgitation

    PubMed Central

    Jayaprakash, K.; Jayaprasad, N.; Sathish, Gargi; George, Raju

    2015-01-01

    We report a case of blood cyst of the anterior mitral leaflet leading to severe mitral regurgitation and heart failure in a 70-year-old woman with no other factors that could explain the severe mitral regurgitation. PMID:26130890

  14. Effect of dobutamine stress echocardiography on mitral regurgitation

    Microsoft Academic Search

    Sheila K Heinle; Frank D Tice; Joseph Kisslo

    1995-01-01

    Objectives. This study was performed to examine the effect of dobutamine stress echocardiography on mitral regurgitation and to test the hypothesis that mitral regurgitation will increase in patients with an ischemic response.Background. New or worsening mitral regurgitation during stress testing has been proposed as a marker of ischemia. However, it is unclear whether ischemia induced by dobutamine is associated with

  15. Mechanistic insights into functional mitral regurgitation

    Microsoft Academic Search

    Robert A. Levine; Judy Hung; Yutaka Otsuji; Emmanuel Messas; Noah Liel-Cohen; Nadia Nathan; Mark D. Handschumacher; J. Luis Guerrero; Shengqiu He; Ajit P. Yoganathan; Gus J. Vlahakes

    2002-01-01

    Effective valve repair in patients with mitral regurgitation (MR) demands an understanding of its mechanism. In patients with\\u000a ischemic heart disease and functional MR, which doubles late mortality, normal leaflets are apically displaced. This reflects\\u000a an altered balance of forces acting on the leaflets: increased tethering forces restricting closure, resulting from an altered\\u000a geometry of leaflet attachments, and decreased ventricular

  16. The spectrum of mitral regurgitation in idiopathic mitral valve prolapse: a Color Doppler study

    Microsoft Academic Search

    Pierre Decoodt; Béatrice Péperstraete; Raymond Kacenelenbogen; Thierry Verbeet; Jean-Paul Bar; Michel Telerman

    1990-01-01

    To characterize the spectrum of mitral regurgitation in mitral valve prolapse, one hundred patients were studied by color Doppler flow mapping. The findings were correlated with the clinical presentation and with the possible complications. Mitral regurgitation was absent in 46 patients, mild in 26 patients, moderate in 18 patients and severe in 10 patients. The jet orientation was central in

  17. Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color Doppler echocardiography.

    PubMed

    Altiok, Ertunc; Hamada, Sandra; van Hall, Silke; Hanenberg, Mehtap; Dohmen, Guido; Almalla, Mohammed; Grabskaya, Eva; Becker, Michael; Marx, Nikolaus; Hoffmann, Rainer

    2011-02-01

    Direct measurement of anatomic regurgitant orifice area (AROA) by 3-dimensional transesophageal echocardiography was evaluated for analysis of mitral regurgitation (MR) severity. In 72 patients (age 70.6 ± 13.3 years, 37 men) with mild to severe MR, 3-dimensional transesophageal echocardiography and transthoracic color Doppler echocardiography were performed to determine AROA by direct planimetry, effective regurgitant orifice area (EROA) by proximal convergence method, and vena contracta area (VCA) by 2-dimensional color Doppler echocardiography. AROA was measured with commercially available software (QLAB, Philips Medical Systems, Andover, Massachusetts) after adjusting the first and second planes to reveal the smallest orifice in the third plane where planimetry could take place. AROA was classified as circular or noncircular by calculating the ratio of the medial-lateral distance above the anterior-posterior distance (?1.5 compared to >1.5). AROA determined by direct planimetry was 0.30 ± 0.20 cm², EROA determined by proximal convergence method was 0.30 ± 0.20 cm², and VCA was 0.33 ± 0.23 cm². Correlation between AROA and EROA (r = 0.96, SEE 0.058 cm²) and between AROA and VCA (r = 0.89, SEE 0.105 cm²) was high considering all patients. In patients with a circular regurgitation orifice area (n = 14) the correlation between AROA and EROA was better (r = 0.99, SEE 0.036 cm²) compared to patients with noncircular regurgitation orifice area (n = 58, r = 0.94, SEE 0.061 cm²). Correlation between AROA and EROA was higher in an EROA ?0.2 cm² (r = 0.95) than in an EROA <0.2 cm² (r = 0.60). In conclusion, direct measurement of MR AROA correlates well with EROA by proximal convergence method and VCA. Agreement between methods is better for patients with a circular regurgitation orifice area than in patients with a noncircular regurgitation orifice area. PMID:21257014

  18. [Pulsed echo-Doppler evaluation of regurgitant fraction in mitral valve insufficiency].

    PubMed

    Tribouilloy, C; Slama, M A; Kugener, H; Dufossé, H; Rey, J L; Lesbre, J P

    1991-09-01

    The aim of this study was to evaluate the validity of Doppler echocardiographic evaluation of the regurgitant fraction in pure mitral insufficiency. The Doppler echocardiographic measurement of systemic flow was made at the level of the aortic ring, and the mitral flow by the method of integration of instantaneous flow proposed by Touche. In a preliminary study, we demonstrated a close correlation between forward aortic and mitral flow in 20 normal subjects (r = 0.94; SD = 0.31 l/mn; y = 0.98 x -0.004). We then studied a group of 38 patients with pure isolated mitral regurgitation. Five patients were excluded because of the poor quality of the echocardiographic documents. The hemodynamic regurgitant fraction was determined by measuring pulmonary flow by thermodilution and the left ventricular outflow by digitised angiography. The average Doppler and hemodynamic regurgitant fractions were 46.6 +/- 18% and 42 +/- 17% respectively. There was a close correlation between the Doppler and hemodynamic values (r = 0.91; SD = 7.8%; y = 0.97 x + 5.7). The correlations were also good between Doppler regurgitant fraction and the four angiographic grades of regurgitation (r = 0.88). A statistically significant difference was observed between the Doppler regurgitant fractions of Grades I and II and of Grades III and IV (p less than 0.001). In addition, the ratio of mitral VTI/aortic VTI gave a useful index of regurgitation in pure mitral insufficiency. When the ratio was greater than 1.3 the regurgitant fraction was over 40% with a sensitivity of 79% and a specificity of 86%. Finally, this study shows that pure, isolated mitral regurgitation can be evaluated by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1958116

  19. Surgical treatment of functional ischemic mitral regurgitation.

    PubMed

    Jensen, Henrik

    2015-03-01

    In many ways we are at a crossroad in terms of what constitutes optimal FIMR treatment: is CABG combined with mitral valve ring annuloplasty better than CABG alone in moderate FIMR? Is mitral valve repair really better than replacement? And does adding a valvular repair or subvalvular reverse remodeling procedure shift that balance? In the present thesis I aim to shed further light on these questions by addressing the current status and future perspectives of the surgical treatment of FIMR. CURRENT SURGICAL TREATMENT FOR FIMR. CABG alone: The overall impression from the literature is that patients are left with a high grade of persistent/recurrent FIMR from isolated CABG. CABG is most effective to treat FIMR in patients with viable myocardium (at least five viable segments) and absence of dyssynchrony between papillary muscles (< 60 ms). Mitral valve ring annuloplasty. A vast number of different designs are available to perform mitral valve ring annuloplasty with variations over the theme of complete/partial and rigid/semi-rigid/flexible. Also, the three-dimensional shape of the rigid and semi-rigid rings is the subject of great variation. A rigid or semi-rigid down-sized mitral valve ring annuloplasty is the most advocated treatment in chronic FIMR grade 2+ or higher. Combined CABG and mitral valve ring annuloplasty: CABG combined with mitral valve ring annuloplasty leads to reverse LV remodeling and reduced volumes. Despite this, the recurrence rate after combined CABG and mitral valve ring annuloplasty is 20-30% at 2-4 years follow-up. This is also true for studies strictly using down-sized mitral valve ring annuloplasty by two sizes. A number of preoperative risk factors to develop recurrent FIMR were identified, e.g. LVEDD > 65-70 mm, coaptation depth > 10 mm, anterior leaflet angle > 27-39.5°, posterior leaflet angle > 45° and interpapillary muscle distance > 20 mm. CABG alone vs. combined CABG and mitral valve ring annuloplasty: The current available literature, including three randomized studies and a meta analysis, indicate that combined CABG and mitral valve ring annuloplasty has no late survival difference compared with CABG alone, and early mortality might even be higher. Meanwhile, adding a mitral valve ring annuloplasty results in a lower NYHA functional class, most likely as a consequence of a lower incidence of persistent or recurrent FIMR. More randomized studies are being conducted to further address this topic. Mitral valve ring annuloplasty vs. mitral valve replacement. The early survival may be higher after repair compared with replacement, meanwhile, the literature is more ambiguous in terms of late survival advantages, and recent reports find no late survival advantage from repair over replacement. The recurrence rates after ring annuloplasty addressed above were also present in this subset of patients, whereas the incidence of recurrent FIMR after valve replacement is scarcely reported. There was an overall tendency of slightly higher incidence of reoperations after ring annuloplasty. The mitral valve annulus: Innovations in mitral valve ring annuloplasty: The latest innovation in mitral valve ring annuloplasty design includes adjustable rings, allowing adjustment of septo-lateral dimensions intra- or postoperatively. Minimally invasive ring annuloplasty using indirect coronary sinus devices, has been introduced, but so far have produced suboptimal results in terms of safety and efficacy. Also, first in man testing of direct percutaneous catheter based mitral annuloplasty techniques have been conducted. Leaflets and chordae: Direct repair techniques: Surgical methods have been developed to directly address the mitral valve leaflets and chordae tendineae to correct leaflet tethering in FIMR. Both the Alfieri stich and the minimally invasive MitraClip attaches the anterior and posterior leaflets, typically the A2-P2 region, to correct incomplete leaflet coaptation. Patch augmentation of the posterior leaflet in the P2-P3 region increases coaptation in the area most prone to cause

  20. Relation of mitral valve morphology and motion to mitral regurgitation severity in patients with mitral valve prolapse

    PubMed Central

    2012-01-01

    Background Mitral valve thickness is used as a criterion to distinguish the classical from the non-classical form of mitral valve prolapse (MVP). Classical form of MVP has been associated with higher risk of mitral regurgitation (MR) and concomitant complications. We sought to determine the relation of mitral valve morphology and motion to mitral regurgitation severity in patients with MVP. Methods We prospectively analyzed transthoracic echocardiograms of 38 consecutive patients with MVP and various degrees of MR. In the parasternal long-axis view, leaflets length, diastolic leaflet thickness, prolapsing depth, billowing area and non-coaptation distance between both leaflets were measured. Results Twenty patients (53%) and 18 patients (47%) were identified as having moderate to severe and mild MR respectively (ERO = 45 ± 27 mm2 vs. 5 ± 7 mm2, p < 0.001). Diastolic leaflet thickness was similar in both groups (5.5 ± 0.9 mm vs. 5.3 ± 1 mm, p = 0.57). On multivariate analysis, the non-coaptation distance (OR 7.9 per 1 mm increase; 95% CI 1.72-37.2) was associated with significant MR. Thick mitral valve leaflet as traditionally reported (? 5 mm) was not associated with significant MR (OR 0.9; 95% CI 0.2-3.4). Conclusions In patients with MVP, thick mitral leaflet is not associated with significant MR. Leaflet thickness is probably not as important in risk stratification as previously reported in patients with MVP. Other anatomical and geometrical features of the mitral valve apparatus area appear to be much more closely related to MR severity. PMID:22284298

  1. Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

    PubMed Central

    Acker, Michael A.; Parides, Michael K.; Perrault, Louis P.; Moskowitz, Alan J.; Gelijns, Annetine C.; Voisine, Pierre; Smith, Peter K.; Hung, Judy W.; Blackstone, Eugene H.; Puskas, John D.; Argenziano, Michael; Gammie, James S.; Mack, Michael; Ascheim, Deborah D.; Bagiella, Emilia; Moquete, Ellen G.; Ferguson, T. Bruce; Horvath, Keith A.; Geller, Nancy L.; Miller, Marissa A.; Woo, Y. Joseph; D’Alessandro, David A.; Ailawadi, Gorav; Dagenais, Francois; Gardner, Timothy J.; O’Gara, Patrick T.; Michler, Robert E.; Kron, Irving L.

    2014-01-01

    Background Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. Methods We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. Results At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, ?6.6 and ?6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. Conclusions We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.) PMID:24245543

  2. Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood

    PubMed Central

    Kim, Eung Re; Kim, Woong-Han; Choi, Eun Seok; Cho, Sungkyu; Jang, Woo Sung; Kim, Yong Jin

    2015-01-01

    Background Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results The median age at the time of surgery was 47 months (range, 3 to 140 months) and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years). Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients. PMID:25705592

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

    PubMed Central

    2012-01-01

    A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation) may not only improve the patient’s functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts. PMID:23020892

  4. A Three-Dimensional Computational Fluid Dynamics Model of Regurgitant Mitral Valve Flow: Validation Against In Vitro Standards and 3D Color Doppler Methods

    Microsoft Academic Search

    Annalisa Quaini; Suncica Canic; Giovanna Guidoboni; Roland Glowinski; Stephen R. Igo; Craig J. Hartley; William A. Zoghbi; Stephen H. Little

    2011-01-01

    3D color Doppler echocardiography has recently been employed to evaluate 3D proximal isovelocity surface area (PISA) and vena\\u000a contracta (VC) area measures of regurgitant valve severity. Computational fluid dynamics (CFD) modeling may provide insight\\u000a into the strengths and limitations of emerging 3D color Doppler applications for the quantification of mitral regurgitation\\u000a (MR). The objective of this study is to evaluate

  5. Successful robot-assisted repair of congenital mitral valve regurgitation.

    PubMed

    Raju, Vijayakumar; Burkhart, Harold M; Cetta, Frank; Suri, Rakesh M

    2014-09-01

    Congenital mitral valve regurgitation (CMR) is very uncommon in adults and is usually associated with other congenital malformations. Repair of the mitral valve remains the standard of care. Very limited reports are available on minimally invasive surgical approaches in treating CMR. This report represents the first case series of the successful application of robotics in correcting CMR and associated anomalies, including a partial atrioventricular canal defect. PMID:25193192

  6. Pivotal Role of Bedside Doppler Echocardiography in the Assessment of Patients with Acute Heart Failure and Mitral Regurgitation

    Microsoft Academic Search

    Pierre Vladimir Ennezat; Annaïk Bellouin; Sylvestre Maréchaux; Francis Juthier; Georges Fayad; André Vincentelli; Alain Berrébi; Jean Luc Auffray; Jean Jacques Bauchart; Frédéric Mouquet; David Montaigne; Philippe Asseman; Thierry H. Le Jemtel; Philippe Pibarot

    2009-01-01

    Patients presenting with mitral regurgitation and acute heart failure remain a challenge for the clinicians. Bedside echocardiography ascertains the functional or primary nature of mitral regurgitation, thereby allowing to focus therapy on the left ventricle and mitral valve apparatus in patients with functional mitral regurgitation and to hasten mitral valve repair or replacement when acute heart failure results from primary

  7. Reduction of mitral valve regurgitation with Mitraclip® percutaneous system.

    PubMed

    Tamburino, C; Immè, S; Barbanti, M; Mulè, M; Pistritto, A M; Aruta, P; Cammalleri, V; Scarabelli, M; Mangiafico, S; Scandura, S; Ussia, G P

    2010-10-01

    Mitral regurgitation (MR) is the second most common heart valve disease worldwide and the current gold-standard treatment is surgical repair or replacement. Nevertheless, many patients do not undergo surgical intervention due to several comorbidities. Percutaneous "edge-to-edge" mitral valve repair using the MitraClip System is an emerging and effective option to this subset of patients. This device has been used to treat both functional and degenerative mitral valve regurgitation and has been compared to surgery in the Endovascular Valve Edge-to-Edge Repair Study II (EVEREST II) randomized trial. Although the field of percutaneous management of MR is at an early stage, it has been demonstrated that percutaneous approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR. PMID:20948505

  8. Curious case of calciphylaxis leading to acute mitral regurgitation.

    PubMed

    Gallimore, Grant Gardner; Curtis, Blair; Smith, Andria; Benca, Michael

    2014-01-01

    Calciphylaxis is uncommon and typically seen in patients with end-stage renal disease. It has been defined as a vasculopathic disorder characterised by cutaneous ischaemia and necrosis due to calcification, intimal fibroplasia and thrombosis of pannicular arterioles. We present the case of a 74-year-old woman with chronic kidney disease stage III who developed calciphylaxis leading to mitral valve calcification, chordae tendineae rupture and acute mitral regurgitation. Although an alternative explanation can typically be found for non-uraemic calciphylaxis, her evaluation did not reveal any usual non-uraemic causes including elevated calcium-phosphorus product, hyperparathyroidism, or evidence of connective tissue disease. Her wounds improved with sodium thiosulfate, pamidronate, penicillin and hyperbaric oxygen therapies but she ultimately decompensated with the onset of acute mitral regurgitation attributed to rupture of a previously calcified chordae tendineae. This case highlights an unusual case of calciphylaxis without clear precipitant as well as a novel manifestation of the disease. PMID:24789150

  9. Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for mitral valve surgery

    Microsoft Academic Search

    Rampaul G Singh; Roger Cappucci; Randi Kramer-Fox; Mary J Roman; Paul Kligfield; Jeffrey S Borer; Clare Hochreiter; O. Wayne Isom; Richard B Devereux

    2000-01-01

    Patients with mitral valve prolapse (MVP) may develop severe mitral regurgitation (MR) and require valve surgery. Preliminary data suggest that high body weight and blood pressure might add to the irreversible factors of older age and male gender in increasing risk of these complications. Fifty-four patients with severe MR due to MVP were compared with 117 control subjects with uncomplicated

  10. [The syndrome of mitral regurgitation in patients with chronic heart failure].

    PubMed

    Larina, V N; Alekhin, M N; art, B Ia

    2009-01-01

    Functional mitral regurgitation is a frequent complication of severe course of ischemic heart disease and plays a role of no small importance in origin and progression of chronic heart failure (CHF). Severe degree of mitral regurgitation is found in 18.9%, moderate - in 29.7% of patients with systolic left ventricular dysfunction. A major precondition for origin of mitral regurgitation is the presence of the process of left ventricular remodeling which disturbs coordination between the ventricle and valvular apparatus. Changes of anatomo-functional state of the mitral valve occurring during its closure determine severity of mitral regurgitation in patients with CHF and left ventricular dysfunction. PMID:20001986

  11. [Late diastolic mitral regurgitation: pulsed Doppler echocardiographic study].

    PubMed

    Sanada, J; Kawahira, M; Kubo, H; Kuroiwa, N; Nakamura, K; Hashimoto, S

    1985-09-01

    Since the description of late diastolic mitral regurgitation (MR) detected by left ventriculography, the risk of overestimating systolic MR has been pointed out. However, it has not been well studied by pulsed Doppler echocardiography, though this method is thought to be extremely useful to analyze systolic MR. The purpose of this study was to evaluate the usefulness of pulsed Doppler echocardiography in assessing late diastolic MR and to clarify the pathophysiology of this MR. With the probe in the apical position, the blood flow pattern at the left atrial outflow tract was investigated in 226 consecutive cases who underwent left ventriculography. Late diastolic MR, which could not be attributed to ventricular premature contraction, was observed in 10 cases (4.4%) by left ventriculography. Meanwhile, by pulsed Doppler echocardiography, late diastolic disturbed flow directing towards the left atrial cavity in late diastole was detected in 15 cases (6.6%) including 10 cases with positive left ventriculographic MR. Among these 15 cases, 14 (93%) had atrial fibrillation and exhibited this MR only in the cardiac cycle with prolonged R-R intervals. The limitation in number of cardiac cycles which could be analyzed and the rapid heart rate eliminating the appearance of the beat with prolonged R-R intervals may be the reasons for the paucity of late diastolic MR by left ventriculography. Ten cases (66%) of late diastolic MR, including one with sinus rhythm, had aortic regurgitation, three cases showed high-grade systolic MR, and two had atrial septal defect. The simultaneous recording of pulmonary arterial wedge pressure and left ventricular pressure in three patients show a reversal of pressure gradient across the mitral valve in late diastole when the R-R interval was prolonged. In conclusion, pulsed Doppler echocardiography is useful in detecting late diastolic MR, and in reducing overestimates of systolic MR by ventriculography which was induced by erroneous addition of late diastolic MR, because Doppler method has better time resolution in phase analysis. We believe that incomplete premature mitral valve closure caused by a delay in left ventricular contraction following prolonged R-R intervals, and the reversal of left atrial-left ventricular pressure gradient induced by left ventricular over-filling played important roles in the occurrence of late diastolic MR. PMID:3837069

  12. Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

    NASA Technical Reports Server (NTRS)

    Breburda, C. S.; Griffin, B. P.; Pu, M.; Rodriguez, L.; Cosgrove, D. M. 3rd; Thomas, J. D.

    1998-01-01

    OBJECTIVES: We sought to validate direct planimetry of mitral regurgitant orifice area from three-dimensional echocardiographic reconstructions. BACKGROUND: Regurgitant orifice area (ROA) is an important measure of the severity of mitral regurgitation (MR) that up to now has been calculated from hemodynamic data rather than measured directly. We hypothesized that improved spatial resolution of the mitral valve (MV) with three-dimensional (3D) echo might allow accurate planimetry of ROA. METHODS: We reconstructed the MV using 3D echo with 3 degrees rotational acquisitions (TomTec) using a transesophageal (TEE) multiplane probe in 15 patients undergoing MV repair (age 59 +/- 11 years). One observer reconstructed the prolapsing mitral leaflet in a left atrial plane parallel to the ROA and planimetered the two-dimensional (2D) projection of the maximal ROA. A second observer, blinded to the results of the first, calculated maximal ROA using the proximal convergence method defined as maximal flow rate (2pi(r2)va, where r is the radius of a color alias contour with velocity va) divided by regurgitant peak velocity (obtained by continuous wave [CW] Doppler) and corrected as necessary for proximal flow constraint. RESULTS: Maximal ROA was 0.79 +/- 0.39 (mean +/- SD) cm2 by 3D and 0.86 +/- 0.42 cm2 by proximal convergence (p = NS). Maximal ROA by 3D echo (y) was highly correlated with the corresponding flow measurement (x) (y = 0.87x + 0.03, r = 0.95, p < 0.001) with close agreement seen (AROA (y - x) = 0.07 +/- 0.12 cm2). CONCLUSIONS: 3D echo imaging of the MV allows direct visualization and planimetry of the ROA in patients with severe MR with good agreement to flow-based proximal convergence measurements.

  13. Predisposing factors for severe mitral regurgitation in idiopathic mitral valve prolapse

    Microsoft Academic Search

    Nobuo Fukuda; Takashi Oki; Arata Iuchi; Tomotsugu Tabata; Kazuyo Manabe; Yoshimi Kageji; Miwa Sasaki; Hirotsugu Yamada; Susumu Ito

    1995-01-01

    To elucidate predisposing factors for severe mitral regurgitation (MR) in idiopathic mitral valve prolapse (MVP), 124 MVP patients were classified into the following categories: 55 with isolated clicks (click group), 35 with a late-systolic murmur (late-SM group), and 34 with a holosystolic murmur (holo-SM group). Their clinical and echocardiographic findings were compared with those of 26 patients with spontaneous chordal

  14. Defining "severe" secondary mitral regurgitation: emphasizing an integrated approach.

    PubMed

    Grayburn, Paul A; Carabello, Blasé; Hung, Judy; Gillam, Linda D; Liang, David; Mack, Michael J; McCarthy, Patrick M; Miller, D Craig; Trento, Alfredo; Siegel, Robert J

    2014-12-30

    Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm(2), and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible. PMID:25541133

  15. Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation

    Microsoft Academic Search

    Ulrik Hvass; Michel Tapia; Frank Baron; Bruno Pouzet; Abdel Shafy

    2003-01-01

    BackgroundIn patients with ischemic left ventricular dysfunction (LVD) and functional mitral regurgitation (FMR), restoring a more normal alignment between mitral annulus and laterally displaced papillary muscles (PM) may be beneficial in terms of mitral repair and regional dynamics.

  16. Combined congenitally bicuspid aortic valve and mitral valve prolapse causing pure regurgitation

    PubMed Central

    Roberts, William C.; Zafar, Saleha; Ko, Jong Mi; Carry, Melissa M.; Hebeler, Robert F.

    2013-01-01

    Described herein is a patient with a purely regurgitant congenitally bicuspid aortic valve and a purely regurgitant prolapsing mitral valve. Although it is well established that the bicuspid aortic valve is a congenital anomaly, it is less well appreciated that mitral valve prolapse is almost certainly also a congenital anomaly. The two occurring in the same patient provides support that mitral valve prolapse is also a congenital anomaly. PMID:23382607

  17. Combined congenitally bicuspid aortic valve and mitral valve prolapse causing pure regurgitation.

    PubMed

    Roberts, William C; Zafar, Saleha; Ko, Jong Mi; Carry, Melissa M; Hebeler, Robert F

    2013-01-01

    Described herein is a patient with a purely regurgitant congenitally bicuspid aortic valve and a purely regurgitant prolapsing mitral valve. Although it is well established that the bicuspid aortic valve is a congenital anomaly, it is less well appreciated that mitral valve prolapse is almost certainly also a congenital anomaly. The two occurring in the same patient provides support that mitral valve prolapse is also a congenital anomaly. PMID:23382607

  18. Moderate mitral regurgitation accelerates left ventricular remodeling after postero-lateral myocardial infarction

    PubMed Central

    Soleimani, Mehrdad; Khazalpour, Michael; Cheng, Guangming; Zhang, Zhihong; Acevedo-Bolton, Gabriel; Saloner, David A.; Mishra, Rakesh; Wallace, Arthur W.; Guccione, Julius M.; Ge, Liang; Ratcliffe, Mark B.

    2012-01-01

    Background Chronic ischemic mitral regurgitation (CIMR: MR) is associated with poor outcome. However, the effect of CIMR on left ventricular (LV) remodeling after postero-lateral myocardial infarction (MI) remains controversial. We tested the hypothesis that moderate MR accelerates LV remodeling after postero-lateral MI. Methods/Results Postero-lateral MI was created in 10 sheep. Cardiac MRI was performed 2 weeks before and 2, 8 and 16 weeks after MI. LV and right ventricular (RV) volumes were measured and regurgitant volume (RegurgVolume) calculated as the difference between LV and RV stroke volumes. Multivariate mixed effect regression showed that LV volumes at end-diastole (ED) and end-systole (ES) and LV sphericity were strongly correlated with both RegurgVolume (p<0.0001, p=0.0086 and p=0.0007 respectively) and %Infarct area (p=0.0156, 0=0.0307, and p<0.0001 respectively). On the other hand, while LV hypertrophy (LV wall volume) increased from 2 to 16 weeks post-MI there was no effect of either RegurgVolume or %Infarct. Conclusions Moderate mitral regurgitation accelerates LV remodeling after postero-lateral MI. Further studies are needed to determine whether mitral valve repair is able to slow or reverse MI remodeling after postero-lateral MI. PMID:21945222

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

    PubMed Central

    Aslanabadi, Naser; Toufan, Mehrnoush; Salehi, Rezvaneyeh; Alizadehasl, Azin; Ghaffari, Samad; Sohrabi, Bahram; Separham, Ahmad; Manafi, Ataolaah; Mehdizadeh, Mohammad Bagher; Habibzadeh, Afshin

    2014-01-01

    Abstract Background: Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm2 before BMV vs. 1.90 ± 0.22 cm2 after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81 ± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV. PMID:25870627

  20. Echocardiographic evaluation of mitral valve in patients with pure rheumatic mitral regurgitation.

    PubMed

    Atalay, Semra; Uçar, Tayfun; Ozçelik, Nazire; Ekici, Filiz; Tutar, Ercan

    2007-01-01

    The aims of this study were to evaluate the structure of the mitral valve (MV) and subvalvar apparatus in patients with rheumatic mitral regurgitation (MR) by echocardiography and to compare the differences in morphologic abnormalities between subgroups of patients with and without mitral valve prolapse (MVP). Two-dimensional and color Doppler echocardiographic examinations were performed in 20 consecutive patients with isolated rheumatic MR and in 15 healthy subjects as controls. Annular diameter, left ventricular end-diastolic dimension, anterior leaflet length, and both leaflet thicknesses were greater in MR than those of controls. Anterior leaflet and chordal lengths were greater in severe MR than in mild or moderate MR. Sixty percent of rheumatic MR patients had nodules on the body or tip of the anterior mitral leaflet and MR was more severe in these patients. Nine of 20 patients (45%) had MVP. MR was more severe in the patients with MVP than those without prolapse. Rheumatic etiology should be suspected in patients with MR when irregular focal thickening of MV, relatively immobile posterior leaflet, eccentric regurgitant jet, and anterior MVP are found in echocardiographic study. PMID:17907513

  1. EFFECTS OF ACUTE ISCHEMIC MITRAL REGURGITATION ON THREE DIMENSIONAL MITRAL LEAFLET EDGE GEOMETRY

    PubMed Central

    Bothe, Wolfgang; Nguyen, Tom C.; Ennis, Daniel B.; Itoh, Akinobu; Carlhäll, Carl Johan; Lai, David T.; Ingels, Neil B.; Miller, D. Craig

    2008-01-01

    Background: Improved quantitative understanding of in-vivo leaflet geometry in ischemic mitral regurgitation (IMR) is needed to improve reparative techniques, yet few data are available due to current imaging limitations. Using marker technology we tested the hypotheses that IMR: (1) Occurs chiefly during early-systole; (2) Affects primarily the valve region contiguous with the myocardial ischemic insult; and, (3) Results in systolic leaflet edge restriction. Methods: Eleven sheep had radiopaque markers sutured as five opposing pairs along the anterior (A1-E1) and posterior (A2-E2) mitral leaflet free-edges from the anterior commissure (A1-A2) to the posterior commissure (E1-E2). Immediately postoperatively, biplane videofluoroscopy was used to obtain 4-D marker coordinates before and during acute proximal left circumflex artery occlusion. Regional mitral orifice area (MOA) was calculated in the anterior (Ant-MOA), middle (Mid-MOA) and posterior (Post-MOA) mitral orifice segments during early-systole (EarlyS), mid-systole (MidS), and end-systole (EndS). MOA was normalized to zero (minimum orifice opening) at baseline EndS. Tenting height was the distance of the midpoint of paired markers to the mitral annular plane at EndS. . Results: Acute ischemia increased echocardiographic MR grade (0.5±0.3 vs. 2.3±0.7, p<0.01) and MOA in all regions at EarlyS, MidS and EndS: Ant-MOA (7±10 vs. 22±19mm2, 1±2 vs. 18±16mm2, 0 vs. 17±15mm2); Mid-MOA (9±13 vs. 25±17mm2, 3±6 vs. 21±19mm2, 0 vs. 25±17mm2); and Post-MOA (8±10 vs. 25±16, 2±4 vs. 22±13mm2, 0 vs. 23±13mm2), all p<0.05. There was no change in MOA throughout systole (EarlyS vs. MidS vs. EndS) during baseline conditions or ischemia. Tenting height increased with ischemia near the central and the anterior commissure leaflet edges (B1-B2: 7.1±1.8mm vs. 7.9±1.7mm, C1-C2: 6.9±1.3mm vs. 8.0±1.5mm, both p<0.05). Conclusions: (1) MOA during ischemia was larger throughout systole, indicating that acute IMR in this setting is a holosystolic phenomenon; (2) Despite discrete posterolateral myocardial ischemia, Post-MOA was not disproportionately larger; (3) Acute ovine IMR was associated with leaflet restriction near the central and the anterior commissure leaflet edges. This entire constellation of annular, valvular, and subvalvular ischemic alterations should be considered in the approach to mitral repair for IMR. PMID:18321461

  2. Artificial muscle technology applied towards treating ischemic mitral regurgitation caused by left ventricular remodeling

    E-print Network

    Sabourin, Nicaulas A. (Nicaulas Alexandre), 1978-

    2004-01-01

    Ischemic Mitral Regurgitation (MR) affects a large portion of patients suffering from ischemic heart disease. Significant MR develops in one quarter to one third of patients who suffer from ischemic heart disease and doubles ...

  3. Management of Organic Mitral Regurgitation: Guideline Recommendations and Controversies

    PubMed Central

    Gurzun, Maria-Magdalena; Popescu, Andreea C.; Ginghina, Carmen

    2015-01-01

    Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients. PMID:25810729

  4. Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction.

    PubMed

    Loperfido, F; Biasucci, L M; Pennestri, F; Laurenzi, F; Gimigliano, F; Vigna, C; Rossi, E; Favuzzi, A; Santarelli, P; Manzoli, U

    1986-10-01

    In 72 patients with previous myocardial infarction (MI), mitral regurgitation (MR) was assessed by pulsed-wave Doppler echocardiography and compared with physical and 2-dimensional echocardiographic findings. MR was found by Doppler in 29 of 42 patients (62%) with anterior MI, 11 of 30 (37%) with inferior MI (p less than 0.01) and in none of 20 normal control subjects. MR was more frequent in patients who underwent Doppler study 3 months after MI than in those who underwent Doppler at discharge (anterior MI = 83% vs 50%, p less than 0.01; inferior MI = 47% vs 27%, p = not significant). Of 15 patients who underwent Doppler studies both times, 3 (all with anterior MI) had MR only on the second study. Of the patients with Doppler MR, 12 of 27 (44%) with a left ventricular (LV) ejection fraction (EF) greater than 30% and 1 of 13 (8%) with an EF of 30% or less (p less than 0.01) had an MR systolic murmur. Mitral prolapse or eversion and papillary muscle fibrosis were infrequent in MI patients, whether or not Doppler MR was present. The degree of Doppler MR correlated with EF (r = -0.61), LV systolic volume (r = 0.47), and systolic and diastolic mitral anulus circumference (r = 0.52 and 0.51, respectively). Doppler MR was present in 24 of 28 patients (86%) with an EF of 40% or less and in 16 of 44 (36%) with EF more than 40% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3766410

  5. Mitral valve prolapse with left atrial enlargement out of proportion to mitral regurgitation.

    PubMed

    Thomas, Michael J; Bach, David S

    2012-07-01

    Chronic severe mitral regurgitation (MR) is associated with compensatory dilation of the left atrium (LA) and left ventricle (LV). However, LA enlargement is not unique to patients with MR. Herein are reported the details of nine patients with mitral valve prolapse (MVP) and no more than mild MR, but in whom the LA enlargement is out of proportion to the MR severity. Because of the potential to overestimate MR severity using an integrative echocardiography/Doppler approach that includes evidence of chamber dilation in the diagnosis of severe MR, there may be significant clinical implications if the connective tissue abnormality underlying MVP or other factors results in an independent enlargement of the left atrium. PMID:22953664

  6. Mitral regurgitation determined by radionuclide cardiography: dependence on posture and exercise.

    PubMed Central

    Kelbaek, H; Aldershvile, J; Skagen, K; Hildebrandt, P; Nielsen, S L

    1994-01-01

    OBJECTIVES--To evaluate dependence of posture and exercise on the degree of mitral regurgitation using combined first pass and equilibrium radionuclide cardiography. DESIGN--24 patients with clinically stable chronic mitral regurgitation and sinus rhythm were studied by first pass list mode and simultaneous multigated frame mode equilibrium radionuclide cardiography using red cells labelled with technetium-99m. RESULTS--When patients changed posture from supine to sitting upright, left ventricular volumes decreased considerably. Regurgitation tended to increase in patients with valve prolapse but decreased in patients with ischaemic heart disease and dilated cardiomyopathy. During submaximal bicycle exercise cardiac output increased without dilatation of the left ventricle. The increase in left ventricular forward stroke volume was more pronounced than that in the total stroke volume, leading to a considerable decrease in the regurgitant flow through the mitral valve. The repeatability and observer variability of radionuclide determination of regurgitation was acceptable, with limits of agreement within about 10%. CONCLUSIONS--Change in posture induces a normal haemodynamic response in most patients with chronic mitral regurgitation; the effect of posture on regurgitation depends on the underlying disease. Mild to moderate exercise causes no deterioration in the severity of regurgitation. PMID:7917689

  7. Severe Mitral Regurgitation due to Traumatic Anterolateral Papillary Muscle Rupture: A Case Report

    PubMed Central

    Lee, Chul Ho; Lee, Sub; Jang, Jae Seok

    2012-01-01

    A 29-year-old man was admitted for abrupt dyspnea and hemoptysis. An echocardiogram revealed severe mitral regurgitation due to papillary muscle rupture for which an emergency mitral valve replacement operation was performed 4 days after admission. Herein, we report our experience with this case along with a review of the literature. PMID:23275923

  8. Two and three dimensional echocardiography for pre-operative assessment of mitral valve regurgitation.

    PubMed

    Quader, Nishath; Rigolin, Vera H

    2014-01-01

    Mitral regurgitation may develop when the leaflets or any other portion of the apparatus becomes abnormal. As the repair techniques for mitral valve disease evolved, so has the need for detailed and accurate imaging of the mitral valve prior to surgery in order to better define the mechanism of valve dysfunction and the severity of regurgitation. In patients with significant mitral valve disease who require surgical intervention, multiplane transesophageal echocardiogram (TEE) is invaluable for surgical planning. However, a comprehensive TEE in a patient with complex mitral valve disease requires great experience and skill. There is evidence to suggest that 3D echocardiography can overcome some of the limitations of 2D multiplane TEE and thus is crucial in evaluation of patients undergoing mitral valve surgery. In the following sections, we review some of the crucial 2D and 3D echo images necessary for evaluation of MR based on the Carpentier classification. PMID:25344779

  9. Creation of Nonischemic Functional Mitral Regurgitation by Annular Dilatation and Nonplanar Modification in a Chronic In Vivo Swine Model

    PubMed Central

    Yamauchi, Haruo; Feins, Eric N.; Vasilyev, Nikolay V.; Shimada, Shogo; Zurakowski, David; del Nido, Pedro J.

    2013-01-01

    Background Mechanisms and treatments of nonischemic functional mitral regurgitation (NIMR) are not fully established in part due to a lack of proper large animal models. We developed a novel technique of NIMR creation in a swine model by making multiple small incisions in the mitral annulus. Methods and Results Ex-vivo experiments using isolated swine hearts (n=10) showed a 15% increase in annular area (6.8 to 7.8cm2) after 16 incisions were made along the posterior mitral annulus of a pressurized left ventricle (LV). In an in vivo swine model (n=7, 46.4±2.2kg) NIMR was created by making 14-26 2mm incisions in the atrial aspect of the mitral annulus using a cardioport video-assisted imaging system in the beating heart. Animals were sacrificed at 4 weeks (n=4) and 6 weeks (n=3). Three-dimensional (3D) echocardiography was obtained before and immediately after NIMR creation, and at euthanasia; vena contracta area (VCA), mitral annular dimension, LV volume, and inter-papillary muscle distance were measured. The mitral annular incisions resulted in mild-moderate mitral regurgitation and an increased VCA. NIMR creation altered mitral valve (MV) geometry by decreasing mitral annular nonplanarity and increasing annular area, primarily in the anteroposterior dimension. NIMR creation did not significantly change LV volume or inter-papillary muscle distance. Longer follow-up period did not significantly affect these outcomes. Conclusions NIMR can successfully be created in a beating-heart swine model and results in dilatation and 3D changes in mitral annular geometry. This model can enhance the experimental validation of new valve repair devices and techniques. PMID:24030417

  10. A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area.

    PubMed

    Chandra, Sonal; Salgo, Ivan S; Sugeng, Lissa; Weinert, Lynn; Settlemier, Scott H; Mor-Avi, Victor; Lang, Roberto M

    2011-09-01

    Mitral effective regurgitant orifice area (EROA) using the flow convergence (FC) method is used to quantify the severity of mitral regurgitation (MR). However, it is challenging and prone to interobserver variability in complex valvular pathology. We hypothesized that real-time three-dimensional (3D) transesophageal echocardiography (RT3D TEE) derived anatomic regurgitant orifice area (AROA) can be a reasonable adjunct, irrespective of valvular geometry. Our goals were to 1) to determine the regurgitant orifice morphology and distance suitable for FC measurement using 3D computational flow dynamics and finite element analysis (FEA), and (2) to measure AROA from RT3D TEE and compare it with 2D FC derived EROA measurements. We studied 61 patients. EROA was calculated from 2D TEE images using the 2D-FC technique, and AROA was obtained from zoomed RT3DE TEE acquisitions using prototype software. 3D computational fluid dynamics by FEA were applied to 3D TEE images to determine the effects of mitral valve (MV) orifice geometry on FC pattern. 3D FEA analysis revealed that a central regurgitant orifice is suitable for FC measurements at an optimal distance from the orifice but complex MV orifice resulting in eccentric jets yielded nonaxisymmetric isovelocity contours close to the orifice where the assumptions underlying FC are problematic. EROA and AROA measurements correlated well (r = 0.81) with a nonsignificant bias. However, in patients with eccentric MR, the bias was larger than in central MR. Intermeasurement variability was higher for the 2D FC technique than for RT3DE-based measurements. With its superior reproducibility, 3D analysis of the AROA is a useful alternative to quantify MR when 2D FC measurements are challenging. PMID:21666109

  11. Prevalence of mitral valve prolapse and associated valvular regurgitations in healthy teenagers undergoing screening echocardiography

    PubMed Central

    Sattur, Sudhakar; Bates, Sharon; Reza Movahed, Mohammad

    2010-01-01

    BACKGROUND: The true prevalence of mitral valve prolapse (MVP) in the population has been controversial. OBJECTIVE: To evaluate the prevalence of MVP and associated valvular abnormalities in healthy teenage students. METHODS: The Anthony Bates Foundation performed screening echocardiography in high schools across the United States. A total of 2072 students between 13 and 19 years of age were identified for the present study. RESULTS: Total prevalence of MVP was 0.7%. The prevalence of MVP was significantly higher among female teenagers (nine of 690 female teenagers [1.3%] versus five of 1382 male teenagers [0.4%], P=0.01, OR 3.6, CI 1.21 to 10.70). The prevalence of mitral regurgitation (MR) and tricuspid regurgitation (TR) was higher in teenagers with MVP. MR occurred in five of 14 teenagers (35.7%) with MVP versus 15 of 2058 controls (0.7%) (P<0.001, OR 75.6, CI 22.6 to 252.5). TR occurred in one of 14 teenagers (7.1%) with MVP versus nine of 2058 controls (0.4%) (P<0.001, OR 17.5, CI 2.0 to 148.3). CONCLUSION: The prevalence of MVP in this cohort of healthy teenage students was less than 1%. Furthermore, the prevalence of MVP was higher in female teenagers and was associated with a higher prevalence of MR and TR. PMID:20664768

  12. Impact of a preoperative mitral regurgitation scoring system on outcome of surgical repair for mitral valve prolapse

    Microsoft Academic Search

    Kaoru Tanaka; Eiji Ohtaki; Takayoshi Matsumura; Kazuhiko Misu; Tetsuya Tohbaru; Ryuta Asano; Koichi Kitahara; Jun Umemura; Tetsuya Sumiyoshi; Hitoshi Kasegawa; Saichi Hosoda

    2003-01-01

    The optimal timing of surgical correction of severe mitral regurgitation (MR) is important for improved morbidity and mortality. We utilized a scoring system to decide the timing of procedures. Based on clinical features and echocardiographic data, we hypothesized that preoperative semi-quantitation of MR using this scoring system may be useful for predicting prognosis after repair. The MR score was composed

  13. Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling

    PubMed Central

    Szymanski, Catherine; Bel, Alain; Cohen, Iris; Touchot, Bernard; Handschumacher, Mark D.; Desnos, Michel; Carpentier, Alain; Menasché, Philippe; Hagège, Albert A.; Levine, Robert A.; Messas, Emmanuel

    2012-01-01

    Background Undersized ring annuloplasty for ischemic mitral regurgitation (MR) is associated with variable results and >30% MR recurrence. We tested whether subvalvular repair by severing second-order mitral chordae can improve annuloplasty by reducing papillary muscle tethering. Methods and Results Posterolateral myocardial infarction known to produce chronic remodeling and MR was created in 28 sheep. At 3 months, sheep were randomized to sham surgery versus isolated undersized annuloplasty versus isolated bileaflet chordal cutting versus the combined therapy (n=7 each). At baseline, chronic myocardial infarction (3 months), and euthanasia (6.6 months), we measured left ventricular (LV) volumes and ejection fraction, wall motion score index, MR regurgitation fraction and vena contracta, mitral annulus area, and posterior leaflet restriction angle (posterior leaflet to mitral annulus area) by 2-dimensional and 3-dimensional echocardiography. All groups were comparable at baseline and chronic myocardial infarction, with mild to moderate MR (MR vena contracta, 4.6±0.1 mm; MR regurgitation fraction, 24.2±2.9%) and mitral annulus dilatation (P<0.01). At euthanasia, MR progressed to moderate to severe in controls but decreased to trace with ring plus chordal cutting versus trace to mild with chordal cutting alone versus mild to moderate with ring alone (MR vena contracta, 5.9±1.1 mm in controls, 0.5±0.08 with both, 1.0±0.9 with chordal cutting alone, 2.0±0.7 with ring alone; P<0.01). In addition, LV end-systolic volume increased by 108% in controls versus 28% with ring plus chordal cutting, less than with each intervention alone (P<0.01). In multivariate analysis, LV end-systolic volume and mitral annulus area most strongly predicted MR (r2=0.82, P<0.01). Conclusions Comprehensive annular and subvalvular repair improves long-term reduction of both chronic ischemic MR and LV remodeling without decreasing global or segmental LV function at follow-up. PMID:23139296

  14. Systemic Artery to Pulmonary Artery Fistula Associated with Mitral Regurgitation: Successful Treatment with Endovascular Embolization

    SciTech Connect

    Iwazawa, Jin, E-mail: iwazawa.jin@nissay-hp.or.j [Nissay Hospital, Department of Radiology (Japan); Nakamura, Kenji; Hamuro, Masao; Nango, Mineyoshi; Sakai, Yukimasa; Nishida, Norifumi [Osaka City University Graduate School of Medicine, Department of Radiology (Japan)

    2008-07-15

    We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.

  15. Surgical treatment for functional ischemic mitral regurgitation: current options and future trends.

    PubMed

    Nicolini, Francesco; Agostinelli, Andrea; Vezzani, Antonella; Molardi, Alberto; Benassi, Filippo; Gallingani, Alan; Romano, Giorgio; Gherli, Tiziano

    2015-01-01

    There is an increasing number of patients with mitral regurgitation secondary to dilated cardiomyopathy. Ischemic mitral regurgitation is a common complication of left ventricular dysfunction related to chronic coronary artery disease: it is present in 10-20% of these patients and is associated with a worse prognosis also after coronary revascularization. Currently, coronary artery bypass grafting combined with restrictive annuloplasty is the most commonly performed surgical procedure, although novel approaches have been used with varying degrees of success. The suboptimal results obtained with the commonly used surgical approaches require the development of alternative surgical techniques with the aim to correct  the causal mechanisms of the disease. In fact the pathophysiology of ischemic mitral regurgitation is  multifactorial involving global and regional left ventricular remodeling, as well as the dysfunction and distortion of the components of the entire mitral valve apparatus. The purpose of this review is to present the current surgical techniques available for the treatment of ischemic mitral regurgitation and to discuss novel approaches to the repair of this complex disease. (www.actabiomedica.it). PMID:25948023

  16. Severe mitral regurgitation due to left atrial aneurysm corrected by endoatrial patch plasty.

    PubMed

    Parachuri, V Rao; Banakal, Sanjaykumar C; Appajaiah, Chiran B

    2009-03-01

    Congenital aneurysm of the body of the left atrium causing severe mitral incompetence is extremely rare. The cause of mitral incompetence has been attributed to a distortion of the mitral annulus by the aneurysm, or to coexisting pathology in the mitral valve apparatus. Surgical techniques to treat this condition include excision of the aneurysm along with mitral valve repair or replacement. Herein is described the case of a 30-year-old man with large aneurysm of the left atrial body and severe mitral regurgitation (MR) treated by endoatrial patch plasty. The mitral incompetence was due to prolapse of the posterior mitral annulus into the neck of the aneurysm. Under cardiopulmonary bypass, the neck of the aneurysm was closed using a Dacron patch. Endoaneurysmorrhaphy with a Dacron patch effectively restored the mitral competence and simultaneously excluded the aneurysm from the left atrium. To further strengthen the posterior mitral annulus, a mitral annuloplasty was added using a rigid Carpentier-Edwards ring. The patient was anticoagulated with warfarin for six weeks after surgery. Transthoracic echocardiography performed at a six-month follow up confirmed the absence of any residual aneurysm or MR. To the authors' knowledge, this is the first case of left atrial aneurysm with severe MR to be treated in this way. PMID:19455888

  17. The Mitral Valve Prolapsus: Quantification of the Regurgitation Flow Rate by Experimental Time-Dependant PIV

    NASA Astrophysics Data System (ADS)

    Billy, F.; Coisne, D.; Sanchez, L.; Perrault, R.

    2001-10-01

    Color Doppler is routinely used for visualisation of intra cardiac flows and quantification of valvular heart disease, Nevertheless the 2D visualization of a complex 3D phenomenon is the major limitation of this technique, In particular, in clinical setting, the flow rate calculation upstream a regurgitant orifice (i,e, mitral valve insufficiency), assumes that the velocity field in the convergent region have hemispheric shapes and introduce miscalculation specially in case of prolaps regurgitant orifices, The main objective of this study was to characterize the dynamic 3D velocity field of the convergent region upstream a prolaps model of regurgitant orifice based on 2D time dependent PIV reconstruction.

  18. Early and late results of reconstructive operation for congenital mitral regurgitation in pediatric age group.

    PubMed

    Okita, Y; Miki, S; Kusuhara, K; Ueda, Y; Tahata, T; Tsukamoto, Y; Komeda, M; Yamanaka, K; Shiraishi, S; Tamura, T

    1988-08-01

    Sixty-six children aged between 8 months and 15 years (average age 5.5 +/- 3.8 years) underwent mitral reconstructive operations for congenital mitral regurgitation between June 1969 and February 1987. The pathologic findings of the mitral valves were annular dilatation in 37 patients, cleft of the leaflet in eight, hypoplasia of the leaflet in 44, perforation of the leaflet in one, chordal elongation in 22, chordal absence in 16, and chordal shortening in seven. The methods of repair consisted of asymmetric annuloplasty (Kay-Reed method) in 61 patients, De Vega-type annuloplasty in one, plication of redundant leaflet in 15, and closure of cleft or perforation in nine. The single operative death (1.5%) was due to heart block. Follow-up data were available over 373.8 patient-years (average 5.7 years). The four late deaths (6.0%) were due to heart failure in two patients, pneumonia in one, and hepatitis in one. The actuarial survival rate was 93.1% +/- 3.1% at 7 years and 88.4% +/- 5.1% after 17 years. Valvuloplasty failed in 19 of the long-term survivors. One of these patients underwent mitral valve replacement 11 years after initial operation. The rate of freedom from reoperation was 86% +/- 10% after 17 years. The rate of freedom from valvuloplasty failure was 80% +/- 6.7% after 5 years, 67% +/- 7.2% after 10 years, and 44% +/- 11.9% after 15 years. PMID:3398549

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

    PubMed

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

    2007-05-15

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flow-meter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r(2) = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 +/- 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r(2) = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 +/- 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. PMID:17493476

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

    PubMed Central

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

    2012-01-01

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional–PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flowmeter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional–PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r2 = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 ± 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r2 = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 ± 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. PMID:17493476

  1. Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction

    Microsoft Academic Search

    Micha S Feinberg; Ehud Schwammenthal; Lev Shlizerman; Avital Porter; Hanoch Hod; Dov Freimark; Shlomi Matezky; Valentina Boyko; Lori Mandelzweig; Zvi Vered; Solomon Behar; Alex Sagie

    2000-01-01

    Mitral regurgitation (MR) complicating acute myocardial infarction (AMI) is associated with increased mortality. The prognostic significance of only mild MR detected by echocardiography in patients with AMI is unknown. This study assessed the long-term risk associated with mild MR detected by color Doppler echocardiography within the first 48 hours of admission in 417 consecutive patients with AMI. No MR was

  2. Influence of involvement of anterior leaflet versus posterior leaflet on residual regurgitation as assessed by transesophageal echocardiography in patients undergoing valve repair for mitral regurgitation due to mitral valve prolapse

    PubMed Central

    2009-01-01

    Background Repair of anterior leaflet prolapse is technically more challenging and this might influence outcomes as compared to the repair of posterior leaflet prolapse in patients undergoing surgical correction of mitral regurgitation. We investigated the association of anterior leaflet prolapse with minor residual mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) who underwent valve repair. Methods Eligible for this study were consecutive patients with severe MR due to MVP, who underwent mitral valve repair with residual MR by postpump transesophageal echocardiography ?2+ during a 20-month period at Pasquinucci Hospital, Massa. Patients undergoing other cardiovascular surgical interventions were excluded. Two groups were defined according to the involvement of mitral valve leaflets: group 1, consisting of patients with anterior leaflet prolapse (isolated or not); and group 2, consisting of patients with isolated posterior leaflet prolapse. Results A total of 70 patients (18 in group 1 and 52 in group 2) were analyzed. Patients in group 2 were younger than those in group 1, but the difference was not significant (P = 0.052). There were no significant differences between the 2 study groups with respect to other variables. The proportion of patients with residual MR 1+/2+ was higher in group 1 than in group 2 (61.1% vs. 32.7%, respectively; P = 0.034). In a logistic regression model, anterior leaflet prolapse was an independent predictor of residual MR 1+/2+ (odds ratio, 4.0; 95% confidence interval, 1.14 to 14.04; P = 0.03). Conclusion In our study population, patients with anterior leaflet prolapse had a higher proportion of residual MR 1+/2+ as compared to those with posterior leaflet prolapse after repair of mitral valve. PMID:19922602

  3. [Severe mitral regurgitation as the first symptom of systemic lupus erythematosus in a young women required mitral valve replacement].

    PubMed

    Nowicka, Anna; Pi?tkowska, Anna; Biegalski, Wojciech; Dankowski, Rafa?; Michalski, Marek; Szymanowska, Katarzyna; Szyszka, Andrzej; Jemielity, Marek; Seniuk, Wojciech; Sosnowski, Piotr

    2012-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multiorgan inflammatory damage. The heart is frequently involved in SLE. The best known cardiac manifestations are pericarditis and Libman-Saks endocarditis. Severe valvular impairment is rather rare and occurs in few years and in advanced stage of the disease. In this study we report a case of a young women with SLE and heart failure due to mitral regurgitation as the first manifestation of the disease. PMID:22528724

  4. Posterior leaflet augmentation improves leaflet tethering in repair of ischemic mitral regurgitation?,??

    PubMed Central

    Robb, J. Daniel; Minakawa, Masahito; Koomalsingh, Kevin J.; Shuto, Takashi; Jassar, Arminder S.; Ratcliffe, Sarah J.; Gorman, Robert C.; Gorman, Joseph H.

    2011-01-01

    Abstract Objectives: Ischemic mitral regurgitation results from annular dilatation, leaflet tethering and leaflet flattening. Undersized annuloplasty corrects annular dilatation but worsens leaflet tethering and flattening. This exacerbation of abnormal leaflet geometry may contribute to poor repair results for ischemic mitral regurgitation (IMR). Using a sheep model of IMR, we hypothesized that posterior leaflet augmentation and less-extreme annular undersizing would relieve tethering and increase leaflet curvature. Methods: Eight weeks after posterolateral infarct, 10 sheep with ?2+ IMR underwent either a 24-mm planar ring annuloplasty (n = 5) or a 30-mm planar ring annuloplasty with concomitant posterior leaflet augmentation (n = 5). Real-time three-dimensional echocardiography allowed measurement of indices of leaflet curvature and tethering before and after annuloplasty. Results: Comparing pre- and post-repair values in the P1, P2, and P3 leaflet regions, undersized 24-mm ring annuloplasty made no significant difference to mean septolateral curvature (0.23–0.26, 0.33–0.29, and 0.27–0.37 cm?1, respectively), whereas leaflet augmentation in combination with a 30-mm ring annuloplasty increased septolateral curvature (P1 0.30–1.02, P2 0.31–1.23, and P3 0.35–0.84 cm?1, p-values ? 0.05). The mean tethering angle formed between the annular plane and the posterior leaflet increased in all three posterior regions for the 24-mm ring group (P1 12–23°, P2 26–31°, and P3 16–25°), but decreased in all regions for the group undergoing leaflet augmentation (P1 +5 to ?6°, P2 +13 to ?13°, P3 +16-15°, all p-values ? 0.05). Conclusions: Undersized annuloplasty exacerbates leaflet tethering. Posterior leaflet augmentation with less severe annular reduction increases leaflet curvature and decreases tethering; this technique more completely addresses the pathogenic mechanism of IMR and may improve repair durability. PMID:21546260

  5. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study

    NASA Technical Reports Server (NTRS)

    Kwan, Jun; Shiota, Takahiro; Agler, Deborah A.; Popovic, Zoran B.; Qin, Jian Xin; Gillinov, Marc A.; Stewart, William J.; Cosgrove, Delos M.; McCarthy, Patrick M.; Thomas, James D.

    2003-01-01

    BACKGROUND: This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aalpha; posterior, Palpha) were measured. In ICM-MR, Aalpha measured in the medial and central planes was significantly larger than that in the lateral plane (39+/-5 degrees, 34+/-6 degrees, and 27+/-5 degrees, respectively; P<0.01), whereas Palpha showed no significant difference in any of the 3 AP planes (61+/-7 degrees, 57+/-7 degrees, and 56+/-7 degrees, P>0.05). In DCM-MR, both Aalpha (38+/-8 degrees, 37+/-9 degrees, and 36+/-7 degrees, P>0.05) and Palpha (59+/-6 degrees, 58+/-5 degrees, and 57+/-6 degrees, P>0.05) revealed no significant differences in the 3 planes. CONCLUSIONS: The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.

  6. In vitro measurement of the coaptation force distribution in normal and functional regurgitant porcine mitral valves.

    PubMed

    Adams, John; O'Rourke, Malachy J

    2015-07-01

    Closure of the left atrioventricular orifice is achieved when the anterior and posterior leaflets of the mitral valve press together to form a coaptation zone along the free edge of the leaflets. This coaptation zone is critical to valve competency and is maintained by the support of the mitral annulus, chordae tendinae, and papillary muscles. Myocardial ischemia can lead to an altered performance of this mitral complex generating suboptimal mitral leaflet coaptation and a resultant regurgitant orifice. This paper reports on a two-part experiment undertaken to measure the dependence of coaptation force distribution on papillary muscle position in normal and functional regurgitant porcine mitral heart valves. Using a novel load sensor, the local coaptation force was measured in vitro at three locations (A1-P1, A2-P2, and A3-P3) along the coaptation zone. In part 1, the coaptation force was measured under static conditions in ten whole hearts. In part 2, the coaptation force was measured in four explanted mitral valves operating in a flow loop under physiological flow conditions. Here, two series of tests were undertaken corresponding to the normal and functional regurgitant state as determined by the position of the papillary muscles relative to the mitral valve annulus. The functional regurgitant state corresponded to grade 1. The static tests in part 1 revealed that the local force was directly proportional to the transmitral pressure and was nonuniformly distributed across the coaptation zone, been strongest at A1-P1. In part 2, tests of the valve in a normal state showed that the local force was again directly proportional to the transmitral pressure and was again nonuniform across the coaptation zone, been strongest at A1-P1 and weakest at A2-P2. Further tests performed on the same valves in a functional regurgitant state showed that the local force measured in the coaptation zone was directly proportional to the transmitral pressure. However, the force was now observed to be weakest at A1-P1 and strongest at A2-P2. Movement of the anterolateral papillary muscle (APM) away from both the annular and anterior-posterior (AP) planes was seen to contribute significantly to the altered force distribution in the coaptation zone. It was concluded that papillary muscle displacement typical of myocardial ischemia changes the coaptation force locally within the coaptation zone. PMID:25661678

  7. Management of mitral regurgitation during left ventricular reconstruction for ischemic heart failure†

    PubMed Central

    Klein, Patrick; Braun, Jerry; Holman, Eduard R.; Versteegh, Michel I.M.; Verwey, Harriette F.; Dion, Robert A.E.; Bax, Jeroen J.; Klautz, Robert J.M.

    2012-01-01

    OBJECTIVE Remodeling of the left ventricle (LV) in ischemic cardiomyopathy frequently leads to functional mitral regurgitation (MR). The indication for correcting MR in patients undergoing LV reconstruction (LVR) is unclear. In this study, we evaluated our strategy of correcting MR ? grade 2+ by restrictive mitral annuloplasty (RMA) during LVR. METHODS We studied 92 consecutive patients (76 men, mean age 61 ± 10 years) who underwent LVR for ischemic heart failure (IHF). RMA was performed in all patients with MR ? grade 2+ on preoperative echocardiography and in patients who showed increased MR to ?grade 2+ immediately after LVR. Patients were attributed to a RMA and no-RMA group, depending on whether or not concomitant RMA had been performed. Mean clinical and structured echocardiographic follow-up was 47 ± 20 months and was 100% complete. RESULTS In 38 out of 40 patients (95%) with preoperative MR ? grade 2+, concomitant RMA was planned and performed. In 17 out of 52 patients (33%) with MR < grade 2+ preoperatively, MR increased after LVR to ?grade 2+ leading to additional RMA during a second period of aortic cross-clamping. Early mortality in the RMA group (n = 55) was 12.7% and survival at 36 months 78.2 ± 11.2%. Early mortality in the no-RMA group (n = 37) was 5.4% and survival at 36 months 81.1 ± 12.8%. Patients in the RMA group had significantly more reduced LV function with greater LV dimensions and volumes preoperatively. Echocardiography demonstrated sustained improvement in LVEF with reduction of LV volumes in both patient groups. Recurrence of MR at late follow-up was observed in 2 patients (1 patient per group). CONCLUSIONS Patients with IHF eligible for LV reconstruction have MR ? grade 2+ in 44% of cases. In one-third of IHF patients with MR < grade 2+ preoperatively, MR increases to ?grade 2+ after LVR. Concomitant mitral valve repair for MR ? grade 2+, on either preoperative echocardiography or immediately after LVR, results in favorable late clinical and echocardiographic outcome that proved to be similar to patients without concomitant mitral valve repair, despite more advanced disease. PMID:21664829

  8. Mitochondrial apoptotic pathway activation in the atria of heart failure patients due to mitral and tricuspid regurgitation.

    PubMed

    Chang, Jen-Ping; Chen, Mien-Cheng; Liu, Wen-Hao; Lin, Yu-Sheng; Huang, Yao-Kuang; Pan, Kuo-Li; Ho, Wan-Chun; Fang, Chih-Yuan; Chen, Chien-Jen; Chen, Huang-Chung

    2015-08-01

    Apoptosis occurs in atrial cardiomyocytes in mitral and tricuspid valve disease. The purpose of this study was to examine the respective roles of the mitochondrial and tumor necrosis factor-? receptor associated death domain (TRADD)-mediated death receptor pathways for apoptosis in the atrial cardiomyocytes of heart failure patients due to severe mitral and moderate-to-severe tricuspid regurgitation. This study comprised eighteen patients (7 patients with persistent atrial fibrillation and 11 in sinus rhythm). Atrial appendage tissues were obtained during surgery. Three purchased normal human left atrial tissues served as normal controls. Moderately-to-severely myolytic cardiomyocytes comprised 59.7±22.1% of the cardiomyocytes in the right atria and 52.4±12.9% of the cardiomyocytes in the left atria of mitral and tricuspid regurgitation patients with atrial fibrillation group and comprised 58.4±24.8% of the cardiomyocytes in the right atria of mitral and tricuspid regurgitation patients with sinus rhythm. In contrast, no myolysis was observed in the normal human adult left atrial tissue samples. Immunohistochemical analysis showed expression of cleaved caspase-9, an effector of the mitochondrial pathways, in the majority of right atrial cardiomyocytes (87.3±10.0%) of mitral and tricuspid regurgitation patients with sinus rhythm, and right atrial cardiomyocytes (90.6±31.4%) and left atrial cardiomyocytes (70.7±22.0%) of mitral and tricuspid regurgitation patients with atrial fibrillation. In contrast, only 5.7% of cardiomyocytes of the normal left atrial tissues showed strongly positive expression of cleaved caspase-9. Of note, none of the atrial cardiomyocytes in right atrial tissue in sinus rhythm and in the fibrillating right and left atria of mitral and tricuspid regurgitation patients, and in the normal human adult left atrial tissue samples showed cleaved caspase-8 expression, which is a downstream effector of TRADD of the death receptor pathway. Immunoblotting of atrial extracts showed that there was enhanced expression of cytosolic cytochrome c, an effector of the mitochondrial pathways, but no expression of membrane TRADD and cytosolic caspase-8 in the right atrial tissue of mitral and tricuspid regurgitation patients with sinus rhythm, and right atrial and left atrial tissues of mitral and tricuspid regurgitation patients with atrial fibrillation. Taken together, this study showed that mitochondrial pathway for apoptosis was activated in the right atria in sinus rhythm and in the left and right atria in atrial fibrillation of heart failure patients due to mitral and tricuspid regurgitation, and this mitochondrial pathway activation may contribute to atrial contractile dysfunction and enlargement in this clinical setting. PMID:26004742

  9. Posterior Leaflet Augmentation in Ischemic Mitral Regurgitation Increases Leaflet Coaptation and Mobility

    PubMed Central

    Jassar, Arminder S.; Minakawa, Masahito; Shuto, Takashi; Robb, J. Daniel; Koomalsingh, Kevin J.; Levack, Melissa M.; Vergnat, Mathieu; Eperjesi, Thomas J.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    2013-01-01

    Background Restoring leaflet coaptation is the primary objective in repair of ischemic mitral regurgitation (IMR). The common practice of placing an undersized annuloplasty ring partially achieves this goal by correcting annular dilation; however, annular reduction has been demonstrated to exacerbate posterior leaflet tethering. Using a sheep model of IMR, we tested the hypothesis that posterior leaflet augmentation (PLA) combined with standard annuloplasty sizing increases leaflet coaptation more effectively than undersized annuloplasty alone. Methods Eight-weeks after posterobasal myocardial infarction, 15 sheep with ?2+ IMR underwent annuloplasty with either a 24mm annuloplasty ring (24mm group, n=5), 30mm ring (30mm group, n=5) or a 30mm ring with concomitant augmentation of the posterior leaflet (PLA group, n=5). Using 3D echocardiography, post-repair coaptation zone and posterior leaflet mobility were assessed. Results Leaflet coaptation length after repair was greater in the PLA group (4.1±0.3mm) and the 24mm group (3.8±0.5mm) as compared to the 30mm group (2.7±0.6mm, p<0.01). Leaflet coaptation area was significantly greater in the PLA-group (121.5±6.6mm2) as compared to the 30mm-group (77.5±17.0mm2) or the 24mm-group (92.5±17.9mm2, p<0.01). Posterior leaflet mobility was significantly greater in the PLA group as compared to the 30mm, or the 24mm group. Conclusions PLA combined with standard-sized annuloplasty enhances leaflet coaptation more effectively than either standard-sized annuloplasty or undersized annuloplasty alone. Increased leaflet coaptation after PLA provides redundancy to IMR repair, and may decrease incidence of both recurrent IMR and mitral stenosis. Abstract Word Count = 230 PMID:22795059

  10. Combined computational and experimental approach to improve the assessment of mitral regurgitation by echocardiography.

    PubMed

    Sonntag, Simon J; Li, Wei; Becker, Michael; Kaestner, Wiebke; Büsen, Martin R; Marx, Nikolaus; Merhof, Dorit; Steinseifer, Ulrich

    2014-05-01

    Mitral regurgitation (MR) is one of the most frequent valvular heart diseases. To assess MR severity, color Doppler imaging (CDI) is the clinical standard. However, inadequate reliability, poor reproducibility and heavy user-dependence are known limitations. A novel approach combining computational and experimental methods is currently under development aiming to improve the quantification. A flow chamber for a circulatory flow loop was developed. Three different orifices were used to mimic variations of MR. The flow field was recorded simultaneously by a 2D Doppler ultrasound transducer and Particle Image Velocimetry (PIV). Computational Fluid Dynamics (CFD) simulations were conducted using the same geometry and boundary conditions. The resulting computed velocity field was used to simulate synthetic Doppler signals. Comparison between PIV and CFD shows a high level of agreement. The simulated CDI exhibits the same characteristics as the recorded color Doppler images. The feasibility of the proposed combination of experimental and computational methods for the investigation of MR is shown and the numerical methods are successfully validated against the experiments. Furthermore, it is discussed how the approach can be used in the long run as a platform to improve the assessment of MR quantification. PMID:24398572

  11. Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation

    PubMed Central

    Little, Stephen H.; Pirat, Bahar; Kumar, Rahul; Igo, Stephen R.; McCulloch, Marti; Hartley, Craig J.; Xu, Jiaqiong; Zoghbi, William A.

    2012-01-01

    OBJECTIVES Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity. BACKGROUND Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler. METHODS Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study). RESULTS In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively). CONCLUSIONS Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging. PMID:19356505

  12. Automatic quantitative analysis of mitral and tricuspid regurgitations by cine MRI with mathematical morphological image segmentation

    Microsoft Academic Search

    S. Zheng

    1995-01-01

    MRI is able to display successfully the rapid and turbulent flows like regurgitations in cardiac cavities for clinical examination purposes. This paper presents a new and efficient method to realise automatic evaluation of heart disease with valvular insufficiencies by means of watershed algorithm in mathematical morphology, by which the contours of regurgitant jets and related auricles are fastly and accurately

  13. Percutaenous mitral valve: A non-stented coronary sinus device for the treatment of functional mitral regurgitation in heart failure patients.

    PubMed

    Sack, Stefan; Kahlert, Philipp; Erbel, Raimund

    2009-01-01

    Functional mitral regurgitation in heart failure limits survival in a severity-graded fashion. Even mild mitral regurgitation doubles mortality risk. We report the use of a non-stented coronary sinus device to reduce mitral annulus dimension in order to re-establish mitral valve competence. The device (PTMA, Viacor, Inc., Wilmington, MA, USA) consists of a multi-lumen PTFE (Teflon) PTMA catheter in which Nitinol (nickel-titanium alloy) treatment rods are advanced. For individual use up to three rods of different length and stiffness can be used. Therefore dimension reduction can be performed in an incremental fashion. Fluoroscopy and 3 D echocardiography are performed throughout the procedure to visiualize the positioning and confirm maximum treatment effect. The case describes the use and the effect of PTMA treatment. Safety and efficacy of the PTMA device will be investigated in the upcoming PTOLEMY 2 trial. PMID:19431068

  14. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations.

    PubMed

    Asgar, Anita W; Mack, Michael J; Stone, Gregg W

    2015-03-31

    The development of secondary mitral regurgitation (MR) due to left ventricular dysfunction, also known as functional MR, is strongly associated with a poor prognosis in patients with heart failure. The mechanisms underlying secondary MR are multifactorial; accurate imaging assessment of secondary MR may be challenging and nuanced; and the appropriate roles of medical, surgical, and interventional therapies for management of secondary MR are controversial and evolving. In this review, the pathophysiology, evaluation, and prognosis of secondary MR in patients with heart failure are discussed, and we evaluate in detail the evidence for the various therapeutic approaches for secondary MR, including guideline-directed medication for left ventricular dysfunction, cardiac resynchronization therapy and revascularization when appropriate, and mitral valve surgery and transcatheter interventions. The role of a multidisciplinary heart team in determining the optimal management strategy for secondary MR is also discussed. PMID:25814231

  15. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures

    Microsoft Academic Search

    Tirone E. David; Ahmad Omran; Susan Armstrong; Zhao Sun; Joan Ivanov

    1998-01-01

    Objective: This study was carried out to evaluate the long-term results of mitral valve repair for mitral regurgitation caused by myxomatous disease of the mitral valve and the late effects of chordal replacement with expanded polytetrafluoroethylene sutures in this operation. Methods: A total of 324 patients with mitral regurgitation caused by myxomatous disease underwent mitral valve repair from 1981 to

  16. Outcome of valve repair and the cox maze procedure for mitral regurgitation and associated atrial fibrillation

    Microsoft Academic Search

    Nobuhiro Handa; Hartzell V. Schaff; James J. Morris; Betty J. Anderson; Stephen L. Kopecky; Maurice Enriquez-Sarano

    1999-01-01

    Objective: The objective was to determine whether the Cox maze procedure provides adjunctive benefit in patients with atrial fibrillation undergoing mitral valve repair. Methods: We compared the outcome of 39 patients who had the Cox maze procedure plus mitral valve repair between January 1993 and December 1996 (maze group) with that of 58 patients with preoperative atrial fibrillation who had

  17. Gargantuan left atrium: a sequela of mitral regurgitation and mitral stenosis.

    PubMed

    Omslaer, Brian T; Biederman, Robert W W

    2015-06-01

    Cardiac magnetic resonance imaging and echocardiography revealed a gargantuan left atrium measuring 18.9 cm × 15.7 cm × 11.3 cm in a 56-year-old patient diagnosed with severe rheumatic mitral stenosis, severe pulmonary hypertension, and permanent atrial fibrillation. A chest x-ray also revealed a cardiothoracic ratio approaching 1.0 and a transthoracic echocardiogram measured diameters as large as 19.2 cm. The patient then underwent mitral valve replacement and left atrial reduction surgery and has had no further admissions or complications. PMID:25556297

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

    PubMed Central

    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 (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results. PMID:20331896

  19. Pre- and afterload reduction in chronic mitral regurgitation: a double-blind randomized placebo-controlled trial of the acute and 2 weeks' effect of nifedipine or isosorbide dinitrate treatment on left ventricular function and the severity of mitral regurgitation

    PubMed Central

    KELBÆK, HENNING; ALDERSHVILE, JAN; SKAGEN, KNUD; HILDEBRANDT, PER; NIELSEN, STEEN L.

    1996-01-01

    1The acute effect and effect of 14 days' treatment with isosorbide dinitrate (ISDN) and nifedipine (NIF) was evaluated by radionuclide cardiography in patients with chronic mitral regurgitation and sinus rhythm. 2In 23 patients with clinically stable disease blood pressure was lowered by 15% and left ventricular volume was reduced by 16–20% after 20?mg sublingual ISDN causing combined pre-and afterload reduction. Afterload reduction alone induced by 10?mg NIF resulted in an acute 9% decrease in left ventricular endsystolic volume, whereas forward stroke volume increased by 30%, and regurgitation fraction tended to decrease. No haemodynamic effects could be detected after 14 days' treatment with 20?mg ISDN orally twice daily (preload reduction), whereas 20?mg NIF twice daily (afterload reduction) caused an increase in forward stroke volume (18%) and a decrease in both regurgitant volume (20%) and regurgitation fraction (22%) without affecting blood pressure or heart rate. 3ISDN and NIF have beneficial acute haemodynamic effects in patients with chronic mitral regurgitation probably due to their pre- and afterload reducing properties. The reduction in regurgitation induced by NIF appears to be sustained after 14 days therapy. PMID:8799512

  20. 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.

    PubMed

    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. PMID:23211360

  1. [Percutaneous repair of mitral regurgitation: a new tool in the armamentarium for advanced heart failure?].

    PubMed

    Ussia, Gian Paolo; Cammalleri, Valeria; Scandura, Salvatore; Tamburino, Corrado

    2012-05-01

    Mitral regurgitation (MR) is the second most common heart valve disease worldwide, requiring surgical intervention in Europe. The current gold-standard treatment is surgical repair or replacement. Despite clear international guidelines, many patients do not undergo surgical intervention due to comorbidities, real or perceived high risk for cardiac surgery. The treatment of patients with functional MR in advanced heart failure has unsatisfactory results in terms of long-term survival as shown by retrospective small surgical experiences even if there is weak evidence for beneficial effects on left ventricular remodeling and functional capacity. Nevertheless, the appropriateness and timing of valve surgery in patients with advanced heart failure remain controversial. Based on these results, the focus of research has shifted in recent years to the development of percutaneous approaches to treat severe MR, in order to restore valve function in a minimally invasive fashion. Currently, various percutaneous techniques are under investigation in clinical trials and others have been developed, based on the surgical principles of mitral valve repair. This article focuses on the percutaneous mitral valve repair procedure using the MitraClip system (Abbott Vascular, Abbott Park, Illinois, USA). This approach that reproduces the edge-to-edge technique described by Alfieri, is safe and effective in improving functional class and reducing rehospitalization rates for heart failure patients. PMID:22539141

  2. Tissue Doppler-Derived Myocardial Acceleration during Isovolumetric Contraction Predicts Pulmonary Capillary Wedge Pressure in Patients with Significant Mitral Regurgitation.

    PubMed

    Omar, Alaa Mabrouk Salem; Abdel-Rahman, Mohamed Ahmed; Khorshid, Hazem; Helmy, Mostafa; Raslan, Hala; Rifaie, Osama

    2015-08-01

    The aim of this study was to determine whether isovolumic contraction velocity (IVV) and acceleration (IVA) predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation. Forty-four patients with mitral regurgitation were studied. PCWP was invasively measured. IVV, IVA and the ratio IVRT/Te'-E (where IVRT = isovolumic relaxation time, and Te'-E = time difference between the onset of mitral annular e' and mitral flow E waves) were measured. Mean age was 59.2 ± 13.3 y. Twenty-six patients had an ejection fraction ?55%, and 18 patients had an ejection fraction <55%. IVRT/Te'-E was impossible in 11 patients because Te'-E = zero. PCWP correlated with IVV, IVA and IVRT/Te'-E; overall (r = -0.714, -0.892 and, -0.752, all p < 0.001), ejection fraction ?55 (r = -0.467, -0.749, -0.639, p = 0.016, <0.001, 0.003) and ejection fraction <55% (r = -0.761, -0.911 and -0.833, all p < 0.001). Similar correlations were found for sinus and atrial fibrillation. Our study suggests that IVV and IVA correlate with PCWP in patients with mitral regurgitation irrespective of systolic function or rhythms and, thus, can be alternatives to the tedious IVRT/Te'-E, especially when impossible because Te'-E = 0. PMID:25944284

  3. Demonstration of mitral valve prolapse with CT for planning of mitral valve repair.

    PubMed

    Koo, Hyun Jung; Yang, Dong Hyun; Oh, Sang Young; Kang, Joon-Won; Kim, Dae-Hee; Song, Jae-Kwan; Lee, Jae Won; Chung, Cheol Hyun; Lim, Tae-Hwan

    2014-10-01

    Mitral valve prolapse (MVP), the most frequent cause of severe nonischemic mitral regurgitation, often warrants surgical or interventional valve repair. The severity of mitral regurgitation positively correlates with the development of heart failure and death. Even in patients who are asymptomatic, severe mitral regurgitation causes higher rates of death, heart failure, and atrial fibrillation. Repair procedures for mitral regurgitation have progressed to include leaflet repair, chordal transfer, ring or band annuloplasty, and new percutaneous procedures. In planning for mitral valve repair, detection and localization of mitral valve abnormalities are important. The causes of mitral regurgitation include degenerative mitral valve (eg, prolapsed leaflet, myxomatous degeneration, and Barlow disease [excessive degenerated tissues with elongated chordae]). Cardiac computed tomography (CT) is helpful for depicting mitral valve abnormalities. It allows complete visualization of cardiac anatomic features, including the coronary arteries, paravalvular structures, and cardiac wall motion. This review addresses the role of cardiac CT in depicting anatomic features of the mitral valve, provides a practical method for localizing the exact site of MVP, and discusses the CT findings of various causes of mitral regurgitation. The first step in reconstructing CT images for MVP is to select the best cardiac phase for depicting the anatomic features of the mitral valve. Additional views of the mitral valve then show the specific mitral valve abnormality. This article provides technical tips for demonstrating MVP with CT, as well as imaging results for various causes of MVP and intraoperative findings. Online supplemental material is available for this article. PMID:25310416

  4. differential effects of the angiotensin-converting enzyme inhibitor lisinopril versus the beta-adrenergic receptor blocker atenolol on hemodynamics and left ventricular contractile function in experimental mitral regurgitation

    Microsoft Academic Search

    Shintaro Nemoto; Masayoshi Hamawaki; Gilberto De Freitas; Blase A Carabello

    2002-01-01

    ObjectivesThe goal of this study was to determine the therapeutic efficacy of angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic receptor blockers in experimental chronic mitral regurgitation (MR), gaining knowledge using methods difficult to apply in humans.

  5. Echocardiographic predictors of mitral regurgitation in high school and collegiate competitive athletes.

    PubMed

    Hamburger, Robert F; Burt, Francis X; Panidis, Ioannis P; Bove, Alfred A

    2013-11-15

    Previous studies have compared cardiac morphology between strength and endurance athletes, but few studies have examined predictors of valvular regurgitation in this population. This study evaluated predictors of mitral regurgitation (MR) in high school and collegiate athletes. Athletes in 9 different sports (n = 144) underwent transthoracic echocardiography. We used 97 sedentary patients as controls. Left ventricular (LV) end-diastolic diameter, septal wall thickness, posterior wall thickness, relative wall thickness (RWT), LV mass, LV volume, and mass/volume ratio were calculated and indexed for body surface area. Valvular regurgitation was graded from 0 to 4. Using logistic regression, RWT was associated with decreased odds of MR, with each 0.07 increase in RWT accounting for a 0.52 decrease in odds of MR (95% confidence interval 0.32 to 0.85, p = 0.009). Differences were best exemplified by comparison of soccer and football players, who represent predominantly aerobic versus predominantly isometric exercise, respectively. Soccer players had a larger LV end-diastolic index (29.2 ± 3 vs 24.9 ± 2.6, p <0.001), lesser RWT (0.33 ± 0.06 vs 0.38 ± 0.08, p = 0.014), and lower mass/volume ratio (1.04 ± 0.21 vs 1.29 ± 0.3, p <0.001), with a greater prevalence of MR (45.8% vs 8.5%). Sedentary subjects were similar to football players in LV volume and soccer players in LV mass. In conclusion, RWT is a negative predictor of MR, with higher values reducing the odds of MR. MR appears to be related to the relation between wall thickness and chamber size rather than chamber size alone. PMID:24012032

  6. Leaflet concavity: a rapid visual clue to the presence and mechanism of functional mitral regurgitation.

    PubMed

    Nesta, Francesca; Otsuji, Yutaka; Handschumacher, Mark D; Messas, Emmanuel; Leavitt, Marcia; Carpentier, Alain; Levine, Robert A; Hung, Judy

    2003-12-01

    Repairing mitral regurgitation (MR) requires an understanding of its mechanism. Evaluating restricted leaflet closure in functional MR is challenging. Tenting area between leaflets and annulus in long-axis (LAX) views correlates with MR, but is positive even in control subjects; in the 4-chamber view, the incomplete mitral leaflet closure (IMLC) tenting pattern may be subtle and variable. We tested the hypothesis that leaflet concavity toward the left atrium in the LAX view, a rapid visual clue indicating abnormal tethering predominantly by intermediate chords, is a strong indicator of functional MR. We reviewed 90 patients: 40 with inferior myocardial infarction and ejection fraction > or = 50%; 40 with global left ventricular dysfunction and ejection fraction < 50%; and 10 control subjects. We assessed leaflet shape (concave or convex toward the left atrium) and maximum systolic proximal MR jet width in the LAX views. To quantify shape, we measured the leaflet concavity area between the anterior leaflet and a line connecting its ends. Conventional IMLC area was also assessed. Patients with leaflet concavity had significantly greater MR than those without this finding (jet width of 4.6 +/- 0.7 vs 0.5 +/- 0.1 mm, P <.0001), indicating mild-moderate versus trace MR, with differences comparable in those with inferior myocardial infarction and left ventricular dysfunction. Leaflet concavity area most strongly predicted MR by multivariate regression (R(2) = 0.7). Conventional IMLC area did not uniquely distinguish patients with or without MR and correlated more weakly with MR (R(2) = 0.30 vs 0.73). Mitral leaflet concavity in the LAX view provides rapid and reliable recognition of functional MR, with greater reliability than IMLC area. This shape, consistent with tethering by intermediate chords, may have implications for potential intervention. PMID:14652610

  7. Exercise First-Pass Radionuclide Assessment of Left and Right Ventricular Function and Valvular Regurgitation in Symptomatic Mitral Valve Prolapse

    Microsoft Academic Search

    Frank J. Lumia; Margaret M. LaManna; Mowaffak Atfeh; Vladir Maranhao

    1989-01-01

    The changes in right ventricular (RV) and left ventricular (LV) function and in regurgitant fractions on first-pass exercise radionuclide angiography (RNA) were assessed in 29 consecutive patients with symptomatic mitral valve prolapse (MVP).The mean right ventricular ejection fraction (RVEF) was 35±8% at rest and 46±15% after exercise (p < 0.001). The mean left ventricular ejection fraction (LVEF) was 62 ±

  8. Multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography in patients with mitral valve prolapse, flail, and endocarditis: Diagnostic accuracy in the identification of mitral regurgitant defects by correlation with surgical findings

    Microsoft Academic Search

    Eustachio Agricola; Michele Oppizzi; Michele De Bonis; Francesco Maisano; Lucia Toracca; Tiziana Bove; Ottavio Alfieri

    2003-01-01

    Multiplane transesophageal echocardiography is a useful tool to study mitral regurgitation. We evaluated the diagnostic accuracy of multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography. We used 4 midesophageal and 2 transgastric views in 313 patients with degenerative lesions, endocarditic lesions, or both to identify regurgitant defects, comparing transesophageal echocardiography results with surgical findings.

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

    ClinicalTrials.gov

    2014-08-08

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

  10. Multi-MitraClip therapy for severe degenerative mitral regurgitation: "Anchor" technique for extremely flail segments.

    PubMed

    Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

    2015-08-01

    In high-risk or inoperable patients, implantation of MitraClip for treatment of severe symptomatic mitral regurgitation (MR) from central (A2/P2 pathology, EVEREST patient) is effective in reducing symptoms and improving functional class. Extending the use of MitraClip to the non-EVEREST patient is of considerable interest. MitraClip implantation for wide flail segments and non-central MR is technically more challenging but represents an important and highly prevalent subset of patients. We present a case of an 82-year-old male referred to our institution for medically refractory primary MR. Trans-esophageal echocardiogram demonstrated severe (4+) MR, annular dilatation, P3?>?P2 mitral valve prolapse, malcoaptation, and wide flail gaps and widths. The patient's age, frailty, chronic kidney disease, and mild cognitive impairment rendered him a candidate for MitraClip therapy. Our target area, the areas of maximum flail (A3/P3), proved too wide for grasping. Hence, the first clip was deployed medial to the target area. Subsequent deployment, in a sequential fashion ("zipper technique"), was not technically feasible due to persistent instability of the target area. Consideration was given to an alternative approach by "anchoring" our target area where the 2nd and 3rd clips were deployed lateral to the A3/P3 segment in efforts to "anchor" the maximum flail segment. This maneuver allowed final clip deployment into a more stable target area. Subsequent imaging demonstrated reduction in MR from 4+ to 1+ with preservation of a normal transmitral gradient. We report the first successful US case of four MitraClip implantation for the treatment of severe primary MR by "anchoring" flail segments. © 2015 Wiley Periodicals, Inc. PMID:25559345

  11. Durability of mitral valve repair for degenerative disease

    Microsoft Academic Search

    A. Marc Gillinov; Delos M. Cosgrove; Eugene H. Blackstone; Ramon Diaz; John H. Arnold; Bruce W. Lytle; Nicholas G. Smedira; Joseph F. Sabik; Patrick M. McCarthy; Floyd D. Loop

    1998-01-01

    Background:Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the procedure of choice. Objective: This study was undertaken to identify factors influencing the durability of mitral valve repair. Patients and methods: Between 1985 and 1997, 1072 patients underwent primary

  12. Effects of chronic beta-adrenergic blockade on the left ventricular and cardiocyte abnormalities of chronic canine mitral regurgitation.

    PubMed Central

    Tsutsui, H; Spinale, F G; Nagatsu, M; Schmid, P G; Ishihara, K; DeFreyte, G; Cooper, G; Carabello, B A

    1994-01-01

    The mechanism by which beta blockade improves left ventricular dysfunction in various cardiomyopathies has been ascribed to improved contractile function of the myocardium or to improved beta-adrenergic responsiveness. In this study we tested two hypotheses: (a) that chronic beta blockade would improve the left ventricular dysfunction which develops in mitral regurgitation, and (b) that an important mechanism of this effect would be improved innate contractile function of the myocardium. Two groups of six dogs with chronic severe mitral regurgitation were studied. After 3 mo both groups had developed similar and significant left ventricular dysfunction. One group was then gradually beta-blocked while the second group continued to be observed without further intervention. In the group that remained unblocked, contractile function remained depressed. However, in the group that received chronic beta blockade, contractile function improved substantially. The contractility of cardiocytes isolated from the unblocked hearts and then studied in the absence of beta receptor stimulation was extremely depressed. However, contractility of cardiocytes isolated from the beta-blocked ventricles was virtually normal. Consistent with these data, myofibrillar density was much higher, 55 +/- 4% in the beta-blocked group vs. 39 +/- 2% (P < 0.01) in the unblocked group; thus, there were more contractile elements to generate force in the beta-blocked group. We conclude that chronic beta blockade improves left ventricular function in chronic experimental mitral regurgitation. This improvement was associated with an improvement in the innate contractile function of isolated cardiocytes, which in turn is associated with an increase in the number of contractile elements. Images PMID:7911128

  13. Meta-Analysis of the Usefulness of Mitraclip in Patients With Functional Mitral Regurgitation.

    PubMed

    D'ascenzo, Fabrizio; Moretti, Claudio; Marra, Walter Grosso; Montefusco, Antonio; Omede, Pierluigi; Taha, Salma; Castagno, Davide; Gaemperli, Oliver; Taramasso, Maurizio; Frea, Simone; Pidello, Stefano; Rudolph, Volker; Franzen, Olaf; Braun, Daniel; Giannini, Cristina; Ince, Huseyin; Perl, Leor; Zoccai, Giuseppe; Marra, Sebastiano; D'Amico, Maurizio; Maisano, Francesco; Rinaldi, Mauro; Gaita, Fiorenzo

    2015-07-15

    Midterm outcomes for patients presenting with heart failure and functional mitral regurgitation (MR) treated with Mitraclip remain unclear. Pubmed, Medline, and Google Scholar were systematically searched for studies enrolling patients with severe-moderate MR who underwent Mitraclip implantation. All events after at least 6 months were the primary safety end point (including death, rehospitalization for heart failure, and reinterventions), whereas change in the ejection fraction, left ventricular volumes, arterial pulmonary pressure, and left atrial diameters were considered as secondary end points. Meta-regression analysis was performed to evaluate the effect of baseline clinical and echocardiographic parameters on efficacy outcomes: 875 patients were included in 9 studies; 1.48 clips (1.3 to 1.7) for patients were implanted, and after a median follow-up of 9 months (6 to 12), 409 patients (78% [75% to 83%]) were in class New York Heart Association I/II and 57 (11% [8% to 14%]) still had moderate-to-severe MR. Overall adverse events occurred in 137 (26% [20% to 31%]) of the patients and 78 (15% [1% to 17%]) of them died; 6-minute walk test improved by 100 m (83 to 111), whereas a significant reduction in left ventricular volumes and systolic pulmonary pressure was reported. At meta-regression analysis, an increase in left ventricle systolic volumes positively affected reduction of volumes after Mitraclip, whereas atrial fibrillation reduced the positive effect of the valve implantation on ejection fraction on end-diastolic and -systolic volumes. In conclusion, Mitraclip represents an efficacious strategy for patients with heart failure and severe MR. It offers a significant improvement in functional class and in cardiac remodeling, in patients with severely dilated hearts as well, although its efficacy remains limited in the presence of atrial fibrillation. PMID:25975726

  14. Outcomes of patients with ischemic mitral regurgitation undergoing percutaneous coronary intervention.

    PubMed

    Yousefzai, Rayan; Bajaj, Navkaranbir; Krishnaswamy, Amar; Goel, Sachin S; Agarwal, Shikhar; Aksoy, Olcay; Aggarwal, Bhuvnesh; Duarte, Valeria E; Anabtawi, Abdel; Parashar, Akhil; Sodhi, Nishtha; Thomas, James; Griffin, Brian P; Tuzcu, E Murat; Kapadia, Samir R

    2014-10-01

    Ischemic mitral regurgitation (IMR) is associated with poor outcomes in patients with coronary artery disease. The impact of percutaneous coronary intervention (PCI) on patients with IMR is not well elucidated. We sought to determine the outcomes of patients with severe IMR who underwent PCI. Patients with severe (?3+) IMR who underwent PCI from 1998 to 2010 were identified. Improvement in IMR was defined as reduction in severity from ?3+ to ?2+ without any other invasive intervention beyond PCI. Outcomes were compared between patients with and without improvement in IMR after PCI. One hundred thirty-seven patients with severe IMR were included in our study. After PCI, 50 patients (36.5%) had improvement in IMR with PCI alone and 24 patients (18.5%) required another intervention. Left atrial size was a significant predictor of improvement in IMR (odds ratio 0.39, 95% confidence interval 0.2 to 0.8). Left ventricular size decreased (systolic diameter 3.9±0.3 vs 4.6±0.2 cm, p=0.0008 and diastolic diameter 5.2±0.2 vs 5.7±0.2 cm, p=0.002) and ejection fraction increased (39.1±4.0% vs 33.1±1.9%, p=0.002) significantly after PCI in the patients with improvement in IMR compared with patients without improvement. Patients with improvement in IMR had numerically better survival; however, it was not statistically significant (p log-rank=0.2). In conclusion, 1/3 of the patients with IMR had improvement in severity of IMR with PCI alone. Improvement in IMR was associated with left ventricular reverse remodeling. Left atrial size was an important predictor of improvement in IMR after PCI. PMID:25118123

  15. Early improvement of functional mitral regurgitation in patients with idiopathic dilated cardiomyopathy.

    PubMed

    Stolfo, Davide; Merlo, Marco; Pinamonti, Bruno; Poli, Stefano; Gigli, Marta; Barbati, Giulia; Fabris, Enrico; Di Lenarda, Andrea; Sinagra, Gianfranco

    2015-04-15

    The aim of the study was to assess the clinical and prognostic impact of early functional mitral regurgitation (FMR) improvement on the outcome of patients with idiopathic dilated cardiomyopathy (IDC). The prevalence and prognostic role of FMR improvement, particularly at early follow-up, in patients with IDC are still unclear. From 1988 to 2009, we enrolled 470 patients with IDC with available FMR data at baseline and after 6 ± 2 months. According to the evolution of FMR, patients were classified into 3 groups: stable absent-mild FMR, early FMR improvement (downgrading from moderate-severe to absent-mild), and persistence/early development of moderate-severe FMR. At baseline, 177 of 470 patients (38%) had moderate-severe FMR. Patients with early FMR improvement had significantly better survival rate-free from heart transplant with respect to those with persistence/early development of moderate-severe FMR (93%, 81%, and 66% vs 91%, 64%, and 52% at 1, 6, and 12 years, respectively; p = 0.044). At 6-month follow-up multivariate analysis, FMR improvement was associated with better prognosis (hazard ratio 0.78, 95% confidence interval [CI] 0.64 to 0.96, p = 0.02); the other independent predictors were male gender, heart failure duration, and early re-evaluation of the New York Heart Association class and left ventricle systolic function. This model provided more accurate risk stratification compared with the baseline model (Net Reclassification Index 80% at 12 months and 41% at 72 months). In conclusion, in a large cohort of patients with IDC receiving optimal medical treatment, early improvement of FMR was frequent (53%) and emerged as a favorable independent prognostic factor with an incremental short- and long-term power compared with the baseline evaluation. PMID:25721482

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

    PubMed

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

    2015-04-15

    The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surface area (PISA) as a tool for quantitative assessment of mitral regurgitation (MR) against in vitro and in vivo reference methods. A customized 3D PISA software was validated in vitro against a flowmeter MR phantom. Sixty consecutive patients, with ?mild MR of any cause, were recruited and the regurgitant volume (RVol) was measured by 2D PISA, 3D peak PISA, and 3D integrated PISA, using transthoracic (TTE) and transesophageal echocardiography (TEE). Cardiac magnetic resonance imaging (CMR) was used as reference method. Flowmeter RVol was associated with 3D integrated PISA as follows: y = 0.64x + 4.7, r(2) = 0.97, p <0.0001 for TEE and y = 0.88x + 4.07, r(2) = 0.96, p <0.0001 for TTE. The bias and limit of agreement in the Bland-Altman analysis were 6.8 ml [-3.5 to 17.1] for TEE and -0.059 ml [-6.2 to 6.1] for TTE. In vivo, TEE-derived 3D integrated PISA was the most accurate method for MR quantification compared to CMR: r(2) = 0.76, y = 0.95x - 3.95, p <0.0001; 5.1 ml (-14.7 to 26.5). It was superior to TEE 3D peak PISA (r(2) = 0.67, y = 1.00x + 6.20, p <0.0001; -6.3 ml [-33.4 to 21.0]), TEE 2D PISA (r(2) = 0.54, y = 0.76x + 0.18, p <0.0001; 8.4 ml [-20.4 to 37.2]), and TTE-derived measurements. It was also most accurate by receiver operating characteristic analysis (area under the curve 0.99) for the detection of severe MR, RVol cutoff = 48 ml, sensibility 100%, and specificity 96%. RVol and the cutoff to define severe MR were underestimated using the most accurate method. In conclusion, quantitative 3D color Doppler echocardiography of the PISA permits a more accurate MR assessment than conventional techniques and, consequently, should enable an optimized management of patients suffering from MR. PMID:25747111

  17. Incidental moderate mitral regurgitation in patients undergoing coronary artery bypass grafting: update on guidelines and key randomized trials.

    PubMed

    Ramakrishna, Harish; Ghadimi, Kamrouz; Augoustides, John G T

    2014-02-01

    Incidental moderate mitral regurgitation (MR) in patients presenting for coronary artery bypass grafting (CABG) is not only common but also probably adversely affects clinical outcome. The echocardiographic evaluation of incidental MR must be comprehensive and integrated, as it remains a cornerstone in management decisions. Current guidelines support surgical mitral intervention in this setting as a reasonable option, reflecting clinical equipoise towards moderate MR in the setting of planned CABG. There are currently 2 major randomized trials in progress that will test whether surgical correction of moderate MR combined with CABG improves major clinical outcomes as compared to CABG alone. These landmark trials will be completed in the near future. In the interim, significant progress in the fields of cardiac resynchronization therapy, transcatheter mitral valve intervention, and minimally invasive mitral valve surgery promise to affect the management alternatives for moderate MR in patients undergoing CABG regardless of operative risk. It is likely that in the coming decade there will be less tolerance for incidental moderate MR given its already known outcome effects and the multimodal interventions that continue to mature with better safety profiles. PMID:24440010

  18. Comparison of real-time three-dimensional transesophageal echocardiography to two-dimensional transesophageal echocardiography for quantification of mitral valve prolapse in patients with severe mitral regurgitation.

    PubMed

    Izumo, Masaki; Shiota, Maiko; Kar, Saibal; Gurudevan, Swaminatha V; Tolstrup, Kirsten; Siegel, Robert J; Shiota, Takahiro

    2013-02-15

    Real-time 3-dimensional (3D) transesophageal echocardiography (TEE) provides more accurate geometric information on the mitral valve (MV) than 2-dimensional (2D) TEE. The aim of this study was to quantify MV prolapse using real-time 3D TEE in patients with severe mitral regurgitation. In 102 patients with severe mitral regurgitation due to MV prolapse and/or flail, 2D TEE quantified MV prolapse, including prolapse gap and width in the commissural view. Three-dimensional TEE also determined prolapse gap and width with the use of the 3D en face view. On the basis of the locations of MV prolapse, all patients were classified into group 1 (pure middle leaflet prolapse, n = 50) or group 2 (involvement of medial and/or lateral prolapse, n = 52). Prolapse gap and prolapse width determined by 3D TEE were significantly greater than those by 2D TEE (all p values <0.001). The differences in prolapse gap and prolapse width between 2D TEE and 3D TEE were significantly greater in group 2 than group 1 (? gap 1.3 ± 1.4 vs 2.4 ± 1.8 mm, ? width 2.5 ± 3.0 vs 4.4 ± 5.1 mm, all p values <0.01). The differences in prolapse gap and width between 2D TEE and 3D TEE were best correlated with 3D TEE-derived prolapse width (r = 0.41 and r = 0.74, respectively). Two-dimensional TEE underestimated the width of MV prolapse and leaflet gap compared to 3D TEE. Two-dimensional TEE could not detect the largest prolapse gap and width, because of the complicated anatomy of the MV. In conclusion, 3D TEE provided more precise quantification of MV prolapse than 2D TEE. PMID:23206924

  19. Left atrial mechanical functions in chronic primary mitral regurgitation patients: a velocity vector imaging-based study

    PubMed Central

    Yurdakul, Selen; Y?ldirimtürk, Özlem

    2014-01-01

    Introduction Assessment of the left atrium (LA) mechanical function provides further information on the level of cardiac compensation. We aimed to evaluate LA function using a strain imaging method: velocity vector imaging (VVI) in chronic primary mitral regurgitation (MR). Material and methods We recruited 48 patients with chronic, isolated, moderate to severe MR (54.70 ±15.35 years and 56% male) and 30 age- and sex-matched healthy controls (56.52 ±15.95 years and 56% male). The LA volumes during reservoir (RV), conduit (CV) and contractile phases (AV) were measured. Global strain (S), systolic strain rate (SRs), early diastolic (ESRd) and late diastolic strain rate (LSRd) were calculated. Results LA RV (50 ±18.7 to 37.9 ±5.9; p = 0.0001), CV (43.1 ±29 to 21 ±2.56; p = 0.0001), and AV (17.9 ±13.5 to 10.9 ±1.9; p = 0.006) were increased in MR patients. The LA reservoir phase strain was 16.2 ±8.1% in the MR group and 51.1 ±5.7% in the control group (p = 0.0001). The LA SRs (1.01 ±0.52 s–1 for MR and 2.1 ±0.22 s–1 for controls; p = 0.0001), LA ESRd (0.83 ±0.34 s–1 for MR and 2.26 ±0.17 s–1 for controls; p = 0.0001) and LA LSRd (0.76 ±0.24 s–1 for MR and 2.2 ±0.26 s–1 for controls; p = 0.0001) were impaired in MR patients. Conclusions The LA deformation indices may be used as adjunctive parameters to determine LA dysfunction in chronic primary MR. PMID:25097574

  20. Importance of Exercise Capacity in Predicting Outcomes and Determining Optimal Timing of Surgery in Significant Primary Mitral Regurgitation

    PubMed Central

    Naji, Peyman; Griffin, Brian P.; Barr, Tyler; Asfahan, Fadi; Gillinov, A. Marc; Grimm, Richard A.; Rodriguez, L. Leonardo; Mihaljevic, Tomislav; Stewart, William J.; Desai, Milind Y.

    2014-01-01

    Background In primary mitral regurgitation (MR), exercise echocardiography aids in symptom evaluation and timing of mitral valve (MV) surgery. In patients with grade ?3 primary MR undergoing exercise echocardiography followed by MV surgery, we sought to assess predictors of outcomes and whether delaying MV surgery adversely affects outcomes. Methods and Results We studied 576 consecutive such patients (aged 57±13 years, 70% men, excluding prior valve surgery and functional MR). Clinical, echocardiographic (MR, LVEF, indexed LV dimensions, RV systolic pressure) and exercise data (metabolic equivalents) were recorded. Composite events of death, MI, stroke, and congestive heart failure were recorded. Mean LVEF was 58±5%, indexed LV end?systolic dimension was 1.7±0.5 mm/m2, rest RV systolic pressure was 32±13 mm Hg, peak?stress RV systolic pressure was 47±17 mm Hg, and percentage of age? and gender?predicted metabolic equivalents was 113±27. Median time between exercise and MV surgery was 3 months (MV surgery delayed ?1 year in 28%). At 6.6±4 years, there were 53 events (no deaths at 30 days). On stepwise multivariable survival analysis, increasing age (hazard ratio of 1.07 [95% confidence interval, 1.03 to 1.12], P<0.01), lower percentage of age? and gender?predicted metabolic equivalents (hazard ratio of 0.82 [95% confidence interval, 0.71 to 0.94], P=0.007), and lower LVEF (0.94 [0.89 to 0.99], P=0.04) independently predicted outcomes. In patients achieving >100% predicted metabolic equivalents (n=399), delaying surgery by ?1 year (median of 28 months) did not adversely affect outcomes (P=0.8). Conclusion In patients with primary MR that underwent exercise echocardiography followed by MV surgery, lower achieved metabolic equivalents were associated with worse long?term outcomes. In those with preserved exercise capacity, delaying MV surgery by ?1 year did not adversely affect outcomes. PMID:25213567

  1. Echocardiographic Assessment of Mitral Valve Regurgitation, Pattern and Prevalence, Expanding Clinical Awareness Through an Institutional Survey with the Perspective of a Quality Improvement Project

    PubMed Central

    Kossaify, Antoine; Akiki, Vanessa

    2014-01-01

    BACKGROUND Mitral regurgitation (MR) is frequently reported in everyday echocardiograms; accurate assessment is essential for appropriate management and decision making. OBJECTIVE We performed a self-audit in order to define the prevalence and pattern of MR and to evaluate methods of assessment with the perspective of developing a quality improvement project. METHODS AND SETTING This retrospective analytical study was conducted in a university hospital. Inclusion criteria: age more than 18 years and medical records available within the facility, including a “complete” medical history. Using the picture archiving and communication system, we reviewed 961 echocardiograms performed over a 6-month period. The methods of assessment of native mitral valve regurgitation were reported, and also relevant medical data were collected using an electronic archiving system. RESULTS AND DISCUSSION Among the 961 patients reviewed, 322 (33.50%) had MR, with variable grades. MR pattern (organic versus functional) was not specified in 49.68% of cases. “Eyeball” assessment and “color jet area” were the most frequently used methods for MR assessment (90.06% and 27.95%, respectively), while “vena contracta” and “flow convergence” methods were rarely implemented (1.55% and 2.17%, respectively). Discussion is made according to current guidelines, while showing the strengths and weaknesses of each method. CONCLUSION The prevalence of MR was 33.50%, and in nearly half of cases, the MR pattern was not specified. Qualitative and semi-quantitative methods of assessment were mostly used; quantitative assessment should be implemented more frequently, in accordance with current guidelines. Increasing clinical awareness by creating and implementing a quality improvement project is essential in this context. PMID:25210482

  2. Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study

    PubMed Central

    Prakash, Roshan; Horsfall, Matthew; Markwick, Andrew; Pumar, Marsus; Lee, Leong; Sinhal, Ajay; Joseph, Majo X; Chew, Derek P

    2014-01-01

    Objective We sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities. Methods This was a retrospective matched cohort study using a clinical-echocardiography reporting database linked to a clinical and administrative database in an Australian tertiary hospital. We identified our study cohort (patients with significant MR) and control cohort (without MR) on transthoracic echocardiographies performed between 2005 and 2010. The main outcome measures were mortality and heart failure rehospitalisation. A Cox proportional hazards model was used to adjust for clinical covariates and the ‘win ratio’ methodology was utilised to estimate the impact of MR on main outcomes. Results A total of 218 matched patients with and without significant MR were followed-up for 1?year. Significant MR was associated with an adjusted HR for mortality of 1.83 (95% CI 1.28 to 2.62, p<0.001). The win ratio for death and death or heart failure readmission was 0.57 (95% CI 0.40 to 0.78, p=0.0002) and 0.53 (95% CI 0.39 to 0.71, p<0.0001), respectively. Significant MR with left ventricular (LV) systolic dysfunction and age between 75 and 85?years were associated with a substantial reduction in median survival by 2.3?years. Significant MR with LV systolic dysfunction, age beyond 85 and advance comorbidities were associated with a lesser reduction in median survival by 0.2?years. Conclusions Significant MR in patients with multiple comorbidities leads to increase in death and heart failure rehospitalisation with reduced estimated median survival. However, its impact diminishes with increasing comorbidities. PMID:25034628

  3. Long-term influence of mild or moderate ischemic mitral regurgitation after off-pump coronary artery bypass surgery

    PubMed Central

    Hong, Jong-Myeon; Cartier, Raymond; Pellerin, Michel; Demers, Philippe; Bouchard, Denis; Couture, Pierre

    2010-01-01

    BACKGROUND: The issue of mild to moderate ischemic mitral regurgitation (IMR) is controversial after conventional surgery, and has not been specifically studied after off-pump coronary artery bypass graft (OPCAB) surgery. OBJECTIVE: To review the influence of mild or moderate IMR on long-term survival and recurrent cardiac events after OPCAB surgery. METHODS: A total of 1000 consecutive and systematic OPCAB patients who underwent operations between September 1996 and March 2004 were prospectively followed. Sixty-seven patients (6.7%) had mild to moderate IMR at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event-free survival were studied to assess the effect of IMR. RESULTS: The mean (± SD) follow-up period was 66±22 months and was completed in 97% of the cohort. IMR patients were older (P<0.001), and had lower ejection fractions (P<0.001) and more comorbidities. More female patients presented with IMR (P=0.002). Operative mortality (P=0.25) and prevalence of perioperative myocardial infarction (P=0.25) were comparable for both groups. Eight-year survival was decreased in IMR patients (P<0.001), but after adjusting for risk factors in the Cox regression model, mild to moderate IMR was not found to be a significant risk factor of long-term mortality (P=0.42). Major adverse cardiac event-free survival at eight years was significantly lower in IMR patients (P<0.001) and, more specifically, in patients with 2+ IMR. After adjusting for risk factors, IMR remained a significant cause of poor outcome (hazard ratio 2.09), especially for recurrent congestive heart failure and myocardial infarction. CONCLUSIONS: OPCAB patients with preoperative mild or moderate IMR had a higher prevalence of preoperative risk factors than those without IMR. They had comparable perioperative mortality and morbidity but, over the long term, were found to be at risk for recurrent cardiac events. PMID:20386769

  4. Usefulness of the brain natriuretic peptide to atrial natriuretic peptide ratio in determining the severity of mitral regurgitation

    PubMed Central

    Shimamoto, Ken; Kusumoto, Miyako; Sakai, Rieko; Watanabe, Hirota; Ihara, Syunichi; Koike, Natsuha; Kawana, Masatoshi

    2007-01-01

    BACKGROUND: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels were characterized in subjects with mitral regurgitation (MR). METHODS: Sixty-two cases of moderate or severe chronic MR were studied. The blood levels of neurohormonal factors were stratified by the known MR prognostic factors of New York Heart Association (NYHA) functional class, left ventricular end-diastolic diameters, left ventricular end-systolic diameter (LVDs), ejection fraction (EF), left atrial diameter and presence of atrial fibrillation (AF). RESULTS: ANP levels were higher in NYHA class II and lower in classes I and III/IV (P=0.0206). BNP levels were higher in NYHA class II than class I (P=0.0355). The BNP/ANP ratio was significantly higher in NYHA classes II and III/IV than in class I (P=0.0007). To differentiate between NYHA classes I/II and III/IV, a cut-off BNP/ANP ratio of 2.97 produced a sensitivity of 78% and specificity of 87%. Compared with subjects in sinus rhythm, patients with AF had an enlarged left atrium and lower ANP levels. The BNP/ANP ratio correlated significantly with left atrial diameter, LVDs and EF (r=0.429, P=0.0017; r=0.351, P=0.0117; and r=–0.349, P=0.0122; respectively), and was significantly higher among all the known operative indications for MR tested (LVDs 45 mm or more, EF 60% or less, NYHA class II or greater and AF; P=0.0073, P=0.003, P=0.0102 and P=0.0149, respectively). CONCLUSIONS: In chronic MR, levels of ANP and BNP, and the BNP/ANP ratio are potential indicators of disease severity. PMID:17380223

  5. Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging

    SciTech Connect

    Lette, J.; Gagnon, A.; Lapointe, J.; Cerino, M.

    1989-07-01

    A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm.

  6. Comparison of outcomes of percutaneous MitraClip versus surgical repair or replacement for degenerative mitral regurgitation in octogenarians.

    PubMed

    Buzzatti, Nicola; Maisano, Francesco; Latib, Azeem; Taramasso, Maurizio; Denti, Paolo; La Canna, Giovanni; Colombo, Antonio; Alfieri, Ottavio

    2015-02-15

    Octogenarians affected by mitral regurgitation (MR) are an increasing high-risk population. MitraClip repair is emerging as a promising option for this kind of patients. In this retrospective study, the outcomes of patients aged ?80 years, affected by isolated degenerative MR, who underwent isolated transcatheter (n = 25) or surgical (n = 35, 29 repairs and 6 replacements) mitral intervention from September 2008 to February 2014 were compared. MitraClip patients had higher mean age (84.5 ± 3.2 vs 81.9 ± 2.0 years, p <0.01), median Logistic Euroscore 19.4 (11.1 to 29.0) versus 8.4 (7.0 to 10.1) (p <0.01), median Society of Thoracic Surgeons predicted mortality 5.3 (3.5 to 6.6) versus 2.7 (2.3 to 3.9) (p <0.01), and more advanced New York Heart Association class (III to IV in 68% vs 37%, p = 0.02). At 30 days, 1 death occurred in the MitraClip group (p = 0.2). MitraClip was associated with significantly less complications (p <0.05) but more residual MR >2 (p <0.01). Two-year actuarial survival rate was 90% for MitraClip versus 97% for surgery (p <0.01). Higher Society of Thoracic Surgeons mortality was associated with reduced follow-up survival rate (p = 0.01). Two-year actuarial freedom from MR >2 was 70% versus 100%, respectively (p <0.01). New York Heart Association class and quality of life improved after MitraClip and were similar to surgical patients. Recurrent MR >2 was not significantly associated with follow-up mortality in this elderly setting. After the introduction of MitraClip, octogenarian patients with isolated degenerative MR receiving mitral treatment significantly increased (p <0.01). In conclusion, MitraClip patients, despite being older, more symptomatic, and affected by more co-morbidities showed significantly reduced postoperative complications. Two-year mortality was higher in the MitraClip group likely because of co-morbidities. Transcatheter mitral repair resulted in more octogenarians being treated compared with the past. PMID:25529545

  7. Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair.

    PubMed

    Matsumoto, Takashi; Nakamura, Mamoo; Yeow, Wen-Loong; Hussaini, Asma; Ram, Vinny; Makar, Moody; Gurudevan, Swaminatha V; Trento, Alfredo; Siegel, Robert J; Kar, Saibal

    2014-12-01

    Preexisting pulmonary hypertension (PH) is associated with poor outcomes after surgical mitral valve repair for functional mitral regurgitation (FMR). However its clinical impact on MitraClip therapy remains unknown. The aim of this study was therefore to evaluate the impact of preexisting PH on MitraClip therapy for patients with FMR. Ninety-one consecutive patients who had FMR and who underwent the MitraClip procedure were studied. They were divided into 2 groups on the basis of pulmonary artery systolic pressure: the PH group (n = 48) and the non-PH group (n = 43). PH was defined as pulmonary artery systolic pressure >50 mm Hg using Doppler echocardiography. Procedural success (defined as magnetic resonance reduction to grade 2+ or less) and 30-day mortality were similar in the 2 groups. At 12 months, New York Heart Association functional class had improved to class I or II in most patients in the PH (from 2.9% to 94.3%) and non-PH (from 9.4% to 96.9%) groups. The mean pulmonary artery systolic pressure of the PH group significantly decreased from baseline but remained higher than that of the non-PH group (50.8 ± 15.3 vs 36.7 ± 11.6 mm Hg, p <0.001). After a mean of 25.0 ± 16.9 months of follow-up, Kaplan-Meier analysis demonstrated significantly higher all-cause mortality in the PH group. In Cox regression analysis, preexisting PH was the most powerful predictor of all-cause mortality (hazard ratio 3.731, 95% confidence interval 1.653 to 8.475, p = 0.002). In conclusion, MitraClip therapy reduced FMR and alleviated symptoms with an excellent early safety profile in the PH and non-PH groups. However, preexisting PH was associated with worse all-cause mortality. PMID:25306555

  8. Aortic coarctation associated with aortic valve stenosis and mitral regurgitation in an adult patient: a two-stage approach using a large-diameter stent graft.

    PubMed

    Novosel, Luka; Perkov, Dražen; Dobrota, Savko; ?ori?, Vedran; Štern Padovan, Ranka

    2014-02-01

    We report a case of a staged surgical and endovascular management in a 62-year-old woman with aortic coarctation associated with aortic valve stenosis and mitral regurgitation. The patient was admitted for severe aortic valve stenosis and mitral valve incompetence. During hospitalization and preoperative imaging, a previously undiagnosed aortic coarctation was discovered. The patient underwent a 2-stage approach that combined a Bentall procedure and mitral valve replacement in the first stage, followed by correction of the aortic coarctation by percutaneous placement of an Advanta V12 large-diameter stent graft (Atrium, Mijdrecht, The Netherlands) which to our knowledge has not been used in an adult patient with this combination of additional cardiac comorbidities. A staged approach combining surgical treatment first and endovascular placement of an Advanta V12 stent graft in the second stage can be effective and safe in adult patients with coarctation of the aorta and additional cardiac comorbidities. PMID:24332897

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

    PubMed

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

    2010-10-15

    Despite their potential as a sensitive measure of ventricular performance, tissue Doppler velocities vary with normal aging. This is inconvenient for nonspecialists to interpret and makes it difficult to use as an entry criterion for clinical studies. The age-adjusted tissue Doppler Z-scores might avoid these disadvantages and be more discriminant for myocardial impairment than the raw velocities. We conducted a meta-regression of studies reporting age-specific normal tissue Doppler velocities to determine a consensus formula for Z-scores (8 studies, 1,867 patients) that we then tested in an independent study at our institution. We next compared the Z-scores head-to-head with the raw velocities for their ability to distinguish a fresh set of 81 healthy subjects from groups in whom subtle ventricular dysfunction might be expected, including 50 patients with dilated cardiomyopathy, 50 with aortic regurgitation, and 50 with mitral regurgitation. The discriminant capacity, assessed by the area under the receiver operating characteristic curves, was higher for the Z-scores than for the raw velocities in each patient group. At the septal angle of the mitral annulus: dilated cardiomyopathy 0.95 versus 0.92 (p = 0.03), aortic regurgitation 0.83 versus 0.78 (p = 0.02), mitral regurgitation 0.85 versus 0.81 (p = 0.04). At the lateral angle: dilated cardiomyopathy 0.94 versus 0.88 (p = 0.005), aortic regurgitation 0.92 versus 0.83 (p = 0.001), mitral regurgitation 0.87 versus 0.85 (p = 0.31). In conclusion, the Z-scores of the tissue Doppler velocities were better than the raw velocities at detecting myocardial impairment in valvular or heart muscle disease. The calculation needs only the raw velocity and patient age. Tissue Doppler Z-scores could be used to create a novel, more sensitive, definition of ventricular dysfunction and might make it easier for nonspecialists to interpret the reports. PMID:20920662

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

    PubMed Central

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

    2015-01-01

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

  11. Laser Doppler velocimetry and flow visualization studies in the regurgitant leakage flow region of three mechanical mitral valves.

    PubMed

    Meyer, R S; Deutsch, S; Bachmann, C B; Tarbell, J M

    2001-04-01

    Streak line flow visualization and laser Doppler velocimetry (LDV) were conducted in the regurgitant leakage flow region of 3 mechanical heart valve types: CarboMedics, Medtronic Hall, and St. Jude Medical. Streak line flow visualization identified regions of high regurgitant flow, and LDV measurements were focused on those locations. Maximum regurgitant flow velocities after valve closure ranged from 0.7 to 2.6 m/s, and maximum Reynolds shear stress after valve closure ranged from 450 to 3,600 dyne/cm2. These data indicate that leakage flows can generate turbulent jets with elevated Reynolds stresses even in bileaflet valves. PMID:11318758

  12. The double-orifice technique in mitral valve repair: A simple solution for complex problems

    Microsoft Academic Search

    Ottavio Alfieri; Francesco Maisano; Michele De Bonis; Pier Luigi Stefano; Lucia Torracca; Michele Oppizzi; Giovanni La Canna

    2001-01-01

    Objective: The aim of this study is to report our results with the central doubleorifice technique used for the treatment of complex mitral valve lesions. Methods: The central double-orifice repair has been used in 260 patients (mean age, 56 ± 14.3 years) over a period of 7 years. The mechanism responsible for mitral regurgitation was prolapse of both leaflets in

  13. Automated mitral annular tracking: a novel method for evaluating mitral annular motion using two-dimensional echocardiography.

    PubMed

    Eto, Yoko; Yamada, Hirotsugu; Shin, Joon-Han; Agler, Deborah A; Tsujino, Hiroyuki; Qin, Jian-Xin; Saracino, Giuseppe; Greenberg, Neil L; Thomas, James D; Shiota, Takahiro

    2005-04-01

    We developed an automated mitral annular tracking method based on a digital processing of high frame rate cineloop images of 2-dimensional echocardiography. In this study, its feasibility and accuracy was validated in 11 healthy volunteers and 16 patients with left ventricular (LV) dysfunction. The mitral annular excursion measured by automated mitral annular tracking agreed well with that measured by 3-dimensional echocardiography and correlated with LV ejection fraction. The longitudinal mitral annular excursion was reduced whereas the radial one was preserved for patients with LV dysfunction compared with control subjects. The novel automated mitral annular tracking method is clinically feasible and has potential capability to quantify the comprehensive mitral annular motion for evaluating LV function in a clinical setting. PMID:15846156

  14. A Dynamic Heart System to Facilitate the Development of Mitral Valve Repair Techniques

    PubMed Central

    Richards, Andrew L.; Cook, Richard C.; Bolotin, Gil; Buckner, Gregory D.

    2013-01-01

    Objective The development of a novel surgical tool or technique for mitral valve repair can be hampered by cost, complexity, and time associated with performing animal trials. A dynamically pressurized model was developed to control pressure and flowrate profiles in intact porcine hearts in order to quantify mitral regurgitation and evaluate the quality of mitral valve repair. Methods A pulse duplication system was designed to replicate physiological conditions in explanted hearts. To test the capabilities of this system in measuring varying degrees of mitral regurgitation, the output of eight porcine hearts was measured for two different pressure waveforms before and after induced mitral valve failure. Four hearts were further repaired and tested. Measurements were compared with echocardiographic images. Results For all trials, cardiac output decreased as left ventricular pressure was increased. After induction of mitral valve insufficiencies, cardiac output decreased, with a peak regurgitant fraction of 71.8%. Echocardiography clearly showed increases in regurgitant severity from post-valve failure and with increased pressure. Conclusions The dynamic heart model consistently and reliably quantifies mitral regurgitation across a range of severities. Advantages include low experimental cost and time associated with each trial, while still allowing for surgical evaluations in an intact heart. PMID:19224369

  15. Development of a semi-automated method for mitral valve modeling with medial axis representation using 3D ultrasound

    PubMed Central

    M. Pouch, Alison; A. Yushkevich, Paul; M. Jackson, Benjamin; S. Jassar, Arminder; Vergnat, Mathieu; H. Gorman, Joseph; C. Gorman, Robert; M. Sehgal, Chandra

    2012-01-01

    Purpose: Precise 3D modeling of the mitral valve has the potential to improve our understanding of valve morphology, particularly in the setting of mitral regurgitation (MR). Toward this goal, the authors have developed a user-initialized algorithm for reconstructing valve geometry from transesophageal 3D ultrasound (3D US) image data. Methods: Semi-automated image analysis was performed on transesophageal 3D US images obtained from 14 subjects with MR ranging from trace to severe. Image analysis of the mitral valve at midsystole had two stages: user-initialized segmentation and 3D deformable modeling with continuous medial representation (cm-rep). Semi-automated segmentation began with user-identification of valve location in 2D projection images generated from 3D US data. The mitral leaflets were then automatically segmented in 3D using the level set method. Second, a bileaflet deformable medial model was fitted to the binary valve segmentation by Bayesian optimization. The resulting cm-rep provided a visual reconstruction of the mitral valve, from which localized measurements of valve morphology were automatically derived. The features extracted from the fitted cm-rep included annular area, annular circumference, annular height, intercommissural width, septolateral length, total tenting volume, and percent anterior tenting volume. These measurements were compared to those obtained by expert manual tracing. Regurgitant orifice area (ROA) measurements were compared to qualitative assessments of MR severity. The accuracy of valve shape representation with cm-rep was evaluated in terms of the Dice overlap between the fitted cm-rep and its target segmentation. Results: The morphological features and anatomic ROA derived from semi-automated image analysis were consistent with manual tracing of 3D US image data and with qualitative assessments of MR severity made on clinical radiology. The fitted cm-reps accurately captured valve shape and demonstrated patient-specific differences in valve morphology among subjects with varying degrees of MR severity. Minimal variation in the Dice overlap and morphological measurements was observed when different cm-rep templates were used to initialize model fitting. Conclusions: This study demonstrates the use of deformable medial modeling for semi-automated 3D reconstruction of mitral valve geometry using transesophageal 3D US. The proposed algorithm provides a parametric geometrical representation of the mitral leaflets, which can be used to evaluate valve morphology in clinical ultrasound images. PMID:22320803

  16. Modified De Vega mitral valve annuloplasty in an infant with endocarditis.

    PubMed

    Ciccolo, Michael L; Collazos, Juan C; Acherman, Ruben J; Galindo, Alvaro; Luna, Carlos F; Restrepo, Humberto; Evans, William N

    2008-07-01

    Surgical management of infant mitral valve regurgitation is challenging. There are no large surgical series of mitral valve repair in infants. Mitral valve repair is preferable to replacement. We report the modified De Vega adjustable annuloplasty with mitral valve repair in an infant with mitral valve regurgitation from endocarditis. PMID:18573442

  17. Unraveling regulatory mechanisms of atrial remodeling of mitral regurgitation pigs by gene expression profiling analysis: role of type I angiotensin II receptor antagonist.

    PubMed

    Chen, Mien-Cheng; Chang, Jen-Ping; Chang, Tzu-Hao; Hsu, Sheng-Da; Huang, Hsien-Da; Ho, Wan-Chun; Wang, Feng-Sheng; Hsiao, Chang-Chun; Liu, Wen-Hao

    2015-05-01

    Left atrial enlargement associated with mitral regurgitation (MR) predicts a poor prognosis. However, the underlying regulatory mechanisms of atrial remodeling remain unclear. We used high-density oligonucleotide microarrays and enrichment analysis to identify the alteration of RNA expression pattern and biological processes involved in the atrial remodeling of pigs with and without MR. Gene arrays from left atria tissues were compared in 13 pigs (iatrogenic MR pigs [n = 6], iatrogenic MR pigs treated with valsartan [n = 4], and pigs without MR [n = 3]). A total of 22 genes were differentially upregulated by altered fold change >2.0 (Log2FC > 1), and 49 genes were differentially downregulated by altered fold change <0.5 (Log2FC < -1) in the left atria of the MR pigs compared with the pigs without MR. Enrichment analysis showed that renin-angiotensin system was identified in the Kyoto Encyclopedia of Genes and Genomes pathway. Notably, 12 of the 22 upregulated genes were identified to be downregulated by valsartan and 10 of the 49 downregulated genes were identified to be upregulated by valsartan. The tissue concentrations of angiotensin II and gene expression of hypertrophic gene, myosin regulatory light chain 2, ventricular isoforms, and fibrosis-related genes were significantly increased in the MR pigs compared with pigs without MR. In conclusion, differentially expressed transcriptome and related biological pathways have been identified in the left atria of the MR pigs compared with pigs without MR. Additionally, some of the differentially expressed genes could be regulated by type I angiotensin II receptor blocker. PMID:25500755

  18. Reduction of severe mitral regurgitation with the MitraClip system improves renal function in two patients presenting with acute kidney injury and progressive renal failure due to cardio renal syndrome.

    PubMed

    Asdonk, T; Nickenig, G; Hammerstingl, C

    2014-10-01

    Mitral regurgitation (MR) is a frequent valve disorder in elderly patients, often accompanied by multiple comorbidities such as renal impairment. In these patients percutaneous mitral valve (MV) repair has become an established treatment option but the role of MR on renal dysfunction is not yet well defined. We here report on two cases presenting with severe MR and progressive renal failure caused by cardio renal syndrome, in which percutaneous MV treatment with the MitraClip system significantly improved renal function. These findings suggest that interventional MV repair can prevent progression of renal deterioration in patients suffering from combined advanced heart and renal failure. Further clinical studies are necessary to support our finding and to answer the question whether optimizing renal function by implantation of the MitraClip device is also of prognostic relevance in these patients. PMID:24616212

  19. Papillary muscle approximation to septum for functional tricuspid regurgitation.

    PubMed

    Lohchab, Shamsher Singh; Chahal, Ashok Kumar; Agrawal, Nilesh

    2015-07-01

    Current techniques for repair of functional tricuspid regurgitation are associated with a significant degree of residual or recurrent regurgitation. We describe a technique of anterior papillary muscle attachment to the septum to correct residual tricuspid regurgitation persisting after annuloplasty. In our early experience in 15 patients (6 men and 9 women) with a mean age of 32?±?11 years, who underwent annuloplasty for severe functional tricuspid regurgitation secondary to rheumatic mitral valve disease, this technique effectively eliminated residual tricuspid regurgitation. PMID:25635105

  20. Leakage test during mitral valve repair.

    PubMed

    Watanabe, Taiju; Arai, Hirokuni

    2014-11-01

    Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction. PMID:25156036

  1. Mitral Regurgitation (Beyond the Basics)

    MedlinePLUS

    ... developed countries, although it still occurs commonly in developing countries. ? Congenital heart abnormality – Children who are born with ... level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces ...

  2. Mitral valve repair by Alfieri's technique does not limit exercise tolerance more than Carpentier's correction

    Microsoft Academic Search

    Jean-Marc Frapier; Catherine Sportouch; Valerie Rauzy; Philippe Rouviere; Stéphane Cade; Rolland G. Demaria; Jean-Marc Davy; Bernard Albat

    2006-01-01

    Objective: The main goal of this study was to evaluate if the edge-to-edge mitral repair could be a limiting factor for exercise tolerance and to compare these results to those of classical techniques. Methods: Between 2000 and 2002, 54 consecutive patients were operated on for mitral valve regurgitation (MR). Twenty-five patients were operated with Alfieri's technique (group A) and 29

  3. Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: the strong heart study

    Microsoft Academic Search

    Richard B Devereux; Erica C Jones; Mary J Roman; Barbara V Howard; Richard R Fabsitz; Jennifer E Liu; Vittorio Palmieri; Thomas K Welty; Elisa T Lee

    2001-01-01

    PurposeMitral valve prolapse is heritable and occurs frequently in the general population despite associations with mitral regurgitation and infective endocarditis, suggesting that selective advantages might be associated with mitral valve prolapse.

  4. Chordal replacement for leaflet prolapse in a posterior mitral valve with a calcified mitral annulus

    PubMed Central

    Sawazaki, Masaru; Tomari, Shiro; Izawa, Naoto

    2012-01-01

    Mitral annular calcification (MAC) is sometimes associated with Carpentier type 2 mitral valve regurgitation and is a challenge to repair. Complete annular decalcification and mitral valve reconstruction is considered the ideal treatment. This report demonstrates the success of chordal replacement and band annuloplasty without resection of the leaflet and MAC. We have followed the patient for 7 years postoperatively, with no progression of MAC and no regurgitation by echocardiography. PMID:22678240

  5. Restoration of normal left ventricular geometry after percutaneous mitral annuloplasty: Case report and review of literature.

    PubMed

    Soofi, Muhammad Adil; Alsamadi, Faisal

    2015-08-01

    Surgical mitral valve intervention is not considered suitable in patients with severe functional mitral regurgitation due to severe dilated cardiomyopathy and severe systolic dysfunction. In such patients percutaneous mitral valve intervention is the next best alternative. We are presenting case report of a patient who presented with severe dyspnea progressing to orthopnea and paroxysmal nocturnal dyspnea. He was found to have severe functional mitral regurgitation and severe left ventricle systolic dysfunction. Surgical mitral intervention was not considered suitable and percutaneous mitral annuloplasty was done. At one month follow-up significant improvement in symptoms were noted with improvement in severity of mitral regurgitation severity. At 6 months follow-up further improvement in symptoms were noted along with significant improvement in the severity of mitral regurgitation and normalization of left ventricle geometry. At 1 year follow-up his symptoms further improved, left ventricle geometry remained normal and mitral regurgitation severity remained mild to moderate. Our case demonstrate that in patient with severe LV systolic dysfunction, severe mitral regurgitation and left bundle branch block percutaneous mitral annuloplasty can obviate the need for CRT-D due to significant improvement in LV function and geometry along with regression in severity of mitral regurgitation. Improvement in mitral regurgitation severity and LV geometry started early and kept improving with excellent result at 6 and 12 months. © 2014 Wiley Periodicals, Inc. PMID:25258184

  6. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy

    Microsoft Academic Search

    Steven F. Bolling; G. Michael Deeb; Louis A. Brunsting; David S. Bach

    1995-01-01

    Uncontrollable severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy, significantly contributing to heart failure in these patients, and predicts a poor survival. Although elimination of mitral valve regurgitation could be most beneficial in this group, corrective mitral valve surgery has not been routinely undertaken in these very ill patients because of the presumed prohibitive operative mortality. We studied

  7. Simplifying proximal isovelocity surface area as an assessment method of mitral valve area in patients with rheumatic mitral stenosis by fixing aliasing velocity and mitral valve angle

    PubMed Central

    Salem Omar, Alaa Mabrouk; Abdel-Rahman, Mohammed Ahmed; Tanaka, Hidekazu; Rifaie, Osama

    2012-01-01

    We aimed to test the ability of a simple equation using proximal isovelocity surface area method (PISA), created by fixing the angle to 100° and the aliasing velocity to 33 cm/s, to calculate mitral valve area (MVA) and assess severity in patients with rheumatic mitral stenosis (MS). Methods and results In a series of 51 consecutive patients with rheumatic MS, MVA was assessed by four methods, conventional PISA equation (PISAconventional), simple PISA equation (PISAsimple), pressure half time (PHT), and planimetry (PLN) which was taken as the reference method. All methods correlated significantly with PLN with the highest correlation found in case of PISAconventional and PISAsimple (r = 0.97, 0.96, p < 0.001), while the correlation in case PHT was relatively weaker (r = 0.69, p < 0.001). Bland–Altman analysis revealed that the level of agreement with PLN was better in case of both PISA methods than PHT and, moreover, were close to each other. The number of cases that showed agreement of severity grade with planinetry was better in case of PISAconventional (42 cases) and PISAsimple (44 cases) than that in case of PHT (34 cases, p = 0.037). Finally, the measure of agreement with Cohen’s Kappa test was better in case of PISAconventional and PISAsimple than that in case of PHT. Conclusion Provided that aliasing velocity is fixed at 33 cm/s, PISA can effectively predict mitral valve area and severity of MS by a simple equation, with the advantage of easy and accurate calculation over other methods. PMID:24174840

  8. Tricuspid regurgitation

    MedlinePLUS

    ... in the lungs Swelling of the right lower heart chamber ... Surgical valve repair or replacement usually provides a cure. The outlook is poor for people who have severe tricuspid regurgitation that cannot be corrected.

  9. Ischemic mitral valve prolapse: mechanisms and implications for valve repair

    Microsoft Academic Search

    Jérome Jouan; Michel Tapia; Richard C. Cook; Emmanuel Lansac; Christophe Acar

    2004-01-01

    Objective: The aim of this study was to assess the mechanisms of prolapse in ischemic mitral valve regurgitation (MR) and the techniques of valve repair. Methods: Out of 121 patients operated upon for ischemic MR, a prolapse was present in 44 patients (36.4%). The operation was performed emergently in four cases (9.1%) and electively in 40 patients (90.9%). Fifteen patients

  10. Calcified left atrial myxoma with floppy mitral valve

    Microsoft Academic Search

    G P Sharratt; M L Grover; J L Monro

    1979-01-01

    A heavily calcified left atrial myxoma in a man aged 53 was diagnosed from the plain chest x-ray film and confirmed by echocardiography. There was also moderate mitral regurgitation caused by a floppy mitral valve. Before a systemic embolus is considered to have arisen from a floppy mitral valve, echocardiography must be performed.

  11. Unique mitral valve mass: Think beyond vegetation.

    PubMed

    Farhoud, Mahmoud; Bakdash, Husam

    2014-10-01

    Osteosarcoma is a rare cardiac malignant tumor. This case of cardiac osteosarcoma presented with atrial fibrillation. Initial echocardiogram demonstrated mitral valve echodensity and mitral valve regurgitation. Surgery and histopathological examination identified the tumor as an osteosarcoma. Tumor grade appeared to be prognostically important in cardiac sarcoma, with poor prognosis in high-grade tumors. PMID:25298954

  12. Genetic mechanisms of mitral valve prolapse

    Microsoft Academic Search

    Susan A. Slaugenhaupt; Robert A. Levine; Albert A. Hagege; Xavier Jeunemaitre; Hervé Le Marec; Jean-Jacques Schott; Vincent Probst

    2008-01-01

    Mitral valve prolapse (MVP) is a common cardiac disorder that exhibits a strong hereditary component. Defined as billowing\\u000a of the mitral leaflets into the left atrium, it is the most common cause of isolated mitral regurgitation requiring surgical\\u000a repair, and it can lead to congestive heart failure, endocarditis, atrial arrhythmias, and an increased risk of stroke and\\u000a sudden death. Three-dimensional

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

    PubMed

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

    2014-06-01

    We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology. PMID:24904176

  14. Mitral and tricuspid valve surgery for Coffin-Lowry syndrome.

    PubMed

    Yoshida, Takeshi; Ohashi, Takeki; Furui, Masato; Kageyama, Souichirou; Kodani, Noriko; Kobayashi, Yutaka; Hirai, Yasutaka; Sakakura, Reo

    2015-05-01

    Coffin-Lowry syndrome is a rare X-linked disorder characterized by craniofacial and skeletal abnormalities, mental retardation, short stature, and hypotonia. An 18-year-old man with morphologic features characteristic of Coffin-Lowry syndrome was referred to our institution for valve disease surgery for worsening cardiac failure. Echocardiography showed severe mitral valve regurgitation associated with tricuspid valve regurgitation. Mitral valve implantation with a biological valve and tricuspid annular plication with a ring was performed. The ascending aorta was hypoplastic. Both the mitral papillary muscle originating near the mitral annulus and the chordae were shortened. The patient's postoperative course was uneventful and his cardiac failure improved. PMID:23873216

  15. Automatic detection of cardiac cycle and measurement of the mitral annulus diameter in 4D TEE images

    NASA Astrophysics Data System (ADS)

    Graser, Bastian; Hien, Maximilian; Rauch, Helmut; Meinzer, Hans-Peter; Heimann, Tobias

    2012-02-01

    Mitral regurgitation is a wide spread problem. For successful surgical treatment quantification of the mitral annulus, especially its diameter, is essential. Time resolved 3D transesophageal echocardiography (TEE) is suitable for this task. Yet, manual measurement in four dimensions is extremely time consuming, which confirms the need for automatic quantification methods. The method we propose is capable of automatically detecting the cardiac cycle (systole or diastole) for each time step and measuring the mitral annulus diameter. This is done using total variation noise filtering, the graph cut segmentation algorithm and morphological operators. An evaluation took place using expert measurements on 4D TEE data of 13 patients. The cardiac cycle was detected correctly on 78% of all images and the mitral annulus diameter was measured with an average error of 3.08 mm. Its full automatic processing makes the method easy to use in the clinical workflow and it provides the surgeon with helpful information.

  16. Short-term hemodynamic performance of the mitral Carpentier-Edwards PERIMOUNT pericardial valve. Carpentier-Edwards PERIMOUNT Investigators

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Morehead, A. J.; Thomas, J. D.; Smedira, N. G.; Cosgrove, D. M. 3rd; Marchand, M. A.

    2001-01-01

    BACKGROUND: Although long-term durability data exist, little data are available concerning the hemodynamic performance of the Carpentier-Edwards PERIMOUNT pericardial valve in the mitral position. METHODS: Sixty-nine patients who were implanted with mitral PERIMOUNT valves at seven international centers between January 1996 and February 1997 consented to participate in a short-term echocardiography follow-up. Echocardiographs were collected at a mean of 600+/-133 days after implantation (range, 110 to 889 days); all underwent blinded core lab analysis. RESULTS: At follow-up, peak gradients were 9.09+/-3.43 mm Hg (mean, 4.36+/-1.79 mm Hg) and varied inversely with valve size (p < 0.05). The effective orifice areas were 2.5+/-0.6 cm2 and tended to increase with valve size (p = 0.08). Trace mitral regurgitation (MR) was common (n = 48), 9 patients had mild MR, 1 had moderate MR, none had severe MR. All MR was central (n = 55) or indeterminate (n = 3). No paravalvular leaks were observed. Mitral regurgitation flow areas were 3.4+/-2.8 cm2 and were without significant volumes. CONCLUSIONS: In this multicenter study, these mitral valves are associated with trace, although physiologically insignificant, central MR. Despite known echocardiographic limitations, the PERIMOUNT mitral valves exhibit similar hemodynamics to other prosthetic valves.

  17. Mitral balloon valvuloplasty.

    PubMed

    Fawzy, Mohamed Eid

    2010-07-01

    Percutaneous mitral balloon valvuloplasty (MBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality (0-0.5%), cerebral accident (1-2%), mitral regurgitation (MR) requiring surgery (1.6-3%). These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV ranges from 4% to 70% depending on the patient selection, valve morphology, and duration of follow-up. Restenosis was encountered in 31% of the author's series at mean follow-up 9 ± 5.2 years (range 1.5-19 years) and the 10, 15, and 19 years restenosis-free survival rates were (78 ± 2%) (52 ± 3%) and (26 ± 4%), respectively, and were significantly higher for patients with favorable mitral morphology (MES ? 8) at 88 ± 2%, 67 ± 4% and 40 ± 6%), respectively (P < 0.0001). The 10, 15, and 19 years event-free survival rates were (88 ± 2%, 60 ± 4% and 28 ± 7%, respectively, and were significantly higher for patients with favorable mitral morphology (92 ± 2%, 70 ± 4% and 42 ± 7%, respectively (P < 0.0001). The effect of MBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size, and atrial fibrillation are addressed in this review. In addition, the application of MBV in specific clinical situations such as in children, during pregnancy and for restenosis is discussed. PMID:23960605

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

    PubMed Central

    Roshanali, Farideh; Vedadian, Ali; Shoar, Saeed; Sandoughdaran, Saleh; Naderan, Mohammad; Mandegar, Mohammad Hossein

    2012-01-01

    Objective Considering the importance of annular dynamics in the valvular and ventricular function, we sought to evaluate the effects of treated pericardial annuloplasty rings on mitral annular dynamics and left-ventricular (LV) function after mitral valve repair. The results were compared with the mitral annular dynamics and LV function in patients with rigid and flexible rings and also in those without any heart problems. Materials and Methods One hundred and thirty-six consecutive patients with a myxomatous mitral valve and severe regurgitation were prospectively enrolled in this observational cohort study. The patients underwent comparable surgical mitral valve reconstruction; of these 100 received autologous pericardium rings (Group I), 20 were given flexible prosthetic rings (Group II), and 16 received rigid rings (Group III). Other repair modalities were also performed, depending on the involved segments. The patients were compared with 100 normal subjects in whom an evaluation of the coronary artery was not indicative of valvular or myocardial abnormalities (Group IV). At follow-up, LV systolic indices were assessed via two-dimensional echocardiography at rest and during dobutamine stress echocardiography. Mitral annular motion was examined through mitral annulus systolic excursion (MASE). Peak transmitral flow velocities (TMFV) and mitral valve area (MVA) were also evaluated by means of continuous-wave Doppler. Results A postoperative echocardiographic study showed significant mitral regurgitation (>=2+) in one patient in Group I, one patient in Group II, and none in Group III. None of the patients died. There was a noteworthy increase in TMFV with stress in all the groups, the increase being more considerable in the prosthetic ring groups (Group I from 1.10 ± 0.08 to 1.36 ± 0.13 m/s, Group II from 1.30 ± 0.11 to 1.59 ± 0.19 m/s, Group III from 1.33 ± 0.09 to 1.69 ± 0.21 m/s, and Group IV from 1.08 ± 0.08 to 1.21 ± 0.12 m/s). Recruitment of LVEF reserve during stress was observed in the pericardial ring and normal groups (Group I from 54.6±6.2 to 64.6±7.3%, P<0.005; and Group IV from 55.3 ± 5.7 to 66 ± 6.2%, P<0.05), but no significant changes were detected in the prosthetic ring groups (Group II from 50.4 ± 5 to 55.0 ± 5.1, and Group III from 51.1 ± 6.6 to 53.8 ± 4.7). There was a significant MASE increase in both of the studied longitudinal segments at rest and during stress in Groups I and IV compared with the prosthetic ring groups. There was no calcification of the pericardial rings. Conclusions The use of treated autologous pericardium rings for mitral valve annuloplasty yields excellent mitral annular dynamics, preserves LV function during stress conditions, and leaves no echocardiographic signs of degeneration. PMID:24757605

  19. Clinical, echocardiographic, and biomechanical differences in mitral valve prolapse affecting one or both leaflets

    Microsoft Academic Search

    William R Mills; J. Edward Barber; Jeffery A Skiles; Norman B Ratliff; Delos M Cosgrove; Ivan Vesely; Brian P Griffin

    2002-01-01

    Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation necessitating surgical correction. Unileaflet prolapse (ULP), usually involving the posterior leaflet, is more common than bileaflet prolapse (BLP), which is more difficult to repair. Little is known about clinical, echocardiographic, and biomechanical differences between ULP and BLP. In this study, biomechanical testing was performed on mitral valve

  20. Minimally invasive concomitant aortic and mitral valve surgery: the “Miami Method

    PubMed Central

    2015-01-01

    Valve surgery via a median sternotomy has historically been the standard of care, but in the past decade various minimally invasive approaches have gained increasing acceptance. Most data available on minimally invasive valve surgery has generally involved single valve surgery. Therefore, robust data addressing surgical techniques in patients undergoing double valve surgery is lacking. For patients undergoing combined aortic and mitral valve surgery, a minimally invasive approach, performed via a right lateral thoracotomy (the “Miami Method”), is the preferred method at our institution. This method is safe and effective and leads to an enhanced recovery in our patients given the reduction in surgical trauma. The following perspective details our surgical approach, concepts and results for combined aortic and mitral valve surgery. PMID:25694974

  1. Mitral valve prolapse and occult aortic coarctation.

    PubMed Central

    Ludman, P.; Yacoub, M.; Dancy, M.

    1990-01-01

    A 22 year old man developed symptoms of left ventricular failure secondary to atrial fibrillation and congenital mitral regurgitation. After operation for mitral valve repair he was unable to be successfully weaned from cardiopulmonary bypass and this was ascribed to poor left ventricular function. He therefore underwent emergency cardiac transplantation but again was unable to be weaned from bypass. At post-mortem examination a previously undiagnosed aortic coarctation was revealed. The presentation of occult aortic coarctation is discussed, and its association with congenital mitral valve abnormalities reviewed. Images Figure 2 PMID:2099423

  2. Functional tricuspid regurgitation: an underestimated issue.

    PubMed

    Di Mauro, Michele; Bezante, Gian Paolo; Di Baldassarre, Angela; Clemente, Daniela; Cardinali, Alfredo; Acitelli, Angelo; Salerni, Sara; Penco, Maria; Calafiore, Antonio M; Gallina, Sabina

    2013-09-30

    This review article focuses on functional tricuspid regurgitation (FTR) that has long been a neglected and underestimated entity. FTR is defined as leakage of the tricuspid valve during systole in the presence of structurally normal leaflets and chordae. FTR may be secondary to several heart diseases, more commonly mitral valve disease, pulmonary hypertension, atrial fibrillation, cardiomyopathies, right ventricular dysplasia, and idiopathic annular dilatation. The reported prevalence of moderate or greater FTR is roughly 16%, but it rises up to 89% when considering FTR of any grade. According to the recommendations of the European Association of Echocardiography, two-dimensional transthoracic echocardiography (TTE) is the first-line imaging modality for the assessment of valvular regurgitation, whereas three-dimensional TTE may provide additional information in patients with complex valve lesions. Transesophageal echocardiography may be used when TTE results are inconclusive. The natural history of FTR is unfavorable, even in less than severe tricuspid regurgitation. Data from the literature suggest that moderate or greater FTR is a risk factor for worse survival. In addition, FTR of any grade may worsen over time, which makes it reasonable to consider the correction of FTR at an early stage, preferably at the time of mitral valve surgery. Tricuspid valve annuloplasty is the gold standard surgical treatment for FTR and is associated with a recurrence rate, defined as postoperative moderate or severe FTR, ranging from 2.5 to 5.5% at 1-year follow-up. PMID:23647591

  3. Mechanics of the mitral valve

    PubMed Central

    Rausch, Manuel K.; Famaey, Nele; Shultz, Tyler O’Brien; Bothe, Wolfgang; Miller, D. Craig

    2013-01-01

    Alterations in mitral valve mechanics are classical indicators of valvular heart disease, such as mitral valve prolapse, mitral regurgitation, and mitral stenosis. Computational modeling is a powerful technique to quantify these alterations, to explore mitral valve physiology and pathology, and to classify the impact of novel treatment strategies. The selection of the appropriate constitutive model and the choice of its material parameters are paramount to the success of these models. However, the in vivo parameters values for these models are unknown. Here we identify the in vivo material parameters for three common hyperelastic models for mitral valve tissue, an isotropic one and two anisotropic ones, using an inverse finite element approach. We demonstrate that the two anisotropic models provide an excellent fit to the in vivo data, with local displacement errors in the sub-millimeter range. In a complementary sensitivity analysis, we show that the identified parameter values are highly sensitive to prestrain, with some parameters varying up to four orders of magnitude. For the coupled anisotropic model, the stiffness varied from 119,021kPa at 0% prestrain via 36kPa at 30% prestrain to 9kPa at 60% prestrain. These results may, at least in part, explain the discrepancy between previously reported ex vivo and in vivo measurements of mitral leaflet stiffness. We believe that our study provides valuable guidelines for modeling mitral valve mechanics, selecting appropriate constitutive models, and choosing physiologically meaningful parameter values. Future studies will be necessary to experimentally and computationally investigate prestrain, to verify its existence, to quantify its magnitude, and to clarify its role in mitral valve mechanics. PMID:23263365

  4. Redo mitral valve replacement using the valve-on-valve method.

    PubMed

    Miyairi, Satoshi; Koide, Masaaki; Kunii, Yoshifumi; Tsuda, Kazumasa; Ohashi, Yuko; Harada, Takashi

    2015-07-01

    Despite improvements in bioprosthetic valve function, increased human life-expectancy has led to a growing number of bioprosthetic valve deterioration cases requiring reoperation. We report 2 cases of primary tissue failure of a bioprosthetic valve, which were treated by mitral valve replacement using the valve-on-valve method. The reasons for the reoperations were a severely calcified valve annulus, and severe adhesion of a previous bioprosthetic valve. We removed only the leaflets of the bioprosthetic valve and sutured a Carbomedics OptiForm valve onto the sewing cuff of the previous bioprosthesis. No complications, including major cardiac events, were noted during the follow-up. PMID:24585313

  5. Minimally invasive mitral valve surgery: the subxiphoid approach

    Microsoft Academic Search

    Haldun Y Karagoz; Kemal Bayazit; Bektas Battaloglu; Murat Kurtoglu; Gökhan Özerdem; Beyhan Bakkaloglu; Beril Sönmez

    1999-01-01

    Background. This report describes mitral valve replacement using a unique subxiphoid approach with a lower ministernotomy and a skin crease incision and compares the operative and echocardiographic results to patients undergoing mitral valve replacements using previously described strategies.Methods. Fifty-four patients underwent mitral valve replacement using a subxiphoid approach (group 1); 32 patients underwent mitral valve replacement, 11 patients underwent mitral

  6. Esophagopharyngeal acid regurgitation: Dual pH monitoring criteria for its detection and insights into mechanisms

    Microsoft Academic Search

    Rohan B. H. Williams; Galib N. Ali; Karen L. Wallace; Jeremy S. Wilson; David J. de Carle; Ian J. Cook

    1999-01-01

    Background & Aims: A valid technique for the detection of esophagopharyngeal acid regurgitation would be valuable to evaluate suspected reflux-related otolaryngologic and respiratory disorders. The aim of this study was to derive pH criteria that optimally define esophagopharyngeal acid regurgitation and to examine patterns of regurgitation. Methods: In 19 healthy controls and 15 patients with suspected regurgitation, dual or quadruple

  7. Effect of lesional differences in prolapsed leaflets on clinical outcomes in patients with mitral valve prolapse

    PubMed Central

    Suzuki, Keiko; Murata, Mitsushige; Yasuda, Risako; Tsuruta, Hikaru; Tomotsugu, Naoki; Abe, Takayuki; Iwanaga, Shiro; Akaishi, Makoto; Fukuda, Keiichi

    2012-01-01

    Background Mitral valve prolapse (MVP) is usually benign, although serious complications may occur. It remains unclear whether the region of prolapsed mitral leaflets might affect prognosis. The aim of this study was to investigate lesional differences of clinical courses of MVP. Methods and Results We retrospectively investigated 128 MVP patients who had been followed up for for a mean of 56.4 months. They were classified into prolapse of the anterior mitral leaflet (AML, n = 59), posterior mitral leaflet (PML, n = 47), or both leaflets (AML & PML, n = 22). Echocardiographic and clinical data were examined from medical records. Average time to clinical events; MV surgery, new onset of atrial fibrillation (AF), echocardiographic evidence of new chordal rupture, and worsening of mitral regurgitation severity were all significantly shorter in PML prolapse than in those with AML or AML & PML prolapses. Increases in the left ventricular dimensions and estimated pulmonary arterial systolic pressures were significantly larger in PML prolapse, compared with AML or AML & PML prolapses. A subanalysis of PML prolapse revealed that new chordal rupture tended to be more frequent in middle scallop prolapse (48%) compared with lateral and medial scallops (18%). In contrast, new onset of AF tended to occur in lateral and medial scallop prolapses (44%) compared with middle scallop prolapse (20%). Conclusions PML prolapse patients had a poor outcome, compared with AML or AML & PML prolapse patietns. Precise regional evaluation of the prolapsed leaflets may predict cardiac complications in MVP. PMID:22937485

  8. Novel mitral clipping technique overcoming extreme atrial dilatation.

    PubMed

    Tiroch, Klaus; Vorpahl, Marc; Seyfarth, Melchior

    2014-10-01

    The mitral clipping technique is emerging as a promising new treatment option for severe mitral regurgitation. The device was designed and assessed in intermediate risk populations, which is in contrast to the real world, where most patients are deemed to be at very high risk for open heart surgery. The cardiac anatomy of these patients often challenges the freedom grades of the current mitral clip device. In this case presentation, we describe a novel technique overcoming extreme atrial dilation in a patient with severe mitral regurgitation despite previous implantation of two mitral clips. Based on a low/anterior trans-septal puncture, this procedure relied on a counter clock-wise 90° turn of the steerable sheath and alignment of the clip delivery system to the mitral valve, thereby gaining additional longitudinal freedom. This resulted in the successful implantation of two additional clips with achievement of a mild to moderate mitral regurgitation without relevant gradient and dramatic and sustained clinical improvement of the patient. PMID:24167092

  9. Review of mitral valve insufficiency: repair or replacement

    PubMed Central

    Madesis, Athanasios; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Kougioumtzi, Ioanna; Kesisis, George; Tsiouda, Theodora; Beleveslis, Thomas; Koletas, Alexander; Zarogoulidis, Konstantinos

    2014-01-01

    Mitral valve (MV) dysfunction is the second-most common clinically significant form of valvular defect in adults. MV regurgitation occurs with the increasing frequency of degenerative changes of the aging process. Moreover, other causes of clinically significant MV regurgitation include cardiac ischemia, infective endocarditis and rhematic disease more frequently in less developed countries. Recent evidence suggests that the best outcomes after repair of severe degenerative mitral regurgitation (MR) are achieved in asymptomatic or minimally symptomatic patients, who are selected for surgery soon after diagnosis on the basis of echocardiography. This review will focus on the surgical management of mitral insufficiency according to its aetiology today and will give insight to some of the perspectives that lay in the future. PMID:24672698

  10. Review of mitral valve insufficiency: repair or replacement.

    PubMed

    Madesis, Athanasios; Tsakiridis, Kosmas; Zarogoulidis, Paul; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Kougioumtzi, Ioanna; Kesisis, George; Tsiouda, Theodora; Beleveslis, Thomas; Koletas, Alexander; Zarogoulidis, Konstantinos

    2014-03-01

    Mitral valve (MV) dysfunction is the second-most common clinically significant form of valvular defect in adults. MV regurgitation occurs with the increasing frequency of degenerative changes of the aging process. Moreover, other causes of clinically significant MV regurgitation include cardiac ischemia, infective endocarditis and rhematic disease more frequently in less developed countries. Recent evidence suggests that the best outcomes after repair of severe degenerative mitral regurgitation (MR) are achieved in asymptomatic or minimally symptomatic patients, who are selected for surgery soon after diagnosis on the basis of echocardiography. This review will focus on the surgical management of mitral insufficiency according to its aetiology today and will give insight to some of the perspectives that lay in the future. PMID:24672698

  11. Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications

    Microsoft Academic Search

    Eugene A. Grossi; Judith D. Goldberg; Angelo LaPietra; Xiang Ye; Peter Zakow; Martin Sussman; Julie Delianides; Alfred T. Culliford; Rick A. Esposito; Greg H. Ribakove; Aubrey C. Galloway; Stephen B. Colvin

    2001-01-01

    Objective: This study reviews the 223 consecutive mitral valve operations for ischemic mitral insufficiency performed at New York University Medical Center between January 1976 and January 1996. The results for mitral valve reconstruction are compared with those for prosthetic mitral valve replacement. Methods: From January 1976 to January 1996, 223 patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n

  12. Vanishing De Vega annuloplasty for functional tricuspid regurgitation.

    PubMed

    Duran, C M; Kumar, N; Prabhakar, G; Ge, Z; Bianchi, S; Gometza, B

    1993-10-01

    Annuloplasty is performed for significant functional tricuspid regurgitation even if it is presumed that in some cases the regurgitation will regress spontaneously after correction of the left-sided lesion. In an attempt to avoid the drawbacks of a permanent annuloplasty, we used a reabsorbable De Vega annuloplasty in a selected group of patients. Of 73 patients with functional tricuspid regurgitation operated on between May 1989 and May 1991, 25 with pulmonary arteriolar resistance below 400 dyne.sec.cm-5 underwent a De Vega annuloplasty with 2-0 polydioxanone suture. The diagnosis of significant functional tricuspid regurgitation (mean 2.74 +/- 1.05) was established by transthoracic color Doppler echocardiography in all patients. The degree of functional tricuspid regurgitation and pulmonary arteriolar resistance were measured with the patients anesthetized. In 16 patients the regurgitation remained severe (3+ to 4+) and in 9 it was moderate (2+). Twenty-three patients had mitral (12 repairs, 11 replacements) and 9 had aortic (4 repairs, 5 replacements) valve operations. The immediate postbypass residual functional tricuspid regurgitation was 0 to 1+ in 23 and 0 in 2. There was 1 (4%) operative death. The maximum follow-up period was 24 months (mean 13.9 months). There were 2 (8.3%) late deaths. Six patients underwent reoperation because of mitral dysfunction. Four of them who were reoperated on between 2 and 5 weeks after the initial procedure showed no recurrence of functional tricuspid regurgitation. The other 2, reoperated on at 5 and 10 months after the first operation, had recurrence of functional tricuspid regurgitation. Visual inspection of these two tricuspid valves showed a dilated anulus with otherwise normal valves. All surviving patients are in New York Heart Association functional class I or II without significant functional tricuspid regurgitation (mean 0.78 +/- 0.56). We concluded that functional tricuspid regurgitation in patients with low pulmonary arteriolar resistance can be adequately treated by a vanishing De Vega annuloplasty, which will stent the tricuspid anulus for about 4 months. PMID:8412253

  13. Concomitant tricuspid valve repair in patients with minimally invasive mitral valve surgery

    PubMed Central

    Pfannmüller, Bettina; Davierwala, Piroze; Hirnle, Gregor; Borger, Michael A.; Misfeld, Martin; Garbade, Jens; Seeburger, Joerg; Mohr, Friedrich W.

    2013-01-01

    Background The aim of this study was to investigate the 10-year Leipzig experience with minimally invasive mitral valve (MIMV) surgery in combination with tricuspid valve (TV) surgery. Methods Between January 2002 and December 2011, a total of 441 patients with mitral valve (MV) dysfunction and concomitant TV regurgitation (TR) underwent MIMV surgery at the Leipzig Heart Center. The mean age was 68.7±10.0 years, mean LVEF was 56.7%±13.1% and 184 patients (41.7%) were male. The Average logEuroSCORE was 8.3%±7.2%, and patients had an average follow-up of 3.4±2.4 years. Results Pre-discharge echocardiography showed no or mild mitral regurgitation (MR) in 95.1% and no or mild TR in 84.1%. Overall 30-day mortality was 4.3% with nineteen deaths. Five-year survival was 77.2%±2.5%. Five-year freedom from TV-related reoperation was 91.0%±1.8%. Conclusions Our 10-year experience show that MIMV surgery in combination with TV surgery can be performed routinely with good peri- and post-operative results. Our observations support current recommendations to perform concomitant TV repair, particularly if tricuspid annular dilation is present. PMID:24349978

  14. Colour flow Doppler mapping in the assessment of prosthetic valve regurgitation

    Microsoft Academic Search

    J Chambers; M Monaghan; G Jackson

    1989-01-01

    Two hundred Carpentier-Edwards, Björk-Shiley, and Starr-Edwards prostheses in 173 patients were examined. Sixteen (16%) in the aortic and 24 (25%) in the mitral position were associated with clinical signs of regurgitation. A phased array system (Hewlett-Packard A77020A) with a 2.5 MHz duplex and 1.9 MHz continuous wave transducer was used. Colour flow mapping showed trivial transvalvar regurgitation in 23 (53%)

  15. Perioperative management of a patient with Chagas disease having mitral valve surgery.

    PubMed

    Leckie, Robert S; Leckie, Steven; Mahmood, Feroze

    2009-06-01

    A patient with advanced Chagas disease presented with symptoms attributable to dilated cardiomyopathy and mitral regurgitation. Although esophageal involvement is part of the constellation of findings in Chagas, transesophageal echocardiography was safely used to guide the mitral valve surgery. PMID:19502028

  16. New Locus for Autosomal Dominant Mitral Valve Prolapse on Chromosome 13 Clinical Insights From Genetic Studies

    Microsoft Academic Search

    Francesca Nesta; Maire Leyne; Chaim Yosefy; Charles Simpson; Daisy Dai; Jane E. Marshall; Judy Hung; Susan A. Slaugenhaupt; Robert A. Levine

    2010-01-01

    Background—Mitral valve prolapse (MVP) is a common disorder associated with mitral regurgitation, endocarditis, heart failure, and sudden death. To date, 2 MVP loci have been described, but the defective genes have yet to be discovered. In the present study, we analyzed a large family segregating MVP, and identified a new locus, MMVP3. This study and others have enabled us to

  17. Percutaneous mitral heart valve repair--MitraClip.

    PubMed

    Doshi, Jay V; Agrawal, Sahil; Garg, Jalaj; Paudel, Rajiv; Palaniswamy, Chandrasekar; Doshi, Tina V; Gotsis, William; Frishman, William H

    2014-01-01

    Mitral regurgitation (MR) is the most common cardiac valvular disease in the United States. Approximately 4 million people have severe MR and roughly 250,000 new diagnoses of MR are made each year. Mitral valve surgery is the only treatment that prevents progression of heart failure and provides sustained symptomatic relief. Mitral valve repair is preferred over replacement for the treatment of MR because of freedom from anticoagulation, reduced long-term morbidity, reduced perioperative mortality, improved survival, and better preservation of left ventricular function compared with valve replacement. A large proportion of patients in need of valve repair or replacement do not undergo such procedures because of a perceived unacceptable perioperative risk. Percutaneous catheter-based methods for valvular pathology that parallel surgical principles for valve repair have been developed over the last few years and have been proposed as an alternate measure in high-risk patients. The MitraClip (Abbott Labs) device is one such therapy and is the subject of this review. PMID:25098200

  18. Mitral valve function following ischemic cardiomyopathy: a biomechanical perspective

    PubMed Central

    Rim, Yonghoon; McPherson, David D.; Kim, Hyunggun

    2014-01-01

    Ischemic mitral valve (MV) is a common complication of pathologic remodeling of the left ventricle due to acute and chronic coronary artery diseases. It frequently represents the pathologic consequences of increased tethering forces and reduced coaptation of the MV leaflets. Ischemic MV function has been investigated from a biomechanical perspective using finite element-based computational MV evaluation techniques. A virtual 3D MV model was created utilizing 3D echocardiographic data in a patient with normal MV. Two types of ischemic MVs containing asymmetric medial-dominant or symmetric leaflet tenting were modeled by altering the configuration of the normal papillary muscle (PM) locations. Computational simulations of MV function were performed using dynamic finite element methods, and biomechanical information across the MV apparatus was evaluated. The ischemic MV with medial-dominant leaflet tenting demonstrated distinct large stress distributions in the posteromedial commissural region due to the medial PM displacement toward the apical-medial direction resulting in a lack of leaflet coaptation. In the ischemic MV with balanced leaflet tenting, mitral incompetency with incomplete leaflet coaptation was clearly identified all around the paracommissural regions. This computational MV evaluation strategy has the potential for improving diagnosis of ischemic mitral regurgitation and treatment of ischemic MVs. PMID:24211876

  19. Problem: Heart Valve Regurgitation

    MedlinePLUS

    ... Blood Pressure Tools & Resources Stroke More Problem: Heart Valve Regurgitation Updated:Apr 24,2015 What is valve ... was last reviewed on 02/18/13. Heart Valve Problems and Disease • Home • About Heart Valves • Heart ...

  20. Mitral Valve Prolapse

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Is Mitral Valve Prolapse? Mitral (MI-tral) valve prolapse (MVP) is a ... blood and how your heart's electrical system works. Mitral Valve Prolapse In MVP, when the left ventricle contracts, one ...

  1. Mitral Valve Mechanics Following Posterior Leaflet Patch Augmentation

    PubMed Central

    Rahmani, Azadeh; Rasmussen, Ann Q.; Honge, Jesper L.; Ostli, Bjorn; Levine, Robert A.; Hagège, Albert; Nygaard, Hans; Nielsen, Sten L.; Jensen, Morten O.

    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 on the chordae tendineae. Data were acquired before and after 12 mm posterior and 5 mm apical posterior papillary muscle displacement to simulate the effect from one of the main contributors of FIMR, before and after patch augmentation. Results The effect of displacing the posterior papillary muscle induced tethering on the intermediate chordae tendineae to the posterior leaflet, and resulted in a 39.8% force increase (p = 0.014). Posterior leaflet patch augmentation of the FIMR valve induced a 31.1% force decrease (p = 0.007). There was no difference in force between the healthy and the repaired valve simulations (p = 0.773). Conclusion Posterior leaflet patch augmentation significantly reduced the forces exerted on the intermediate chordae tendineae from the posterior papillary muscle following FIMR simulation. As changes in chordal tension lead to a redistribution of the total stress exerted on the valve, patch augmentation may have an adverse long-term influence on mitral valve function and remodeling. PMID:23610985

  2. Sex Differences in the Morphology and Outcomes of Mitral Valve Prolapse: A Cohort study

    PubMed Central

    Avierinos, Jean-François; Inamo, Jocelyn; Grigioni, Francesco; Gersh, Bernard; Shub, Clarence; Enriquez-Sarano, Maurice

    2010-01-01

    Background Mitral valve prolapse is more common in women than in men, but men more often have surgery for severe regurgitation. Objective To compare morphology and outcomes of mitral prolapse in men and women Design Retrospective cohort study Setting Mayo Clinic Patients 4461 women and 3768 men diagnosed with mitral valve prolapse on echocardiogram 1989–98 (896 Olmsted County residents and 7,333 referred patients) Measurements Mitral prolapse characteristics (localization, leaflet thickening or flail, regurgitation), ventricular and atrial characteristics, cardiac surgery and mortality. Results Compared to men, women had less posterior prolapse (22% vs. 31%); less flail (2% vs. 8%); more leaflet thickening (32% vs. 28%), and less frequent severe regurgitation (10% vs. 23%; all p<0.001). At each level of regurgitation, left ventricular and atrial diameters were smaller in women than in men but were larger after normalization to body-surface-area in women than in men. Among patients with severe regurgitation women were less likely than men to undergo cardiac valve surgery (52% vs.60%, adjusted RR 0.79[0.74–0.84]). At 15-years, women with no/mild mitral regurgitation had better survival than men (87% vs. 77%, adjusted RR 0.82[0.76–0.89]) but those with severe regurgitation had worse survival than men (60% vs. 68%, adjusted RR 1.13[1.01–1.26]). Survival 10-years after surgery was similar in women and men (77% vs. 79%, p=0.14). Our observations were similar in Olmsted County and referred patients. Limitations Diagnosis based on echocardiogram, absence of clinical data at previous initial diagnosis, reason for index echocardiogram and cause of death. Conclusion There are sex differences in the morphology and severity of mitral valve prolapse. Among patients with severe regurgitation, women have higher mortality and lower surgery rates than men. PMID:19047025

  3. Evaluation of left ventricular systolic function in young adults with mitral valve prolapse

    PubMed Central

    Malev, Eduard; Zemtsovsky, Eduard; Pshepiy, Asiyet; Timofeev, Eugeny; Reeva, Svetlana; Prokudina, Maria

    2012-01-01

    OBJECTIVE: To evaluate left ventricular function in young adults with mitral valve prolapse (MVP) without significant mitral regurgitation using two-dimensional strain imaging. METHODS AND RESULTS: A total of 58 asymptomatic young subjects (mean [± SD] age 19.7±1.6 years; 72% male) with MVP were compared with 60 sex- and age-matched healthy subjects. MVP was diagnosed by billowing one or both mitral leaflets >2 mm above the mitral annulus in the long-axis parasternal view. Longitudinal, radial and circumferential strain and strain rate were determined using speckle tracking with a grey-scale frame rate of 50 fps to 85 fps. There were no significant differences in the global systolic left ventricular function of the subjects with MVP compared with the control group. In the MVP group, most of the global myocardial systolic deformation indexes were not reduced. Only the global circumferential strain showed a decrease in the prolapse subjects. Regional, longitudinal, circumferential and radial strain and strain rate were decreased only in septal segments. A decrease in the rotation of the same septal segments at the basal level was also observed. CONCLUSION: Regional septal myocardial deformation indexes decrease in subjects with MVP. These changes may be the first sign indicating the deterioration of left ventricular systolic function as well as the existence of primary cardiomyopathy in asymptomatic young subjects with MVP. PMID:23592928

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

    PubMed Central

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

    2013-01-01

    OBJECTIVES Papillary muscle rupture (PMR) is a rare, but serious mechanical complication of myocardial infarction (MI). Although mitral valve replacement is usually the preferred treatment for this condition, mitral valve repair may offer an improved outcome. In this study, we sought to determine the outcome of mitral valve repair for post-MI PMR and to provide a systematic review of the literature on this topic. METHODS Between January 1990 and December 2010, 9 consecutive patients (mean age 63.5 ± 14.2 years) underwent mitral valve repair for partial post-MI PMR. Clinical data, echocardiographic data, catheterization data and surgical reports were reviewed. Follow-up was obtained in December of 2012 and it was complete; the mean follow-up was 8.7 ± 6.1 (range 0.2–18.8 years). RESULTS Intraoperative and in-hospital mortality were 0%. Intraoperative repair failure rate was 11.1% (n = 1). Freedom from Grade 3+ or 4+ mitral regurgitation and from reoperation at 1, 5, 10 and 15 years was 87.5 ± 11.7%. Estimated 1-, 5-, 10- and 15-year survival rates were 100, 83.3 ± 15.2, 66.7 ± 19.2 and 44.4 ± 22.2%, respectively. There were 3 late deaths, and 2 were cardiac-related. All late survivors were in New York Heart Association Class I or II. No predictors of long-term survival could be identified. CONCLUSIONS Mitral valve repair for partial or incomplete post-MI PMR is reliable and provides good short- and long-term results, provided established repair techniques are used and adjacent tissue is not friable. PMR type and adjacent tissue quality ultimately determine the feasibility and durability of repair. PMID:23520228

  5. Delayed left atrial wall dissection after mitral valve replacement.

    PubMed

    Idir, M; Deville, C; Roudaut, R

    2000-04-01

    We report two unusual cases of left atrial wall dissection creating a left atrial pseudoaneurysm associated with regurgitation a few months after mitral valve replacement. We emphasize the important role of transesophageal echocardiography in the diagnosis. The two patients successfully underwent surgery. PMID:10978990

  6. An Atypical Mitral Valve Prolapse in a Patient With Behçet's Disease

    PubMed Central

    Yoon, Se-Jung; Choi, Eui-Young; Jung, Jae-Hun

    2011-01-01

    We report the case of a 42-year-old male who was admitted to the hospital with progressive dyspnea. Cardiomegaly and diffuse pulmonary edema were visible on chest X-ray and multiple oral and genital ulcers on physical examination. On admission, echocardiography revealed mitral valve prolapse (MVP) predominantly involving a basal portion of the posterior leaflet, with severe mitral regurgitation. A successful mitral valve replacement with St. Jude #29 was performed, after pre-treatment with prednisolone for 2 weeks. Fifteen months following the operation, the patient expired from severe pulmonary edema and secondary pneumonia. This case demonstrates, for the first time in the literature, an unusual feature of mitral prolapse in the basal portion with severe mitral regurgitation in a patient with Behçet's disease. As suggested by this case, we should consider an atypical type of MVP as a possible inflammatory involvement of the heart in patients with Behçet's disease. PMID:21607174

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

    PubMed

    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. PMID:24360740

  8. Ecocardiografía tridimensional. Nuevas perspectivas sobre la caracterización de la válvula mitral

    PubMed Central

    Solis, Jorge; Sitges, Marta; Levine, Robert A.; Hung, Judy

    2010-01-01

    Recent developments in three-dimensional echocardiography have made it possible to obtain images in real time, without the need for off-line reconstruction. These developments have enabled the technique to become an important tool for both research and daily clinical practice. A substantial proportion of the studies carried out using three-dimensional echocardiography have focused on the mitral valve, the pathophysiology of mitral valve disease and, in particular, functional mitral regurgitation. The aims of this article were to review the contribution of three-dimensional echocardiography to understanding of the functional anatomy of the mitral valve and to summarize the resulting clinical applications and therapeutic implications. PMID:19232192

  9. Emergent Presentation of Decompensated Mitral Valve Prolapse and Atrial Septal Defect

    PubMed Central

    Kang, Jessie; Das, Bijon

    2015-01-01

    Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death. PMID:25987923

  10. Emergent presentation of decompensated mitral valve prolapse and atrial septal defect.

    PubMed

    Kang, Jessie; Das, Bijon

    2015-05-01

    Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death. PMID:25987923

  11. Dynamic modelling of prosthetic chorded mitral valves using the immersed boundary method

    Microsoft Academic Search

    P. N. Watton; X. Y. Luo; X. Wang; G. M. Bernacca; P. Molloy; D. J. Wheatley

    2007-01-01

    Current artificial heart valves either have limited lifespan or require the recipient to be on permanent anticoagulation therapy. In this paper, effort is made to assess a newly developed bileaflet valve prosthesis made of synthetic flexible leaflet materials, whose geometry and material properties are based on those of the native mitral valve, with a view to providing superior options for

  12. Mitral Valve Prolapse

    MedlinePLUS

    Problem: Mitral Valve Prolapse Updated:Apr 24,2015 What is mitral valve prolapse (MVP)? Mitral valve prolapse is a condition in which the two valve ... mitral valve do not close smoothly or evenly. Mitral valve prolapse is also known as click-murmur syndrome, Barlow's ...

  13. Mitral valve prolapse

    MedlinePLUS

    Mitral valve prolapse is a heart problem involving the mitral valve, which separates the upper and lower chambers of ... from moving backwards when the heart beats (contracts). Mitral valve prolapse is the term used when the valve does ...

  14. Determination of correlation between backflow volume and mitral valve leaflet young modulus from two dimensional echocardiogram images

    NASA Astrophysics Data System (ADS)

    Jong, Rudiyanto P.; Osman, Kahar; Adib, M. Azrul Hisham M.

    2012-06-01

    Mitral valve prolapse without proper monitoring might lead to a severe mitral valve failure which eventually leads to a sudden death. Additional information on the mitral valve leaflet condition against the backflow volume would be an added advantage to the medical practitioner for their decision on the patients' treatment. A study on two dimensional echocardiography images has been conducted and the correlations between the backflow volume of the mitral regurgitation and mitral valve leaflet Young modulus have been obtained. Echocardiogram images were analyzed on the aspect of backflow volume percentage and mitral valve leaflet dimensions on different rates of backflow volume. Young modulus values for the mitral valve leaflet were obtained by using the principle of elastic deflection and deformation on the mitral valve leaflet. The results show that the backflow volume increased with the decrease of the mitral valve leaflet Young modulus which also indicate the condition of the mitral valve leaflet approaching failure at high backflow volumes. Mitral valve leaflet Young modulus values obtained in this study agreed with the healthy mitral valve leaflet Young modulus from the literature. This is an initial overview of the trend on the prediction of the behaviour between the fluid and the structure of the blood and the mitral valve which is extendable to a larger system of prediction on the mitral valve leaflet condition based on the available echocardiogram images.

  15. Repair of Posterior Mitral Valve Prolapse with a Novel Leaflet Plication Clip in an Animal Model

    PubMed Central

    Feins, Eric N.; Yamauchi, Haruo; Marx, Gerald R.; Freudenthal, Franz P.; Liu, Hua; del Nido, Pedro J.; Vasilyev, Nikolay V.

    2013-01-01

    Objective Recently there has been increased interest in minimally-invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A technique was developed for treating mitral valve prolapse that utilizes a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n=7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was applied under direct vision to the P2 segment to eliminate prolapse. Animals were survived for 2 hours. Epicardial echocardiography was obtained pre- and post-prolapse creation and 2 hours post-clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed pre- and post-clip placement. Results There were no cases of clip embolization. Median MR grade increased from “trivial” (0–1.5) to “moderate-severe” post-MR creation (2.5–4+) (P<0.05), and decreased to “mild” post-clip placement (0–3+) (P<0.05). Vena contracta area tended to increase post-chordae cutting and decrease post-clip placement: 0.08±0.10cm2 vs. 0.21±0.15cm2 vs. 0.16±0.16cm2 (P=0.21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51±0.07cm vs. 0.44±0.18cm (P=1.0). Conclusions The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without impacting leaflet mobility. This approach represents a simple technique that may improve the effectiveness of beating-heart and open-heart, minimally-invasive valve surgery. PMID:24210830

  16. Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting

    PubMed Central

    Tamburino, Corrado; Ussia, Gian Paolo; Maisano, Francesco; Capodanno, Davide; La Canna, Giovanni; Scandura, Salvatore; Colombo, Antonio; Giacomini, Andrea; Michev, Iassen; Mangiafico, Sarah; Cammalleri, Valeria; Barbanti, Marco; Alfieri, Ottavio

    2010-01-01

    Aims This study sought to evaluate the feasibility and early outcomes of a percutaneous edge-to-edge repair approach for mitral valve regurgitation with the MitraClip® system (Evalve, Inc., Menlo Park, CA, USA). Methods and results Patients were selected for the procedure based on the consensus of a multidisciplinary team. The primary efficacy endpoint was acute device success defined as clip placement with reduction of mitral regurgitation to ?2+. The primary acute safety endpoint was 30-day freedom from major adverse events, defined as the composite of death, myocardial infarction, non-elective cardiac surgery for adverse events, renal failure, transfusion of >2 units of blood, ventilation for >48 h, deep wound infection, septicaemia, and new onset of atrial fibrillation. Thirty-one patients (median age 71, male 81%) were treated between August 2008 and July 2009. Eighteen patients (58%) presented with functional disease and 13 patients (42%) presented with organic degenerative disease. A clip was successfully implanted in 19 patients (61%) and two clips in 12 patients (39%). The median device implantation time was 80 min. At 30 days, there was an intra-procedural cardiac tamponade and a non-cardiac death, resulting in a primary safety endpoint of 93.6% [95% confidence interval (CI) 77.2–98.9]. Acute device success was observed in 96.8% of patients (95% CI 81.5–99.8). Compared with baseline, left ventricular diameters, diastolic left ventricular volume, diastolic annular septal–lateral dimension, and mitral valve area significantly diminished at 30 days. Conclusion Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favourable short-term safety and efficacy results. PMID:20299349

  17. Postoperative mitral leaflet rupture in an infant with Loeys-Dietz syndrome.

    PubMed

    Nishida, Koichi; Tamura, Satoshi; Yamazaki, Sachiko; Sugita, Ryo; Yamagishi, Masaaki; Noriki, Sakon; Morisaki, Hiroko

    2014-12-01

    This report describes an infantile case of Loeys-Dietz syndrome (LDS) with spontaneous mitral leaflet rupture. The patient was diagnosed with a type B interruption of the aortic arch. Bilateral pulmonary artery banding was performed 5?days after birth. On the 53rd day, intra-cardiac repair was performed without valvuloplasty. Although the operation was successful, mitral regurgitation deteriorated at 4?weeks after operation. On the 88th day, a mitral valvuloplasty was performed and a severely ruptured anterior leaflet was observed. Seven?days after valvuloplasty, the mitral valve insufficiency again worsened and a fourth operation was performed. Two tears were observed in the anterior and posterior mitral valve leaflets, and a mitral valve replacement was required. Subsequently, the patient was diagnosed with LDS according to gene mutational status. LDS is known to have a poor prognosis with cardiovascular complications, but valve rupture has not been previously reported in other cases. PMID:25521989

  18. A Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair.

    PubMed

    Mahmood, Feroze; Matyal, Robina

    2015-07-01

    Intraoperative echocardiography of the mitral valve has evolved from a qualitative assessment of flow-dependent variables to quantitative geometric analyses before and after repair. In addition, 3-dimensional echocardiographic data now allow for a precise assessment of mitral valve apparatus. Complex structures, such as the mitral annulus, can be interrogated comprehensively without geometric assumptions. Quantitative analyses of mitral valve apparatus are particularly valuable for identifying indices of left ventricular and mitral remodeling to establish the chronicity and severity of mitral regurgitation. This can help identify patients who may be unsuitable candidates for repair as the result of irreversible remodeling of the mitral valve apparatus. Principles of geometric analyses also have been extended to the assessment of repaired mitral valves. Changes in mitral annular shape and size determine the stress exerted on the mitral leaflets and, therefore, the durability of repair. Given this context, echocardiographers may be expected to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success and failure of the repair procedure. As a result, anesthesiologists have progressed from being mere service providers to participants in the decision-making process. It is therefore prudent for them to acquaint themselves with the principles of intraoperative quantitative mitral valve analysis to assist in rational and objective decision making. PMID:26086507

  19. Mitral Valve Prolapse

    MedlinePLUS

    ... MVP, disease of the mitral valve What causes mitral valve prolapse? Mitral valve prolapse (MVP) is among the most common heart conditions, ... MedlinePlus www.nlm.nih.gov/medlineplus/mitralvalveprolapse.html Mitral Valve Prolapse PubMed Health www.ncbi.nlm.nih.gov/pubmedhealth/ ...

  20. Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

    PubMed Central

    Doolub, Gemina

    2015-01-01

    A 37-year-old male with known intravenous drug use was admitted with an acute onset of worsening confusion and speech impairment. His vitals and biochemical profile demonstrated severe sepsis, with a brain CT showing several lesions suspicious for cerebral emboli. He then went on to have a bedside transthoracic echocardiogram that was positive for vegetation on the mitral valve, with associated severe mitral regurgitation. Unfortunately, before he was stable enough to be transferred for valve surgery, he suffered an episode of acute pulmonary oedema requiring intubation and ventilation on intensive care unit. PMID:26120312

  1. Left atrial ultrastructure in mitral valvular disease.

    PubMed Central

    Thiedemann, K. U.; Ferrans, V. J.

    1977-01-01

    Light microscopic and ultrastructural observations were made on left atrial tissues obtained from 14 patients at the time of operation for correction of mitral valvular disease. Cardiac muscle cells varied in size but most frequently were hypertrophied. In fibrotic areas, present in all left atria, the muscle cells tended to be isolated from adjacent cells and exhibited degenerative changes of varying severity. These changes consisted or proliferation of Z-band material and cytoskeletal filaments, myofibrillar loss, proliferation of elements of free and extended junctional sarcoplasmic reticulum, variations in size and number of mitochondria, occurrence of abnormal mitochondria, dissociation of intercellular junctions, formation of spherical microparticles, and accumulation of lysosomal degradation products. Hypertrophy was considered to lead to cellular degeneration, with decrease or loss of contractile function. Atrial fibrillation was associated with severe cellular degeneration. The severity of degeneration was greater in patients with mitral regurgitation, with or without associated mitral stenosis, than in patients with pure mitral stenosis. Images Figure 17 Figure 18 Figure 19 Figure 1 Figure 2 Figure 3 Figure 20 Figure 21 Figure 4 Figure 5 Figure 6 Figure 7 Figure 22 Figure 23 Figure 24 Figure 8 Figure 9 Figure 10 Figure 25 Figure 26 Figure 27 Figure 28 Figure 11 Figure 12 Figures 29-30 Figure 13 Figure 14 Figures 15-16 PMID:145805

  2. Immersed boundary method and lattice Boltzmann method coupled FSI simulation of mitral leaflet flow

    Microsoft Academic Search

    Yongguang Cheng; Hui Zhang

    2010-01-01

    Coupling the immersed boundary (IB) method and the lattice Boltzmann (LB) method might be a promising approach to simulate fluid–structure interaction (FSI) problems with flexible structures and moving boundaries. To investigate the possibility for future IB–LB coupled simulations of the heart flow dynamics, an IB–LB coupling scheme suitable for rapid boundary motion and large pressure gradient FSI is proposed, and

  3. [Myocobacterium tuberculosis endomyocarditis. Apropos of a case in a patient with a mitral valve prosthesis].

    PubMed

    Palcoux, M C; Lamaison, D; Cassagnes, J; Ricoux, M; Lusson, J R; Courtadon, M; Richard, E; Jallut, H

    1982-11-01

    A case of lethal cardiac tuberculosis with myocardial and endocardial involvement is reported in a 46 year old man with a Starr-Edwards mitral valve prosthesis inserted two years previously for severe mitral regurgitation, secondary to ruptured chordae of the posterior mitral leaflet. Apart from tuberculous pericarditis, cardiac involvement is extremely rare; it occurs in "tuberculous septicemia" whose characteristic features--tuberculinic anergy, hematological abnormalities especially pancytopenia,--lead to delay in diagnosis, which is usually fatal. The case presented is an example. PMID:6818922

  4. Infective endocarditis associated with mitral valve prolapse in a patient with Klinefelter syndrome.

    PubMed

    Ueki, Yasushi; Izawa, Atsushi; Ebisawa, Souichiro; Motoki, Hirohiko; Miyashita, Yusuke; Tomita, Takeshi; Koyama, Jun; Takano, Tamaki; Amano, Jun; Ikeda, Uichi

    2014-01-01

    We herein report a case of infective endocarditis associated with mitral valve prolapse (MVP) in a 34-year-old man with Klinefelter syndrome. The patient was admitted with a fever and headache that had persisted for three weeks. Repeated blood cultures showed growth of Streptococcus oralis. Echocardiography demonstrated severe mitral regurgitation with a large vegetation attached to the prolapsed anterior leaflet. Surgical plasty of the mitral valve was performed because the vegetation measured over 10 mm in diameter and there was a risk of recurrence of embolic complications. This case demonstrates the link between MVP and Klinefelter syndrome and highlights the importance of performing cardiovascular screening and preventing endocarditis. PMID:24785888

  5. Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair

    Microsoft Academic Search

    R. De Simone; R. Lange; W. Saggau; E. Gams; A. Tanzeem; S. Hag; Universitgt Heidelberg

    The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardio- graphy (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from

  6. [Mitral valvuloplasty in a patient with congenital kyphoscoliosis: case report and literature review].

    PubMed

    Cipriani, Alberto; Mojoli, Marco; Tarantini, Giuseppe

    2015-04-01

    Percutaneous transluminal mitral commissurotomy (PTMC) is the procedure of choice for the treatment of severe mitral stenosis in symptomatic patients. In recent years, epidemiological changes among these patients are observed, since they more frequently are older, with several comorbidities and unfavorable mitral anatomy, all features that may contraindicate PTMC. Notwithstanding this, high rates of success and safety are achieved, following improvements in the learning curve and technique. We report the case of a 68-year-old Caucasian male, affected by chronic obstructive pulmonary disease and congenital kyphoscoliosis, admitted for acute pulmonary edema in severe mitral valve stenosis and moderate mitral regurgitation. PTMC was performed successfully, without any complications, using few simple tricks. PMID:25959762

  7. Pharmacologic Resolution of Functional Out flow Tract Obstruction after Mitral Valve Repair

    PubMed Central

    Benea, Diana C.; Cerin, Gheorghe; Diena, Marco; Tesler, Ugo F.

    2005-01-01

    A 74-year-old woman with mitral regurgitation secondary to ruptured chordae tendineae, complicated by a cleft in the posterior mitral leaflet and a severely calcified mitral annulus, underwent mitral valve repair by implantation of polytetrafluoroethylene chords and closure of the cleft, without the use of an annuloplasty ring. Immediately after the repair, severe left ventricular outflow tract obstruction developed secondary to the systolic anterior motion of the mitral valve. Echocardiography identified the cause as functional, in the presence of a hypertrophic left ventricle with no significant preoperative intraventricular dynamic gradient. The obstruction was severe enough to render impossible the weaning of the patient from cardiopulmonary bypass. This problem was reversed by the infusion of ?-blocking agents into the extracorporeal circuit. PMID:16429904

  8. Mitral Valve Prolapse

    MedlinePLUS

    Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of the ... Migraine headaches Chest discomfort Most people who have mitral valve prolapse (MVP) don't need treatment because they don' ...

  9. Mitral Valve Prolapse

    MedlinePLUS

    ... the 2 flaps of the mitral valve swing open to let blood flow from the atrium to the ventricle. The flaps normally open only one way and the blood only flows one way. What is mitral valve prolapse? If ...

  10. Mitral Valve Prolapse

    PubMed Central

    Rosser, Walter W.

    1992-01-01

    The author discusses the pathophysiology of mitral valve prolapse and provides guidelines to identify and treat low-to high-risk mitral valve prolapse. An approach to diagnosing bacterial endocarditis and its prophylaxis are also discussed. The author reviews mitral valve prolapse syndrome and the risk of sudden death.

  11. Mitral Valve Prolapse

    MedlinePLUS

    ... back into the left atrium. Continue What Is Mitral Valve Prolapse? In someone who has mitral valve prolapse (MVP), one or both of the valve's flaps ... most valuable player) even if you have MVP (mitral valve prolapse)! Reviewed by: Rupal Christine Gupta, MD Date reviewed: ...

  12. Transapical aortic valve and mitral valve in ring prosthesis implantation - a new advance in transcatheter procedures.

    PubMed

    Neves, Paulo C; Paulo, Nelson Santos; Gama, Vasco; Vouga, Luís

    2014-08-01

    Transcatheter valve implantation offers a new treatment modality to those patients whose general condition makes conventional surgery very risky. However, the transcatheter option has only been available for the aortic valve. We describe a case of a successful implantation of two Edwards SAPIEN(®) 26 and 29 mm transapical valves, respectively, in aortic and mitral positions, on a 74-year-old patient with severe aortic and mitral stenosis. The procedure progressed uneventfully. Predischarge echocardiogram showed a peak aortic gradient of 20 mmHg, mild periprosthetic regurgitation, peak and mean mitral gradients of 12 and 4, respectively, and moderate (II/IV) periprosthetic regurgitation. Indications for transapical valve implantation will rapidly increase in the near future. It is essential to individualize the treatment be applied for each patient, in order to optimize the success of the procedure. PMID:24786177

  13. Human Myxomatous Mitral Valve Prolapse: Role of Bone Morphogenetic Protein 4 in valvular interstitial cell activation

    PubMed Central

    Sainger, Rachana; Grau, Juan B.; Branchetti, Emanuela; Poggio, Paolo; Seefried, William F.; Field, Benjamin C.; Acker, Michael A.; Gorman, Robert C.; Gorman, Joseph H.; Hargrove, Clark W.; Bavaria, Joseph E.; Ferrari, Giovanni

    2011-01-01

    Myxomatous Mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in industrialized countries and a leading cause of mitral valve surgery for isolated mitral regurgitation. The key role of valvular interstitial cells (VICs) during mitral valve development and homeostasis has been recently suggested, however little is known about the molecular pathways leading to MVP. We aim to characterize Bone Morphogenetic Protein 4 (BMP4) as a cellular regulator of mitral valvular interstitial cell activation towards a pathologic synthetic phenotype and to analyze the cellular phenotypic changes and extracellular matrix (ECM) reorganization associated with the development of myxomatous mitral valve prolapse. Microarray analysis showed significant up regulation of BMP4-mediated signaling molecules in myxomatous MVP when compared to controls. Histological analysis and cellular characterization suggest that during myxomatous MVP development, healthy quiescent mitral VICs undergo a phenotypic activation via up regulation of BMP4-mediated pathway. In vitro hBMP4 treatment of isolated human mitral VICs mimics the cellular activation and ECM remodeling as seen in MVP tissues. The present study characterizes the cell biology of mitral VICs in physiological and pathological conditions and provides insights into the molecular and cellular mechanisms mediated by BMP4 during MVP. The ability to test and control the plasticity of VICs using different molecules may help in developing new diagnostic and therapeutic strategies for myxomatous MVP. PMID:22105615

  14. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

    PubMed Central

    Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Tavlasoglu, Murat; Ucar, Halil Ibrahim; Yorgancioglu, Cem

    2015-01-01

    Abstract Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.

  15. Schistosome feeding and regurgitation.

    PubMed

    Skelly, Patrick J; Da'dara, Akram A; Li, Xiao-Hong; Castro-Borges, William; Wilson, R Alan

    2014-08-01

    Schistosomes are parasitic flatworms that infect >200 million people worldwide, causing the chronic, debilitating disease schistosomiasis. Unusual among parasitic helminths, the long-lived adult worms, continuously bathed in blood, take up nutrients directly across the body surface and also by ingestion of blood into the gut. Recent proteomic analyses of the body surface revealed the presence of hydrolytic enzymes, solute, and ion transporters, thus emphasising its metabolic credentials. Furthermore, definition of the molecular mechanisms for the uptake of selected metabolites (glucose, certain amino acids, and water) establishes it as a vital site of nutrient acquisition. Nevertheless, the amount of blood ingested into the gut per day is considerable: for males ?100 nl; for the more actively feeding females ?900 nl, >4 times body volume. Ingested erythrocytes are lysed as they pass through the specialized esophagus, while leucocytes become tethered and disabled there. Proteomics and transcriptomics have revealed, in addition to gut proteases, an amino acid transporter in gut tissue and other hydrolases, ion, and lipid transporters in the lumen, implicating the gut as the site for acquisition of essential lipids and inorganic ions. The surface is the principal entry route for glucose, whereas the gut dominates amino acid acquisition, especially in females. Heme, a potentially toxic hemoglobin degradation product, accumulates in the gut and, since schistosomes lack an anus, must be expelled by the poorly understood process of regurgitation. Here we place the new observations on the proteome of body surface and gut, and the entry of different nutrient classes into schistosomes, into the context of older studies on worm composition and metabolism. We suggest that the balance between surface and gut in nutrition is determined by the constraints of solute diffusion imposed by differences in male and female worm morphology. Our conclusions have major implications for worm survival under immunological or pharmacological pressure. PMID:25121497

  16. Schistosome Feeding and Regurgitation

    PubMed Central

    Skelly, Patrick J.; Da'dara, Akram A.; Li, Xiao-Hong; Castro-Borges, William; Wilson, R. Alan

    2014-01-01

    Schistosomes are parasitic flatworms that infect >200 million people worldwide, causing the chronic, debilitating disease schistosomiasis. Unusual among parasitic helminths, the long-lived adult worms, continuously bathed in blood, take up nutrients directly across the body surface and also by ingestion of blood into the gut. Recent proteomic analyses of the body surface revealed the presence of hydrolytic enzymes, solute, and ion transporters, thus emphasising its metabolic credentials. Furthermore, definition of the molecular mechanisms for the uptake of selected metabolites (glucose, certain amino acids, and water) establishes it as a vital site of nutrient acquisition. Nevertheless, the amount of blood ingested into the gut per day is considerable: for males ?100 nl; for the more actively feeding females ?900 nl, >4 times body volume. Ingested erythrocytes are lysed as they pass through the specialized esophagus, while leucocytes become tethered and disabled there. Proteomics and transcriptomics have revealed, in addition to gut proteases, an amino acid transporter in gut tissue and other hydrolases, ion, and lipid transporters in the lumen, implicating the gut as the site for acquisition of essential lipids and inorganic ions. The surface is the principal entry route for glucose, whereas the gut dominates amino acid acquisition, especially in females. Heme, a potentially toxic hemoglobin degradation product, accumulates in the gut and, since schistosomes lack an anus, must be expelled by the poorly understood process of regurgitation. Here we place the new observations on the proteome of body surface and gut, and the entry of different nutrient classes into schistosomes, into the context of older studies on worm composition and metabolism. We suggest that the balance between surface and gut in nutrition is determined by the constraints of solute diffusion imposed by differences in male and female worm morphology. Our conclusions have major implications for worm survival under immunological or pharmacological pressure. PMID:25121497

  17. Mitral valve prolapse and mitral regurgitation are common in patients with polycystic kidney disease type 1

    Microsoft Academic Search

    Anne Lumiaho; Risto Ikäheimo; Raija Miettinen; Lea Niemitukia; Tomi Laitinen; Arto Rantala; Erkki Lampainen; Markku Laakso; Juha Hartikainen

    2001-01-01

    Patients with autosomal dominant polycystic kidney disease (ADPKD) have an increased occurrence of cardiac valve abnormalities. However, the prevalence of cardiac abnormalities in patients with a uniform genotype of ADPKD has not been previously reported. We performed M-mode and color Doppler echocardiography on 109 patients from 16 families with polycystic kidney disease type 1 (PKD1). Findings were compared with those

  18. Human myxomatous mitral valve prolapse: role of bone morphogenetic protein 4 in valvular interstitial cell activation.

    PubMed

    Sainger, Rachana; Grau, Juan B; Branchetti, Emanuela; Poggio, Paolo; Seefried, William F; Field, Benjamin C; Acker, Michael A; Gorman, Robert C; Gorman, Joseph H; Hargrove, Clark W; Bavaria, Joseph E; Ferrari, Giovanni

    2012-06-01

    Myxomatous mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in industrialized countries and a leading cause of mitral valve surgery for isolated mitral regurgitation. The key role of valvular interstitial cells (VICs) during mitral valve development and homeostasis has been recently suggested, however little is known about the molecular pathways leading to MVP. We aim to characterize bone morphogenetic protein 4 (BMP4) as a cellular regulator of mitral VIC activation towards a pathologic synthetic phenotype and to analyze the cellular phenotypic changes and extracellular matrix (ECM) reorganization associated with the development of myxomatous MVP. Microarray analysis showed significant up regulation of BMP4-mediated signaling molecules in myxomatous MVP when compared to controls. Histological analysis and cellular characterization suggest that during myxomatous MVP development, healthy quiescent mitral VICs undergo a phenotypic activation via up regulation of BMP4-mediated pathway. In vitro hBMP4 treatment of isolated human mitral VICs mimics the cellular activation and ECM remodeling as seen in MVP tissues. The present study characterizes the cell biology of mitral VICs in physiological and pathological conditions and provides insights into the molecular and cellular mechanisms mediated by BMP4 during MVP. The ability to test and control the plasticity of VICs using different molecules may help in developing new diagnostic and therapeutic strategies for myxomatous MVP. PMID:22105615

  19. Systematic review of robotic minimally invasive mitral valve surgery

    PubMed Central

    Seco, Michael; Cao, Christopher; Modi, Paul; Bannon, Paul G.; Wilson, Michael K.; Vallely, Michael P.; Phan, Kevin; Misfeld, Martin; Mohr, Friedrich

    2013-01-01

    Background Robotic telemanipulators have evolved to assist the challenges of minimally invasive mitral valve surgery (MVS). A systematic review was performed to provide a synopsis of the literature, focusing on clinical outcomes and cost-effectiveness. Method Structured searches of MEDLINE, Embase, and Cochrane databases were performed in August 2013. All original studies except case-reports were included in qualitative review. Studies with ?50 patients were presented quantitatively. Results After applying inclusion and exclusion criteria to the search results, 27 studies were included in qualitative review, 16 of which had ?50 patients. All studies were observational in nature, and thus the quality of evidence was rated low to medium. Patients generally had good left ventricular performance, were relatively asymptomatic, and mean patient age ranged from 52.6-58.4 years. Rates of intraoperative outcomes ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106±22 to 188.5±53.8 min for cardiopulmonary bypass (CPB) time and 79±16 to 140±40 min for cross-clamp (XC) time. Rates of short-term postoperative outcomes ranged from: 0.0-3.0% for mortality, 0.0-3.2% for myocardial infarction (MI), 0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3±6.7 to 36.6±24.7 hours for intensive care length of stay, 3.1±0.3 to 6.3±3.9 days for hospital length of stay (HLOS) and 81.7-97.6% had no or trivial mitral regurgitation (MR) before discharge. Conclusions All subtypes of mitral valve prolapse are repairable with robotic techniques. CPB and XC times are long, and novel techniques such as the Cor-Knot, Nitinol clips or running sutures may reduce the time required. The overall rates of early postoperative mortality and morbidity are low. Improvements in postoperative quality of life (QoL) and expeditious return to work offset the increase in equipment and intraoperative cost. Evidence for long-term outcomes is as yet limited. PMID:24349971

  20. Floppy mitral valve (FMV)/mitral valve prolapse (MVP) and the FMV/MVP syndrome: pathophysiologic mechanisms and pathogenesis of symptoms.

    PubMed

    Boudoulas, Konstantinos Dean; Boudoulas, Harisios

    2013-01-01

    Mitral valve prolapse (MVP) results from the systolic movement of a portion or segments of the mitral valve leaflets into the left atrium during left ventricular systole. It is well appreciated today that floppy mitral valve (FMV) is the central issue in the MVP and mitral valve regurgitation (MVR) story. The term FMV refers to the expansion of the area of the mitral valve leaflets with elongated chordae tendineae, chordae rupture and mitral annular dilation. FMV/MVP occurs in a heterogeneous group of patients with a wide spectrum of mitral valve involvement from mild to severe. Two types of symptoms can be defined in FMV/MVP patients. In one group of patients, symptoms are directly related to progressive MVR. In the other group, symptoms cannot be explained by the degree of MVR alone; activation of the autonomic nervous system has been implicated for the explanation of symptoms in this group of patients which is referred to as the FMV/MVP syndrome. In this brief review, the natural history, pathophysiologic mechanisms and management of patients with FMV/MVP/MVR and FMV/MVP syndrome are discussed. PMID:23942374

  1. Perioperative clinical decision-making in surgery for mitral valve repair.

    PubMed

    Naqvi, T Z

    2007-04-01

    Echocardiography has played a critical role in the progress in mitral valve reconstructive surgery which was revolutionized as ''the French correction'' by Alain Carpentier in the mid 1980s. Mitral regurgitation (MR) is the most challenging valvular heart disease throughout the world and is related to rheumatic etiology in the underdeveloped world and to degenerative etiology in the Western world. Echocardiography plays an integral role in the management of patients with significant MR. This includes evaluation and follow-up during the medical management phase of MR to intraoperative mitral valve repair and post operative follow-up, using a combination of transthoracic echocardiography and transesophageal echocardiography. Newer developments include evaluation by transthoracic and transesophageal three-dimensional echocardiography. This review summarizes role of echocardiography in diagnosis, therapy and follow-up of patients with clinically significant MR. Discussion will focus on mitral valve repair for degenerative MR of myxomatous etiology and functional and ischemic MR. PMID:17342039

  2. Early Expression of Mitral Valve Prolapse in the Framingham Offspring: Phenotypic Spectrum

    PubMed Central

    Delling, Francesca N.; Gona, Philimon; Larson, Martin G.; Lehman, Birgitta; Manning, Warren J.; Levine, Robert A.; Benjamin, Emelia J.; Vasan, Ramachandran S.

    2014-01-01

    Background Mitral valve prolapse (MVP) is a common disorder associated with mitral regurgitation (MR), endocarditis, heart failure and sudden death. In the familial context, prior studies have described non-diagnostic mitral valve morphologies (‘prodromal forms’ and ‘minimal superior displacement’ [MSD]) that may represent early expression of MVP in those genetically predisposed. Our objective was to explore the spectrum of MVP abnormalities in the community and compare their clinical and echocardiographic features. Methods Phenotypic heterogeneity of MVP was assessed by measuring annular diameter (D), leaflet displacement (Dis), thickness (T), anterior/posterior leaflet projections (A, P) onto the annulus, coaptation height (C or P/D), and MR jet height (JH) in a sample of 296 individuals of the Framingham Offspring Study who were identified as having MVP (n=77) or its prodromal form (N=11) or MSD (N=57), with 151 controls with no feature of MVP or its non-diagnostic forms. Results The prodromal form did not meet diagnostic criteria but resembled fully diagnostic MVP with regards to D, T and JH (all p > 0.05); they were similar to individuals with posterior MVP with regard to leaflet asymmetry and coaptation height (p = 0.91). Compared to MSDs and controls, prodromals had greater C, T, D and JH (all p < 0.05). MSDs shared the posterior leaflet asymmetry with classic MVP, but their coaptation point was more posterior (C = 31% versus 42%, p<0.0001). Conclusion Non-diagnostic morphologies of MVP are observed in the community and share the common feature of posterior leaflet asymmetry with fully affected individuals. Prodromal morphology and MSD may represent early expressions of MVP and additional studies are warranted to elucidate the natural history of these phenotypes. PMID:24206636

  3. The mitral valve prolapse epidemic: fact or fiction.

    PubMed Central

    Lewis, R. P.; Wooley, C. F.; Kolibash, A. J.; Boudoulas, H.

    1987-01-01

    In spite of two decades of research, the precise relationship of anatomic mitral valve prolapse (floppy valve) to the neuroendocrine disorder (MVP syndrome) remains unclear. In all likelihood they are two separate genetic disorders which travel together in some fashion. Mitral valve prolapse is a common disorder but progressive mitral regurgitation usually occurs late in life and in only a few patients. Other complications such as bacterial endocarditis, stroke, and sudden death are far less common but can occur at younger ages. The neuroendocrine syndrome in civilian life is mainly seen in young females (interestingly the peak incidence years correspond to peak female sex hormone output) but can be seen in males when subjected to unusual stress such as military service. More recent echocardiographic studies have questioned whether all prolapsing valves are truly abnormal. It has been shown that echographic prolapse can be produced in normal subjects by reducing venous return and impaired venous return may be present in some patients with the MVP syndrome. However, clicks and murmurs are apparently not heard when normal valves prolapse. It is our opinion that the presence of a click or typical murmur requires some anatomic abnormality of the mitral valve. One wonders if minimal valve abnormality (noted and dismissed by Davies) is the valve abnormality present in many young females with MVP syndrome, and that it may remain a mild abnormality throughout life. Recent psychiatric studies suggest that MVP is present in 30% of patients with Panic Disorder. It is not clear that this psychiatric syndrome is the same thing as the MVP syndrome. In Devereux's study, anxiety proneness was no different in the MVP cohort than in relatives without MVP. It is possible that diagnostic mixing of two similar but separate disorders has occurred, as has been the case since World War I. Perhaps the most important question is whether young patients with MVP syndrome and no echocardiographic criteria for "floppiness" will develop progressive mitral regurgitation or other complications in later life. In other words, how often is MVP syndrome in a young individual without echocardiographic evidence of a floppy valve a precourser to eventual progressive mitral regurgitation? Are there two different populations? Because of the long course of the disorder, several more years of observation (and, it is hoped, prospective longitudinal study) will be required to answer this question. Images Fig. 1 PMID:3303618

  4. Mitral balloon valvuloplasty

    Microsoft Academic Search

    Mohamed Eid Fawzy

    2010-01-01

    Percutaneous mitral balloon valvuloplasty (MBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of

  5. Infective endocarditis in the billowing mitral leaflet syndrome.

    PubMed Central

    Lachman, A S; Bramwell-Jones, D M; Lakier, J B; Pocock, W A; Barlow, J B

    1975-01-01

    Ten patients with the billowing mitral leaflet syndrome complicated by infective endocarditis are reported. Two patients had a non-ejection systolic click and 8 had both a non-ejection systolic click and a late systolic murmur. These auscultatory features were difficult to detect in 4 instances in that they were intermittent, soft, or brought out only with postural change. Seven patients were unaware of their cardiac lesions. A low grade pyrexia was present in all 10 patients. Four patients presented with clinical features caused by reversible neurological lesions. Blood cultures were positive in all patients, with Staphylococcus albus the infecting organism in 6. Antibiotic therapy was successful with significant mitral regurgitation supervening in only one instance. The importance of the billowing leaflet as a potential site of infective endocarditis is emphasized. It seems that antibiotic prophylaxis is indicated at times of increased risk of infection in subjects with a non-ejection systolic click or a late systolic murmur. PMID:1138736

  6. Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; McPherson, David D.; Kim, Hyunggun

    2015-01-01

    Posterior leaflet prolapse following chordal elongation or rupture is one of the primary valvular diseases in patients with degenerative mitral valves (MVs). Quadrangular resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of posterior leaflet prolapse. Virtual MV repair simulation of leaflet resection in association with patient-specific 3D echocardiographic data can provide quantitative biomechanical and physiologic characteristics of pre- and post-resection MV function. We have developed a solid personalized computational simulation protocol to perform virtual MV repair using standard clinical guidelines of posterior leaflet resection with annuloplasty ring implantation. A virtual MV model was created using 3D echocardiographic data of a patient with posterior chordal rupture and severe mitral regurgitation. A quadrangle-shaped leaflet portion in the prolapsed posterior leaflet was removed, and virtual plication and suturing were performed. An annuloplasty ring of proper size was reconstructed and virtual ring annuloplasty was performed by superimposing the ring and the mitral annulus. Following the quadrangular resection and ring annuloplasty simulations, patient-specific annular motion and physiologic transvalvular pressure gradient were implemented and dynamic finite element simulation of MV function was performed. The pre-resection MV demonstrated a substantial lack of leaflet coaptation which directly correlated with the severe mitral regurgitation. Excessive stress concentration was found along the free marginal edge of the posterior leaflet involving the chordal rupture. Following the virtual resection and ring annuloplasty, the severity of the posterior leaflet prolapse markedly decreased. Excessive stress concentration disappeared over both anterior and posterior leaflets, and complete leaflet coaptation was effectively restored. This novel personalized virtual MV repair strategy has great potential to help with preoperative selection of the patient-specific optimal MV repair techniques, allow innovative surgical planning to expect improved efficacy of MV repair with more predictable outcomes, and ultimately provide more effective medical care for the patient. PMID:26103002

  7. Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease

    Microsoft Academic Search

    Ko Bando; Junjiro Kobayashi; Yoshio Kosakai; Mitsuhiro Hirata; Yoshikado Sasako; Satoshi Nakatani; Toshikatsu Yagihara; Soichiro Kitamura

    2002-01-01

    Objective: We sought to determine whether the Cox maze procedure provides additional benefit to patients with atrial fibrillation undergoing mitral valve operations. Methods: Between May 1992 and August 2000, we performed 258 Cox maze procedures with mitral valve replacement (n = 147) or mitral valve repair (n = 111). We compared the outcomes of these patients with those of 61

  8. Image-based fluidstructure interaction model of the human mitral valve Xingshuang Ma a

    E-print Network

    Luo, Xiaoyu

    Image-based fluid­structure interaction model of the human mitral valve Xingshuang Ma a , Hao Gao Available online 15 November 2012 Keywords: Human mitral valve Clinical imaging Magnetic resonance imaging Fluid­structure interaction Immersed boundary method a b s t r a c t The mitral valve (MV) is one

  9. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound

    Microsoft Academic Search

    L Hatle; A Brubakk; A Tromsdal; B Angelsen

    1978-01-01

    A noninvasive method is described for measuring the pressure drop across the mitral valve in mitral stensois by Doppler ultrasound. A maximum frequency estimator was used to record maximum velocity in the Doppler signal from the mitral jet. Provided the angle between the ultrasound beam and the maximum velocity is close to zero the pressure drop can be calculated directly.

  10. Repair of Mitral Valve Billowing and Prolapse (Barlow): The Surgical Technique

    Microsoft Academic Search

    Roland Fasol; Katja Mahdjoobian

    Mitral valve repair in patients with mitral valve billow- ing and prolapse (Barlow) can be a demanding surgical procedure. A mitral valve repair method, which incorpo- rates the complete resection of the middle scallop of the posterior leaflet, a sliding and folding plasty with the remaining lateral scallops combined with a triangular resection of the anterior leaflet and a ring-annuloplasty

  11. Outcome of atrial fibrillation after mitral valve repair

    Microsoft Academic Search

    Jean F. Obadia; Mazen el Farra; Olivier H. Bastien; Michel Lièvre; Yvan Martelloni; Jean F. Chassignolle

    1997-01-01

    Objective: The aim of the study was to evaluate the prognostic factors for return to sinus rhythm after mitral valve repair. Method: One hundred ninety-one patients underwent surgery for mitral valve repair, including 142 procedures for valve repair only (74%). The patients with preoperative atrial fibrillation (50.5%) were older, clinically more symptomatic, and had a greater degree of left atrial

  12. Port-access mitral valve replacement in dogs

    Microsoft Academic Search

    Mario F. Pompili; John H. Stevens; Thoms A. Burdon; Lawrence C. Siegel; William S. Peters; Greg H. Ribakove; Bruce A. Reitz

    1996-01-01

    Objective: The objective was to assess mitral valve replacement in a minimally invasive fashion by means of port-access technology. Methods: Fifteen dogs, 28 ± 3 kg (mean ± standard deviation), were studied with the port-access mitral valve replacement system (Heartport, Inc., Redwood City, Calif.). Eleven dogs underwent acute studies and were sacrificed immediately after the procedure. Four dogs were allowed

  13. Morphometric investigations in mitral stenosis using two dimensional echocardiography

    Microsoft Academic Search

    P Schweizer; P Bardos; W Krebs; R Erbel; C Minale; S Imm; B J Messmer; S Effert

    1982-01-01

    A method is proposed for comparing the orifice size and the morphology of stenotic mitral valves, removed intact at the time of replacement, with the preoperative two dimensional echocardiographic cross-sections. The excised mitral valve apparatus is suspended on a specially constructed mounting. To avoid shrinkage the orifice is stabilised with an airfilled balloon. A radiography is taken directing the x-ray

  14. Mitral valve surgery - open

    MedlinePLUS

    ... place. There are two types of mitral valves: Mechanical -- made of man-made (synthetic) materials, such as ... Mechanical heart valves do not fail often. They last from 12-20 years. However, blood clots develop ...

  15. Fluid-Structure Interactions of the Mitral Valve and Left Heart: Comprehensive Strategies, Past, Present and Future

    PubMed Central

    Einstein, Daniel R.; Del Pin, Facundo; Jiao, Xiangmin; Kuprat, Andrew P.; Carson, James P.; Kunzelman, Karyn S.; Cochran, Richard P.; Guccione, Julius M.; Ratcliffe, Mark B.

    2009-01-01

    SUMMARY The remodeling that occurs after a posterolateral myocardial infarction can alter mitral valve function by creating conformational abnormalities in the mitral annulus and in the posteromedial papillary muscle, leading to mitral regurgitation (MR). It is generally assumed that this remodeling is caused by a volume load and is mediated by an increase in diastolic wall stress. Thus, mitral regurgitation can be both the cause and effect of an abnormal cardiac stress environment. Computational modeling of ischemic MR and its surgical correction is attractive because it enables an examination of whether a given intervention addresses the correction of regurgitation (fluid-flow) at the cost of abnormal tissue stress. This is significant because the negative effects of an increased wall stress due to the intervention will only be evident over time. However, a meaningful fluid-structure interaction model of the left heart is not trivial; it requires a careful characterization of the in-vivo cardiac geometry, tissue parameterization though inverse analysis, a robust coupled solver that handles collapsing Lagrangian interfaces, automatic grid-generation algorithms that are capable of accurately discretizing the cardiac geometry, innovations in image analysis, competent and efficient constitutive models and an understanding of the spatial organization of tissue microstructure. In this manuscript, we profile our work toward a comprehensive fluid-structure interaction model of the left heart by reviewing our early work, presenting our current work and laying out our future work in four broad categories: data collection, geometry, fluid-structure interaction and validation. PMID:20454531

  16. Eikenella corrodens: an unusual cause of endocarditis in a patient with silent mitral valve prolapse.

    PubMed

    Hansen, L A; Salem, A G; Edson, R S

    1989-11-01

    A 69-year old man with clinically silent mitral valve prolapse developed infective endocarditis secondary to Eikenella corrodens after dental work. The patient required surgical removal of abscessed teeth and long-term antibiotic therapy. E. corrodens is a gram-negative coccobacillus which normally inhabits the oropharynx, gastrointestinal tract, and upper respiratory tract. The organism can cause cutaneous and abdominal abscesses, meningitis, osteomyelitis, and endocarditis. Patients with mitral valve prolapse and a pre-existent systolic murmur or Doppler echocardiographic evidence of mitral regurgitation should receive prophylactic antibiotics for any procedure associated with a bacteremia. An infection caused by E. corrodens should be considered in patients with fever after dental manipulation or in patients with "culture-negative" endocarditis. PMID:2694371

  17. Emerging trends in heart valve engineering: Part III. Novel technologies for mitral valve repair and replacement.

    PubMed

    Kheradvar, Arash; Groves, Elliott M; Simmons, Craig A; Griffith, Boyce; Alavi, S Hamed; Tranquillo, Robert; Dasi, Lakshmi P; Falahatpisheh, Ahmad; Grande-Allen, K Jane; Goergen, Craig J; Mofrad, Mohammad R K; Baaijens, Frank; Canic, Suncica; Little, Stephen H

    2015-04-01

    In this portion of an extensive review of heart valve engineering, we focus on the current and emerging technologies and techniques to repair or replace the mitral valve. We begin with a discussion of the currently available mechanical and bioprosthetic mitral valves followed by the rationale and limitations of current surgical mitral annuloplasty methods; a discussion of the technique of neo-chordae fabrication and implantation; a review the procedures and clinical results for catheter-based mitral leaflet repair; a highlight of the motivation for and limitations of catheter-based annular reduction therapies; and introduce the early generation devices for catheter-based mitral valve replacement. PMID:25287646

  18. Mitral valve prolapse: a study of 45 children.

    PubMed

    Van Der Ham, D P; De Vries, J K; Van Der Merwe, P-L

    2003-01-01

    The knowledge pertaining to mitral valve prolapse is mainly based on studies in adults. In this study, the clinical profile as described in adults was compared with that found in children up to the age of 13 years. Forty-five children with echocardiographic-proven mitral valve prolapse and who met the inclusion criteria were included in the study. The male:female ratio in this study was 1:1.37 and was not statistically significantly different from reported ratios. Most of the children were asymptomatic. Twenty-one of the 31 patients referred from outside the hospital had an incidentally found murmur. The symptoms found in this study were not similar to those described in adults. The most commonly found symptoms were shortness of breath and fatigue, in contrast to those of chest pain and palpitations described in adults. Comparing males to females in this study, significantly lower weight (p = 0.005) and body mass index (p = 0.003) were found in girls, and a significantly lower pulse rate (p = 0.002) in boys. Left-sided cardiac enlargement was diagnosed in 11 patients on chest X-ray and in six patients on electrocardiogram. One patient had Marfan syndrome and four others had a Marfanoid appearance. In conclusion, most children with mitral valve prolapse are asymptomatic. Mitral valve prolapse is not an uncommon finding in children younger than 13 years of age. Patients with mitral valve regurgitation were advised to take infective endocarditis prophylaxis prior to invasive procedures. PMID:14532960

  19. Reciprocal interactions between mitral valve endothelial and interstitial cells reduce endothelial-to-mesenchymal transition and myofibroblastic activation.

    PubMed

    Shapero, Kayle; Wylie-Sears, Jill; Levine, Robert A; Mayer, John E; Bischoff, Joyce

    2015-03-01

    Thickening of mitral leaflets, endothelial-to-mesenchymal transition (EndMT), and activated myofibroblast-like interstitial cells have been observed in ischemic mitral valve regurgitation. We set out to determine if interactions between mitral valve endothelial cells (VECs) and interstitial cells (VICs) might affect these alterations. We used in vitro co-culture in Transwell™ inserts to test the hypothesis that VICs secrete factors that inhibit EndMT and conversely, that VECs secrete factors that mitigate the activation of VICs to a myofibroblast-like, activated phenotype. Primary cultures and clonal populations of ovine mitral VICs and VECs were used. Western blot, quantitative reverse transcriptase PCR (qPCR) and functional assays were used to assess changes in cell phenotype and behavior. VICs or conditioned media from VICs inhibited transforming growth factor ? (TGF?)-induced EndMT in VECs, as indicated by reduced expression of EndMT markers ?-smooth muscle actin (?-SMA), Slug, Snai1 and MMP-2 and maintained the ability of VECs to mediate leukocyte adhesion, an important endothelial function. VECs or conditioned media from VECs reversed the spontaneous cell culture-induced change in VICs to an activated phenotype, as indicated by reduced expression of ?-SMA and type I collagen, increased expression chondromodulin-1 (Chm1), and reduced contractile activity. These results demonstrate that mitral VECs and VICs secrete soluble factors that can reduce VIC activation and inhibit TGF?-driven EndMT, respectively. These findings suggest that the endothelium of the mitral valve is critical for the maintenance of a quiescent VIC phenotype and that, in turn, VICs prevent EndMT. We speculate that the disturbance of the ongoing reciprocal interactions between VECs and VICs in vivo may contribute to the thickened and fibrotic leaflets observed in ischemic mitral regurgitation, and in other types of valve disease. PMID:25633835

  20. Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy.

    PubMed

    Vriesendorp, Pieter A; Schinkel, Arend F L; Soliman, Osama I I; Kofflard, Marcel J M; de Jong, Peter L; van Herwerden, Lex A; Ten Cate, Folkert J; Michels, Michelle

    2015-03-01

    Severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HC) may benefit from surgical myectomy. In patients with enlarged mitral leaflets and mitral regurgitation, myectomy can be combined with anterior mitral leaflet extension (AMLE) to stiffen the midsegment of the leaflet. The aim of this study was to evaluate the long-term results of myectomy combined with AMLE in patients with obstructive HC. This prospective, observational, single-center cohort study included 98 patients (49 ± 14 years, 37% female) who underwent myectomy combined with AMLE from 1991 to 2012. End points included all-cause mortality and change in clinical and echocardiographic characteristics. Mortality was compared with age- and gender-matched patients with nonobstructive HC and subjects from the general population. Long-term follow-up was 8.3 ± 6.1 years. There was no operative mortality, and New York Heart Association class was reduced from 2.8 ± 0.5 to 1.3 ± 0.5 (p <0.001), left ventricular outflow tract gradient from 93 ± 25 to 9 ± 8 mm Hg (p <0.001), mitral valve regurgitation from grade 2.0 ± 0.9 to 0.5 ± 0.8 (p <0.001), and systolic anterior motion of the mitral valve from grade 2.4 ± 0.9 to 0.1 ± 0.3 (p <0.001). The 1-, 5-, 10-, and 15-year cumulative survival rates were 98%, 92%, 86%, and 83%, respectively, and did not differ from the general population (99%, 97%, 92%, and 85%, respectively, p = 0.3) or patients with nonobstructive HC (98%, 97%, 88%, and 83%, respectively, p = 0.8). In conclusion, in selected patients with obstructive HC, myectomy combined with AMLE is a low-risk surgical procedure. It results in long-term symptom relief and survival similar to the general population. PMID:25591899

  1. Flow Convergence Flow Rates from 3Dimensional Reconstruction of Color Doppler Flow Maps for Computing Transvalvular Regurgitant Flows Without Geometric Assumptions: An In Vitro Quantitative Flow Study

    Microsoft Academic Search

    Xiaokui Li; Takahiro Shiota; Alain Delabays; Dag Teien; XiaoDong Zhou; Brian Sinclair; Natesa G. Pandian; David J. Sahn

    1999-01-01

    Objective: This study was designed to develop and test a 3-dimensional method for direct measurement of flow convergence (FC) region surface area and for quantitating regurgitant flows with an in vitro flow system. Background: Quantitative methods for characterizing regurgitant flow events such as flow convergence with 2-dimensional color flow Doppler imaging systems have yielded variable results and may not be

  2. Minimally Invasive Port-Access Mitral Valve Surgery

    Microsoft Academic Search

    F. W. Mohr; V. Falk; A. Diegeler; T. Walther; J. A. M. van Son; R. Autschbach; Hans G. Borst

    1998-01-01

    Objectives: This study evaluates the feasibility of video-assisted minimally invasive mitral valve surgery by means of the Port-Access system. The aim of the study was to minimize surgical access and to develop a video-assisted surgical technique. Methods: The Port-Access system allows for closed chest endoluminal aortic clamping, cardioplegic arrest, and decompression of the heart. The mitral valve was either repaired

  3. Comparison of need for operative therapy in patients with mitral valve prolapse involving both leaflets versus posterior leaflet only.

    PubMed

    Shah, Asad A; Desai, Bhargavi S; Samad, Zainab; Jollis, James G; Glower, Donald D

    2012-11-01

    Mitral valve prolapse may involve 1 leaflet or 2 leaflets, yet management guidelines do not differentiate posterior leaflet (PML) from bileaflet (BML) prolapse. We hypothesized that patients with BML have a prolonged natural history with more severe atrial and ventricular enlargement but less severe mitral regurgitation (MR) compared to patients with PML. Patients with mitral valve prolapse undergoing mitral repair were identified and preoperative characteristics were recorded. Patients with predominant PML prolapse (n = 304) versus BML prolapse (n = 131) were identified based on preoperative echocardiographic and intraoperative findings. Timing of operation was based on standard guidelines. Despite being equally symptomatic, patients with BML differed significantly from those with PML in being younger (54 vs 60 years, p <0.0001), more likely to be women (51% vs 24%, p <0.0001), and having a larger valve (37 vs 32 mm, p <0.0001). Despite similar cardiac function and dimensions, patients with BML had less severe MR (24% vs 13% with <4+ MR, p = 0.01) and less severe pulmonary hypertension (14% vs 31%, p <0.0001) at time of operation. In conclusion, patients with BML often meet indications for mitral valve repair with similar cardiac enlargement but less MR than patients with PML prolapse. Patients with BML prolapse may benefit from timing mitral repair based more on symptomatic 3+ MR or cardiac enlargement and less on presence of severe MR. PMID:22835412

  4. Robotically-assisted left atrial fibrillation ablation and mitral valve repair through a right mini-thoracotomy.

    PubMed

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

    2004-10-01

    A combined robotic-assisted left atrial ablation and mitral valve repair was done through a 5-cm right anterior mini-thoracotomy. The patient was a 54-year-old man with severe mitral regurgitation and a 10-month history of persistent atrial fibrillation. The patient underwent off-pump, beating heart epicardial peripulmonary vein microwave ablation using the FLEX 10 catheter (AFx Inc, Fremont, CA), followed by supplemental on-pump endocardial lesions. The procedure was done using the da Vinci surgical robot (Intuitive Surgical Inc, Sunnyvale, CA). The mitral valve repair consisted of a No. 38 Cosgrove annuloplasty band implantation (Edwards Life Sciences, LLC, Irvine, CA). The postoperative recovery was uneventful, and the patient maintained normal sinus rhythm. PMID:15464454

  5. Cross-sectional echocardiographic visualization of abnormal systolic motion of the left ventricle in mitral valve prolapse.

    PubMed

    D'Cruz, I A; Shah, S; Hirsch, L J; Goldbarg, A N

    1981-01-01

    In 11 of 34 patients with typical mitral valve prolapse on the M-mode echocardiogram, cross-sectional echocardiography in the apical four-chamber view revealed a characteristic abnormality not previously described. In mid- to late-systole the ventricular septum contracted vigorously, forming a bend or sharp convexity toward the left ventricle, while motion of the posterolateral basal left ventricle was diminished and delayed. This finding was not encountered in 35 other patients with innocent systolic murmurs, or in 15 patients with mitral regurgitation of etiologies other than mitral valve prolapse. This abnormal pattern of left ventricular contraction on cross-sectional echocardiography occurred with equal frequency in patients with holosystolic and late-systolic prolapse; it was seen more frequently in patients with severe prolapse than in those with mild to moderate prolapse. PMID:7214519

  6. Natural history of valvular regurgitation using side-by-side echocardiographic analysis in anorexigen-treated subjects.

    PubMed

    Klein, Allan L; Griffin, Brian P; Grimm, Richard A; Rodriguez, L Leonardo; Sallach, John A; Morehead, Annitta J

    2005-12-15

    In 1997, the US Food and Drug Administration (FDA) reported valvular regurgitation (aortic regurgitation [AR] mild or greater and/or mitral regurgitation [MR] moderate or greater) in 32.8% of patients treated with anorexigens. This study sought to determine the natural history of valvular regurgitation in patients who were included in the FDA's original report. This was a nonrandomized, natural history study of these subjects. Cohort I consisted of 155 of 186 patients (83%) who were reported to the FDA. Cohort II consisted of a similar group of 311 patients who were not included. Initial echocardiograms were obtained for medical indications before the study initiation, and study echocardiograms were standardized and obtained at 3-month intervals. Level III echocardiographers performed blinded, side-by-side comparison of the first and last study echocardiograms at a core laboratory. Cohorts I and II consisted of predominantly female, middle-aged, obese subjects. At enrollment, patients in cohorts I and II had mild or greater AR (17.9%, 13.5%) and moderate or greater MR (3.3%, 4.0%), respectively, which was less than in the FDA's report. At follow-up, there were no statistically significant changes in the degree of valvular regurgitation in either cohort when the first and last study echocardiograms were read side by side. In conclusion, this natural history follow-up study demonstrates that MR and AR in long-term anorexigen-treated patients was less than reported to the FDA, did not progress, and remained echocardiographically stable during the 10-month duration of the study. PMID:16360362

  7. Interpretation of cardiac pathophysiology from pressure waveform analysis: mitral valve gradients: Part I.

    PubMed

    Kern, M J; Aguirre, F

    1992-08-01

    The mitral valve gradient is dependent on the precise measurement of left atrial (or pulmonary capillary wedge) and left ventricular pressures. Artifacts involving either pressure measurement will produce inaccuracies which may have clinical significance. Several methods and formulas using both invasive and noninvasive techniques should verify clinical findings and confirm the severity of mitral valve disease prior to definite therapy. The changes in mitral valve gradients after balloon catheter valvuloplasty will be discussed in part II of this hemodynamic rounds. PMID:1394420

  8. Myocardial deformation and rotational profiles in mitral valve prolapse.

    PubMed

    Zito, Concetta; Carerj, Scipione; Todaro, Maria Chiara; Cusmà-Piccione, Maurizio; Caprino, Alessandra; Di Bella, Gianluca; Oreto, Lilia; Oreto, Giuseppe; Khandheria, Bijoy K

    2013-10-01

    We studied whether evaluation of overall left ventricular (LV) and left atrial (LA) mechanics would be useful to detect subclinical dysfunction in patients with mitral valve prolapse (MVP), mitral regurgitation (MR), and normal LV ejection fraction (EF). Fifty consecutive patients (27 men, mean age 61 ± 19 years) with MVP, MR, and normal systolic function (LVEF ?60%) were prospectively enrolled and compared with 40 age- and gender-matched healthy subjects (22 men, mean age: 59 ± 16 years). At baseline, 2-dimensional and color-flow Doppler transthoracic echocardiography were performed for MR quantification and analysis of left-chambers mechanics. Patients were divided into groups by severity of MR: mild (n = 14), moderate (n = 19), and severe (n = 17). Left ventricular dimensions, volume and mass, and LA area and volume indices were significantly increased in patients with moderate and severe MR compared with control subjects. Circumferential strain, basal/apical rotations, and twist were significantly enhanced in patients with moderate MR compared with controls; with the exception of basal rotation, they decreased in those with severe MR. Furthermore, LA strain and untwisting rate were progressively and significantly reduced from normal subjects to patients with severe MR. Effective regurgitant orifice area and MR vena contracta were significantly related to most systolic and diastolic function parameters and LA volume as well as LA strain and LV untwisting rate in all patients. In conclusion, cardiac mechanics indices, particularly LA deformation and LV rotational parameters, could help unmask incipient myocardial dysfunction in patients with MVP, especially in those with severe MR and yet normal LVEF. PMID:23800550

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

    PubMed

    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 <0.001). After adjustment for age, gender, and co-morbidities, the odd ratio for flail 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. PMID:25966825

  10. First reported human case of native mitral infective endocarditis caused by Streptococcus canis.

    PubMed

    Amsallem, Myriam; Iung, Bernard; Bouleti, Claire; Armand-Lefevre, Laurence; Eme, Anne-Line; Touati, Aziza; Kirsch, Matthias; Duval, Xavier; Vahanian, Alec

    2014-11-01

    A 65 year-old woman was admitted for acute heart failure and severe sepsis revealing definite mitral infective endocarditis with severe regurgitation, complicated by multiple embolisms. Three blood cultures yielded a group G Streptococcus canis strain. Urgent surgery was performed with bioprosthetic valve replacement. Polymerase chain reaction analysis of the valve found S canis DNA. Amoxicillin and gentamicin were given for 2 weeks followed by 4 weeks of amoxicillin alone. She reported contact with a dog without bite. S canis has been reported to cause zoonotic septicemia but to our knowledge, this is the first human case of native valve infective endocarditis. PMID:25442453

  11. [Mitral valve replacement for a manifesting carrier of duchenne muscular dystrophy].

    PubMed

    Ishii, Hirohito; Nakamura, Kunihide; Nagahama, Hiroyuki; Matsuyama, Masakazu; Endo, Jouji; Nishimura, Masanori

    2015-02-01

    Duchenne muscular dystrophy (DMD) is an X-linked disease, but female carriers infrequently have some symptoms, who are called manifesting carriers. Here we report a case of a manifesting carrier of DMD with skeletal muscle weakness and cardiac abnormalities such as deterioration of cardiac function and left ventricular dilatation, who successfully underwent cardiac surgery. A 79-year-old female with acute heart failure for severe mitral regurgitation was admitted to our hospital. Surgical replacement of the mitral valve was performed under general anesthesia with intravenous anesthetics and non-depolarizing muscle relaxant. Cardiac surgery on a manifesting carrier of DMD is rare and requires a careful preoperative assessment of the heart function and anesthetic management. PMID:25743350

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

    PubMed

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

    2014-01-01

    A 27-year-old woman with a history of bileaflet mitral valve prolapse and moderate mitral regurgitation presented to our emergency with untractable polymorphic wide complex tachycardia and unstable haemodynamics. After cardiopulmonary resuscitation, return of spontaneous circulation was achieved 30 min later. Her post-resuscitation ECG showed a prolonged QT interval which progressively normalised over the same day. Her laboratory investigations revealed hypocalcaemia while other electrolytes were within normal limits. A diagnosis of ventricular arrhythmia secondary to structural heart disease further precipitated by hypocalcaemia was made. Further hospital stay did not reveal a recurrence of prolonged QT interval or other arrhythmias except for an episode of non-sustained ventricular tachycardia. However, the patient suffered diffuse hypoxic brain encephalopathy secondary to prolonged cardiopulmonary resuscitation. PMID:24827670

  13. Tissue valves in the mitral position. Five years' experience.

    PubMed Central

    Mary, D A; Pakrashi, B C; Catchpole, R W; Ionescu, M I

    1975-01-01

    Between April 1969 and November 1973 103 patients underwent isolated mitral replacement with three-cusp stented tissue valves. Autologous fascia lata was used in 50 patients, homologous fascia lata in 21, and heterologous pericardium in 32. The early mortality rate (14.6%) was influenced by age, the extent of preoperative cardiac disability, and low cardiac output. The survivors were followed up for periods varying from 8 to 60 months (average 37 months). In general, a factor in late death (13.6%) was high preoperative pulmonary artery pressure. In the autologous fascial series valve failure and infective endocarditis were significantly related to late mortality. The results with homologous fascia and pericardium were better than with autologous fascia valves. The incidence of postoperative mitral regurgitation was singificantly lower in the homologous fascial and pericardial series and none of these grafts had to be removed. The incidence of thromboembolism was low without anticoagulants. Actuarial analysis showed a survival rate at five years of 82.2 per cent. We no longer use autologous fascial valves. Though better results have been obtained with both homologous fascia and pericardium we prefer the physical characteristics of heterologous pericardium and it is easy to obtain. PMID:1191427

  14. Direct Measurement of Proximal Isovelocity Surface Area by Real-Time Three-Dimensional Color Doppler for Quantitation of Aortic Regurgitant Volume: An In Vitro Validation

    PubMed Central

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

    2012-01-01

    Objective The proximal isovelocity surface area (PISA) method is useful in the quantitation of aortic regurgitation (AR). We hypothesized that actual measurement of PISA provided with real-time 3-dimensional (3D) color Doppler yields more accurate regurgitant volumes than those estimated by 2-dimensional (2D) color Doppler PISA. Methods We developed a pulsatile flow model for AR with an imaging chamber in which interchangeable regurgitant orifices with defined shapes and areas were incorporated. An ultrasonic flow meter was used to calculate the reference regurgitant volumes. A total of 29 different flow conditions for 5 orifices with different shapes were tested at a rate of 72 beats/min. 2D PISA was calculated as 2? r2, and 3D PISA was measured from 8 equidistant radial planes of the 3D PISA. Regurgitant volume was derived as PISA × aliasing velocity × time velocity integral of AR/peak AR velocity. Results Regurgitant volumes by flow meter ranged between 12.6 and 30.6 mL/beat (mean 21.4 ± 5.5 mL/beat). Regurgitant volumes estimated by 2D PISA correlated well with volumes measured by flow meter (r = 0.69); however, a significant underestimation was observed (y = 0.5x + 0.6). Correlation with flow meter volumes was stronger for 3D PISA-derived regurgitant volumes (r = 0.83); significantly less underestimation of regurgitant volumes was seen, with a regression line close to identity (y = 0.9x + 3.9). Conclusion Direct measurement of PISA is feasible, without geometric assumptions, using real-time 3D color Doppler. Calculation of aortic regurgitant volumes with 3D color Doppler using this methodology is more accurate than conventional 2D method with hemispheric PISA assumption. PMID:19168322

  15. Mitral valve surgery - minimally invasive

    MedlinePLUS

    ... rate will be slowed by medicine or a mechanical device. If your surgeon can repair your mitral ... There are two main types of new valves: Mechanical -- made of man-made materials, such as titanium ...

  16. Mitral Valve Prolapse (For Parents)

    MedlinePLUS

    ... Atrial Septal Defect Congenital Heart Defects Heart and Circulatory System Arrhythmias Getting an EKG (Video) Heart Murmurs Marfan Syndrome Mitral Valve Prolapse Your Heart & Circulatory System EKG (Video) Ventricular Septal Defect Marfan Syndrome Arrhythmias ...

  17. Implantation of personalized, biocompatible mitral annuloplasty rings: feasibility study in an animal model

    PubMed Central

    Sündermann, Simon H.; Gessat, Michael; Cesarovic, Nikola; Frauenfelder, Thomas; Biaggi, Patric; Bettex, Dominique; Falk, Volkmar; Jacobs, Stephan

    2013-01-01

    OBJECTIVES Implantation of an annuloplasty ring is an essential component of a durable mitral valve repair. Currently available off-the-shelf rings still do not cover all the variations in mitral annulus anatomy and pathology from subject to subject. Computed tomography (CT) and echo imaging allow for 3-D segmentation of the mitral valve and mitral annulus. The concept of tailored annuloplasty rings has been proposed although, to date, no surgically applicable implementation of patient-specific annuloplasty rings has been seen. The objective of this trial was to prove the concept of surgical implantation of a model-guided, personalized mitral annuloplasty ring, manufactured based on individual CT-scan models. METHODS ECG-gated CT angiography was performed in six healthy pigs under general anaesthesia. Based on the individual shape of the mitral annulus in systole, a customized solid ring with integrated suturing holes was designed and manufactured from a biocompatible titanium alloy by a rapid process using laser melting. The ring was implanted three days later and valve function was assessed by intraoperative echocardiography. The macroscopic annulus–annuloplasty match was assessed after heart explantation. RESULTS CT angiography provided good enough image quality in all animals to allow for segmentation of the mitral annulus. The individually tailored mitral rings were manufactured and successfully implanted in all pigs. In 50%, a perfect matching of the implanted ring and the mitral annulus was achieved. In one animal, a slight deviation of the ring shape from the circumference was seen postoperatively. The rings implanted in the first two animals were significantly oversized but the deviation did not affect valve competence. CONCLUSIONS CT image quality and accuracy of the dimensions of the mitral annulus were sufficient for digital modelling and rapid manufacturing of mitral rings. Implantation of individually tailored annuloplasty rings is feasible. PMID:23287589

  18. Mean platelet volume may be elevated in mitral valve prolapse and associated with the severity of prolapse.

    PubMed

    Icli, Atilla; Aksoy, Fatih; Dogan, Abdullah; Arslan, Akif; Ersoy, Ibrahim; Yucel, Habil; Gorgulu, Ozkan

    2013-01-01

    Thromboembolic events can be seen in patients with mitral valve prolapse (MVP). It is unclear whether platelet activation may contribute to these events in patients with MVP. Thus, we aimed to evaluate mean platelet volume (MPV) in patients with MVP and its association with the severity of MVP. This study included 312 patients with MVP and 240 control participants. Mean platelet volume was significantly higher in patients with MVP than in controls (8.9 ± 0.7 vs 7.9 ± 0.6 fL, P = .001). In linear regression analysis, MPV was independently associated with the degree of mitral regurgitation (? = .23, 95% confidence interval (CI): 0.14-0.32, P = .001), maximal leaflet displacement (? = .24, 95%CI: 0.17-0.31, P = .001), and mean thickness of the anterior (? = .47, 95%CI: 0.27-0.61, P = .001) and posterior leaflets (? = .22, 95%CI: 0.03-0.41, P = .02). Our findings show that MPV can be elevated in patients with MVP and may be independently associated with severity of mitral regurgitation, leaflet displacement, and thickness of the leaflets. PMID:23064218

  19. Percutaneous mitral valvuloplasty refined: use of a novel modified antegrade approach.

    PubMed

    Stratos, Konstantinos; Toutouzas, Konstantinos; Synetos, Andreas; Latsios, George; Stathogiannis, Konstantinos; Kaitozis, Odysseas; Drakopoulou, Maria; Mastrokostopoulos, Antonios; Anousakis-Vlachochristou, Nikolaos; Tsiachris, Dimitris; Papanikolaou, Aggelos; Sideris, Skevos; Tsiamis, Eleftherios; Tousoulis, Dimitrios

    2015-01-01

    Mitral stenosis usually occurs many years after an episode of rheumatic fever and it has an indolent course until its later stages, when it acutely worsens. The rates of mitral stenosis keep declining; nonetheless, the need for advanced and sophisticated treatment modalities still remains. Our group has been applying a novel modified antegrade approach for treating mitral valve stenosis and, although we have limited experience, the results thus far are favorable. We present the preliminary data of three patients who suffered from symptomatic mitral valve stenosis and underwent successful percutaneous mitral valvuloplasty with this novel modified antegrade approach. This method increases the safety and the efficacy of the procedure and has the same clinical results as other available percutaneous techniques. PMID:26021251

  20. How Is Mitral Valve Prolapse Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Mitral Valve Prolapse Diagnosed? Mitral valve prolapse (MVP) most often is detected during a routine ... heart. Rate This Content: NEXT >> July 1, 2011 Mitral Valve Prolapse Clinical Trials Clinical trials are research studies that ...

  1. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect

    PubMed Central

    Kozak, Marcelo Felipe; Kozak, Ana Carolina Leiroz Ferreira Botelho Maisano; Marchi, Carlos Henrique De; de Godoy, Moacyr Fernandes; Croti, Ulisses Alexandre; Moscardini, Airton Camacho

    2015-01-01

    Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect. Objective To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect. Methods We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%). Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%. Results At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%). The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26), unlike patients without such abnormalities (P=0.016). During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02). However, after a multivariate analysis, none of the factors reached significance. Conclusion None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit more of the operation.

  2. Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans: importance of convective and inertial forces during left ventricular filling

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Vandervoort, P. M.; Greenberg, N. L.; Smedira, N. G.; McCarthy, P. M.; Garcia, M. J.; Thomas, J. D.

    2000-01-01

    OBJECTIVES: We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference. BACKGROUND: Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-mode provides a spatiotemporal representation of flow across the mitral valve. METHODS: In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements. RESULTS: From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([deltapI]max = 1.78+/-1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35+/-0.24 vs. 0.81+/-0.15, p< 0.0001). It also allowed an accurate approximation of the peak pressure difference ([deltapc+I]max = 0.95 [delta(p)cathh]max + 0.24, r = 0.96, p<0.001, error = 0.08+/-0.54 mm Hg). CONCLUSIONS: Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmitral flow, which should improve the understanding of diastolic filling and function of the heart.

  3. A Locus for Autosomal Dominant Mitral Valve Prolapse on Chromosome 11p15.4

    PubMed Central

    Freed, Lisa A.; Acierno Jr., James S.; Dai, Daisy; Leyne, Maire; Marshall, Jane E.; Nesta, Francesca; Levine, Robert A.; Slaugenhaupt, Susan A.

    2003-01-01

    Mitral valve prolapse (MVP) is a common cardiovascular abnormality in the United States, occurring in ?2.4% of the general population. Clinically, patients with MVP exhibit fibromyxomatous changes in one or both of the mitral leaflets that result in superior displacement of the leaflets into the left atrium. Although often clinically benign, MVP can be associated with important accompanying sequelae, including mitral regurgitation, bacterial endocarditis, congestive heart failure, atrial fibrillation, and even sudden death. MVP is genetically heterogeneous and is inherited as an autosomal dominant trait that exhibits both sex- and age-dependant penetrance. In this report, we describe the results of a genome scan and show that a locus for MVP maps to chromosome 11p15.4. Multipoint parametric analysis performed by use of GENEHUNTER gave a maximum LOD score of 3.12 for the chromosomal region immediately surrounding the four-marker haplotype D11S4124-D11S2349-D11S1338-D11S1323, and multipoint nonparametric analysis (NPL) confirms this finding (NPL=38.59; P=.000397). Haplotype analysis across this region defines a 4.3-cM region between the markers D11S1923 and D11S1331 as the location of a new MVP locus, MMVP2, and confirms the genetic heterogeneity of this disorder. The discovery of genes involved in the pathogenesis of this common disease is crucial to understanding the marked variability in disease expression and mortality seen in MVP. PMID:12707861

  4. Idiopathic mitral valve prolapse with tricuspid, aortic and pulmonary valve involvement: an autopsy case report.

    PubMed

    Desai, Heena M; Amonkar, Gayathri P

    2015-01-01

    Mitral valve prolapse (MVP) is usually asymptomatic, but can be associated with complications such as infective endocarditis, mitral regurgitation, thromboembolism and sudden cardiac death. It has been very rarely reported to occur in association with other valvular involvement. A 55-year-old male patient was brought dead and at autopsy the mitral valve orifice was stenotic and the leaflets were enlarged, myxoid and bulging suggestive of MVP and chordae tendinae were thickened, stretched and elongated. Similar changes were seen in the tricuspid valve. The pulmonary and aortic valves also showed myxomatous degeneration of their cusps. Myxomatous degeneration is the most common cause of MVP and it can be associated with involvement of the other valves. Concomitant involvement of the aortic valve has been reported, however it is very rare and simultaneous involvement of the pulmonary valve has not been reported in the literature so far. We report a case of MVP associated with myxomatous degeneration of the tricuspid, pulmonary and aortic valves. PMID:25885138

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

    PubMed Central

    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. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

    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.

  7. Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.

    PubMed

    Jung, Hyun Ju; Yu, Ga-Yon; Seok, Jung-Ho; Oh, Chungsik; Kim, Seong-Hyop; Yoon, Tae-Gyoon; Kim, Tae-Yop

    2014-01-01

    A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making. PMID:24567819

  8. Fetomaternal outcome of pregnancy with Mitral stenosis

    PubMed Central

    Ahmed, Nazia; Kausar, Hafeeza; Ali, Lubna; Rakhshinda

    2015-01-01

    Objective: To evaluate the frequency of fetomaternal outcome of pregnancy with Mitral stenosis admitted in Civil Hospital Karachi. Methods: It was a two years descriptive study done in the Department of Obstetrics and Gynaecology Civil Hospital Karachi. All pregnant women with a known or newly diagnosed Mitral stenosis on echocardiography were included in the study. History was taken regarding age, parity, gestational age (calculated by ultrasound) and complaints. Mode of delivery and Maternal mortality noted. Foetal outcome was analyzed by birth weight and Apgar score. Results: A total of 101 patients meeting the inclusion criteria were enrolled in the study. The ages of the women ranged between 20-29 years (69%) and 81% were multigravidas. Vaginal delivery occurred in 67 (66.3%) women and 78.3% were term pregnancies. Preterm deliveries were 21.8% and 27.7% newborns were low birth weight. APGAR score <7 was found in 14.9% of neonates and 9 babies had intrauterine death. Low ejection fraction<55% was diagnosed in 20(13.9%) women and Maternal mortality was found in two cases. Conclusion: Heart disease in pregnancy is associated with significant morbidity, it should be carefully managed in a tertiary care hospital to obtain optimum maternal and foetal outcome.

  9. Evaluation of mitral valve replacement anchoring in a phantom

    NASA Astrophysics Data System (ADS)

    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.

  10. Update on percutaneous mitral valve therapy: clinical results and real life experience.

    PubMed

    Ussia, G P; Cammalleri, V; Scandura, S; Immè, S; Pistritto, A M; Ministeri, M; Chiarandà, M; Caggegi, A; Barbanti, M; Aruta, P; Tamburino, C

    2012-02-01

    Mitral regurgitation (MR) is a common valvulopathy worldwide increasing in prevalence. Cardiac surgical intervention, preferable repair, is the standard of care, but a relevant number of patients with severe MR do not undergo surgery because of high peri-operative risk. Percutaneous mitral valve repair with the MitraClip System has evolved as a new tool for the treatment of severe MR. The procedure simulates the surgical edge-to-edge technique, developed by Alfieri in 1991, creating a double orifice valve by a permanent approximation of the two mitral valve leaflets. Several preclinical studies, registries and Food and Drug Administration approved clinical trials (EVEREST, ACCESS-EU) are currently available. The percutaneous approach has been recently studied in a randomized controlled trial, concluding that the device is less effective at reducing MR, when compared with surgery, by associated with a lower adverse event rate. The patients enrolled in this trial had a normal surgical risk and mainly degenerative MR with preserved left ventricular function. On the other hand, results derived from the clinical "real life" experience, show that patients actually treated in Europe present a higher surgical risk profile, more complex mitral valve anatomy and functional MR in the most of cases. Thus these data suggest that MitraClip procedure is feasible and safe in this subgroup of patients that should be excluded from the EVEREST trial due to rigid exclusion criteria. Despite the promising results clinical experience is still small, and no data related the durability are currently available. Therefore, MitraClip device should be reserved now to high risk or inoperable patients. PMID:22322574

  11. Computational Mitral Valve Evaluation and Potential Clinical Applications.

    PubMed

    Chandran, Krishnan B; Kim, Hyunggun

    2015-06-01

    The mitral valve (MV) apparatus consists of the two asymmetric leaflets, the saddle-shaped annulus, the chordae tendineae, and the papillary muscles. MV function over the cardiac cycle involves complex interaction between the MV apparatus components for efficient blood circulation. Common diseases of the MV include valvular stenosis, regurgitation, and prolapse. MV repair is the most popular and most reliable surgical treatment for early MV pathology. One of the unsolved problems in MV repair is to predict the optimal repair strategy for each patient. Although experimental studies have provided valuable information to improve repair techniques, computational simulations are increasingly playing an important role in understanding the complex MV dynamics, particularly with the availability of patient-specific real-time imaging modalities. This work presents a review of computational simulation studies of MV function employing finite element structural analysis and fluid-structure interaction approach reported in the literature to date. More recent studies towards potential applications of computational simulation approaches in the assessment of valvular repair techniques and potential pre-surgical planning of repair strategies are also discussed. It is anticipated that further advancements in computational techniques combined with the next generations of clinical imaging modalities will enable physiologically more realistic simulations. Such advancement in imaging and computation will allow for patient-specific, disease-specific, and case-specific MV evaluation and virtual prediction of MV repair. PMID:25134487

  12. Feasibility of mitral flow assessment by echo-contrast ultrasound, part II: experimental study on a mechanical model of the left heart.

    PubMed

    Herman, B; Einav, S; Vered, Z

    2000-06-01

    The feasibility of assessing mitral flow by means of ultrasonic monitoring of backscattered power from an echo-contrast agent in the left atrium and left ventricle was studied. A mechanical model of the left heart was built in which two thin rubber balloons connected to each other in a feedback loop via two artificial heart valves mimicked the left atrium and left ventricle. The model was driven by compressed air. Its input and output flows were measured as the functions of a pacing rate, driving pressure and artificially introduced mitral regurgitation. These were compared with the corresponding data derived from the ultrasonic measurements that are based on the correlation between echo-contrast agent concentration in the volume of interest and the flow through it. Algorithms for quantitative estimations of forward stroke volume (cardiac output) and mitral regurgitation are given. This study shows, for the first time, both analytically and experimentally, that the pulsating modulation of contrast agent concentration vs. time curves in the ventricle and atrium volumes is closely related to the pulsating nature of the flow in the system. It also shows that the amplitude of the atrium concentration modulation is directly proportional to the maximum value of the incoming (to atrium) flow. PMID:10942827

  13. The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review.

    PubMed

    Badar, Athar A; Brunton, Alan Pt; Mahmood, Ammad H; Dobbin, Stephen; Pozzi, Andrea; McMinn, Jenna F; Sinclair, Andrew Je; Gardner, Roy S; Petrie, Mark C; Curry, Phil A; Al-Attar, Nawwar Hk; Pettit, Stephen J

    2015-08-01

    A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5-14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation. PMID:26163051

  14. Minimally invasive mitral valve replacement: Port-access technique, feasibility, and myocardial functional preservation

    Microsoft Academic Search

    Daniel S. Schwartz; Greg H. Ribakove; Eugene A. Grossi; Patricia M. Buttenheim; Jess D. Schwartz; Robert M. Applebaum; Itzhak Kronzon; F. Gregory Baumann; Stephen B. Colvin; Aubrey C. Galloway

    1997-01-01

    Objective: This experiment examined the feasibility of minimally invasive port-access mitral valve replacement via a 2.5 cm incision. Methods: The study evaluated valvular performance and myocardial functional recovery in six mongrel dogs after port-access mitral valve replacement with a St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial

  15. The Influence of Annuloplasty Ring Geometry on Mitral Leaflet Curvature

    PubMed Central

    Ryan, Liam P.; Jackson, Benjamin M.; Hamamoto, Hirotsuga; Eperjesi, Thomas J.; Plappert, Theodore J.; St. John-Sutton, Martin; Gorman, Robert C.; Gorman, Joseph H.

    2013-01-01

    Background The effect of mitral leaflet curvature on stress reduction is an important mechanism in optimizing valve function. We hypothesize that annuloplasty ring shape could directly influence leaflet curvature and, potentially, repair durability. We describe an echocardiographically based methodology for quantifying mitral valve geometry and its application to the characterization of ovine mitral valve geometry before and after implantation of an annuloplasty ring. Methods Multiple mitral annular and leaflet geometric variables were calculated for 8 naïve adult male sheep using real-time three-dimensional echocardiographic images. These indexes were recalculated after annuloplasty using a 30-mm Carpentier-Edward Physio ring (n = 4; Edwards Lifesciences, Irvine, CA) or a 30-mm saddle ring (n = 4). Results After implantation of the Physio ring, the annular height to commissural width ratio (AHCWR) decreased from 19.4% ± 2.3% to 11.1% ± 2.5% (p = 0.06). After implantation of the saddle ring, AHCWR increased from 19.6% ± 1.3% to 24.3% ± 1.3% (p < 0.05). Statistically significant increases in three-dimensional Gaussian curvature occurred after implantation within six defined leaflet regions (A1 to A3, P1 to P3) of the saddle ring but only within the P1 and P3 leaflet regions with the Physio ring. Conclusions Annuloplasty ring shape affects leaflet curvature. Implantation of a saddle ring reflecting normal human annular geometry augmented ovine annular non-planarity and increased three-dimensional leaflet curvature across the entire mitral valve surface. The Physio ring decreased annular nonplanarity and increased leaflet curvature only across limited regions of the posterior leaflet. These findings confirm the hypothesis that ring design influences leaflet curvature. PMID:18721556

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

    NASA Astrophysics Data System (ADS)

    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.

  17. Tricuspid regurgitation in the diagnosis of chromosomal anomalies in the fetus at 11–14 weeks of gestation

    Microsoft Academic Search

    I C Huggon; D B DeFigueiredo; L D Allan

    2003-01-01

    Objective: To analyse patient data to elucidate the apparent association between an abnormal karyotype and tricuspid regurgitation found during fetal echocardiography at early gestations.Setting: Tertiary referral centre for fetal medicine and cardiology.Methods: Fetuses between 11 and 14 weeks’ gestation were selected for detailed echocardiography. Referral reasons were increased nuchal translucency, a suspected cardiac or extracardiac malformation, and a family history

  18. Aortic regurgitation: disease progression and management.

    PubMed

    Goldbarg, Seth H; Halperin, Jonathan L

    2008-05-01

    Aortic regurgitation (AR) is a common valvular heart disease that unless appropriately managed is associated with morbidity and mortality. Left ventricular (LV) mechanics and aortic impedance are the main determinants of outcome in patients with AR and govern clinical management. Mild and moderate AR in individuals with normal LV dimensions are both generally benign. In the absence of symptoms and before LV dimensions increase, even severe AR is not generally associated with increased morbidity or mortality. Once LV enlargement occurs, however, symptoms and/or a decline in ejection fraction can develop, and both represent an indication for surgical intervention. Disease progression occurs at a variable rate, and is often insidious. Hence, symptoms do not correlate with objective evidence of ventricular dysfunction. Exercise testing can help highlight symptoms related to valve dysfunction. Asymptomatic patients with severe AR and preserved LV function can benefit from vasodilator drug therapy. Several agents from this class can reduce AR severity, but results are inconsistent. In this Review, we examine the epidemiology of AR in terms of the interplay between arterial and ventricular forces marking progression of disease over time, and analyze the practice guidelines regarding diagnosis and treatment. PMID:18364707

  19. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 2: Endpoint Definitions: A Consensus Document From the Mitral Valve Academic Research Consortium.

    PubMed

    Stone, Gregg W; Adams, David H; Abraham, William T; Kappetein, Arie Pieter; Généreux, Philippe; Vranckx, Pascal; Mehran, Roxana; Kuck, Karl-Heinz; Leon, Martin B; Piazza, Nicolo; Head, Stuart J; Filippatos, Gerasimos; Vahanian, Alec S

    2015-07-21

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26184623

  20. Wide range force feedback for catheter insertion mechanism for use in minimally invasive mitral valve repair surgery

    NASA Astrophysics Data System (ADS)

    Ahmadi, Roozbeh; Sokhanvar, Saeed; Packirisamy, Muthukumaran; Dargahi, Javad

    2009-02-01

    Mitral valve regurgitation (MR) is a condition in which heart's mitral valve does not close tightly, which allows blood to leak back into the left atrium. Restoring the dimension of the mitral-valve annulus by percutaneous intervention surgery is a common choice to treat MR. Currently, this kind of open heart annuloplasty surgery is being performed through sternotomy with cardiomyopathy bypass. In order to reduce trauma to the patient and also to eliminate bypass surgery, robotic assisted minimally invasive surgery (MIS) procedure, which requires small keyhole incisions, has a great potential. To perform this surgery through MIS procedure, an accurate computer controlled catheter with wide-range force feedback capabilities is required. There are three types of tissues at the site of operation: mitral leaflet, mitral annulus and left atrium. The maximum allowable applied force to these three types of tissue is totally different. For instance, leaflet tissue is the most sensitive one with the lowest allowable force capacity. For this application, therefore, a wide-range force sensing is highly required. Most of the sensors that have been developed for use in MIS applications have a limited range of sensing. Therefore, they need to be calibrated for different types of tissue. The present work, reports on the design, modeling and simulation of a novel wide-range optical force sensor for measurement of contact pressure between catheter tip and heart tissue. The proposed sensor offers a wide input range with a high resolution and sensitivity over this range. Using Micro-Electro-Mechanical-Systems (MEMS) technology, this sensor can be microfabricated and integrated with commercially available catheters.

  1. Integrating particle image velocimetry and laser Doppler velocimetry measurements of the regurgitant flow field past mechanical heart valves.

    PubMed

    Kini, V; Bachmann, C; Fontaine, A; Deutsch, S; Tarbell, J M

    2001-02-01

    This study investigates the transient regurgitant flow downstream of a prosthetic heart valve using both laser Doppler velocimetry (LDV) and particle image velocimetry (PIV). Until now, LDV has been the more commonly used tool in investigating the flow characteristics associated with mechanical heart valves. The LDV technique allows point-by-point velocity measurements and provides enough information about the temporal variations in the flow. The main drawback of this technique is the time consuming nature of the data acquisition process in order to assess an entire flow field area. The PIV technique, on the other hand, allows measurement of the entire flow field in space in a plane at a given instant. In this study, PIV with spatial resolution of 0 (1 mm) and LDV with a temporal resolution of 0 (1 ms) were used to measure the regurgitant flow proximal to the Björk-Shiley monostrut (BSM) valve in the mitral position. With PIV, the ability to measure 2 velocity components over an entire plane simultaneously provides a very different insight into the flow field compared to a more traditional point-to-point technique like LDV. In this study, a picture of the effects of occluder motion on the fluid flow in the atrial chamber is interpreted using an integration of PIV and LDV measurements. Specifically, fluid velocities in excess of 3.0 m/s were recorded in the pressure-driven jet during valve closure, and a 1.5 m/s sustained regurgitant jet was observed on the minor orifice side. Additionally, the effects of the impact and subsequent rebound of the occluder on the flow also were clearly recorded in spatial and temporal detail by the PIV and LDV measurements, respectively. The PIV results provide a visually intuitive way of interpreting the flow while the LDV data explore the temporal variations and trends in detail. This analysis is an integrated flow description of the effects of valve closure and leakage on the pulsatile regurgitation flow field past a tilting-disc mechanical heart valve (MHV). It further reinforces the hypothesis that the planar flow visualization techniques, when integrated with traditional point-to point techniques, provide significantly more insight into the complex pulsatile flow past MHVs. PMID:11251479

  2. Tophaceous pseudogout of the mitral valve

    Microsoft Academic Search

    Marc R Moon; James I Fann; Prakash C Deedwania; Rollington Ferguson; Jon C Kosek; Thomas A Burdon

    1998-01-01

    This report describes a 61-year-old patient on chronic hemodialysis with multiple, left-sided, intracardiac masses causing intermittent coronary obstruction. Mitral valve replacement was performed. Massive deposition of calcium pyrophosphate crystals in and around the valve cusps led to the diagnosis of tophaceous pseudogout (tumoral calcinosis) of the mitral valve.

  3. Independence of mitral valve prolapse and neurosis

    Microsoft Academic Search

    A J Hickey; G Andrews; D E Wilcken

    1983-01-01

    An association has been claimed between mitral valve prolapse and the neuroses, especially the anxiety states, panic disorders, and agoraphobia. In this study 103 patients with echocardiographically confirmed mitral valve prolapse were tested with the Eysenck Personality Inventory for neuroticism and with the General Health Questionnaire for the presence of neurotic symptoms. The scores for neuroticism and neurotic symptoms were

  4. Prevalence of Mitral Valve Prolapse in Hypertension

    PubMed Central

    Holgado, Gemelia M.; Prakash, Ravi

    1987-01-01

    Mitral valve prolapse was found in one of 133 patients with hypertension (0.75 percent) studied by two-dimensional echocardiography. This rarity may be related to the presence of hypertrophied papillary muscles that probably pull the chordae tendinae and mitral valve leaflets away from the left atrium in systole, thus preventing their eversion and prolapse. PMID:3499517

  5. FLUID-STRUCTURE INTERACTION MODELS OF THE MITRAL VALVE: FUNCTION IN NORMAL AND PATHOLOGIC STATES

    SciTech Connect

    Kunzelman, K. S.; Einstein, Daniel R.; Cochran, R. P.

    2007-08-29

    Successful mitral valve repair is dependent upon a full understanding of normal and abnormal mitral valve anatomy and function. Computational analysis is one such method that can be applied to simulate mitral valve function in order to analyze the roles of individual components, and evaluate proposed surgical repair. We developed the first three-dimensional, finite element (FE) computer model of the mitral valve including leaflets and chordae tendineae, however, one critical aspect that has been missing until the last few years was the evaluation of fluid flow, as coupled to the function of the mitral valve structure. We present here our latest results for normal function and specific pathologic changes using a fluid-structure interaction (FSI) model. Normal valve function was first assessed, followed by pathologic material changes in collagen fiber volume fraction, fiber stiffness, fiber splay, and isotropic stiffness. Leaflet and chordal stress and strain, and papillary muscle force was determined. In addition, transmitral flow, time to leaflet closure, and heart valve sound were assessed. Model predictions in the normal state agreed well with a wide range of available in-vivo and in-vitro data. Further, pathologic material changes that preserved the anisotropy of the valve leaflets were found to preserve valve function. By contrast, material changes that altered the anisotropy of the valve were found to profoundly alter valve function. The addition of blood flow and an experimentally driven microstructural description of mitral tissue represent significant advances in computational studies of the mitral valve, which allow further insight to be gained. This work is another building block in the foundation of a computational framework to aid in the refinement and development of a truly noninvasive diagnostic evaluation of the mitral valve. Ultimately, it represents the basis for simulation of surgical repair of pathologic valves in a clinical and educational setting.

  6. Mitral Web -A New Concept for Mitral Valve Repair: Improved Engineering Design and In-Vitro Studies

    E-print Network

    Pekkan, Kerem

    Mitral Web - A New Concept for Mitral Valve Repair: Improved Engineering Design and In of Biomedical Engineering, Georgia Institute of Technology, GA, USA Myxomatous mitral valve disease is currently reported that mitral valve repair is preferable to valve replace- ment, as it offers certain advantages

  7. Pseudoaneurysm Arising from Mitral Aortic Intervalvular Fibrosa (P-MAIVF) Communicating with Left Atrium (LA): Multiple Detector Computed Tomography (MDCT) Evaluation

    PubMed Central

    Mittal, Kartik; Agrawal, Rajat; Dey, Amit K.; Gadewar, Rohit; Dadhania, Divyesh; Hira, Priya

    2015-01-01

    Summary Background The entity pseudoaneurysm arising from the mitral aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac finding caused by multiple factors. This entity is usually diagnosed with echocardiography and confirmed with cardiac computed tomography (CT). Case Report We presented a case of congenital P-MAIVF communicating with the left atrium (LA) and an aberrant right subclavian artery, misdiagnosed as primary mitral regurgitation (MR) in transthoracic echocardiogram (TTE) due to relative contraindications to transesophageal echocardiogram (TEE), revealed in a hemophilic patient, and diagnosed with cardiac CT. Conclusions In conclusion, cardiac CT plays a definitive role not only in anatomical assessment and confirmation of the lesion but also in primary diagnostics in patients suspected of MAIVF – especially those with relative and absolute contraindications to TEE. PMID:25745522

  8. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    PubMed

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

    2014-01-01

    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER. PMID:24211894

  9. Assessment of transmitral flow after mitral valve edge-to-edge repair using High-speed particle image velocimetry

    NASA Astrophysics Data System (ADS)

    Jeyhani, Morteza; Shahriari, Shahrokh; Labrosse, Michel; Kadem, Lyes

    2013-11-01

    Approximately 500,000 people in North America suffer from mitral valve regurgitation (MR). MR is a disorder of the heart in which the mitral valve (MV) leaflets do not close securely during systole. Edge-to-edge repair (EtER) technique can be used to surgically treat MR. This technique produces a double-orifice configuration for the MV. Under these un-physiological conditions, flow downstream of the MV forms a double jet structure that may disturb the intraventricular hemodynamics. Abnormal flow patterns following EtER are mainly characterized by high-shear stress and stagnation zones in the left ventricle (LV), which increase the potential of blood component damage. In this study, a custom-made prosthetic bicuspid MV was used to analyze the LV flow patterns after EtER by means of digital particle image velocimetry (PIV). Although the repair of a MV using EtER technique is an effective approach, this study confirms that EtER leads to changes in the LV flow field, including the generation of a double mitral jet flow and high shear stress regions.

  10. Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

    PubMed Central

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-01-01

    We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/?L. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences. PMID:25883714

  11. Iatrogenic aortic insufficiency following mitral valve replacement: case report and review of the literature.

    PubMed

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-06-01

    We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/?L. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences. PMID:25883714

  12. Mitral valve prolapse in the general population

    Microsoft Academic Search

    Lisa A Freed; Emelia J Benjamin; Daniel Levy; Martin G Larson; Jane C Evans; Deborah L Fuller; Birgitta Lehman; Robert A Levine

    2002-01-01

    ObjectivesThe aim of this study was to examine the echocardiographic features and associations of mitral valve prolapse (MVP) diagnosed by current two-dimensional echocardiographic criteria in an unselected outpatient sample.

  13. Blood cyst of the mitral valve.

    PubMed

    Grimaldi, Antonio; Capritti, Elvia; Pappalardo, Federico; Radinovic, Andrea; Ferrarello, Santo; Cammalleri, Valeria; Collu, Egidio; Ammirati, Enrico; Fumero, Andrea; Benussi, Stefano; De Bonis, Michele; Zangrillo, Alberto; Alfieri, Ottavio

    2012-01-01

    Blood cysts of the mitral valve are mostly benign diverticuli lined by endothelium and filled with blood and can be safely monitored with echocardiographic follow-up. We report a case of asymptomatic blood cyst of the mitral valve in a 63-year-old woman referred for a systolic murmur. At 3-year echo follow-up, the patient is free from notable clinical events. PMID:22089814

  14. Marfan syndrome and mitral valve prolapse

    PubMed Central

    Weyman, Arthur E.; Scherrer-Crosbie, Marielle

    2004-01-01

    Mitral valve prolapse (MVP), an abnormal displacement into the left atrium of a thickened and redundant mitral valve during systole, is a relatively frequent abnormality in humans and may be associated with serious complications. A recent study implicates fibrillin-1, a component of extracellular matrix microfibrils, in the pathogenesis of a murine model of MVP. This investigation represents an initial step toward understanding the mechanisms involved in human MVP disease and the development of potential treatments. PMID:15578086

  15. Atrial Vectorcardiogram in Mitral Valve Disease

    Microsoft Academic Search

    G. E. Burch; T. D. Giles

    1973-01-01

    Atrial vectorcardiograms (P sSPACE-loops) were recorded at high gain from 19 adult patients with mitral valve disease and enlargement of the left atrium using the equilateral tetrahedral reference frame. The P sSPACE-loops of the patients with mitral valve disease differed from P sSPACE-loops of 39 normal subjects in that (1) they were more distorted and contained a large number of

  16. From primary tricuspid regurgitation to arrhythmogenic right ventricular cardiomyopathy.

    PubMed

    Gwizda?a, Adrian; Popiak, Hubert; Janus, Magdalena; Grajek, Stefan; Straburzy?ska-Migaj, Ewa

    2013-01-01

    Since arrhythmogenic right ventricular dysplasia is still an under-recognised clinical entity, its 'deceitful' course requires alertness of physicians, and - in particular - awareness of its less typical manifestations. Therefore, we present a case report of a 52-year-old male subject with signs and symptoms of right ventricular heart failure and marked tricuspid regurgitation. PMID:24197591

  17. Maternal Food Regurgitation to Nymphs in Earwigs (Forficula auricularia)

    E-print Network

    Kölliker, Mathias

    Maternal Food Regurgitation to Nymphs in Earwigs (Forficula auricularia) Michael Staerkle & Mathias of larvae / nymphs is also found (Costa 2006). Paren- tal care in (sub-) social insects is generally-to-mouthpart contacts between parents and their larvae / nymphs (e.g. Pukowski 1933; Lamb 1976; Vancassel 1984; Liu 1991

  18. Relation of mitral valve prolapse to basal left ventricular hypertrophy as determined by cardiac magnetic resonance imaging.

    PubMed

    Zia, Mohammad Imran; Valenti, Valentina; Cherston, Caroline; Criscito, Maressa; Uretsky, Seth; Wolff, Steven

    2012-05-01

    We aimed to characterize the extent and distribution of focal basal left ventricular (LV) hypertrophy in patients with mitral valve prolapse (MVP). Sixty-three patients (mean age: 58 ± 14 years) with MVP and 20 age-matched normal volunteers (mean age: 53 ± 11 years) were assessed using cardiac magnetic resonance imaging. We compared the ratio of basal to mid end-diastolic wall thickness in both groups and correlated it with clinical and imaging parameters. Of the 63 patients, 44 (70%) had posterior leaflet prolapse, 2 (3%) had anterior leaflet prolapse, and 17 (27%) had bileaflet prolapse. There was a significantly increased ratio of basal to mid-ventricular end-diastolic wall thickness in all segments of the left ventricle in those with MVP compared to the controls. The inferolateral (2.1 vs 1.0, p <0.01) and anterolateral (2.1 vs 1.1) ratios (p <0.01) were the greatest compared to the other myocardial segments. The degree of mitral annular excursion had a strong positive correlation with the degree of hypertrophy (r(2) = 0.81, p <0.01) and was an independent predictor in adjusted multivariate analysis (p <0.0001). Age, body mass index, LV end-diastolic volume index, LV end -systolic volume index, LV stroke volume index, degree of prolapse, and mitral regurgitation volume did not have any significant correlation with the degree of hypertrophy. In conclusion, MVP is associated with concentric basal LV hypertrophy and good correlation between the excursion of the mitral valve annulus and the degree of relative LV hypertrophy suggests that locally increased myocardial function could be responsible for this remodeling. PMID:22335854

  19. Usefulness of preoperative cardiac dimensions to predict success of reverse cardiac remodeling in patients undergoing repair for mitral valve prolapse.

    PubMed

    Athanasopoulos, Leonidas V; McGurk, Siobhan; Khalpey, Zain; Rawn, James D; Schmitto, Jan D; Wollersheim, Laurens W; Maloney, Ann M; Cohn, Lawrence H

    2014-03-15

    Mitral valve repair for mitral regurgitation (MR) is currently recommended based on the degree of MR and left ventricular (LV) function. The present study examines predictors of reverse remodeling after repair for degenerative disease. We retrospectively identified 439 patients who underwent repair for myxomatous mitral valve degeneration and had both pre- and postoperative echocardiographic data available. Patients were categorized based on left atrial (LA) diameter and LV diameter standards of the American Society of Echocardiography. The outcome of interest was the degree of reverse remodeling on all heart dimensions at follow-up. Mean age was 57 ± 12 years, and 37% of patients were women. Mean preoperative LV end-diastolic diameter was 5.8 ± 0.7 cm, LV end-systolic diameter 3.5 ± 0.6 cm, LA 4.7 ± 0.7 cm, and median ejection fraction 60%. Median observation time was 81 months, and time to postoperative echocardiography was 38 months. Overall, 95% of patients had normal LV diastolic dimensions postoperatively, 93% normal LV systolic dimensions, and 37% normal LA dimensions. A Cox regression analysis showed that moderate (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3 to 3.4) or severe preoperative LA dilatation (OR 2.7, 95% CI 1.7 to 4.4), abnormal preoperative LV end-systolic dimensions (OR 1.3, 95% CI 1.1 to 1.5), and age in years (OR 1.02, 95% CI 1.01 to 1.03) were predictive of less reverse remodeling on follow-up. In conclusion, preoperative LV end-systolic dimensions and LA dilatation substantially affect the likelihood of successful LA remodeling and normalization of all heart dimensions after mitral valve repair for MR. These findings support early operation for MR before the increase in heart dimensions is nonreversible. PMID:24444780

  20. Mitral Valve Prolapse with Rigid Annular Calcifications: A New Technique for Mitral Valve Replacement

    PubMed Central

    Wallsh, Eugene; Franzone, Andrew; Weinstein, Gerald; Bruno, Peter; Rossi, Peter

    1985-01-01

    Severe calcification of the mitral annulus presents a technical challenge in valve replacement, and in the case reported here, we replaced the valve with a new technique. Employing a rim of tissue created from the supra-annular left atrium imbricated to the edge of the posterior mitral leaflet, we created a substitute “annulus” for prosthetic valve fixation. Images PMID:15226981

  1. Mitral valve prolapse and mitral insufficiency in two siblings with Gaucher's disease

    PubMed Central

    Celik, S; Erdol, C; Baykan, M; Gokce, M; Orem, C; Durmus, I

    2000-01-01

    Gaucher's disease is an autosomal recessive storage disorder. We report two siblings with Gaucher's disease, both of which had mitral valve prolapse and mitral insufficiency. One of the siblings died of bacterial endocarditis and pneumonia, while the other continues under followup. PMID:22368585

  2. Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation

    PubMed Central

    Park, Sun Hee; Yang, Young Ae; Kim, Kyu Yeon; Park, Sang Mi; Kim, Hong Nyun; Kim, Jae Hee; Jang, Se Yong; Bae, Myung Hwan; Lee, Jang Hoon

    2015-01-01

    Background It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR. Methods This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH). Results During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 ± 3.72% vs. -15.66 ± 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042). Conclusion GS-4CH may be a useful predictor of mortality in patient with chronic AR.

  3. Gebelikte Mitral Darl›¤›n›n Prognostik Faktörleri

    Microsoft Academic Search

    Emre Altekin; Gürkan Zorlu

    Amaç: Mitral darl›kl› gebelerde gebelik sürecinde geliflen komplikasyonlar› tayin etmek. Yöntem: Mitral darl›kl› 37 gebe kad›n 1998- 2001 y›llar› aras›nda izlendi. Ekokardiyografik mitral kapak ala- n›, NYHA s›n›flamas›na göre gebelik öncesi fonksiyonel kapasite tayin edildi. Fonksiyonel kapasitede ilerleme, tromboemboli, ölüm, t›bbi tahliye gereklilii, cerrahi veya balon mitral valvotomi maternal olay olarak deer- lendirildi. Düflük, fetal\\/yenidoan ölümü, prematüre veya düflük kilolu

  4. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

    Examination of 36 home-reared young adults with Down's syndrome found that 20 had abnormal echocardiographic findings. Thirteen had mitral valve prolapse, three had mitral valve prolapse and aortic insufficiency, two had only aortic insufficiency, and two had other mitral valve disorders. Theories of pathogenesis and relationship to exercise and…

  5. 'Fast-implantable' aortic valve implantation and concomitant mitral procedures.

    PubMed

    Ferrari, Enrico; Siniscalchi, Giuseppe; Marinakis, Sotirios; Berdajs, Denis; von Segesser, Ludwig

    2014-10-01

    Concomitant aortic and mitral valve replacement or concomitant aortic valve replacement and mitral repair can be a challenge for the cardiac surgeon: in particular, because of their structure and design, two bioprosthetic heart valves or an aortic valve prosthesis and a rigid mitral ring can interfere at the level of the mitroaortic junction. Therefore, when a mitral bioprosthesis or a rigid mitral ring is already in place and a surgical aortic valve replacement becomes necessary, or when older high-risk patients require concomitant mitral and aortic procedures, the new 'fast-implantable' aortic valve system (Intuity valve, Edwards Lifesciences, Irvine, CA, USA) can represent a smart alternative to standard aortic bioprosthesis. Unfortunately, this is still controversial (risk of interference). However, transcatheter aortic valve replacements have been performed in patients with previously implanted mitral valves or mitral rings. Interestingly, we learned that there is no interference (or not significant interference) among the standard valve and the stent valve. Consequently, we can assume that a fast-implantable valve can also be safely placed next to a biological mitral valve or next to a rigid mitral ring without risks of distortion, malpositioning, high gradient or paravalvular leak. This paper describes two cases: a concomitant Intuity aortic valve and bioprosthetic mitral valve implantation and a concomitant Intuity aortic valve and mitral ring implantation. PMID:25015540

  6. Electrocardiographic Changes in Mitral Valve Prolapse Syndrome

    PubMed Central

    Peighambari, Mohammad Mehdi; Alizadehasl, Azin; Totonchi, Ziae

    2014-01-01

    Introduction: Mitral valve prolapse syndrome (MVP) is the most common valvular abnormalityin the 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 repolarizationincluding notch in descending arm of QRS and J-point and/or ST segment changes in 100 patientswith MVP with 100 healthy individuals. MVP patients were referred to cardiology clinic withsymptoms 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 early repolarizationas a prevalent sign in ECG of patients which was a notch in descending arm of QRS and/or STsegment or J-point elevation seen in 74% of patients ( 51% in inferior leads and 23% in I and aVLleads) , whilst the same findings were 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. PMID:24753827

  7. Neonatal familial Evans syndrome associated with joint hypermobility and mitral valve regurgitation in three siblings in a Saudi Arab family.

    PubMed

    Ahmed, Fathelrahman E; Albakrah, Mohameed S

    2009-01-01

    The occurrence of autoimmune hemolytic anemia and immune thrombocytopenia in the absence of a known underlying cause led to the diagnosis of Evans syndrome in a 9-month-old male. Subsequently, a similar diagnosis was made in two siblings (a 3-year-old boy and a 1-day-old girl). The 9-month-old had a chronic course with exacerbations. He was treated with steroids, intravenous immunoglobulin and colchicine with a variable response. He died of congestive heart failure at the age of 8 years. The brotherâs disease course was one of remission and exacerbation. With time, remissions were prolonged and paralleled an improvement in joint hypermobility. The sister died of sepsis after a chronic course with severe exacerbations. Only two families with Evans syndrome have been reported in the English medical literature. In one report (in a Saudi Arab family), the disease was associated with hereditary spastic paraplegia. PMID:19448367

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

    Microsoft Academic Search

    A S Sadee; A E Becker

    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 calcification of one commissure (eight anterolateral, seven posteromedial); (c) fibrosis with calcification of both commissures (seven valves);

  9. Evaluation of Tricuspid Regurgitation Severity: Echocardiographic and Clinical Correlation

    Microsoft Academic Search

    Yaron Shapira; Avital Porter; Mordechay Wurzel; Mordechay Vaturi; Alex Sagie

    1998-01-01

    The correlation between 19 echocardiographic markers of tricuspid regurgitation (TR) severity and findings on physical examination was studied in 66 consecutive patients (age 63 ± 12 years) with moderate or severe TR. Clinical TR was defined by two or more of the following: prominent jugular venous pulse V waves, pulsating liver, and sea-saw parasternal movement. Thirty-eight patients (57.6%) had clinical TR,

  10. Effects of blood viscosity on proximal flow convergence calculations of regurgitant flow rate and jet dimensions as evaluated by color Doppler flow mapping: An in vitro study

    Microsoft Academic Search

    André Schmidt; Antônio Pazin-Filho; Oswaldo César Almeida-Filho; Lourenço Gallo-Júnior; José Antonio Marin-Neto; Benedito Carlos Maciel

    2001-01-01

    There are limited data on the potential influence of blood viscosity on the quantification of valvular regurgitation by color Doppler in the clinical setting. This study was designed to evaluate the effects of blood viscosity on jet dimensions and the proximal flow convergence (proximal isovelocity surface area, PISA) method of estimating valvular insufficiency severity. We used an in vitro flow

  11. Dynamic shape modeling of the mitral valve from real-time 3D ultrasound images using continuous medial representation

    NASA Astrophysics Data System (ADS)

    Pouch, Alison M.; Yushkevich, Paul A.; Jackson, Benjamin M.; Gorman, Joseph H., III; Gorman, Robert C.; Sehgal, Chandra M.

    2012-03-01

    Purpose: Patient-specific shape analysis of the mitral valve from real-time 3D ultrasound (rt-3DUS) has broad application to the assessment and surgical treatment of mitral valve disease. Our goal is to demonstrate that continuous medial representation (cm-rep) is an accurate valve shape representation that can be used for statistical shape modeling over the cardiac cycle from rt-3DUS images. Methods: Transesophageal rt-3DUS data acquired from 15 subjects with a range of mitral valve pathology were analyzed. User-initialized segmentation with level sets and symmetric diffeomorphic normalization delineated the mitral leaflets at each time point in the rt-3DUS data series. A deformable cm-rep was fitted to each segmented image of the mitral leaflets in the time series, producing a 4D parametric representation of valve shape in a single cardiac cycle. Model fitting accuracy was evaluated by the Dice overlap, and shape interpolation and principal component analysis (PCA) of 4D valve shape were performed. Results: Of the 289 3D images analyzed, the average Dice overlap between each fitted cm-rep and its target segmentation was 0.880+/-0.018 (max=0.912, min=0.819). The results of PCA represented variability in valve morphology and localized leaflet thickness across subjects. Conclusion: Deformable medial modeling accurately captures valve geometry in rt-3DUS images over the entire cardiac cycle and enables statistical shape analysis of the mitral valve.

  12. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 1: Clinical Trial Design Principles: A Consensus Document From the Mitral Valve Academic Research Consortium.

    PubMed

    Stone, Gregg W; Vahanian, Alec S; Adams, David H; Abraham, William T; Borer, Jeffrey S; Bax, Jeroen J; Schofer, Joachim; Cutlip, Donald E; Krucoff, Mitchell W; Blackstone, Eugene H; Généreux, Philippe; Mack, Michael J; Siegel, Robert J; Grayburn, Paul A; Enriquez-Sarano, Maurice; Lancellotti, Patrizio; Filippatos, Gerasimos; Kappetein, Arie Pieter

    2015-07-21

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26184622

  13. A case of mitral stenosis with achalasia.

    PubMed

    Ashutosh, Kumar; Biswakes, Majumdar; Bhawani, G; Dipankar, Ghoshdasdtidar; Binod, Aggrawal; Saroj, Mondal; Rupesh, Singh; Achyut, Sarkar

    2009-12-01

    A 65-year-old woman with rheumatic heart disease and severe mitral stenosis developed dysphagia. As her dysphagia could not be directly attributed to an enlarged left atrium, she underwent barium swallow, which established the diagnosis of achalasia. This case report shows two unrelated diseases present in the same patient which individually can cause dysphagia. PMID:20054769

  14. Mitral Valve Prolapse in Young Patients.

    ERIC Educational Resources Information Center

    McFaul, Richard C.

    1987-01-01

    A review of research regarding mitral valve prolapse in young children indicates that up to five percent of this population have the condition, with the majority being asymptomatic and requiring reassurance that the condition usually remains mild. Beta-blocking drugs are prescribed for patients with disabling chest pain, dizziness, palpitation, or…

  15. Development of a simultaneous cryo-anchoring and radiofrequency ablation catheter for percutaneous treatment of mitral valve prolapse.

    PubMed

    Boronyak, Steven M; Merryman, W David

    2012-09-01

    Mitral valve prolapse (MVP) is one subtype of mitral valve (MV) disease and is often characterized by enlarged leaflets that are thickened and have disrupted collagen architecture. The increased surface area of myxomatous leaflets with MVP leads to mitral regurgitation, and there is need for percutaneous treatment options that avoid open-chest surgery. Radiofrequency (RF) ablation is one potential therapy in which resistive heating can be used to reduce leaflet size via collagen contracture. One challenge of using RF ablation to percutaneously treat MVP is maintaining contact between the RF ablation catheter tip and a functioning MV leaflet. To meet this challenge, we have developed a RF ablation catheter with a cryogenic anchor for attachment to leaflets in order to apply RF ablation. We demonstrate the effectiveness of the dual-energy catheter in vitro by examining changes in leaflet biaxial compliance, thermal distribution with infrared (IR) imaging, and cryogenic anchor strength. We report that 1250 J of RF energy with cryo-anchoring reduced the determinant of the deformation gradient tensor at systolic loading by 23%. IR imaging revealed distinct regions of cryo-anchoring and tissue ablation, demonstrating that the two modalities do not counteract one another. Finally, cryogenic anchor strength to the leaflet was reduced but still robust during the application of RF energy. These results indicate that a catheter having combined RF ablation and cryo-anchoring provides a novel percutaneous treatment strategy for MVP and may also be useful for other percutaneous procedures where anchored ablation would provide more precise spatial control. PMID:22532322

  16. Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse.

    PubMed

    Szymanski, Catherine; Magne, Julien; Fournier, Alexandre; Rusinaru, Dan; Touati, Gilles; Tribouilloy, Christophe

    2015-05-15

    The aim of the study was to assess the impact of atrial fibrillation (AF) on outcome in patients who underwent mitral valve repair (MVRp) for mitral valve prolapse (MVP). Four hundred and forty-three consecutive patients underwent MVRp for organic mitral regurgitation due to MVP. Echocardiography was performed preoperatively and after surgery. Postoperative left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Before surgery, 187 patients (42%) had preoperative AF. After surgery, LVEF significantly decreased from 67 ± 9% to 56 ± 10% (p <0.0001). Compared with patients in sinus rhythm (SR), those in AF were significantly older (p <0.0001), had more severe symptoms (p = 0.004), had lower LVEF (p = 0.002), and higher EuroSCORE (p = 0.05). Compared with patients in SR, patients with AF had significantly lower 10-year survival (64 ± 4% vs 83 ± 3%, p = 0.001). On multivariate analysis, preoperative AF was identified as an independent predictor of overall mortality (hazard ratio 1.67; 95% confidence interval 1.15 to 2.42; p = 0.007). At 10 years, patients with paroxysmal AF had lower survival and higher heart failure rate than patients in SR (78 ± 3% vs 66 ± 6%) but had a better outcome compared with those with permanent AF (66 ± 6% vs 53 ± 6%, p = 0.022). Patients with AF had a significantly higher rate of postoperative LVD (23.3% vs 13.4%, p = 0.007). In conclusion, preoperative AF is a predictor of long-term mortality and postoperative LVD after MVRp for MVP. To improve postoperative outcome, surgery in these patients should be performed before onset of AF. PMID:25784520

  17. Can we interpret the orientation of major or minor orifice in implanted tilting disc mechanical mitral valve on X-ray chest PA view ? “The Sion Sign”

    Microsoft Academic Search

    Uday Eknathrao Jadhav; Nageshwar Rao; Manish Puranik; Khalid Shaikh; Shubha Mohite; Jagdish Khandeparkar

    2009-01-01

    Introduction  Chest X-ray is an important investigation in a patient Following Mitral valve replacement. After Mitral valve replacement\\u000a in Chest X-Ray Postero-Anterior (P-A) view the Prosthesis in the mitral Position is seen in sagital open position as opposed\\u000a to a prosthesis in Aortic Position which is seen as coronal slit.\\u000a \\u000a \\u000a \\u000a Material & Methods  Tilting Disc Mechanical Heart valves have a Major Orifice

  18. Extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow’s milk allergy

    PubMed Central

    Vandenplas, Y; De Greef, E

    2014-01-01

    Aim Cow’s milk protein allergy (CMPA) is treated using an elimination diet with an extensive protein hydrolysate. We explored whether a thickened or nonthickened version was best for infants with suspected CMPA, which commonly causes regurgitation/vomiting. Methods Diagnosis of CMPA was based on a positive challenge test. We compared the efficacy of two casein extensive hydrolysates (eCH), a nonthickened version (NT-eCH) and a thickened version (T-eCH), using a symptom-based score covering regurgitation, crying, stool consistency, eczema, urticarial and respiratory symptoms. Results A challenge was performed in 52/72 infants with suspected CMPA and was positive in 65.4%. All confirmed CMPA cases tolerated eCH. The symptom-based score decreased significantly in all infants within a month, and the highest reduction was in those with confirmed CMPA. Regurgitation was reduced in all infants (6.4 ± 3.2–2.8 ± 2.9, p < 0.001), but fell more with the T-eCH (?4.2 ± 3.2 regurgitations/day vs. ?3.0 ± 4.5, ns), especially in infants with a negative challenge (?3.9 ± 4.0 vs. ?1.9 ± 3.4, ns). Conclusion eCH fulfilled the criteria for a hypoallergenic formula, and the NT-eCH and T-eCH formulas both reduced CMPA symptoms. The symptom-based score is useful for evaluating how effective dietary treatments are for CMPA. PMID:24575806

  19. Recurrent bilateral varicose veins secondary to tricuspid regurgitation

    Microsoft Academic Search

    S. A. Badger; R. R. Makar; E. W. Chew; B. Lee

    Background  Varicose veins are a common condition. We present a case of recurrent veins due to tricuspid regurgitation.\\u000a \\u000a \\u000a \\u000a Case history  A 55-year-old female presented with large bilateral varicosities. On examination these were extensive and pulsatile in nature\\u000a over both legs. Three and 5 years previously she presented with similar signs and had undergone bilateral venous surgery including\\u000a Trendelenburg procedure. Past medical history included

  20. Unusual mechanism of tricuspid regurgitation in ventricular septal defect.

    PubMed

    Desai, Ravi V; Seghatol-Eslami, Frank; Nabavizadeh, Fatemeh; Lloyd, Steven G

    2011-02-01

    A 37-year-old woman was diagnosed to have a small ventricular septal defect (VSD) with high velocity tricuspid regurgitation (TR) that was attributed to atrio-VSD (Gerbode). Cardiac MR revealed a small subaortic VSD in the membranous portion of the interventricular septum. The atrioventricular portion was intact. Cardiac MR clearly showed flow jet through the VSD, impinging on the anterior tricuspid leaflet during systole, and bouncing back into the right atrium as TR. This ricochet mechanism of TR in VSD may be misinterpreted as Gerbode defect or as evidence of pulmonary hypertension. PMID:21210838

  1. Adult women with mitral valve prolapse are more flexible

    PubMed Central

    Araujo, C; Chaves, C

    2005-01-01

    Background: Mitral valve prolapse (MVP) is common in women. Other clinical features such as flexibility and hyperlaxity are often associated with MVP, as there is a common biochemical and histological basis for collagen tissue characteristics, range of joint motion, and mitral leaflet excursion. Objective: To confirm whether adult women with MVP are more flexible and hypermobile than those without. Methods: Data from 125 women (mean age 50 years), 31 of them with MVP, were retrospectively analysed with regard to clinical and kinanthropometric aspects. Passive joint motion was evaluated in 20 body movements using Flexitest and three laxity tests. Flexitest individual movements (0 to 4) and overall Flexindex scores were obtained in all subjects by the same investigator. Results: Women with MVP were lighter, less endomorphic and mesomorphic, and more linear. The Flexindex was significantly higher in the women with MVP, both absolute (48 (1.6) v 41 (1.3); p<0.01) and centile for age (67 v 42; p<0.01) values. In 13 out of 20 movements, the Flexitest scores were significantly higher for the women with MVP. Signs of hyperlaxity were about five times more common in these women: 74% v 16% (p<0.01). Scores of 0 and 1 in elbow extension, absence of hyperlaxity, and a Flexindex centile below 65 were almost never found in women with MVP. Conclusion: Flexitest, alone or combined with hyperlaxity tests, may be useful in the assessment of adult women with MVP. PMID:16183767

  2. Giant left ventricular aneurysm after recurrent mitral valve replacement.

    PubMed

    Üreyen, Ça?in Mustafa; Arslan, ?akir; Yüksel, Isa Öner; Ba?, Cem Yunus

    2015-03-01

    Left ventricular pseudoaneurysm after mitral valve replacement has been reported in various studies; however, as far as we know, a true aneurysm after redo mitral valve replacement has not been reported in any article yet. We herein present a patient who developed a true aneurysm and atrioventricular complete block after third surgery of mitral valve. DDD pacemaker was implanted, albeit the patient refused reoperation for aneurysmectomy. PMID:25787213

  3. Model-driven physiological assessment of the mitral valve from 4D TEE

    NASA Astrophysics Data System (ADS)

    Voigt, Ingmar; Ionasec, Razvan Ioan; Georgescu, Bogdan; Houle, Helene; Huber, Martin; Hornegger, Joachim; Comaniciu, Dorin

    2009-02-01

    Disorders of the mitral valve are second most frequent, cumulating 14 percent of total number of deaths caused by Valvular Heart Disease each year in the United States and require elaborate clinical management. Visual and quantitative evaluation of the valve is an important step in the clinical workflow according to experts as knowledge about mitral morphology and dynamics is crucial for interventional planning. Traditionally this involves examination and metric analysis of 2D images comprising potential errors being intrinsic to the method. Recent commercial solutions are limited to specific anatomic components, pathologies and a single phase of cardiac 4D acquisitions only. This paper introduces a novel approach for morphological and functional quantification of the mitral valve based on a 4D model estimated from ultrasound data. A physiological model of the mitral valve, covering the complete anatomy and eventual shape variations, is generated utilizing parametric spline surfaces constrained by topological and geometrical prior knowledge. The 4D model's parameters are estimated for each patient using the latest discriminative learning and incremental searching techniques. Precise evaluation of the anatomy using model-based dynamic measurements and advanced visualization are enabled through the proposed approach in a reliable, repeatable and reproducible manner. The efficiency and accuracy of the method is demonstrated through experiments and an initial validation based on clinical research results. To the best of our knowledge this is the first time such a patient specific 4D mitral valve model is proposed, covering all of the relevant anatomies and enabling to model the common pathologies at once.

  4. Robotically assisted minimally invasive mitral valve surgery

    PubMed Central

    Alwair, Hazaim; Nifong, Wiley L; Chitwood, W Randolph

    2013-01-01

    Increased recognition of advantages, over the last decade, of minimizing surgical trauma by operating through smaller incisions and its direct impact on reduced postoperative pain, quicker recovery, improved cosmesis and earlier return to work has spurred the minimally invasive cardiac surgical revolution. This transition began in the early 1990s with advancements in endoscopic instruments, video & fiberoptic technology and improvements in perfusion systems for establishing cardiopulmonary bypass (CPB) via peripheral cannulation. Society of Thoracic Surgeons data documents that 20% of all mitral valve surgeries are performed using minimally invasive techniques, with half being robotically assisted. This article reviews the current status of robotically assisted mitral valve surgery, its advantages and technical modifications for optimizing clinical outcomes. PMID:24251030

  5. Natural history of mitral valve prolapse

    Microsoft Academic Search

    Alfredo Zuppiroli; Michael Rinaldi; Randi Kramer-Fox; Silvia Favilli; Mary J. Roman; Richard B. Devereux

    1995-01-01

    To assess the rate and predictors of complications in patients with mitral valve prolapse (MVP), 316 subjects (mean age 42 ± 15 years) with echocardiographic MVP were followed prospectively for a mean of 102 months: 220 (70%) were women, 225 (71%) had clinically recognized MVP, and 91 (29%) were detected in family studies. During follow-up, 11 patients (0.4\\/100 subject-years) required

  6. Personalized modeling and assessment of the aortic-mitral coupling from 4D TEE and CT.

    PubMed

    Ionasec, Razvan Ioan; Voigt, Ingmar; Georgescu, Bogdan; Wang, Yang; Houle, Helene; Hornegger, Joachim; Navab, Nassir; Comaniciu, Dorin

    2009-01-01

    The anatomy, function and hemodynamics of the aortic and mitral valves are known to be strongly interconnected. An integrated quantitative and visual assessment of the aortic-mitral coupling may have an impact on patient evaluation, planning and guidance of minimal invasive procedures. In this paper, we propose a novel model-driven method for functional and morphological characterization of the entire aortic-mitral apparatus. A holistic physiological model is hierarchically defined to represent the anatomy and motion of the two left heart valves. Robust learning-based algorithms are applied to estimate the patient-specific spatial-temporal parameters from four-dimensional TEE and CT data. The piecewise affine location of the valves is initially determined over the whole cardiac cycle using an incremental search performed in marginal spaces. Consequently, efficient spectrum detection in the trajectory space is applied to estimate the cyclic motion of the articulated model. Finally, the full personalized surface model of the aortic-mitral coupling is constructed using statistical shape models and local spatial-temporal refinement. Experiments performed on 65 4D TEE and 69 4D CT sequences demonstrated an average accuracy of 1.45 mm and speed of 60 seconds for the proposed approach. Initial clinical validation on model-based and expert measurement showed the precision to be in the range of the inter-user variability. To the best of our knowledge this is the first time a complete model of the aortic-mitral coupling estimated from TEE and CT data is proposed. PMID:20426181

  7. Post-operative echocardiographic evaluation of bioprosthetic mitral valve implantation in sheep.

    PubMed

    De Vleeschauwer, S; De Praetere, H; Meuris, B; Herijgers, P; Herregods, M-C

    2015-01-01

    The ovine model is generally considered to be the best for testing bioprosthetic heart valve durability. Although echocardiography is the method of choice for the interim evaluation of the valve, literature on sheep echocardiography is scarce. Within the context of a study on treatment of pericardial heart valve prostheses, 19 adolescent sheep underwent transthoracic echocardiography six days after mitral implantation of bioprosthetic valves. Echocardiographic examination was performed under mild anesthesia and animals were put in a right lateral decubitus position. Four images were obtained: right parasternal long axis four and five chamber views, right parasternal long axis view with left ventricular outflow, and right parasternal short axis view through the mitral valve. We measured aortic annulus and velocity time integral over the aortic valve to determine stroke volume, cardiac output and cardiac index. The mitral valve was evaluated through color Doppler imaging for valvular and paravalvular leakages. Pulsed wave spectral Doppler was used for the measurement of velocities, pressures and velocity time integrals. For the evaluation of valve stenosis deceleration time and pressure half-time were determined. Effective orifice area of the mitral valve was derived. And, although not measured, other structures could clearly be visualized: right and left ventricle and atrium, wall thicknesses, tricuspid valve. This study shows that echocardiography in sheep is feasible, and that right parasternal images, obtained in animals in a right lateral decubitus position, are well qualified for the interim evaluation of bioprosthetic valves implanted in the mitral position. Besides the implanted valve, other cardiac structures like atria and ventricles can be visualized and evaluated. PMID:25117587

  8. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses.

    PubMed

    Ramakrishna, Harish; DeValeria, Patrick A; Sweeney, John P; Mookaram, Farouk

    2015-01-01

    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. PMID:25849702

  9. Modelisation mathematique realiste de la valve mitrale Sabine Paeme

    E-print Network

    Wolper, Pierre

    Mod´elisation math´ematique r´ealiste de la valve mitrale Sabine Paeme Mai 2009 #12;Table des mati . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.2 Les valves cardiaques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.2.2 Anatomie de la valve mitrale . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3 Physiologie

  10. Age and the clinical profile of idiopathic mitral valve prolapse

    Microsoft Academic Search

    A J Hickey; D E Wilcken

    1986-01-01

    The prevalence of mitral valve prolapse was determined in two independent populations (6887 consecutive adults and children referred for echocardiography during a three year period and 206 non-referred first degree relatives of 65 patients with mitral valve prolapse). In the 118 adults with echocardiographic evidence of prolapse those aged greater than or equal to 50 years were significantly more likely

  11. Mitral valve prolapse in hyperthyroidism of two different origins

    Microsoft Academic Search

    A Brauman; M Algom; Y Gilboa; Y Ramot; A Golik; D Stryjer

    1985-01-01

    The prevalence of mitral valve prolapse was investigated in 126 patients with hyperthyroidism due to Graves' disease or toxic nodular goitre and that of hyperthyroidism in 64 patients with mitral valve prolapse. One hundred and eleven asymptomatic healthy subjects comprised a control group. The patients with hyperthyroidism were divided into those with Graves' disease and those with toxic nodular goitre.

  12. Abnormalities in elastic fibers and other connective-tissue components of floppy mitral valve

    Microsoft Academic Search

    Koichi Tamura; Yuh Fukuda; Masamichi Ishizaki; Yukinari Masuda; Nobuaki Yamanaka; Victor J. Ferrans

    1995-01-01

    Histologic, immunohistochemical, and ultrastructural studies were performed on 12 floppy mitral valves, 4 mitral valves showing focal myxomatous changes without prolapse, and 3 normal mitral valves. All floppy mitral valves were thickened by deposits of proteoglycans and also showed diverse structural abnormalities in collagen and elastic fibers. From these observations we conclude that (1) the structure of all major components

  13. The natural history of aortic valve disease after mitral valve surgery

    Microsoft Academic Search

    Mordehay Vaturi; Avital Porter; Yehuda Adler; Yaron Shapira; Gideon Sahar; Bernardo Vidne; Alex Sagie

    1999-01-01

    OBJECTIVESThe present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.BACKGROUNDLittle is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition there is no firm policy regarding the

  14. Tuft calcium spikes in accessory olfactory bulb mitral cells.

    PubMed

    Urban, Nathaniel N; Castro, Jason B

    2005-05-18

    The mammalian accessory olfactory system is critical for the detection and identification of pheromones and the representation of complex stimuli including sex, genetic relatedness, and individual identity. Mitral cells, the principal cells of the accessory olfactory bulb (AOB), receive monosynaptic input from the sensory periphery and already show highly specific response properties, firing selectively for combinations of genetic markers and gender-specific cues. Vomeronasal sensory neuron axons form synapses onto distal tuft-like branches of mitral cell primary dendrites. We have studied dendritic excitability and synaptic integration in AOB mitral cell dendrites, and we show that dendrites of accessory olfactory bulb mitral cells support action potential propagation and can fire regenerative spike-like events that are likely to contribute to the integration of inputs to these cells. These tuft spikes may be important for the specificity of AOB mitral cell responses. PMID:15901783

  15. Tuft Calcium Spikes in Accessory Olfactory Bulb Mitral Cells

    PubMed Central

    Urban, Nathaniel N.; Castro, Jason B.

    2005-01-01

    The mammalian accessory olfactory system is critical for the detection and identification of pheromones and the representation of complex stimuli including sex, genetic relatedness, and individual identity. Mitral cells, the principal cells of the accessory olfactory bulb (AOB), receive monosynaptic input from the sensory periphery and already show highly specific response properties, firing selectively for combinations of genetic markers and gender-specific cues. Vomeronasal sensory neuron axons form synapses onto distal tuft-like branches of mitral cell primary dendrites. We have studied dendritic excitability and synaptic integration in AOB mitral cell dendrites, and we show that dendrites of accessory olfactory bulb mitral cells support action potential propagation and can fire regenerative spike-like events that are likely to contribute to the integration of inputs to these cells. These tuft spikes may be important for the specificity of AOB mitral cell responses. PMID:15901783

  16. Mitral valve prolapse in hyperthyroidism of two different origins.

    PubMed Central

    Brauman, A; Algom, M; Gilboa, Y; Ramot, Y; Golik, A; Stryjer, D

    1985-01-01

    The prevalence of mitral valve prolapse was investigated in 126 patients with hyperthyroidism due to Graves' disease or toxic nodular goitre and that of hyperthyroidism in 64 patients with mitral valve prolapse. One hundred and eleven asymptomatic healthy subjects comprised a control group. The patients with hyperthyroidism were divided into those with Graves' disease and those with toxic nodular goitre. Of the group as whole, 12 (9.5%) patients had mitral valve prolapse compared with six (5.4%) in the control group, but the difference was not statistically significant. The prevalence of mitral valve prolapse in the patients with toxic goitre was also not significantly different from that in the controls. When the prevalence in the group with Graves' disease was compared with that in the control group (16.3% vs 5.4%) the difference was significant. Only one patient with mitral valve prolapse had hyperthyroidism. PMID:3838679

  17. Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients with mitral stenosis

    Microsoft Academic Search

    Mohamed Eid Fawzy; Layth Mimish; Vas Sivanandam; Jayaram Lingamanaicker; Ashfaq Patel; B. Khan; C. M. G. Duran

    1996-01-01

    The pulmonary vascular hemodynamics were studied in 21 patients with severe mitral stenosis and severe pulmonary hypertension. Hemodynamic data were obtained before and immediately after mitral balloon valvotomy (MBV) and at follow-up 7 to 14 months (mean 12 months) later by repeat catheterization. The mean pulmonary capillary wedge pressure (PCW) decreased from 27 ± 5 to 15 ± 4 mm

  18. Mitral valve closure prediction with 3-D personalized anatomical models and anisotropic hyperelastic tissue assumptions.

    PubMed

    Sprouse, C; Mukherjee, R; Burlina, P

    2013-11-01

    This study is concerned with the development of patient-specific simulations of the mitral valve that use personalized anatomical models derived from 3-D transesophageal echocardiography (3-D TEE). The proposed method predicts the closed configuration of the mitral valve by solving for an equilibrium solution that balances various forces including blood pressure, tissue collision, valve tethering, and tissue elasticity. The model also incorporates realistic hyperelastic and anisotropic properties for the valve leaflets. This study compares hyperelastic tissue laws with a quasi-elastic law under various physiological parameters, and provides insights into error sensitivity to chordal placement, allowing for a preliminary comparison of the influence of the two factors (chords and models) on error. Predictive errors show the promise of the method, yielding aggregate median errors of the order of 1 mm, and computed strains and stresses show good correspondence with those reported in prior studies. PMID:23846436

  19. The Effects of Percutaneous Mitral Balloon Valvuloplasty on the Left Atrial Appendage Function in Patients With Sinus Rhythm and Atrial Fibrillation

    PubMed Central

    Aslanabadi, Naser; Jafaripour, Iraj; Toufan, Mehrnoush; Sohrabi, Bahram; Separham, Ahmad; Madadi, Reza; Feazpour, Hossein; Asgharzadeh, Yosef; Ahmadi, Mostafa; Safaiyan, Abdolrasol; Ghafari, Samad

    2015-01-01

    Introduction: Mitral stenosis (MS) causes structural and functional abnormalities of the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on left atrial function by transesophageal echocardiography (TEE). Methods: We enrolled 56 patients with severe mitral stenosis (valve area less than 1.5 CM2). All participants underwent mitral valvuloplasty; they also underwent transesophageal echocardiography before and at least one month after PTMC. Results: Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrial fibrillation (AF) in remainder 28 cases. There was no significant change in the left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), or the left ventricular end systolic dimension (LVESD) before and after PTMC in both groups. However, both groups showed a significant decrease in the left atrial volume index (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejection fraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantly after PTMC in both groups with SR and AF (P<0.001 for both). Conclusion: Percutaneous transvenous mitral commissurotomy improves left atrial appendage function in patients with mitral stenosis irrespective of the underlying heart rhythm. PMID:25859314

  20. Survival and echocardiographic data in dogs with congestive heart failure caused by mitral valve disease and treated by multiple drugs: A retrospective study of 21 cases

    PubMed Central

    de Madron, Eric; King, Jonathan N.; Strehlau, Günther; White, Regina Valle

    2011-01-01

    This retrospective study reports the survival time [onset of congestive heart failure (CHF) to death from any cause] of 21 dogs with mitral regurgitation (MR) and CHF treated with a combination of furosemide, angiotensin-converting enzyme inhibitor (ACEI, benazepril, or enalapril), pimobendan, spironolactone, and amlodipine. Baseline echocardiographic data: end-systolic and end-diastolic volume indices (ESVI and EDVI), left atrium to aorta ratio (LA/Ao), and regurgitant fraction (RF) are reported. Median survival time (MST) was 430 d. Initial dosage of furosemide (P = 0.0081) and LA/Ao (P = 0.042) were negatively associated with survival. Baseline echocardiographic indices (mean ± standard deviation) were 40.24 ± 16.76 for ESVI, 161.48 ± 44.49 mL/m2 for EDVI, 2.11 ± 0.75 for LA/Ao, and 64.71 ± 16.85% for RF. Combining furosemide, ACEI, pimobendan, spironolactone, and amlodipine may result in long survival times in dogs with MR and CHF. Severity of MR at onset of CHF is at least moderate. PMID:22547843

  1. Fifteen-year experience with the mitral Carpentier-Edwards PERIMOUNT pericardial bioprosthesis

    Microsoft Academic Search

    Michel A Marchand; Michel R Aupart; Robert Norton; Ira R. A Goldsmith; L. Conrad Pelletier; Michel Pellerin; Thomas Dubiel; Willem J Daenen; Paul Herijgers; Filip P Casselman; Michael P Holden; Tirone E David

    2001-01-01

    Background. This multicenter study concerning the mitral PERIMOUNT valve previously reported clinical results at 12 years; this report updates the performance to 15 years postoperatively.Methods. The 435 patients (mean age 60.7 ± 11.6 years; 41.1% male) underwent implantation with the PERIMOUNT valve between 1984 and 1989 at seven institutions. Follow-up was complete for 96.1% of the cohort. The mean follow-up

  2. Correlation between ventricular flow field and valve closing sound of mechanical mitral prostheses

    Microsoft Academic Search

    Toshinosuke Akutsu; Ryota Imai; Jun Saito; Tomoyuki Suzuki

    2008-01-01

    The Jyros (JR) valve and the newer On-X and MIRA valves, all installed antianatomically, were compared with the St. Jude Medical\\u000a (SJM) valve in the mitral position to study the effects of valve design differences on the down-stream flow field and the\\u000a associated valve closing sound. The dynamic particle image velocimetry method utilizing a high-speed video flow visualization\\u000a technique was

  3. Prevalence and correlates of aortic regurgitation in american indians: the Strong Heart Study

    Microsoft Academic Search

    Nathaniel E Lebowitz; Jonathan N Bella; Mary J Roman; Jennifer E Liu; Dawn P Fishman; Mary Paranicas; Elisa T Lee; Richard R Fabsitz; Thomas K Welty; Barbara V Howard; Richard B Devereux

    2000-01-01

    OBJECTIVESWe sought to determine the prevalence and correlates of aortic regurgitation (AR) in a population-based sample group.BACKGROUNDConcern over induction of AR by weight loss medication highlights the importance of assessing the prevalence and correlates of AR in unselected patient groups.METHODSAortic regurgitation was assessed by color flow Doppler echocardiography in 3,501 American Indian participants age 47 to 81 years during the

  4. The outcome and indications of the Cox maze III procedure for chronic atrial fibrillation with mitral valve disease

    Microsoft Academic Search

    Fumitaka Isobe; Yasunaru Kawashima

    1998-01-01

    Objective: The efficacy of the Cox maze III procedure for chronic atrial fibrillation associated with mitral valve disease is unclear, and so was evaluated in this study. Methods: In 30 patients, we applied the maze III procedure (cut and suture), except for one modification in the case of a left posterior sinus node artery. After dividing the patients into sinus

  5. Increased dispersion of refractoriness in the absence of QT prolongation in patients with mitral valve prolapse and ventricular arrhythmias

    Microsoft Academic Search

    Tsung O Cheng; Robert G Tieleman; Harry J G M Crijns; Kong I Lie; H. P. Hamer

    1995-01-01

    BACKGROUND--The mechanism responsible for the reported high incidence of ventricular arrhythmias in mitral valve prolapse is not clear. Electrocardiographic studies show an increased occurrence of repolarisation abnormalities on the 12 lead surface electrocardiogram, indicating regional differences in ventricular recovery. The purpose of this study was to investigate whether dispersion of refractoriness was an arrhythmogenic mechanism. METHODS--QT dispersion was measured in

  6. Mitral valve prolapse and psychiatric complications: a case report.

    PubMed Central

    Stavrakaki, C; Williams, E; Boisjoli, A; Vlad, P; Chassé, H

    1991-01-01

    This case study describes a 9-year-old-girl presenting with symptoms of anxiety and depression who was found to have mitral valve prolapse syndrome. The relationship of mitral valve prolapse and anxiety and depression has been studied and a review of the literature is presented. The family history of heart and psychiatric problems is explored. The importance of the bio-psycho-social approach is stressed as well as the suggestion that mitral valve prolapse be included as part of the differential diagnosis for anxiety. PMID:2049370

  7. Successful thrombolytic treatment of prosthetic mitral valve thrombosis

    PubMed Central

    Gazi, Emine; Altun, Burak; Temiz, Ahmet; Colkesen, Yucel

    2013-01-01

    Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 47-year-old woman who had undergone coronary artery bypass graft and mitral valve replacement operation 9?months ago. A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transoesophageal echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred. PMID:23749862

  8. Quantitative assessment of the hemodynamic consequences of aortic regurgitation by means of continuous wave Doppler recordings.

    PubMed

    Grayburn, P A; Handshoe, R; Smith, M D; Harrison, M R; DeMaria, A N

    1987-07-01

    The purpose of this study was to evaluate the ability of continuous wave Doppler ultrasound recordings to reflect the magnitude and hemodynamic effects of aortic regurgitation. Forty-five patients with angiographically proved aortic regurgitation had Doppler studies performed within 24 hours of cardiac catheterization. High quality spectral recordings of the regurgitant jet were obtained in 31 patients, whereas 14 patients exhibited dropout of high velocity signals precluding measurement of maximal velocities. The slope of the peak to end-diastolic velocity decrease measured by Doppler examination was compared with the decay in the aortic to left ventricular diastolic pressure gradient by catheterization and was found to correlate well (r = 0.86). The Doppler velocity decay slope was generally higher in patients with angiographically severe rather than mild or moderate aortic regurgitation, but considerable overlap was present among groups. However, a diastolic velocity decay slope of greater than 3 m/s2 was seen only in those patients with advanced (3 or 4+) aortic regurgitation. Left ventricular end-diastolic pressure was estimated from the Doppler recordings by subtracting the end-diastolic pressure gradient obtained by the modified Bernoulli equation from the cuff diastolic blood pressure. A correlation was observed (r = 0.84) between Doppler and catheterization left ventricular end-diastolic pressure in the 31 patients with high quality spectral data, although the SEE was substantial (5.5 mm Hg). These data demonstrate that continuous wave Doppler recordings of the regurgitant jet can be useful in assessing the angiographic severity and hemodynamics of aortic regurgitation. PMID:3298358

  9. Mitral valve replacement with Alvarez prosthesis: long-term results

    PubMed Central

    Mashhour, Y. A. S.; Garcia, J. B.; Ionescu, M.; Wooler, G. H.

    1969-01-01

    The high mortality and morbidity that follow insertion of the Alvarez valve in the mitral position, and particularly the thrombo-embolic complications, stopped us from using it clinically in the Leeds General Infirmary. Images PMID:5810369

  10. [Immune state in athletes with mitral valve prolapse].

    PubMed

    Maslennikova, O M; Reznichenko, T A; Firsakova, V Iu

    2013-01-01

    The authors evaluated immune state in 541 professional athletes. The athletes with vitral valve prolapse (132 subjects) appeared to have immune changes - lower immunoglobulines levels, general leucocytes count, if compared to the athletes without mitral valve prolapse. PMID:24340766

  11. “Adjustable” Artificial Chordal Replacement for Repair of Mitral Valve Prolapse

    Microsoft Academic Search

    J. Scott Rankin; Ricardo E. Orozco; Tracey L. Rodgers; David D. Alfery; Donald D. Glower

    2006-01-01

    Achieving a stable repair of mitral valve prolapse can be difficult in complex pathologies, and a 5% to 20% late reoperation rate exists with leaflet resection and recon- struction. During an 8-year period, prolapse was man- aged uniformly with \\

  12. Transapical mitral valved stent implantation: computed tomographic evaluation of different prototype designs.

    PubMed

    Pokorny, Saskia; Heinig, Alin; Hettich, Holger; Bähr, Telse; Marczynski-Bühlow, Martin; Morlock, Michael M; Sattler, Benjamin; Schöttler, Jan; Lutter, Georg

    2014-08-30

    Aims: The evaluation of in vivo shaping of mitral valved stent prototypes using cardiac computed tomography (CT) was the focus of this study. Methods and results: Twelve pigs received a self-expanding mitral valved stent, composed of an atrial element connected to a tubular ventricular body at a modified angle (45°, 90°, 110°) resulting in three designs. Cardiac CT was performed three weeks after implantation, with focus placed on stent design-related parameters: possible left ventricular outflow tract obstruction and stent shaping. CT was successfully conducted in 11/12 animals showing correct stent position within the mitral annulus and no obstruction of the left ventricular outflow tract in 9/11 animals. Minor radial deformations of the stent body were detected. At the atrioventricular junction, deformations of the stent structure were observed in all cases. Stents with a 45° angle exhibited the greatest deflection (?56.4°±14.5°). Conclusions: The effectiveness of cardiac computed tomography in the development process of valved stents to provide essential information and quantitative data about the in vivo stent geometry was demonstrated. The in vivo mechanical deformations of the stent were quantified, identifying critical design areas: a larger preset angle leads to less deflection and improved alignment and hence reduces the mechanical load. PMID:25169591

  13. Odor Enrichment Sculpts the Abundance of Olfactory Bulb Mitral Cells

    PubMed Central

    Johnson, Melissa Cavallin; Biju, K.C.; Hoffman, Joshua; Fadool, Debra Ann

    2013-01-01

    Mitral cells are the primary output cell from the olfactory bulb conveying olfactory sensory information to higher cortical areas. Gene-targeted deletion of the Shaker potassium channel Kv1.3 alters voltage-dependence and inactivation kinetics of mitral cell current properties, which contribute to the “Super-smeller” phenotype observed in Kv1.3-null mice. The goal of the current study was to determine if morphology and density are influenced by mitral cell excitability, olfactory environment, and stage of development. Wildtype (WT) and Kv1.3-null (KO) mice were exposed to a single odorant (peppermint or citralva) for 30 days. Under unstimulated conditions, postnatal day 20 KO mice had more mitral cells than their WT counterparts, but no difference in cell size. Odor-enrichment with peppermint, an olfactory and trigeminal stimulus, decreased the number of mitral cells in three month and one year old mice of both genotypes. Mitral cell density was most sensitive to odor-stimulation in three month WT mice. Enrichment at the same age with citralva, a purely olfactory stimulus, decreased cell density regardless of genotype. There were no significant changes in cell body shape in response to citralva exposure, but the cell area was greater in WT mice and selectively greater in the ventral region of the OB in KO mice. This suggests that trigeminal or olfactory stimulation may modify mitral cell area and density while not impacting cell body shape. Mitral cell density can therefore be modulated by the voltage and sensory environment to alter information processing or olfactory perception. PMID:23485739

  14. Odor enrichment sculpts the abundance of olfactory bulb mitral cells.

    PubMed

    Johnson, Melissa Cavallin; Biju, K C; Hoffman, Joshua; Fadool, Debra Ann

    2013-04-29

    Mitral cells are the primary output cell from the olfactory bulb conveying olfactory sensory information to higher cortical areas. Gene-targeted deletion of the Shaker potassium channel Kv1.3 alters voltage-dependence and inactivation kinetics of mitral cell current properties, which contribute to the "Super-smeller" phenotype observed in Kv1.3-null mice. The goal of the current study was to determine if morphology and density are influenced by mitral cell excitability, olfactory environment, and stage of development. Wildtype (WT) and Kv1.3-null (KO) mice were exposed to a single odorant (peppermint or citralva) for 30 days. Under unstimulated conditions, postnatal day 20 KO mice had more mitral cells than their WT counterparts, but no difference in cell size. Odor-enrichment with peppermint, an olfactory and trigeminal stimulus, decreased the number of mitral cells in three month and one year old mice of both genotypes. Mitral cell density was most sensitive to odor-stimulation in three month WT mice. Enrichment at the same age with citralva, a purely olfactory stimulus, decreased cell density regardless of genotype. There were no significant changes in cell body shape in response to citralva exposure, but the cell area was greater in WT mice and selectively greater in the ventral region of the OB in KO mice. This suggests that trigeminal or olfactory stimulation may modify mitral cell area and density while not impacting cell body shape. Mitral cell density can therefore be modulated by the voltage and sensory environment to alter information processing or olfactory perception. PMID:23485739

  15. Mitral Valve Prolapse and the Association with Cutaneous Mucin Infiltration

    PubMed Central

    Farooq, Uzma; McLeod, Michael P.; Torchia, Daniele; Romanelli, Paolo

    2013-01-01

    Mitral valve prolapse is the most common disorder of the cardiac valves in people in the United States. It can present as both primary and secondary disorders, and when associated with myxomatous changes in the skin, the term cardiocutaneous mucinosis can be used to describe this entity. Patients with mitral valve prolapse may have cutaneous findings on histological analysis that may indicate its severity and complication rate. PMID:23710268

  16. Association between congenitally quadricuspid aortic valve and mitral valve prolapse

    PubMed Central

    George, Betsy Ann; O'Hayre, Tayler Ann

    2013-01-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  17. Association between congenitally quadricuspid aortic valve and mitral valve prolapse.

    PubMed

    George, Betsy Ann; O'Hayre, Tayler Ann; Schussler, Jeffrey M

    2013-07-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  18. Stentless mitral valve replacement using the quattro valve.

    PubMed

    Walther, T; Walther, C; Falk, V; Krüger, M; Dagge, A; Diegeler, A; Autschbach, R; Mohr, F W

    1999-10-01

    This study analyzed early clinical results after stentless mitral valve (Quadrileaflet Mitral Valve (QMV)/Quattro) implantation. A total of 28 patients have received a Quattro valve since August 1997. Patient age was 69+/-8 years; the underlying disease was mitral incompetence (14) and stenosis (13). Preoperative New York Heart Association functional class was 3.2+/-0.4 and cardiac index was 1.8+/-0.6. Mean cross-clamp duration was 58+/-19 minutes. Twenty patients received a 28-mm prosthesis, and eight patients received a 30-mm prosthesis. Four patients had myocardial revascularization, two had tricuspid valve repair, and six had radiofrequency ablation therapy to restore sinus rhythm. Mortality (1) was nonvalve related. Reoperation was necessary in two patients for posterior paravalvular leakage (1) and for functional stenosis (1). Echocardiography showed satisfactory hemodynamic function. By stentless mitral valve implantation the annuloventricular continuity is preserved to stabilize left ventricular function. The Quattro valve resembles native mitral valve function and is well suited for mitral valve replacement. PMID:10660190

  19. Dermatoglyphs in children with mitral valve prolapse.

    PubMed Central

    Tay, J S; Yip, W C; Yap, H K; Lee, B W; Wong, H B; Chay, S O

    1985-01-01

    The dermatoglyphs of 50 Singapore school children with mitral valve prolapse (MVP) were studied, with special reference to the frequency of digital arches. The MVP was diagnosed clinically and substantiated by two dimensional echocardiography. In the study there were 35 Chinese and 15 Malay children, with ages ranging from 6 to 19 years. Four Chinese children had one or more arches on the digits but none of the Malay children was found to have arches. It was shown that the frequency of arches on the digits was not significantly higher than that among 50 controls (who were shown not to have MVP on two dimensional echocardiography) or when compared with the frequency of arches among the Chinese and Malay population in Singapore (2.0% and 2.9% respectively). No other dermatoglyphic abnormalities (including atd angle) were found. PMID:3989829

  20. Cardiac transgenic matrix metalloproteinase-2 expression induces myxomatous valve degeneration: a potential model of mitral valve prolapse disease

    PubMed Central

    Mahimkar, Rajeev; Nguyen, Anita; Mann, Michael; Yeh, Che-Chung; Zhu, Bo-Qing; Karliner, Joel S.; Lovett, David H.

    2012-01-01

    Introduction Myxomatous mitral valve “degeneration” with prolapse (MVP) is the most frequent form of nonischemic mitral valve disease. In myxomatous valves, interstitial cells express extracellular matrix-degrading enzymes and it has been postulated that matrix metalloproteinases (MMPs) contribute to these changes. Methods We generated mice with cardiac-specific expression of constitutively active MMP-2 under the control of the ?-myosin heavy chain promoter. Results These mice are normal at 4–6 months of age; at 12–14 months the mitral valves and chordae tendineae exhibit severe myxomatous change with echocardiographic MVP. Myxomatous change was also evident to a lesser extent in the aortic valves. Myxomatous changes were heterogeneous and limited to the left side of the heart with major disorganization of collagen bundles within the lamina fibrosa. Alcian blue/PAS-stained valves revealed massive accumulation of acidic glycosoaminoglycans within the lamina spongiosa, consistent with valvular interstitial cell differentiation to a chondrocytic phenotype. Cells with the histologic features of hypertrophied chondrocytes were found within the chordae tendineae and the tips of the mitral papillary muscles. Conclusion This report demonstrates that increased activity of a single enzyme, MMP-2, within a transgenic context reproduces many of the features of the human MVP syndrome. The cardiac-specific MMP-2 transgenic mouse potentially provides a unique experimental platform for the evaluation of nonsurgical therapies based on the underlying pathophysiology of this disease. Published by Elsevier Inc. PMID:18835790

  1. Percutaneous repair of paravalvular prosthetic regurgitation: patient selection, techniques and outcomes.

    PubMed

    Sorajja, Paul; Bae, Richard; Lesser, John A; Pedersen, Wesley A

    2015-05-01

    Paravalvular prosthetic regurgitation is common, affecting 5-10% of surgical prostheses and 40-70% of transcatheter valves. While many patients may suffer no significant morbidity, paravalvular prosthetic regurgitation can lead to heart failure and haemolytic anaemia, and, in some studies, has been associated with impaired survival. Over the past several years, percutaneous repair of paravalvular prosthetic regurgitation has been demonstrated to be a highly efficacious therapy. When performed in experienced centres, procedural success with percutaneous repair occurs in 90% of patients. Due to the complex nature of the techniques, there is a significant learning curve with a high potential for prolonged procedures (?2.5?h) and complications (?5%), although death is rare (?0.5%). Percutaneous repair of paravalvular prosthetic regurgitation requires a close collaboration between imaging specialists, surgeons and the interventional operators. Importantly, successful percutaneous repair obviates the need for open surgical correction, which can be high risk or prohibitive due to the need for reoperation in the setting of comorbidities. Herein, we discuss appropriate patient selection, the catheter-based techniques and outcomes of percutaneous repair for symptomatic paravalvular prosthetic regurgitation. PMID:25678496

  2. Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients with mitral stenosis

    Microsoft Academic Search

    Mohamed Eid Fawzy; Layth Mimish; Vas Sivanandam; Jayaram Lingamanaicker; Ashfaq Patel; B. Khan; C. M. G. Duran

    The pulmonary vascular hemodynamics were studied in 21 patients with severe mitral stenosis and severe pulmonary hypertension. Hemodynamic data were obtained before and immediately after mitral balloon valvotomy (MBV) and at fol- low-up 7 to 14 months (mean 12 months) later by repeat catheterization. The mean pulmonary capillary wedge pres- sure (PCW) decreased from 27±5 to 15±4 mm Hg (p

  3. Increased dispersion of refractoriness in the absence of QT prolongation in patients with mitral valve prolapse and ventricular arrhythmias.

    PubMed Central

    Tieleman, R. G.; Crijns, H. J.; Wiesfeld, A. C.; Posma, J.; Hamer, H. P.; Lie, K. I.

    1995-01-01

    BACKGROUND--The mechanism responsible for the reported high incidence of ventricular arrhythmias in mitral valve prolapse is not clear. Electrocardiographic studies show an increased occurrence of repolarisation abnormalities on the 12 lead surface electrocardiogram, indicating regional differences in ventricular recovery. The purpose of this study was to investigate whether dispersion of refractoriness was an arrhythmogenic mechanism. METHODS--QT dispersion was measured in 32 patients with echocardiographically documented mitral valve prolapse and ventricular arrhythmias on 24 hour Holter recordings. QT dispersion was defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface electrocardiogram. QT dispersion corrected for heart rate was calculated by Bazett's formula. The results were compared with the data from 32 matched controls without a history of cardiac disease. Patients taking drugs that influence the QT interval and patients with a QRS duration > 120 ms were excluded. RESULTS--QT dispersion was greater in patients with mitral valve prolapse than in matched controls (60 (20) v 39 (11 ms) respectively, P < or = 0.001) as was corrected QT (64 (20 ms) v 43 (12 ms) respectively, P < or = 0.001). There was no significant difference in minimum or maximum QT intervals between the two groups. CONCLUSIONS--QT dispersion on the 12 lead surface electrocardiogram was greater in patients with mitral valve prolapse with ventricular arrhythmias than in normal controls, but the maximum QT interval was not increased. The results accord with the hypothesis that regional shortening and lengthening of repolarisation times in patients with mitral valve prolapse may account for the increased dispersion of refractoriness. PMID:7888258

  4. Discharge patterning in rat olfactory bulb mitral cells in vivo

    PubMed Central

    Leng, Gareth; Hashimoto, Hirofumi; Tsuji, Chiharu; Sabatier, Nancy; Ludwig, Mike

    2014-01-01

    Abstract Here we present a detailed statistical analysis of the discharge characteristics of mitral cells of the main olfactory bulb of urethane?anesthetized rats. Neurons were recorded from the mitral cell layer, and antidromically identified by stimuli applied to the lateral olfactory tract. All mitral cells displayed repeated, prolonged bursts of action potentials typically lasting >100 sec and separated by similarly long intervals; about half were completely silent between bursts. No such bursting was observed in nonmitral cells recorded in close proximity to mitral cells. Bursts were asynchronous among even adjacent mitral cells. The intraburst activity of most mitral cells showed strong entrainment to the spontaneous respiratory rhythm; similar entrainment was seen in some, but not all nonmitral cells. All mitral cells displayed a peak of excitability at ~25 msec after spikes, as reflected by a peak in the interspike interval distribution and in the corresponding hazard function. About half also showed a peak at about 6 msec, reflecting the common occurrence of doublet spikes. Nonmitral cells showed no such doublet spikes. Bursts typically increased in intensity over the first 20–30 sec of a burst, during which time doublets were rare or absent. After 20–30 sec (in cells that exhibited doublets), doublets occurred frequently for as long as the burst persisted, in trains of up to 10 doublets. The last doublet was followed by an extended relative refractory period the duration of which was independent of train length. In cells that were excited by application of a particular odor, responsiveness was apparently greater during silent periods between bursts than during bursts. Conversely in cells that were inhibited by a particular odor, responsiveness was only apparent when cells were active. Extensive raw (event timing) data from the cells, together with details of those analyses, are provided as supplementary material, freely available for secondary use by others. PMID:25281614

  5. Low Magnesium Levels and FGF-23 Dysregulation Predict Mitral Valve Calcification as well as Intima Media Thickness in Predialysis Diabetic Patients

    PubMed Central

    Jerónimo, Teresa; Fragoso, André; Silva, Claudia; Guilherme, Patrícia; Santos, Nélio; Faísca, Marília; Neves, Pedro

    2015-01-01

    Background. Mitral valve calcification and intima media thickness (IMT) are common complications of chronic kidney disease (CKD) implicated with high cardiovascular mortality. Objective. To investigate the implication of magnesium and fibroblast growth factor-23 (FGF-23) levels with mitral valve calcification and IMT in CKD diabetic patients. Methods. Observational, prospective study involving 150 diabetic patients with mild to moderate CKD, divided according to Wilkins Score. Carotid-echodoppler and transthoracic echocardiography were used to assess calcification. Statistical tests used to establish comparisons between groups, to identify risk factors, and to establish cut-off points for prediction of mitral valve calcification. Results. FGF-23 values continually increased with higher values for both IMT and calcification whereas the opposite trend was observed for magnesium. FGF-23 and magnesium were found to independently predict mitral valve calcification and IMT (P < 0.05). Using Kaplan-Meier analysis, the number of deaths was higher in patients with lower magnesium levels and poorer Wilkins score. The mean cut-off value for FGF-23 was 117?RU/mL and for magnesium 1.7?mg/dL. Conclusions. Hypomagnesemia and high FGF-23 levels are independent predictors of mitral valve calcification and IMT and are risk factors for cardiovascular mortality in this population. They might be used as diagnostic/therapeutic targets in order to better manage the high cardiovascular risk in CKD patients.

  6. Half time of the diastolic aortoventricular pressure difference by continuous wave Doppler ultrasound: a measure of the severity of aortic regurgitation?

    Microsoft Academic Search

    S O Samstad; L Hegrenaes; T Skjaerpe; L Hatle

    1989-01-01

    Thirty four patients with aortic regurgitation were studied by continuous wave Doppler ultrasound. In 30 of these the regurgitation was graded by cineangiography as mild, moderate, or severe and in four severe regurgitation was confirmed at operation. The half times of the aortoventricular pressure differences obtained with Doppler compared well with those obtained from pressure recordings at catheterisation. The relation

  7. Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia

    Microsoft Academic Search

    Mohamed Ben Farhat; Fethi Betbout; Habib Gamra; Faouzi Maatouk; Mokdad Ayari; Ali Cherif; Mourad Jarrar; Habib Boussadia; Sonia Hammami; Iheb Chahbani

    1995-01-01

    Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age ±SD was 33 ± 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral

  8. Modified commissural patch repair in a child with active mitral endocarditis.

    PubMed

    Ishimaru, Kazuhiko; Nishigaki, Kyoichi; Kanaya, Tomomitsu; Araki, Kanta; Shibata, Toshihiko

    2014-05-19

    A 9-year-old patient with massive destruction of the mitral apparatus caused by active infective endocarditis underwent mitral valve plasty using a modified commissural autologous pericardial patch repair. This procedure is a clinically relevant and feasible technique for pediatric patients with active mitral valve endocarditis. PMID:24842454

  9. Using Real-Time Three-Dimensional Ultrasound to Characterize Mitral Valve Motion

    E-print Network

    Ayache, Nicholas

    Using Real-Time Three-Dimensional Ultrasound to Characterize Mitral Valve Motion Paul M. Novotnya results aim to fully characterize the four-dimensional (3D + time) movement of the mitral valve for better understanding of its behavior prior to surgical interventions, such as mitral valve repair. A behavior model

  10. Fast Interactive Simulations of Mitral Valve Repair Neil A. Tenenholtz, Peter E. Hammer, Robert D. Howe

    E-print Network

    Fast Interactive Simulations of Mitral Valve Repair Neil A. Tenenholtz, Peter E. Hammer, Robert D. Howe Keywords: Surgical simulation, human-computer interaction, haptics, mitral valve, cardiac surgery. I. Problem Solved A healthy mitral valve ensures the one-way flow of oxygenated blood from the left

  11. Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse

    Microsoft Academic Search

    Kaan Kulan; Baki Komsuo?lu; Cemal Tuncer; Cansel Kulan

    1996-01-01

    The present study was designed to detect the arrhythmogenic effect of mitral valve prolapse, and the relationship between QT, QT dispersion and ventricular arrhythmias in subjects with mitral valve prolapse. Sixty-four mitral valve prolapse subjects (24 men and 40 women, mean age 27 ± 6), and 80 healthy control subjects (32 men and 48 women, mean age 28 ± 7)

  12. Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

    PubMed Central

    Kalmanson, D; Veyrat, C; Bernier, A; Witchitz, S; Chiche, P

    1976-01-01

    In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification. PMID:1259828

  13. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation

    Microsoft Academic Search

    G T Wilkins; A E Weyman; V M Abascal; P C Block; I F Palacios

    1988-01-01

    Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral

  14. The myxomatous mitral valve and sudden death.

    PubMed

    Chesler, E; King, R A; Edwards, J E

    1983-03-01

    The clincopathologic features of 14 cases of sudden death attributable to dysrhythmias associated with the myxomatous mitral valve are described. The patients were 14-59 years old (mean 27 +/- 11 years). Eleven were female and three male. Of the seven ECGs available, none showed prolongation of the QT interval, but two showed repolarization abnormalities. The material was classified according to the degree of prolapse in the pathologic specimen. When obvious prolapse was found, the expected auscultatory findings had been documented. In three cases there was minimal prolapse, casting some doubt on the hypothesis that traction on the papillary muscles or diastolic dumping of the leaflets may be implicated in the pathogenesis of the dysrhythmias. In one of the cases with minimal prolapse there was a strong family history of sudden death. Endocardial friction lesions were present in 11 cases, including two of the three with minimal prolapse. In five cases there was a thrombotic lesion in the angle between the posterior leaflet and the left atrial wall containing fibrin and platelets. These abnormalities may be important in the pathogenesis of the ventricular dysrhythmias. PMID:6821906

  15. Chronic Regurgitation among Persons with Mental Retardation: A Need for Combined Medical and Interdisciplinary Strategies.

    ERIC Educational Resources Information Center

    Rogers, B.; And Others

    1992-01-01

    This study found chronic regurgitation in 23 of 220 institutionalized adults with severe mental retardation. A high prevalence of dysphagia and gastroesophageal abnormalities was found, suggesting the importance of full evaluation and treatment prior to a diagnosis of rumination in this population. (Author/DB)

  16. Color Doppler Ultrasound Imaging Of Simulated Heart Valve Regurgitant Jets: Correction Of Aliasing By Theoretical Modeling

    Microsoft Academic Search

    Sandy F. C. Stewart

    1991-01-01

    Clinical quantification of native and prosthetic valve regurgitation by color Doppler ultrasound (CDU) remains elusive, partly because CDU aliases at velocities much lower than those typically found in jets. One way to correct aliasing is to model the jet with fluid mechanical theory. An equation fitted to the nonaliased velocities can then be used to replace the aliased velocities with

  17. Images in clinical medicine: Giant C-v waves of tricuspid regurgitation.

    PubMed

    ur Rehman, Habib

    2013-11-14

    A 33-year-old woman who had received a diagnosis of tricuspid valve endocarditis caused by MRSA was evaluated for replacement of the tricuspid valve. Videos show giant systolic pulsations during jugular venous examination and severe tricuspid regurgitation during transthoracic ECG. PMID:24224640

  18. Surgical phantom for off-pump mitral valve replacement

    NASA Astrophysics Data System (ADS)

    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.

  19. Study of in vitro mitral valve filling flow.

    PubMed

    Drost, Timothy; Zimmer, Tiffany; Kim, Hyoung-Bum; Shandas, Robin; Hertzberg, Jean

    2004-01-01

    Diastolic function is a good indicator of overall cardiac health. This study is in support of a non-invasive technique to measure diastolic function. Interpretation of mitral flow, and early diagnosis of normality or dysfunction, can be enhanced by improved understanding of the fluid dynamics. A simple in-vitro model of mitral flow is being used to illustrate vortex dynamics associated with diastolic inflow. A range of tailored mitral flow waveforms are being developed to mimic normal velocity profiles. Laser Doppler velocimetry (LDV) is being used to measure the flow speed. By combining flow visualization, particle image velocimetry and LDV, vortex ring signatures including size, circulation, and propagation speed are being examined as possible metrics for diastolic dysfunction. The detection of these signatures in the downstream flow will be compared to clinical waveforms derived from Doppler ultrasound. PMID:15133983

  20. Mitral-Aortic Intervalvular Fibrosa Involvement by Takayasu’ Arteritis

    PubMed Central

    Davarpasand, Tahereh; Hosseinsabet, Ali; Sotudeh Anvary, Maryam

    2014-01-01

    Takayasu’s arteritis is an inflammatory disease with a variety of manifestations, such as cardiac involvement. We describe a 52-year-old woman with clinical and echocardiographic manifestations mimicking infectious endocarditis, such as periaortic and mital-aortic intervalvular fibrosa abscess with extension to the anterior mitral leaflet. However, no infective tissue was discovered intraoperatively. Pathological evaluation demonstrated Takayasu’s arteritis. To the best of our knowledge, Takayasu’s arteritis can involve mitral-aortic intervalvular fibrosa and imitate infectious endocarditis. PMID:25614864

  1. Long-term, Clinical and Echocardiographic Results After Successful Mitral Balloon Valvotomy and Predictors of Long-term Outcome

    Microsoft Academic Search

    Mohamed Eid Fawzy; Hesham Hegazy; Mohamed Shoukri

    2005-01-01

    Aims To assess the long-term outcome of mitral balloon valvotomy (MBV) and identify predictors of rest- enosis- and event-free survival. Methods and results We report the immediate and long-term clinical and echocardiographic results in 493 patients, mean age 31+ 11, who underwent successful MBV and were followed-up for 0.5-15 years (median 5+ 3) with clinical and echocardiographic examination. After MBV,

  2. Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

    PubMed Central

    Addetia, Karima; Maffessanti, Francesco; Mediratta, Anuj; Yamat, Megan; Weinert, Lynn; Moss, Joshua D.; Nayak, Hemal M.; Burke, Martin C.; Patel, Amit R.; Kruse, Eric; Jeevanandam, Valluvan; Mor-Avi, Victor; Lang, Roberto M.

    2015-01-01

    Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR. Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ? 0.5 cm) or severe (VC width ? 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis. Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively. Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR. PMID:25129393

  3. The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study.

    PubMed

    Teixeira, Rogério; Monteiro, Ricardo; Garcia, João; Baptista, Rui; Ribeiro, Miguel; Cardim, Nuno; Gonçalves, Lino

    2015-08-01

    The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (r?R) and strain rate (rSRR). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e')/r?R. The median age of the sample was 78 (64-84) years, with female gender predominance (63.6 %). The median value of r?R was 16 % (range, 12.7-24.0) and of rSRR was 1.57 s(-1) (range, 1.09-2.05). We observed a significant negative correlation between r?R (r = -0.68, p < 0.01) and rSRR (r = -0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for r?R and rSRR, separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with r?R after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower r?R and rSRR that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics. PMID:25904401

  4. Changes of Serum ?-Endorphin by Programmed Exercise Training Are Correlated with Improvement of Clinical Symptoms and Quality of Life in Female Mitral Valve Prolapse Syndrome

    Microsoft Academic Search

    Huei-Fong Hung; Pai-Feng Kao; Yu-Shuang Lin; Feng-Chia Chen; Fu-Chean Chen; Jen-Chen Tsai; Paul Chan

    2007-01-01

    Background: Mitral valve prolapse (MVP) is a common entity in female population. Although this is a minor disease, it may cause annoying symptoms that impair quality of life (QOL), and no established therapy for this problem. The aim of this study isto examine whether programmed exercise training by treadmill in female MVP syndrome would improve clinical symptoms and QOL. Methods:

  5. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair

    PubMed Central

    Spampinato, Ricardo A.; Borger, Michael A.; Strotdrees, Elfriede; Mohr, Friedrich W.

    2013-01-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  6. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair.

    PubMed

    Spampinato, Ricardo A; Borger, Michael A; Strotdrees, Elfriede; Mohr, Friedrich W

    2013-03-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  7. Analysis of immunostaining and western blotting of endothelin 1 and its receptors in mitral stenosis

    PubMed Central

    Leão, Sydney Correia; Dashwood, Michael R.; de Andrade, Mateus Santana; Santos, Nicolas Nascimento; Teles, Olivia Regina Lins Leal; de Souza, Williasmin Batista; Rodrigues, Tania Maria de Andrade

    2015-01-01

    Introduction Rheumatic Fever represents a serious public health problem in developing countries, with thousands of new cases each year. It is an autoimmune disease, which occurs in response to infection by streptococcus A. Objective The aim of this study was to evaluate the immunolabeling and protein expression for endothelin-1 and 3 (ET-1, ET-3) and its receptors (ETA, ETB) in rheumatic mitral valves. Methods Immunohistochemistry was used to identify ET-1/ET-3 and ETA/ETB receptors in rheumatic and control mitral valves. Quantitative analysis of immunostaining for ET-1/ET-3 and ETA/ETB receptors was performed. In addition, western blot analysis was carried out to assess protein levels in tissue samples. Results ET-1 and ETA receptor immunostaining predominated in stenotic valves, mainly associated with fibrotic regions, inflammatory areas and neovascularization. Quantitative analysis showed that the average area with positive expression of ET-1 was 18.21±14.96%. For ETA and ETB, the mean expressed areas were respectively 15.06±13.13% and 9.20±11.09%. ET-3 did not have a significant expression. The correlation between the expression of both endothelin receptors were strongly positive (R=0.74, P=0.02), but the correlation between ET-1 and its receptor were negative for both ETA (R=-0.37, P=0.25), and ETB (R=-0.14, P=0.39). This data was supported by western blot analysis. Conclusion The strong correlation between ET-1 and its receptors suggests that both play a role in the pathophysiology of rheumatic mitral valve stenosis and may potentially act as biomarkers of this disease.

  8. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

    NASA Technical Reports Server (NTRS)

    Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (< or =5%) patients. Obstructive coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  9. Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot: A Comparative Analysis of Echocardiography and Magnetic Resonance Imaging

    PubMed Central

    Mercer-Rosa, Laura; Yang, Wei; Kutty, Shelby; Rychik, Jack; Fogel, Mark; Goldmuntz, Elizabeth

    2012-01-01

    Background Patients with repaired tetralogy of Fallot (TOF) are monitored for pulmonary regurgitation (PR), and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR), and to develop a new tool for assessing PR by echocardiogram. Methods and Results Patients with repaired TOF (N=143, 12.5± 3.2 years) had an echocardiogram and CMR within three months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall, and (2) myocardial performance index (MPI). The ratio of diastolic and systolic time-velocity integrals (DSTVI) measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection fraction (EF), RV volumes, and pulmonary regurgitant fraction (RF). Pulmonary regurgitation was graded as mild (RF <20%), moderate (RF=20–40%), and severe (RF>40%). On CMR, RF was 34±17% and RV EF was 61±8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%, 95% CI: 92–99%) but overestimated the amount of PR when RF<20% (false positive rate 36%, 95% CI: 18–57%). The DSTVI on echocardiogram showed moderate correlation with RF on CMR (R=0.60, P<0.0001). On CMR, RF of 20% and 40% corresponded with a DSTVI of 0.49 (95% CI: 0.44–0.56), and 0.72 (95% CI: 0.68–0.76), respectively. RV MPI correlated modestly with RV EF (r=?0.33, P<0.001). Conclusions This study suggests that the DSTVI ratio may make a modest contribution to the overall assessment of PR in patients with repaired TOF and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared to CMR. PMID:22869820

  10. Improved noninvasive method for measurement of cardiac output and evaluation of left-sided cardiac valve incompetence

    SciTech Connect

    Kelbaek, H.

    1989-05-01

    A time-saving method was developed to label red blood cells in vitro with /sup 99m/Tc while avoiding centrifugation. After tin incubation, extracellular tin was oxidized by sodium hypochlorite, and EDTA was added for stabilizing the complex prior to /sup 99m/Tc incubation. Labeling yields were 95%, and in vivo decay showed a high stability with a mean biologic half-life of eleven hours. The first-passage radionuclide technique for determination of cardiac output using the above-mentioned tracer was evaluated by using the left ventricle as area-of-interest with individual background correction after complete mixing of the tracer. This technique showed a high level of agreement with invasive methods. By combining this method for measurement of the forward stroke volume with the multigated equilibrium principle for determination of the total left ventricular stroke volume using similar background corrections, an exact evaluation of regurgitation fractions was obtained. In patients with aortic and mitral valve disease the noninvasive radionuclide technique gave similar but probably more accurate results as compared with contrast aortography and ventriculography. The radionuclide technique may be suitable for monitoring and selecting patients for surgical treatment.

  11. Dynamic modelling of chorded mitral valves inside left ventricle

    E-print Network

    Luo, Xiaoyu

    model. This model allows us to investigate the influences of the flow vortex generated by the LV motion and swirls around in a clockwise fashion, forming a main clockwise vortex. This vortex persists through. Yin M, Luo X Y, Wang T J & Watton P , Effects of Flow Vortex on a Chorded Mitral Valve in the Left

  12. Endocarditis of the mitral valve posteromedial papillary muscle.

    PubMed

    Moorjani, Narain; Saad, Rasheed; Gallagher, Patrick; Livesey, Steven

    2014-03-01

    A 36-year-old intravenous drug abuser presented with an aortic root abscess and partial rupture of the posteromedial papillary muscle. Following aortic and mitral valve replacement, histological and microbiological analysis of the papillary muscle demonstrated methicillin-sensitive Staphylococcus aureus infection. PMID:24152175

  13. Fibrillin and other matrix proteins in mitral valve prolapse syndrome

    Microsoft Academic Search

    Joseph F Nasuti; Paul J Zhang; Michael D Feldman; Terri Pasha; Jasvir S Khurana; Joseph H Gorman; Robert C Gorman; Jagat Narula; Navneet Narula

    2004-01-01

    BackgroundUnlike myxomatous degeneration in Marfan syndrome, which has been reported to result from a mutation in the gene that codes for the extracellular structural protein fibrillin, no specific molecular abnormality has been documented to be the underlying cause of myxomatous degeneration in mitral valve prolapse syndrome (MVPS). The present study examined the distribution of fibrillin and other extracellular matrix proteins

  14. Integration of a biomechanical simulation for mitral valve reconstruction into a knowledge-based surgery assistance system

    NASA Astrophysics Data System (ADS)

    Schoch, Nicolai; Engelhardt, Sandy; Zimmermann, Norbert; Speidel, Stefanie; De Simone, Raffaele; Wolf, Ivo; Heuveline, Vincent

    2015-03-01

    A mitral valve reconstruction (MVR) is a complex operation in which the functionality of incompetent mitral valves is re-established by applying surgical techniques. This work deals with predictive biomechanical simulations of operation scenarios for an MVR, and the simulation's integration into a knowledge-based surgery assistance system. We present a framework for the definition of the corresponding surgical workflow, which combines semantically enriched surgical expert knowledge with a biomechanical simulation. Using an ontology, 'surgical rules' which describe decision and assessment criteria for surgical decision-making are represented in a knowledge base. Through reasoning these 'rules' can then be applied on patient-specific data in order to be converted into boundary conditions for the biomechanical soft tissue simulation, which is based on the Finite Elements Method (FEM). The simulation, which is implemented in the open-source C++ FEM software HiFlow3, is controlled via the Medical Simulation Markup Language (MSML), and makes use of High Performance Computing (HPC) methods to cope with real-time requirements in surgery. The simulation results are presented to surgeons to assess the quality of the virtual reconstruction and the consequential remedial effects on the mitral valve and its functionality. The whole setup has the potential to support the intraoperative decision-making process during MVR where the surgeon usually has to make fundamental decision under time pressure.

  15. Effect of Gender on Results of Percutaneous Edge-to-Edge Mitral Valve Repair With MitraClip System.

    PubMed

    Estévez-Loureiro, Rodrigo; Settergren, Magnus; Winter, Reidar; Jacobsen, Per; Dall'Ara, Gianni; Sondergaard, Lars; Cheung, Gary; Pighi, Michele; Ghione, Matteo; Ihlemann, Nikolaj; Moat, Neil E; Price, Susanna; Streit Rosenberg, Tine; Di Mario, Carlo; Franzen, Olaf

    2015-07-15

    Knowledge regarding gender-specific results of percutaneous edge-to-edge mitral valve repair is scarce. The aim of this study was to investigate gender differences in outcomes in a cohort of patients treated with MitraClip implantation. A multicenter registry of 173 patients treated with MitraClip prostheses from 2009 to 2012 at 3 experienced centers was performed. One hundred nine patients (63%) were men. Men were younger (mean age 73 ± 10 vs 79 ± 9 years, p = 0.001) and had a higher prevalence of previous coronary bypass graft surgery (34% vs 13%, p = 0.002), previous myocardial infarction (46% vs 20%, p = 0.001), and diabetes mellitus (26% vs 11%, p = 0.020). There were no differences regarding New York Heart Association (NYHA) functional class before the intervention (NYHA class III or IV in 95% of men vs 97% of women, p = 0.472) or the cause of mitral regurgitation (MR) (functional in 58% of men vs 48% of women, p = 0.233). Men exhibited significantly larger ventricles (mean indexed left ventricular end-systolic diameter 2.4 ± 0.8 vs 2.0 ± 1.6 cm/m(2), p = 0.002, and mean indexed left ventricular end-diastolic volume 92.7 ± 46.1 vs 59.9 ± 24.6 ml/m(2), p <0.001). At 1 month, there were no differences between groups in the reduction of MR or NYHA functional class (MR grade ?2+ in 98.2% of men vs 96.8% of women, p = 0.586, and NYHA class ?II in 78.3% of men vs 77% of women, p = 0.851). At 6 months, results were maintained (MR grade ?2+ in 89.5% of men vs 96.8% of women, p = 0.414, and NYHA class ?II in 73.1% of men vs 74.2% of women, p = 0.912). After a mean follow-up period of 16.1 ± 11.1 months, no difference was found between groups in the incidence of death or admission for heart failure (log-rank p = 0.798). In conclusion, MitraClip implantation seems to be an equally safe and effective treatment of MR in men and women. PMID:25960377

  16. Immediate and long-term effect of mitral balloon valvotomy on left ventricular volume and systolic function in severe mitral stenosis

    Microsoft Academic Search

    Mohamed E. Fawzy; W. B. Choi; L. Mimish; V. Sivanandam; J. Lingamanaicker; A. Khan; A. Patel; B. Khan

    1996-01-01

    To determine the immediate and long-term effect of mitral balloon valvotomy (MBV) on left ventricular (LV) volume and function, we studied 17 patients (mean age 27 ± 9 years) with severe mitral stenosis undergoing MBV by cardiac catheterization and angiography before and immediately after MBV and at mean 12 months later. At baseline, LV end-diastolic volume index (EDVI) was reduced.

  17. An Infant with Nasal Regurgitation Since Birth and Failure to Thrive

    PubMed Central

    Rai, Garjesh Singh; Sharma, Sakshi; Apte, Ashwin

    2015-01-01

    The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3rd of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive ‘bird beak sign’. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller’s Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.

  18. The Prevalence of Hypomagnesaemia in Pediatric Patients with Mitral Valve Prolapse Syndrome and the Effect of Mg Therapy

    PubMed Central

    Amoozgar, Hamid; Rafizadeh, Hashem; Ajami, Gholamhossein; Borzoee, Mohammad

    2012-01-01

    Background A paucity of data exists regarding the prevalence and relationship of hypomagnesaemia with clinical symptoms of mitral valve prolapse (MVP) in pediatric patients. Objective In this study we evaluated the prevalence of magnesium (Mg) deficiency in pediatric patients with MVP syndrome and attempted to clarify the effect of Mg therapy on alleviating their symptoms. Methods The present study was conducted from April 2010 to January 2012, and included 230 patients (90 males and 140 females) with symptoms of mitral valve prolapse and mean age of 11.6±3.66. Serum magnesium (Mg) level less than 1.5 mg/dl was defined as hypomagnesaemia. Patients with 2 mm leaflet displacement and maximum leaflet thickness of 5 mm in echocardiography were considered to have classic MVP, while those with leaflet thickness less than 5 mm were considered as non-classic MVP. Patients with hypomagnesaemia were orally treated with 4.5 mg/kg/day Mg chloride for 5 weeks followed by re-evaluation of symptoms of chest pain, palpitation, fatigue and dyspnea. Results Hypomagnesaemia was found in 19 (8.2 %) of 230 patients with mitral valve prolapse. The re-evaluation of patients with Hypomagnesaemia after 5 weeks of Mg therapy, showed statistically significant relief of chest pain (P=0.01). However, no significant changes was detected in regard to palpitation (P=0.06), fatigue (P= 0.5) and dyspnea (P=0.99). Conclusion This study revealed that the prevalence of hypomagnesaemia in pediatric patients with mitral valve prolapse is relatively low compared to adults, but treatment with oral Mg in patient with hypomagnesaemia decreases chest pain. PMID:24757600

  19. [Right heart failure resulting from pacemaker lead-induced tricuspid valve regurgitation].

    PubMed

    Schroeter, T; Strotdrees, E; Doll, N; Mohr, F W

    2011-06-01

    Pacemaker lead-induced tricuspid valve regurgitation is a severe and often underdiagnosed complication due to the widely variable time interval between implantation and the development of severe tricuspid valve insufficiency with ensuing right heart failure. Complete explantation of inactive pacemaker leads is necessary to avoid permanent damage to right heart structures. If performed in a timely fashion, regression of tricuspid insufficiency can be achieved without additional cardiac procedures. PMID:21547560

  20. A critical appraisal of current management practices for infant regurgitation – recommendations of a working party

    Microsoft Academic Search

    Y. Vandenplas; D. Belli; P. Benhamou; S. Cadranel; J. P. Cezard; S. Cucchiara; C. Dupont; C. Faure; F. Gottrand; E. Hassall; H. S. A. Heymans; C. M. F. Kneepkens; B. Sandhu

    1997-01-01

    Regurgitation is a common manifestation in infants below the age of 1 year and a frequent reason of counselling of general\\u000a practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics.\\u000a Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastro-oesophageal\\u000a reflux in a

  1. Prognostic Implications of Left Ventricular Function During Exercise in Asymptomatic Patients with Aortic Regurgitation

    Microsoft Academic Search

    Joseph Lindsay; Angela Silverman; Lucy B. Van Voorhees; Nicholas G. Nolan

    1987-01-01

    Few data are available that address the prognostic implications of the response of the left ventricle (LV) to exercise in asymptomatic patients with aortic regurgitation (AR) who have normal resting LV function. Thirty-one such patients were contacted two to seven years after rest and exercise radionuclide ventriculography. Eleven had had significant cardiovascular events. Event-free survival at forty-eight months was 64%.Ten

  2. Transjugular approach in valve-in-valve transcatheter mitral valve replacement: direct route to the valve.

    PubMed

    Kaneko, Tsuyoshi; Swain, JaBaris D; Loberman, Dan; Welt, Frederick G P; Davidson, Michael J; Eisenhauer, Andrew C

    2014-06-01

    With the recent emergence of transcatheter valve replacement, high-risk cases of structural valve deterioration after mitral bioprosthesis can be treated with valve-in-valve transcatheter mitral valve replacement (TMVR). The transapical approach has become the principal access for TMVR, but we report an alternative direct access for TMVR--transjugular transseptal route--in an 81-year-old woman with a degenerated mitral bioprosthesis. PMID:24882333

  3. Surgery for congenital mitral valve disease in the first year of life

    Microsoft Academic Search

    Miguel Sousa Uva; Lorenzo Galletti; François Lacour Gayet; Dominique Piot; A. Serraf; Jacqueline Bruniaux; Juan Comas; R. Roussin; A. Touchot; Jean Paul Binet; Claude Planché

    1995-01-01

    Between 1980 and 1993, 20 patients less than 1 year of age underwent operations for congenital mitral valve disease. Ten patients had congenital mitral incompetence and 10 had congenital mitral stenosis. Mean age was 6.6 ± 3.4 months and mean weight was 5.6 ± 1.5 kg. Atrioventricular canal defects, univentricular heart, class III\\/IV hypoplastic left heart syndrome, discordant atrioventricular and

  4. The "loop with anchor" technique to repair mitral valve prolapse.

    PubMed

    Isoda, Susumu; Osako, Motohiko; Kimura, Tamizo; Mashiko, Yuji; Yamanaka, Nozomu; Nakamura, Shingo; Maehara, Tadaaki

    2012-01-01

    The current surgical technique of using an artificial chord (composed of expanded polytetrafluoroethylene [ePTFE] sutures) to repair mitral prolapse is technically difficult to perform. Slippery knot tying and the difficulty of changing the chordae length after the hydrostatic test are frustrating problems. The loop technique solves the problem of slippery knot tying but not the problem of changing the chordae length. Our "loop with anchor" technique consists of the following elements: construction of an anchor at the papillary muscle; determining the loop length; tying the loop to the anchor; suturing the loop to the mitral valve; the hydrostatic test; and re-suturing or changing the loop, if needed. Adjustments can be made for the entire procedure or for a portion of the procedure. PMID:22156285

  5. Beating heart mitral valve repair with integrated ultrasound imaging

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John T.; Peters, Terry M.

    2015-03-01

    Beating heart valve therapies rely extensively on image guidance to treat patients who would be considered inoperable with conventional surgery. Mitral valve repair techniques including the MitrClip, NeoChord, and emerging transcatheter mitral valve replacement techniques rely on transesophageal echocardiography for guidance. These images are often difficult to interpret as the tool will cause shadowing artifacts that occlude tissue near the target site. Here, we integrate ultrasound imaging directly into the NeoChord device. This provides an unobstructed imaging plane that can visualize the valve lea ets as they are engaged by the device and can aid in achieving both a proper bite and spacing between the neochordae implants. A proof of concept user study in a phantom environment is performed to provide a proof of concept for this device.

  6. State of the mitral valve in rabbits with hypokinesia

    NASA Technical Reports Server (NTRS)

    Strelkovska, V. Y.

    1979-01-01

    In hypokinesia, edema of all the layers of the mitral value was observed, which resulted in morphological changes of the cellular and noncellular components. An increase in ratio of elastic and collagenic fibers in the value was also observed along with and changes in their structural and staining properties. The observed changes can limit valve mobility and can result in manifestations of cardiac valve insufficiency, which is found clinically.

  7. Radiofrequency ablation of atrial fibrillation during mitral valve surgery

    Microsoft Academic Search

    David C. Kress; Jasbir Sra; David Krum; Anil Goel; Jennifer Campbell; Jeff Fox

    2002-01-01

    Twenty-three patients underwent endocardial radiofrequency ablation of atrial fibrillation (AF) during mitral valve procedures with a previously described left atrial lesion pattern. A temperature-controlled 7-coil surgical probe delivered 60-second lesions at 80°C. The left atrial appendage was oversewn after ablation. Ages ranged from 28 to 88 years. Nineteen patients had chronic AF that was present for over 1 year in

  8. Bilateral retinal artery occlusion due to mitral valve prolapse.

    PubMed Central

    van Rhee, F.; Blecher, T. E.; DeLepeleire, K. A.; Galloway, N. R.

    1991-01-01

    We report a case of bilateral retinal artery occlusion due to mitral valve prolapse. Most patients with retinal ischaemia in whom it is found have not been previously known to have it. Since it is a common condition it would seem essential that it be included in the differential diagnosis of amaurosis fugax and retinal artery occlusion if future ischaemic events are to be prevented. All patients with retinal ischaemia should have a full cardiovascular examination supplemented by echocardiography. Images PMID:1854701

  9. Heart rate variability of children with mitral valve prolapse

    Microsoft Academic Search

    Lin Han; Ting Fei Ho; William CL Yip; Kit Yee Chan

    2000-01-01

    Studies have indicated that adult patients with mitral valve prolapse (MVP) may have autonomic dysfunction. The purpose of this study was to evaluate heart rate variability (HRV) in children with MVP. Sixty-seven children with MVP (ages 6 to 18 years; 30 boys and 37 girls) were consecutively studied and subdivided into those with or without symptoms. Thirty-seven normal age-matched children

  10. Age and the clinical profile of idiopathic mitral valve prolapse.

    PubMed Central

    Hickey, A J; Wilcken, D E

    1986-01-01

    The prevalence of mitral valve prolapse was determined in two independent populations (6887 consecutive adults and children referred for echocardiography during a three year period and 206 non-referred first degree relatives of 65 patients with mitral valve prolapse). In the 118 adults with echocardiographic evidence of prolapse those aged greater than or equal to 50 years were significantly more likely to have pansystolic murmurs and increased echocardiographic dimensions than those aged less than 50 years; and patients with complications of mitral valve prolapse were significantly older than those without. In the population referred for echocardiography and in the non-referred relatives there was a significant increase in prevalence in the two decades after adolescence (20-39 years) compared with that in the first two decades. The data suggest that prolapse principally becomes manifest in late adolescence when the growth spurt is complete and that thereafter the severity of prolapse increases with age in an important subset of patients. The latter findings accord with the predictions of the response to injury hypothesis for the pathogenesis of progressive changes. PMID:3718797

  11. 1302. P6.51. Using Real-Time Three-Dimensional Ultrasound To Characterize Mitral Valve Motion , M. LINGURARU

    E-print Network

    1302. P6.51. Using Real-Time Three-Dimensional Ultrasound To Characterize Mitral Valve Motion P results aim to fully characterize the four-dimensional (3D + time) movement of the mitral valve for better understanding of its behavior prior to surgical interventions, such as mitral valve repair. A behavior model

  12. Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based on Multiresolution Processing

    E-print Network

    Wong, Kenneth K.Y.

    Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based, The Chinese University of Hong Kong, Hong Kong ABSTRACT Mitral valve repair is one of the most prevalent operations for various mitral valve conditions. Echocardiography, being famous for its low-cost, non

  13. Dynamical Mechanisms of Odor Processing in Olfactory Bulb Mitral Cells Daniel B. Rubin and Thomas A. Cleland

    E-print Network

    Cleland, Thomas A.

    Dynamical Mechanisms of Odor Processing in Olfactory Bulb Mitral Cells Daniel B. Rubin and Thomas A- nisms of odor processing in olfactory bulb mitral cells. J Neuro- physiol 96: 555­568, 2006. First, conductance-based compartmental model of olfactory bulb mitral cells that exhibits the complex dynamical

  14. Anatomic and electrophysiologic relation between the coronary sinus and mitral annulus: Implications for ablation of left-sided accessory pathways

    Microsoft Academic Search

    Jerold S. Shinbane; Michael D. Lesh; William G. Stevenson; Thomas S. Klitzner; Paul D. Natterson; Isaac Wiener; Philip C. Ursell; Leslie A. Saxon

    1998-01-01

    To determine whether precise left-sided accessory pathway localization is possible from the coronary sinus, electrocardiogram (ECG) characteristics from the coronary sinus pair demonstrating earliest activation via the accessory pathway were compared to simultaneous mitral annular ablation catheter ECGs at successful ablation sites in 48 patients. To define the coronary sinus–mitral annular relation, the coronary sinus to mitral annulus distance (D)

  15. Radionuclide angiographic evaluation of left ventricular performance at rest and during exercise in patients with aortic regurgitation

    SciTech Connect

    Iskandrian, A.S.; Heo, J.

    1986-06-01

    Radionuclide angiographic evaluation of LV performance at rest and during exercise in patients with AR have shown that an abnormal EF response to exercise may be observed in asymptomatic patients with normal resting LV function. The EF response to exercise has been correlated with a number of clinical and exercise measurements; important among these are the slope of the systolic pressure-to-end-systolic volume, end-systolic volume, cardiac index, pulmonary capillary wedge pressure, and wall stress. The changes in the regurgitant fraction, EF, and LV volume have shown considerable individual variability; they have also allowed a better understanding of the circulatory responses during exercise. Radionuclide angiography provides a reliable and reproducible method of measuring the rest LVEF that is important in the timing and the outcome of valve replacement. The value of the EF response to exercise in patient management is not yet clear; it is possible that other radionuclide-derived measurements at rest or during exercise, such as the systolic pressure-to-end-systolic volume relationship, and the end-systolic volume may provide complementary information to that provided by the EF.

  16. Developing a Training Tool for Intraoperative Mitral Valve Analysis Neil A. Tenenholtz, Robert D. Howe

    E-print Network

    Developing a Training Tool for Intraoperative Mitral Valve Analysis Neil A. Tenenholtz, Robert D@seas.harvard.edu INTRODUCTION The mitral valve is one of the four valves of the human heart. Serving as a passive check valve transparency. To produce such a fast simulation, a mass-spring approximation of a finite element model

  17. Mitral leaflet modeling: Importance of in vivo shape and material properties

    Microsoft Academic Search

    Marco Stevanella; Gaurav Krishnamurthy; Emiliano Votta; Julia C. Swanson; Alberto Redaelli; Neil B. Ingels

    2011-01-01

    The anterior mitral leaflet (AML) is a thin membrane that withstands high left ventricular (LV) pressure pulses 100,000 times per day. The presence of contractile cells determines AML in vivo stiffness and complex geometry. Until recently, mitral valve finite element (FE) models have neglected both of these aspects. In this study we assess their effect on AML strains and stresses,

  18. On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair

    E-print Network

    On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair Neil A repair of the mitral valve is a difficult procedure that is often avoided in favor of less effective valve replacement because of the associated technical challenges facing non-expert surgeons

  19. Traumatic mitral valve avulsion from the annulus fibrosis producing acute left heart failure in a dog

    PubMed Central

    2004-01-01

    Abstract Traumatic detachment of the mitral valve from the annulus fibrosis occurred in a dog following blunt chest trauma. Euthanasia was elected approximately 7 months posttrauma due to refractory, chronic left heart failure. This is the first reported case of traumatic mitral valve rupture in a dog. PMID:15510686

  20. Percutaneous Mitral Valve Dilatation: Single Balloon versus Double Balloon - A Finite Element Study

    SciTech Connect

    Schievano, Silvia; Kunzelman, Karyn; Nicosia, Mark; Cochran, R. P.; Einstein, Daniel R.; Khambadkone, Sachin; Bonheoffer, Philipp

    2009-01-01

    Background: Percutaneous mitral valve (MV) dilatation is performed with either a single balloon (SB) or double balloon (DB) technique. The aim of this study was to compare the two balloon system results using the finite element (FE) method. Methods and Results: An established FE model of the MV was modified by fusing the MV leaflet edges at commissure level to simulate a stenotic valve (orifice area=180mm2). A FE model of a 30mm SB (low-pressure, elastomeric balloon) and an 18mm DB system (high-pressure, non-elastic balloon) was created. Both SB and DB simulations resulted in splitting of the commissures and subsequent stenosis dilatation (final MV area=610mm2 and 560mm2 respectively). Stresses induced by the two balloon systems varied across the valve. At the end of inflation, SB showed higher stresses in the central part of the leaflets and at the commissures compared to DB simulation, which demonstrated a more uniform stress distribution. The higher stresses in the SB analysis were due to the mismatch of the round balloon shape with the oval mitral orifice. The commissural split was not easily accomplished with the SB due to its high compliance. The high pressure applied to the DB guaranteed the commissural split even when high forces were required to break the commissure welds. Conclusions: The FE model demonstrated that MV dilatation can be accomplished by both SB and DB techniques. However, the DB method resulted in higher probability of splitting of the fused commissures and less damage caused to the MV leaflets by overstretching.

  1. An unusual nasopharyngeal foreign body with unusual presentation as nasal regurgitation and change in voice.

    PubMed

    Kumar, Sunil; Singh, Devendra Bahadur; Singh, Abhishek Bahadur

    2013-01-01

    Upper aerodigestive tract may harbour foreign bodies such as sponges, grains, toy parts, stones, paper, insects, cotton, etc. These objects may go undetected for days or even weeks. A metallic foreign body after being inhaled and ultimately being lodged in the nasopharynx is a rare entity. We report a case of an unusual nasopharyngeal foreign body (metallic bolt) presenting with symptoms of nasal regurgitation and change in voice in a 2-year boy. The foreign body was diagnosed by X-ray skull lateral view including nasopharynx and was removed under general anaesthesia. PMID:23884977

  2. [Clinical significance of mitral valve insufficiency detected by Doppler echocardiography in acute myocardial infarction].

    PubMed

    Kraska, T; Liszewska-Pfejfer, D; Dziduszko-Fedorko, E; Jakubowska-Najnigier, M; Opolski, G; Stanis?awska-Nielepkiewicz, J; Stawicki, S; Zawadzka-By?ko, M

    1990-10-01

    Doppler echocardiography revealed in the third week of the recent myocardial infarction a pattern of mitral insufficiency in 27 (36%) of the 75 patients studied. Mitral insufficiency was usually associated with the more severe clinical course of myocardial infarction, with more frequent supraventricular and ventricular arrhythmias, heart failure, and with more extensive infarction area, as compared with the patients without mitral failure. A decreased contractibility of the left ventricle wall (especially in patients with anterior myocardial infarction accompanied by mitral insufficiency and enlargement ventricular dimension) may suggest its role in the development of mitral insufficiency in myocardial infarction. The results show the need of Doppler echocardiography in recent myocardial infarction to detect patients with an increased risk. PMID:2080111

  3. Orthostatic hypotension, catecholamines, and alpha-adrenergic receptors in mitral valve prolapse.

    PubMed Central

    Schatz, I. J.; Ramanathan, S.; Villagomez, R.; MacLean, C.

    1990-01-01

    The reported association of mitral valve prolapse with autonomic dysfunction and neuroendocrine abnormalities is derived from studies of patients selected because of symptoms or specifically referred for investigation. To determine whether such associations occur in nonreferred and unselected women with mitral valve prolapse, we measured blood pressure, heart rate, and norepinephrine response to standing in 13 volunteers with mitral valve prolapse and in 11 control subjects. Platelet alpha-adrenergic receptor quantity and affinity on standing also were determined in all persons. No significant differences were found between the groups in any of these measurements. Although small subsets of women with mitral valve prolapse may indeed have associated neuroendocrine epiphenomena and autonomic dysfunction, it is probably incorrect to generalize these findings to the vast spectrum of those with mitral valve prolapse. PMID:2155518

  4. Evaluation of obstructive characteristics of mitral disc valve implants with ultrasound doppler techniques.

    PubMed

    Holen, J; Nitter-Hauge, S

    1977-01-01

    Ten adult patients with mitral disc valve implants have been examined on the catheterization table. Non-invasive ultrasound Doppler data, pulmonary artery wedge pressure and left ventricular pressure were recorded simultaneously. The cardiac output was determined with the direct Fick method. The effective valve area was taken as a measure of the flow obstruction in the disc valve implants. This area was calculated from the ultrasound data and the cardiac output as well as from the manometric data and the cardiac output. The resulting two sets of areas demonstrated a linear correlation coefficient of 0.86. The effective valve areas calculated from the ultrasound data were reasonable when compared with the results of in vitro studies of disc valve performance and demonstrated good agreement with the findings of other investigators. PMID:561517

  5. Influence of viscosity and pressure on prosthetic valve regurgitation.

    PubMed

    Pantalos, G M; Sharp, M K

    1993-03-01

    Blood viscosity varies during the course of artificial heart implants and is affected by pathological conditions. To gauge the potential effect of changing viscosity on valve performance, leakage rates were measured across a closed Medtronic-Hall valve with water, water/glycerol and fresh whole bovine blood for aortic and pulmonary pressure ranges. As might be expected from the low Reynolds numbers (< 140), losses across the valve were found to be primarily viscous. For the two Newtonian fluids, leakage was slightly less than linearly proportional to pressure. This is comparable with empirical data for orifice flow, which predicts three fifths power dependence on pressure. For blood, however, the greater than linear dependence on pressure found suggests that the pseudoplasticity (shear-thinning behavior) of blood is important. These data provide evidence that the viscous and non-Newtonian properties of blood must be taken into account in modelling prosthetic valve performance and may affect the test methods and flow regulation strategies for prosthetic blood pumps. PMID:8314639

  6. Copyright by ICR Publishers 2012 Background and aim of the study: The study aim was

    E-print Network

    Kheradvar, Arash

    in the diagnosis of functional disorders such as mitral valve prolapse, functional mitral regurgitation (17 Lifesciences Center for Advanced Cardiovascular Technology, The Henry Samueli School of Engineering, University

  7. Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

    Microsoft Academic Search

    Mohamed Eid Fawzy; Mohamed Shoukri; Bahaa Fadel; Amr Badr; Abdulaziz Al Ghamdi; Charles Canver

    2009-01-01

    Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 ± 11 years) who underwent successful MBV and were followed up for a mean of 8.5 ± 4.8 years

  8. Effect of Ivabradine on Heart Rate and Duration of Exercise in Patients With Mild-to-Moderate Mitral Stenosis: A Randomized Comparison With Metoprolol

    PubMed Central

    Narain, Varun S.; Dwivedi, Sudhanshu K.; Sethi, Rishi; Chandra, Sharad; Puri, Aniket; Saran, Ram K.

    2015-01-01

    Background: Symptoms in mitral stenosis (MS) are heart rate (HR) dependent. Increase in HR reduces diastolic filling period with rise in transmitral gradient. By reducing HR, beta-blockers improve hemodynamics and relieve symptoms, but the use may be limited by side effects. The present randomized crossover study looked at comparative efficacy of ivabradine and metoprolol on symptoms, hemodynamics, and exercise parameters in patients with mild-to-moderate MS (mitral valve area, 1–2 cm2) in normal sinus rhythm. Material and Methods: Baseline clinical assessment, treadmill stress testing, and an echocardiographic Doppler evaluation were performed to determine resting HR, total exercise duration, mean gradient across mitral valve, and mean pulmonary artery systolic pressure (PASP). Patients were then allocated to either metoprolol or ivabradine to maximal tolerated doses over 6 weeks (metoprolol: 100 mg twice a day, ivabradine: 10 mg twice a day). Reevaluation was done at the end of this period, and all drugs stopped for washout over 2 weeks. Thereafter, the 2 groups were crossed over to the other drug that was continued for another 6 weeks. Assessment was again performed at the end of this period. Results: Thirty-three patients of 34 completed the protocol. Fifteen were male, mean age was 28.9 ± 6.6 years, all were in New York Heart Association class 2, and mean resting HR was 103.5 ± 7.2/min. Mean mitral valve area was 1.56 ± 0.16 cm2, mean PASP was 38.1 ± 5.1 mm Hg, and mean gradient across mitral valve was 10.6 ± 1.6 mm Hg. Significant decrease in baseline and peak exercise HR was observed at the end of follow-up with both drugs. Reduction in mitral valve gradient after ivabradine (42%) and metoprolol (37%) and reduction in PASP after both ivabradine (23%) and metoprolol (27%) were to a similar extent. Significant reduction in total exercise duration after both ivabradine and metoprolol therapy was observed. One patient developed blurring of vision with ivabradine therapy but did not require discontinuation of drug. An improvement in dyspnea of one grade was observed in all the patients by treatment with both ivabradine and metoprolol. Conclusions: Both metoprolol and ivabradine reduced symptoms and improved hemodynamics significantly from baseline to a similar extent. Ivabradine thus can be used effectively and safely in patients with MS in normal sinus rhythm who are intolerant or contraindicated for beta-blocker therapy. PMID:25636072

  9. Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development

    PubMed Central

    A, Gulraze; W, Kurdi; FA, Niaz; ME, Fawzy

    2014-01-01

    Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies. Methods: Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years). Results: MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%). Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development. PMID:24639837

  10. Stones have been recorded in the stomachs, regurgitation pellets or faeces of at least six penguin species: Adlie Penguin Pygoscelis

    E-print Network

    Altwegg, Res

    185 Stones have been recorded in the stomachs, regurgitation pellets or faeces of at least six Spheniscus demersus (stones in one of 247 stomach samples, Rand 1960), Emperor Penguin Aptenodytes forsteri or indirectly through the ingestion of prey with stones in stomachs (Splettstoesser & Todd 1999). We report

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

    NASA Technical Reports Server (NTRS)

    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.

  12. Prevalence of calcification of the mitral valve annulus in patients undergoing surgical repair of mitral valve prolapse.

    PubMed

    Fusini, Laura; Ghulam Ali, Sarah; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Maffessanti, Francesco; Celeste, Fabrizio; Guglielmo, Marco; Cefalù, Claudia; Alamanni, Francesco; Zanobini, Marco; Pepi, Mauro

    2014-06-01

    Factors correlating to mitral annulus calcification (MAC) include risk factors predisposing to atherosclerosis. In patients with mitral valve (MV) prolapse (MVP), other anatomic or mechanical factors have been supposed to facilitate MAC. The aims of this study were, in patients with MVP undergoing MV repair, (1) to describe the prevalence and characteristics of MAC, (2) to correlate MAC with clinical risk factors, coronary involvement, and aortic valve disease, and (3) to describe prevalence, site, and extension of MAC in fibroelastic deficiency (FED) versus Barlow's disease (BD) and correlate MAC to surgical outcomes (repair vs replacement). In 410 consecutive patients with MVP suitable for surgical MV repair, detailed clinical and echocardiographic data were collected to characterize MAC in BD and FED. MAC was found in 99 patients (24%). Age, female gender, coronary artery disease, and cardiovascular risk factors were correlated with MAC. MAC was equally distributed in FED and BD groups despite patients with FED being older with more cardiovascular risk factors. The most common localization of MAC was annular involvement adjacent to P2 (75%), P1 (31%), and P3 (35%). The presence of MAC affected surgical outcomes in both groups (8% patients with MAC underwent replacement after a first attempt of repair vs 3% without MAC). MAC is a common finding in patients undergoing MV repair, and several clinical characteristics correlate with MAC either in FED or BD. In conclusion, despite very high percentage of repairability, MAC influences surgical outcomes and very detailed echo evaluation is advocated. PMID:24837266

  13. Severe Tricuspid Regurgitation Diagnosed 13 Years after a Car Accident: A Case Report

    PubMed Central

    Acar, Burak; Suleymanoglu, Muhammed; Burak, Cengiz; Demirkan, Burcu Mecit; Guray, Yesim; Tufekcioglu, Omac; Aydogdu, Sinan

    2015-01-01

    Abstract Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation.

  14. Cellular/Molecular Dopamine Inhibits Mitral/Tufted3Granule Cell Synapses in

    E-print Network

    Delaney, Kerry R.

    potentials. Key words: reciprocal synapse; mitral cell; lateral dendrite; feedback inhibition; D2; Rana pipiens Introduction The olfactory bulb (OB) is responsible for the initial representa- tion of odor

  15. Echocardiographic assessment of left ventricular geometry and the mitral valve apparatus in cats with hypertrophic cardiomyopathy

    Microsoft Academic Search

    Karsten Schober; Amanda Todd

    2010-01-01

    ObjectivesThis retrospective study addressed the general hypothesis that abnormalities of the mitral valve apparatus are common in cats with idiopathic hypertrophic cardiomyopathy (HCM) and contribute to dynamic obstruction of the left ventricular outflow tract (LVOT).

  16. Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot.

    PubMed

    Gorter, Thomas M; van Melle, Joost P; Freling, Hendrik G; Ebels, Tjark; Bartelds, Beatrijs; Pieper, Petronella G; Berger, Rolf M F; van Veldhuisen, Dirk J; Willems, Tineke P

    2015-08-01

    In the assessment of pulmonary regurgitation (PR) using phase contrast MRI, phase offset errors affect the accuracy of flow. This study evaluated the use of automated background correction for phase offset in the quantification of PR fraction and volume in patients with repaired tetralogy of Fallot (TOF), and to assess its clinical impact. We retrospectively analyzed 203 cardiac MRI studies, performed on 1.5-T scanner. Pulmonary flow (QP) and systemic flow (QS) was assessed both with and without background correction. Non-corrected and corrected QP was correlated with QS. PR was correlated with (1) indexed right ventricular end-diastolic volume (RVEDVi) and (2) with differential right and left ventricular stroke volumes (PRSV). Both PR fraction and volume showed major change after correction (-43 to +36 % and -13 to +13 ml/m(2)). Corrected QP and QS were stronger correlated with each other than non-corrected QP and QS [r = 0.78 vs. 0.73 (p < 0.001)]. Both PR fraction and volume were stronger correlated with RVEDVi, compared to their non-corrected counterparts (p < 0.001). PR volume was stronger correlated with RVEDVi, compared to PR fraction [r = 0.74 vs. 0.69 (p < 0.001)]. When patients were divided according to PR severity, 12 % of patients reclassified after correction. Background correction for phase offset significantly changed the quantification of PR. Non-corrected assessment of PR may result in the misclassification of patients. Our data suggest that the use of PR volume is favourable in the follow-up of patients with repaired TOF. PMID:25944487

  17. Mitral Valve Surgery in a Patient with Spinal Progressive Muscular Atrophy: Report of a Case

    Microsoft Academic Search

    Yoshiyuki Takami; Hiroshi Ina; Akihiro Terasawa; Masahide Nakao

    2003-01-01

    We describe our experience in treating a 69-year-old man with spinal progressive muscular atrophy (SPMA), who underwent a\\u000a mitral valve replacement. He was admitted for dyspnea, and surgery was indicated for severe mitral insufficiency associated\\u000a with inferior myocardial infarction. He had been aware of muscle weakness and received a diagnosis of SPMA 18 years previously.\\u000a Worsening muscle atrophy had led

  18. The Heterogeneous Biomechanics and Mechanobiology of the Mitral Valve: Implications for Tissue Engineering

    Microsoft Academic Search

    K. Jane Grande-Allen; Jun Liao

    2011-01-01

    There are compelling reasons to develop a tissue-engineered mitral valve, but this endeavor has not received the same attention\\u000a as tissue engineering strategies for the semilunar valves. Challenges in regenerating a mitral valve include recapitulating\\u000a the complex heterogeneity in terms of anatomy (differently sized leaflets, numerous chordae), extracellular matrix composition,\\u000a biomechanical behavior, valvular interstitial cell and endothelial cell phenotypes, and

  19. [Sudden death as presentation form of papillary fibroelastoma of mitral valve].

    PubMed

    Sánchez Rodríguez, A; Jiménez Moragas, J M; Marín Gurrea, M; Ravina Sanz, J; Sánchez Heredia, A

    2000-05-01

    We describe the case of a 35-year-old male, who presented with sudden death, secondary to anterior miocardial infarction due to embolism. Echocardiography, transthoracic and transesophageal, revealed a tumor in the anterior mitral leaflet. Tumor, histopathologically an papillary fibroelastoma, was excised and the mitral valve was replaced with a mechanical prosthetic valve. We revised the current literature on intracardiac papillary fibroelastoma. PMID:10859828

  20. Mitral valve prolapse and the association with cutaneous mucin infiltration: ("cardiocutaneous mucinosis").

    PubMed

    Farooq, Uzma; Choudhary, Sonal; McLeod, Michael P; Torchia, Daniele; Romanelli, Paolo

    2013-05-01

    Mitral valve prolapse is the most common disorder of the cardiac valves in people in the United States. It can present as both primary and secondary disorders, and when associated with myxomatous changes in the skin, the term cardiocutaneous mucinosis can be used to describe this entity. Patients with mitral valve prolapse may have cutaneous findings on histological analysis that may indicate its severity and complication rate. PMID:23710268

  1. Atrial fibrillation alters the microRNA expression profiles of the left atria of patients with mitral stenosis

    PubMed Central

    2014-01-01

    Background Structural changes of the left and right atria associated with atrial fibrillation (AF) in mitral stenosis (MS) patients are well known, and alterations in microRNA (miRNA) expression profiles of the right atria have also been investigated. However, miRNA changes in the left atria still require delineation. This study evaluated alterations in miRNA expression profiles of left atrial tissues from MS patients with AF relative to those with normal sinus rhythm (NSR). Methods Sample tissues from left atrial appendages were obtained from 12 MS patients (6 with AF) during mitral valve replacement surgery. From these tissues, miRNA expression profiles were created and analyzed using a human miRNA microarray. Results were validated via reverse-transcription and quantitative PCR for 5 selected miRNAs. Potential miRNA targets were predicted and their functions and potential pathways analyzed via the miRFocus database. Results The expression levels of 22 miRNAs differed between the AF and NSR groups. Relative to NSR patients, in those with AF the expression levels of 45% (10/22) of these miRNAs were significantly higher, while those of the balance (55%, 12/22) were significantly lower. Potential miRNA targets and molecular pathways were identified. Conclusions AF alters the miRNA expression profiles of the left atria of MS patients. These findings may be useful for the biological understanding of AF in MS patients. PMID:24461008

  2. Transapical transcatheter valve-in-valve replacement for deteriorated mitral valve bioprosthesis without radio-opaque indicators: the "invisible" mitral valve bioprosthesis.

    PubMed

    Rossi, Marco Luciano; Barbaro, Cristina; Pagnotta, Paolo; Cappai, Antioco; Ornaghi, Diego; Belli, Guido; Presbitero, Patrizia

    2015-02-01

    In view of the high number of bioprosthetic valves implanted during the past 30 years, an increasing number of patients are coming to medical attention because of degenerated bioprostheses. Transcatheter aortic valve-in-valve implantation has been described as a less invasive alternative to re-operation to treat severe structural valve deterioration. As far as degenerated mitral valve bioprostheses are concerned, transcatheter transapical mitral valve-in-valve replacement (TMVR) has been less commonly performed, but may also become a viable alternative to re-do replacement surgery. We describe treatment of a degenerated bioprosthetic mitral valve, characterised by complete absence of any radio-opaque landmarks making the TMVR procedure very challenging. PMID:25456504

  3. Myxomatous mitral valve disease in dogs: Does size matter?

    PubMed Central

    Parker, Heidi G.; Kilroy-Glynn, Paul

    2012-01-01

    Myxomatous mitral valve disease (MMVD) is the most commonly diagnosed cardiovascular disease in the dog accounting for more than 70% of all cardiovascular disease in dogs. As are most canine diseases with genetic underpinnings, risk of MMVD is greatly increased in a subset of breeds. What is uncommon is that the vast majority of the breeds at elevated risk for MMVD are small or toy breeds with average adult weights under 9 kg. These breeds appear to have little in common other than their diminutive size. In the following review we propose a number of mechanisms by which relatively unrelated small breeds may have developed a predisposition for chronic valvular disorders. Although factors such as age are key in the expression of MMVD, taking a comprehensive look at the commonalities, as well as the differences, between the susceptible breeds may assist in finding the causal variants responsible for MMVD and translating them to improved treatments for both dogs and humans. PMID:22356836

  4. Myxomatous mitral valve disease in dogs: does size matter?

    PubMed

    Parker, Heidi G; Kilroy-Glynn, Paul

    2012-03-01

    Myxomatous mitral valve disease (MMVD) is the most commonly diagnosed cardiovascular disease in the dog accounting for more than 70% of all cardiovascular disease in dogs. As are most canine diseases with genetic underpinnings, risk of MMVD is greatly increased in a subset of breeds. What is uncommon is that the vast majority of the breeds at elevated risk for MMVD are small or toy breeds with average adult weights under 9 kg. These breeds appear to have little in common other than their diminutive size. In the following review we propose a number of mechanisms by which relatively unrelated small breeds may have developed a predisposition for chronic valvular disorders. Although factors such as age are key in the expression of MMVD, taking a comprehensive look at the commonalities, as well as the differences, between the susceptible breeds may assist in finding the causal variants responsible for MMVD and translating them to improved treatments for both dogs and humans. PMID:22356836

  5. Epidemiology of symptomatic mitral valve prolapse in black patients.

    PubMed Central

    Zua, M. S.; Dziegielewski, S. F.

    1995-01-01

    This study analyzed the charts of 743 black patients who visited the emergency rom of a Nashville Hospital with symptoms of chest pain, palpitation, or fatigue. One hundred sixty-five met the criteria for the diagnosis of mitral valve prolapse (MVP). Epidemiologic factors of symptomatic MVP in blacks (ie, symptoms reported based on age and sex) were examined to determine whether there are significant differences in the prevalence of symptomatic MVP with relation to black males and females. Similarities were found in the patterns of the ages of both males and females and the symptoms that were reported. No significant differences were found between black males and females, which does not support previous findings. PMID:7752279

  6. Prevalence of mitral valve prolapse in keratoconus patients.

    PubMed Central

    Sharif, K W; Casey, T A; Coltart, J

    1992-01-01

    Fifty patients with advanced degrees of keratoconus, requiring corneal transplantation, were screened for mitral valve prolapse by two dimensional echocardiography. The overall prevalence of 58% was found to be statistically higher than the prevalence of 7% found in a group of age and sex-matched controls. It was also found to be higher than the previously reported prevalence of 38% in a group of keratoconus patients with similar age and sex match to our series. The findings of our study in conjunction with the histopathological and biochemical similarities between the two conditions strongly suggest that they may be different manifestations of similar defects in collagen metabolism. Images Figure 1. Figure 2. PMID:1404188

  7. A Novel Method in the Stratification of Post-Myocardial-Infarction Patients Based on Pathophysiology

    PubMed Central

    Yang, Fan; Sun, Yujun; Li, Zheng; Jiang, Meng; Fan, Yiting; Pu, Jun; Shen, Xuedong

    2015-01-01

    Objectives We proposed that the severity of ST-segment elevation myocardial infarction (STEMI) could be classified based on pathophysiological changes. Methods First-STEMI patients were classified within hospitalization. Grade 0: no detectable myocardial necrosis; Grade 1: myocardial necrosis without functional and morphological abnormalities; Grade 2: myocardial necrosis with reduced LVEF; Grade 3: reduced LVEF on the basis of cardiac remodeling; Grade 4: mitral regurgitation additional to the Grade-3 criteria. Results Of 180 patients, 1.7, 43.9, 26.1, 23.9 and 4.4% patients were classified as Grade 0 to 4, respectively. The classification is an independent predicator of 90-day MACEs (any death, resuscitated cardiac arrest, acute heart failure and stroke): the rate was 0, 5.1, 8.5, 48.8 and 75% from Grade 0 to 4 (p<0.001), respectively. The Grade-2 patients were more likely to have recovered left ventricular ejection fraction than the Grade-3/4 patients did after 90 days (48.9% vs. 19.1%, p<0.001). Avoiding complicated quantification, the classification served as a good reflection of infarction size as measured by cardiac magnetic resonance imaging (0±0, 15.68±8.48, 23.68±9.32, 36.12±11.35 and 40.66±14.33% of the left ventricular mass by Grade 0 to 4, P<0.001), and with a comparable prognostic value (AUC 0.819 vs. 0.813 for infarction size, p = 0.876 by C-statistics) for MACEs. Conclusions The new classification represents an easy and objective method to scale the cardiac detriments for STEMI patients. PMID:26090807

  8. Prognostic implications of left ventricular function during exercise in asymptomatic patients with aortic regurgitation

    SciTech Connect

    Lindsay, J. Jr.; Silverman, A.; Van Voorhees, L.B.; Nolan, N.G.

    1987-05-01

    Few data are available that address the prognostic implications of the response of the left ventricle (LV) to exercise in asymptomatic patients with aortic regurgitation (AR) who have normal resting LV function. Thirty-one such patients were contacted two to seven years after rest and exercise radionuclide ventriculography. Eleven had had significant cardiovascular events. Event-free survival at forty-eight months was 64%. Ten of eleven events occurred in 21 patients with decline in ejection fraction (EF), but the magnitude of decline did not further separate the group with regard to prognosis. Eight events (73% of total events) occurred in the 11 patients (35% of total patients) with an EF during exercise of 0.55 or less. The short and intermediate outlook for asymptomatic patients with AR and normal resting LV function is good regardless of the response of the EF to exercise, but an exercise EF less than or equal to 0.55 does identify a relatively high-risk subset for deterioration beyond twenty-four months.

  9. Mitral inertance in humans: critical factor in Doppler estimation of transvalvular pressure gradients

    NASA Technical Reports Server (NTRS)

    Nakatani, S.; Firstenberg, M. S.; Greenberg, N. L.; Vandervoort, P. M.; Smedira, N. G.; McCarthy, P. M.; Thomas, J. D.

    2001-01-01

    The pressure-velocity relationship across the normal mitral valve is approximated by the Bernoulli equation DeltaP = 1/2 rhoDeltav(2) + M. dv/dt, where DeltaP is the atrioventricular pressure difference, rho is blood density, v is transmitral flow velocity, and M is mitral inertance. Although M is indispensable in assessing transvalvular pressure differences from transmitral flow, this term is poorly understood. We measured intraoperative high-fidelity left atrial and ventricular pressures and simultaneous transmitral flow velocities by using transesophageal echocardiography in 100 beats (8 patients). We computed mean mitral inertance (M) by M = integral((DeltaP)-(1/2 x rho v(2))dt/integral(dv/dt)dt and we assessed the effect of the inertial term on the transmitral pressure-flow relation. ranged from 1.03 to 5.96 g/cm(2) (mean = 3.82 +/- 1.22 g/cm(2)). DeltaP calculated from the simplified Bernoulli equation (DeltaP = 1/2. rhov(2)) lagged behind (44 +/- 11 ms) and underestimated the actual peak pressures (2.3 +/- 1.1 mmHg). correlated with left ventricular systolic pressure (r = -0.68, P < 0.0001) and transmitral pressure gradients (r = 0.65, P < 0.0001). Because mitral inertance causes the velocity to lag significantly behind the actual pressure gradient, it needs to be considered when assessing diastolic filling and the pressure difference across normal mitral valves.

  10. Treatment of hemopericardium caused by mitral balloon valvuloplasty with activated factor VII: a case report

    PubMed Central

    2014-01-01

    Introduction The use of mitral balloon valvuloplasty as a percutaneous intervention for mitral stenosis has been shown to be efficacious. Cardiac tamponade is a rare but serious complication of this procedure. Despite the low incidence of this event, cardiac tamponade is well-reported in the literature. The management strategy of this complication involves pericardial drainage and correction of coagulopathy, followed by surgical exploration if these interventions fail. With this case report, we demonstrate the successful application of activated factor VII in the management of bleeding after balloon valvuloplasty that persisted despite the standard treatments described above. Case presentation Our patient was a 31-year-old Yemenite man with no significant past medical history, who presented with progressively worsening dyspnea on exertion and limited functional capacity over the last few years. A transesophageal echocardiogram revealed severe mitral stenosis, which was treated with a mitral valve valvuloplasty. The procedure was complicated by significant mediastinal bleeding that did not respond to routine maneuvers, which included pericardiocentesis and correction of coagulopathy. Our patient was evaluated for surgical intervention but responded to treatment with activated factor VII. Conclusion Factor VII may be used in the treatment of refractory mediastinal bleeding secondary to mitral valvuloplasty prior to attempting surgical repair, and therefore may spare the patient the morbidity associated with surgery. PMID:24467868

  11. Percutaneous Mechanical Mitral Commissurotomy With a Newly Designed Metallic Valvulotome Immediate Results of the Initial Experience in 153 Patients

    Microsoft Academic Search

    Alain Cribier; Helene Eltchaninoff; Pratap C. Rath; Ramesh Arora; Adel Imam; Mustapha El-Sayed; Sameer Dani; Genevieve Derumeaux; Jacques Benichou; Christophe Tron; Satej Janorkar; Gerard Pontier; Brice Letac

    Background—Percutaneous balloon valvotomy has become a common treatment of mitral stenosis, but the cost of the procedure remains a limitation in countries with restricted financial resources, leading to a frequent reuse of the disposable catheters. To overcome this limitation, a reusable metallic valvotomy device has been developed with the goals of both improving the mitral valvotomy results and decreasing the

  12. Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular septum in mitral valve prolapse

    Microsoft Academic Search

    Allen P. Burke; Andrew Farb; Anita Tang; John Smialek; Renu Virmani

    1997-01-01

    The mechanism of sudden cardiac death in patients with mitral valve prolapse is poorly understood. Twenty-four hearts from patients with mitral valve prolapse who suddenly died (mean age 34 ± 8 years) and 16 trauma control hearts (mean age 30 ± 7 years) were histologically studied. Dysplasia of the atrioventricular nodal artery was present in 18 of 24 hearts with

  13. Outcomes of Nonpledgeted Horizontal Mattress Suture Technique for Mitral Valve Replacement

    PubMed Central

    Kim, Gun Jik; Lee, Jong Tae; Lee, Young Ok; Cho, Joon Young; Oh, Tak-Hyuk

    2014-01-01

    Background Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. Methods We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. Results In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. Conclusion We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL. PMID:25551070

  14. Impaired Corneal Biomechanical Properties and the Prevalence of Keratoconus in Mitral Valve Prolapse

    PubMed Central

    Kalkan Akcay, Emine; Akcay, Murat; Uysal, Betul Seher; Kosekahya, Pinar; Aslan, Abdullah Nabi; Caglayan, Mehtap; Koseoglu, Cemal; Yulek, Fatma

    2014-01-01

    Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery. PMID:24864193

  15. Predictive model for the detection of pulmonary hypertension in dogs with myxomatous mitral valve disease

    PubMed Central

    MIKAWA, Shoma; MIYAGAWA, Yuichi; TODA, Noriko; TOMINAGA, Yoshinori; TAKEMURA, Naoyuki

    2014-01-01

    Pulmonary hypertension (PH) often occurs due to a left heart disease, such as myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs requires expertise in echocardiography: however, the examination for PH is difficult to perform in a clinical setting. Thus, simple and reliable methods are required for the diagnosis of PH in dogs. The purpose of this study was to develop models using multiple logistic regression analysis to detect PH due to left heart disease in dogs with MMVD without echocardiography. The medical records of dogs with MMVD were retrospectively reviewed, and 81 dogs were included in this study and classified into PH and non-PH groups. Bivariate analysis was performed to compare all parameters between the groups, and variables with P values of <0.25 in bivariate analysis were included in multiple logistic regression analysis to develop models for the detection of PH. In multiple logistic regression analysis, the model included a vertebral heart scale short axis of >5.2 v, and a length of sternal contact of >3.3 v was considered suitable for the detection of PH. The predictive accuracy of this model (85.9%) was judged statistically adequate, and therefore, this model may be useful to screen for PH due to left heart disease in dogs with MMVD without echocardiography. PMID:25319513

  16. Non-invasive assessment of left ventricular relaxation during atrial fibrillation using mitral flow propagation velocity†

    PubMed Central

    Asada-Kamiguchi, Junko; Tabata, Tomotsugu; Popovic, Zoran B.; Greenberg, Neil L.; Kim, Yong Jin; Garcia, Mario J.; Wallick, Don W.; Mowrey, Kent A.; Zhuang, Shaowei; Zhang, Youhua; Mazgalev, Todor N.; Thomas, James D.; Grimm, Richard A.

    2009-01-01

    Aims To elucidate the usefulness of the early diastolic mitral flow propagation velocity (Vp) obtained from colour M-mode Doppler for non-invasively assessing left-ventricular (LV) relaxation during atrial fibrillation (AF). Methods and results Ten healthy adult dogs were studied to correlate Vp with the invasive minimum value of the first derivative of LV pressure decay (dP/dtmin) and the time constant of isovolumic LV pressure decay (?) at baseline, during rapid and slow AF, and during AF after inducing myocardial infarction. There were significant positive and negative curvilinear relationships between Vp and dP/dtmin and ?, respectively, during rapid AF. After slowing the ventricular rate, the average value of Vp increased, while dP/dtmin increased and ? decreased. After inducing myocardial infarction, the average value of Vp decreased, while dP/dtmin decreased and ? increased. Conclusion The non-invasively obtained Vp evaluates LV relaxation even during AF regardless of ventricular rhythm or the presence of pathological changes. PMID:19692424

  17. Anxiety and mood disorder in young males with mitral valve prolapse

    PubMed Central

    Lung, For-Wey; Cheng, Chih-Tao; Chang, Wei-To; Shu, Bih-Ching

    2008-01-01

    Objective This study explored the prevalence of panic disorder and other psychiatric disorders in young Han Chinese males with mitral valve prolapse (MVP). With the factors of age, sex, and ethnicity controlled, the specific role of MVP in panic disorder was analyzed. Methods Subjects with chest pain aged between 18 and 25 years were assessed with the echocardiograph for MVP and the Chinese version of the Mini-International Neuropsychiatric Interview for panic disorder (n = 39). Results Of the 39 participants, 35.9% met the diagnosis of anxiety disorder, 46.2% met at least one criterion of anxiety disorder, and 23.1% met the diagnostic criteria of major depressive disorder. There was no statistically significant difference in the prevalence of panic disorder between one of the (8.3%) MVP patients, and two (7.4%) control participants. Conclusions There is a high prevalence of psychiatric disorder, including anxiety disorder and major depressive disorder, in those who report pain symptoms, so that diagnosis and treatment of these patients is of great importance. In addition, individuals with MVP did not have an increased risk for panic disorder. Whether MVP may be a modifier or mediating factor for panic disorder needs to be further assessed in a larger scale study. PMID:21197339

  18. Impaired corneal biomechanical properties and the prevalence of keratoconus in mitral valve prolapse.

    PubMed

    Kalkan Akcay, Emine; Akcay, Murat; Uysal, Betul Seher; Kosekahya, Pinar; Aslan, Abdullah Nabi; Caglayan, Mehtap; Koseoglu, Cemal; Yulek, Fatma; Cagil, Nurullah

    2014-01-01

    Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery. PMID:24864193

  19. Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities

    SciTech Connect

    Tebbe, U.; Schicha, H.; Neumann, P.; Voth, E.; Emrich, D.; Neuhaus, K.L.; Kreuzer, H.

    1985-06-01

    Patients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). The authors performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ventriculography (/sup 99m/technetium), and perfusion scintigrams (/sup 201/thallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams. A significant correlation in pathological results was found only between exercise ECG and both radionuclide ventriculography and pulmonary arterial pressure measurements. Because of the high prevalence of false-positive perfusion scintigrams in patients with typical or atypical chest pain, the use of exercise /sup 201/Tl imaging as a screening method to separate patients with MVP from those with CAD will not be appropriate. The variability of cardiac abnormalities in our patients with MVP and angiographically normal coronary arteries suggests that the MVP syndrome may represent a variable combination of metabolic, ischemic, or myopathic disorders.

  20. Quantification of stenotic mitral valve area and diagnostic accuracy of mitral stenosis by dual-source computed tomography in patients with atrial fibrillation: comparison with cardiovascular magnetic resonance and transthoracic echocardiography.

    PubMed

    Kim, Song Soo; Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Kim, Jun Suk; Hwang, Hweung Kon; Lee, Jae-Hwan

    2015-06-01

    This study aimed to evaluate the utility of dual-source computed tomography (DSCT) for quantification of the mitral valve area (MVA) in patients with atrial fibrillation (AF) and mitral stenosis (MS) and to compare the results of DSCT with those of cardiovascular magnetic resonance (CMR) and transthoracic echocardiography (TTE). One hundred-two patients with AF and MS who had undergone electrocardiography-gated DSCT, TTE and CMR prior to operation were retrospectively enrolled. The MVA was planimetrically determined by DSCT, CMR, and TTE, as well as by Doppler TTE using the pressure half-time method (TTE-PHT). Agreement, relationship between measurements, and the highest accuracy were evaluated using Bland-Altman, Pearson correlation, and receiver operating characteristic analyses. The MVA on DSCT (mean, 1.27 ± 0.27 cm(2)) was significantly larger than that on CMR (1.15 ± 0.28 cm(2), P < 0.05), TTE-planimetry and TTE-PHT (1.16 ± 0.28 and 1.07 ± 0.30 cm(2), respectively; P < 0.05). TTE-planimetry had better correlation with planimetry on DSCT and CMR (r = 0.65 and 0.67, respectively; P < 0.05) than TTE-PHT (r = 0.51 and 0.55, respectively; P < 0.05). Using an MVA of 1.0 cm(2) on TTE-planimetry and TTE-PHT as the reference, the optimal thresholds for detecting severe MS on DSCT was 1.19 cm(2). The planimetry of the MVA measured by DSCT may be a reliable, alternative method for the quantification of MS in patients with AF. PMID:25011534

  1. Postoperative coronary artery spasm after mitral valve replacement?

    PubMed Central

    Pragliola, Claudio; Gaudino, Mario; Farina, Piero; Massetti, Massimo

    2015-01-01

    Introduction Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease Presentation of case We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. Discussion A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. Conclusion This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery PMID:25680533

  2. Increased prevalence of mitral valve prolapse in patients with migraine.

    PubMed Central

    Spence, J D; Wong, D G; Melendez, L J; Nichol, P M; Brown, J D

    1984-01-01

    Patients with classic migraine (69 women and 31 men) selected randomly from a practice list of over 1000 were matched for age, sex and neighbourhood with 100 people who did not have headache problems, and both groups underwent M-mode and two-dimensional echocardiography and clinical examination by cardiologists blinded to the subjects' clinical status. The mean ages were 34.9 +/- 11.3 years for the migraine group and 33.1 +/- 9.9 years for the control group. Definite and possible mitral valve prolapse (MVP), diagnosed according to predefined echocardiographic criteria, were found about twice as often in the migraine group as in the control group (in 15 v. 7 and 16 v. 8 patients respectively); the echocardiograms were definitely normal in 69 migraine patients and 85 controls (chi 2 = 8.39, p less than 0.025). Altogether 25% of the migraine group and 11% of the control group had evidence of MVP from a combination of the echocardiographic and auscultatory findings (chi 2 = 5.72, p less than 0.025). The odds ratio was 2.7, with 95% confidence limits of 1.17 and 6.29. The association between migraine and MVP has implications for the understanding of platelet abnormalities and episodes of cerebral ischemia occurring in both these conditions. PMID:6498701

  3. Association between neutrophil-lymphocyte ratio and mitral annular calcification.

    PubMed

    Varol, Ercan; Aksoy, Fatih; Ozaydin, Mehmet; Erdogan, Dogan; Dogan, Abdullah

    2014-09-01

    Mitral annular calcification (MAC) is closely related to cardiovascular disorders including coronary artery disease, atherosclerosis, heart failure, and stroke. The clinical risk factors for cardiovascular diseases, including age, obesity, hypertension, hyperlipidemia, and diabetes mellitus, are the same for MAC and atherosclerosis. The aim of this study was to assess the neutrophil-lymphocyte ratio (NLR), an inflammatory marker, in patients with MAC. The study group consisted of 117 patients with MAC. Age and sex-matched control group was composed of 38 patients who were admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured hematological indices in patients and control individuals. NLR ratio was significantly higher in patients with MAC than in control individuals (3.3 ± 1.8 vs. 1.6 ± 0.4, respectively; P < 0.001), and NLR ratio was positively correlated with MAC (P < 0.001, r = 0.58). Red cell distribution width was also significantly higher in patients with MAC than in control individuals (16.2 ± 3.3 vs. 13.4 ± 0.9%, respectively; P < 0.001). We have shown that NLR was significantly elevated in patients with MAC and it was correlated with MAC. PMID:24561537

  4. ST-Segment Depression in Hyperventilation Indicates a False Positive Exercise Test in Patients with Mitral Valve Prolapse

    PubMed Central

    Michaelides, Andreas P.; Liakos, Charalampos I.; Antoniades, Charalambos; Tsiachris, Dimitrios L.; Soulis, Dimitrios; Dilaveris, Polichronis E.; Tsioufis, Konstantinos P.; Stefanadis, Christodoulos I.

    2010-01-01

    Objectives. Mitral valve prolapse (MVP) is a known cause for false positive exercise test (ET). The purpose of this study was to establish additional electrocardiographic criteria to distinguish the false positive exercise results in patients with MVP. Methods. We studied 218 consecutive patients (53 ± 6 years, 103 males) with MVP (according to echocardiographic study), and positive treadmill ET was performed due to multiple cardiovascular risk factors or angina-like symptoms. A coronary angiography was performed to detect coronary artery disease (CAD). Results. From 218 patients, 90 (group A) presented with normal coronary arteries according to the angiography (false positive ET) while the rest 128 (group B) presented with CAD. ST-segment depression in hyperventilation phase was present in 54 patients of group A (60%) while only in 14 patients of group B (11%), P < .05. Conclusions. Presence of ST-segment depression in hyperventilation phase favors a false positive ET in patients with MVP. PMID:21113438

  5. Histological and Biochemical Comparisons between Right Atrium and Left Atrium in Patients with Mitral Valvular Atrial Fibrillation

    PubMed Central

    Park, Jae Hyung; Lee, Jihei Sara; Lee, Seung Hyun; Lee, Beom Seob; Kang, Seok-Min; Chang, Byung Cheol

    2014-01-01

    Background and Objectives It has been known that the dominant driver of atrial fibrillation (AF) exists in the left atrium (LA) and the incidence of systemic thromboembolism is higher than that of pulmonary thromboembolism in patients with AF. Therefore, we hypothesized that histological and biochemical characteristics of the LA and the right atrium (RA) are different in patients with mitral valvular AF. Subjects and Methods We analyzed the histology and messenger ribonucleic acid (mRNA) or protein expression associated with endothelial function and thrombogenesis in 33 human atrial appendage tissues (20 LA tissues, 13 RA tissues) taken from 25 patients {57.7±11.3 years old, 44% males, AF: sinus rhythm (SR)=17:8} with mitral valve disease. We also performed whole mRNA quantification in 8 tissues (both LA and RA tissues from 4 patients) by using next generation sequencing (NGS). Results 1) The degree of fibrosis (p=0.001) and subendocardial smooth muscle thickness (p=0.004) were significantly greater in the LA than in the RA. 2) More advanced matrix fibrosis was found in the LA of patients with AF than in the LA of patients with SR (p=0.046), but not in the RA. 3) There was no LA-RA difference in protein (Western blot) and mRNA {quantitative real-time polymerase chain reaction (qRT-PCR)} expressions of NF-?B, 3-NT, CD31, E-selectin, inducible NO synthase, stromal cell-derived factor-1?, Endothelin-1, platelet-derived growth factor, myeloperoxidase, or NCX, except for higher mRNA expression of HCN4 in the RA (qRT-PCR, p=0.026) and that of KCNN1 in the LA (NGS, p=0.016). Conclusion More advanced matrix and subendocardial remodeling were noticed in the LA than in the RA in patients with mitral valvular AF. However, the expressions of tissue factors associated with thrombogenesis were not significantly different between the RA and the LA. PMID:25089135

  6. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome.

    PubMed Central

    Handler, C E; Child, A; Light, N D; Dorrance, D E

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the continuous wave Doppler ultrasound technique. Ten (67%) patients had mitral valve prolapse shown by auscultatory signs or echocardiography or both--a prevalence at least three times greater than that in the general adult population. It is concluded that if the abnormality of collagen biosynthesis found in skin biopsy samples in these patients is also present in their mitral valve tissue this may predispose them to prolapse of the valve. Images PMID:3902069

  7. Aberrant right ventricular branch of right coronary artery with mitral valve prolapse

    PubMed Central

    Arinc, Huseyin; Gunduz, Huseyin; Tamer, Ali; Ozhan, Hakan; Akdemir, Ramazan; Ozkokeli, Mehmet; Uyan, Cihangir

    2004-01-01

    A 37-year-old man presented with a three-week history of chest pain. Transthoracic echocardiography demonstrated a mitral valve prolapse and mild mitral insufficiency. Coronary angiography showed normal left main, circumflex, left anterior descending and right coronary arteries; however, the right ventricular branch of the right coronary artery had a separate ostium. Concomitant congenital heart abnormalities have been observed with coronary artery anomalies. Primary congenital coronary and valvular anomalies may have genetic heredity. In the present case, mitral valve prolapse was accompanied by a right ventricular coronary artery origin anomaly which, to the best of our knowledge, is the first report in the literature in which both anomalies presented together. PMID:19641717

  8. [Chest pain with ischemic electrocardiographic changes: mitral valve prolapse in pediatrics. Case report].

    PubMed

    Matamala-Morillo, Miguel Ángel; Rodríguez-González, Moisés; Segado-Arenas, Antonio

    2015-01-01

    Chest pain is rare and usually benign in pediatrics. Cardiac etiology is even rarer. However, it is a symptom associated with ischemic heart disease and it imposes great social alarm, even in health care workers. Therefore, it is necessary to know the most common causes of this symptom in children, as well as serious diseases that can cause it, which require prompt medical attention. We report a case of chest pain associated with ischemic electrocardiographic changes in a patient with mitral valve prolapse and MASS phenotype (mitral valve prolapse, aortic root enlargement, and skeletal and skin alterations), we review the mitral valve prolapse and stress the importance of knowing it in the pediatric setting. PMID:25622171

  9. [Incidence of tricuspid regurgitation in normal subjects according to a new Doppler echographic criterion].

    PubMed

    Tei, C; Kisanuki, A; Minagoe, S; Shibata, K; Yutsudou, T; Otsuji, Y; Natsugoe, K; Tanaka, H

    1987-09-01

    To develop a Doppler echocardiographic criterion for tricuspid regurgitation (TR) and to determine the incidence of TR in normal subjects, we examined 357 apparently normal subjects ranging in age from five to 95 years using pulsed and continuous wave Doppler echocardiography. A Doppler transducer was placed over the right ventricular apex, with the Doppler beam directed parallel with TR flow. TR was judged to be present when a holosystolic abnormal flow pattern with the peak velocity greater than 1.5 m/sec was recorded at the tricuspid valve orifice. This was based on the theory that in TR systolic pressure gradient across the tricuspid valve should be 10 mmHg or greater in normal subjects. TR was detected in 87 (24%) of 357 subjects and the mean peak velocity of the TR was 2.1 +/- 0.2 m/sec (mean +/- SD). It was more frequent in women (28%) than in men (19%) and differed significantly among the young, middle and old age groups. It was 79% in the first decade, 30% in the second, 10% in the third, 21% in the fourth, 5% in the fifth, 19% in the sixth, 14% in the seventh, 23% in the eight, 37% in the ninth and 40% in the tenth. The minimum dimension of the tricuspid annulus was significantly enlarged (p less than 0.001) in subjects with TR (2.2 +/- 0.3 cm/m2) compared to that of subjects without TR (1.8 +/- 0.3 cm/m2).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3453851

  10. Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

    PubMed Central

    Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-01-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

  11. Ochronotic involvement of the aortic and mitral valves in a 72-year-old man.

    PubMed

    Atalay, Atakan; Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-02-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

  12. Ablation of idiopathic ventricular tachycardia originating from posterior mitral annulus by using electroanatomical mapping

    PubMed Central

    Aksu, Tolga; Guler, Tumer Erdem; Golcuk, Ebru; Ozcan, Kaz?m Serhan; Erden, Ismail

    2015-01-01

    Idiopathic ventricular tachycardia (IVT) is an important type of arrhythmia, which has distinct electrocardiographic features and treatment options. Most of the cases originate from right ventricular outflow tract and less frequently from the left ventricular outflow tract. IVTs originating from mitral annulus are rare, and little is known about the efficacy of radiofrequency catheter ablation in this form. We hereby present a rare case of IVT arising from posterior mitral annulus. The electrocardiographic, electrophysiological, and electroanatomical characteristics of this tachycardia are discussed. PMID:25784821

  13. On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair

    PubMed Central

    Tenenholtz, Neil A.; Hammer, Peter E.; Schneider, Robert J.; Vasilyev, Nikolay V.; Howe, Robert D.

    2011-01-01

    Surgical repair of the mitral valve is a difficult procedure that is often avoided in favor of less effective valve replacement because of the associated technical challenges facing non-expert surgeons. In the interest of increasing the rate of valve repair, an accurate, interactive surgical simulator for mitral valve repair was developed. With a haptic interface, users can interact with a mechanical model during simulation to aid in the development of a surgical plan and then virtually implement the procedure to assess its efficacy. Sub-millimeter accuracy was achieved in a validation study, and the system was successfully used by a cardiac surgeon to repair three virtual pathological valves. PMID:24511427

  14. Alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension.

    PubMed

    Batson, M A; Longmire, S; Csontos, E

    1990-09-01

    We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. Alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented. PMID:2119902

  15. Robotic resection of dual accessory mitral valve tissue in an adult patient.

    PubMed

    Yamaguchi, Shojiro; Ishikawa, Norihiko; Tomita, Shigeyuki; Ohtake, Hiroshi; Kiuchi, Ryuta; Nishida, Yuji; Muramatsu, Kenichi; Watanabe, Go

    2014-09-01

    The presence of isolated accessory mitral valve tissue (AMVT) is extremely rare in adults. We successfully performed robot-assisted resection of dual AMVT that was attached to the papillary muscle and anterior mitral leaflet. Echocardiography was invaluable for identifying the most suitable approach. The short-axis view on echocardiography revealed the precise location where the AMVT was attached. The robotic operation enabled fine visualization; we clearly observed the AMVT and removed its entire extra structure. The patient recovered well and was discharged 3 days after the operation. To the best of our knowledge, this is the first report of successful robotic AMVT resection. PMID:25193197

  16. Left ventricular function and mitral valve opening in massive pulmonary embolism.

    PubMed Central

    Bullock, R E; Hall, R J

    1982-01-01

    M-mode echocardiograms are demonstrated from a patient with subacute massive pulmonary embolism before and after thrombolytic treatment and clinical recovery. Severely impaired left ventricular contraction returned to normal. A reversible reduction in mitral valve opening velocity was also seen and was thought to be in part the result of diminished left atrial filling. This hypothesis was tested experimentally; mitral valve opening velocity was measured in normal subjects and found to be significantly reduced when pulmonary blood flow was impeded during the Valsalva manoeuvre. Images PMID:7126394

  17. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval.

    PubMed

    Yontar, Osman Can; Karaagac, Kemal; Tenekecioglu, Erhan; Tutuncu, Ahmet; Demir, Mehmet; Melek, Mehmet

    2014-01-01

    Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP. PMID:25232403

  18. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval

    PubMed Central

    Yontar, Osman Can; Karaagac, Kemal; Tenekecioglu, Erhan; Tutuncu, Ahmet; Demir, Mehmet; Melek, Mehmet

    2014-01-01

    Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP. PMID:25232403

  19. Vertical left ventricular angulation assessed by thallium 201 myocardial perfusion imaging in patients with mitral valve prolapse

    SciTech Connect

    Arora, R.R.; Horowitz, S.F.; Machac, J.; Goldman, M.E.

    1986-01-01

    Mitral valve prolapse has been associated with septal to aortic root angle abnormalities determined by echocardiography. Thallium 201 imaging in the anterior view permits visualization of the left ventricular long axis. In the present study, the vertical angle was defined as the angle formed by the long axis of the left ventricle and a horizontal line. The vertical angle was determined in 25 patients who had 201 TL stress testing and M-mode echocardiography. Group I (11 patients) had mitral valve prolapse and group II (14 patients) did not have mitral valve prolapse. The vertical angle and ultrasound were read blinded to each other. Height, weight, and body surface area were compared for the two groups, and receiver operator curve analysis performed. Vertical angle measured by TL 201 was significantly more vertical in patients with mitral valve prolapse. Receiver operator curve analysis showed that an angle of greater than 30 degrees successfully identified 9/11 patients with mitral valve prolapse, with a sensitivity of 82% and a specificity of 79%. There were no significant differences in height, weight, or body surface area between the two groups. Thus, patients with mitral valve prolapse have more vertically positioned hearts than patients without mitral valve prolapse, independent of body habitus. The different appearance of a vertically oriented heart may contribute to false-positive readings of TL 201 images.

  20. Carnitine Deficiency as the Possible Etiology of Idiopathic Mitral Valve Prolapse

    PubMed Central

    Trivellato, Mario; De Palo, Elio; Gatti, Rosalba; Parenti, Anna; Piazza, Mario

    1984-01-01

    Idiopathic mitral valve prolapse (IMVP) is a very common cardiac abnormality that may be linked to carnitine deficit (inadequate nutritional intake or absorption). One patient with IMVP and related symptoms that were resistant to drug therapy was fully studied. Free plasma carnitine and 24-hour free urine carnitine were measured twice, 10 days apart, after an overnight fast. Findings: Free plasma carnitine 23 and 28 ?M/L (our laboratory N=38±2 ?M/L); free urine C 25 and 44 ?M/24 hr (N=255±66 ?M/24 hr); FFA 0.88 mEq/L, Duncombe method (N=0.09-0.60); LDL 42% (N = 44-65); cholesterol 161 mg/dl (N = 180-280); triglycerides 84 mg/dl (N = 50-172); SGOT 79 MU/ml (N = up to 40); SGPT 147 MU/ml (N = up to 40); OCT 11.2 MU/ml (N = up to 10.0); aldolase 11.5 MU/ml (N = up to 3.1, Bruns method). Deltoid biopsy: light microscopy showed the presence of optically empty vacuoles; electron microscopy showed lipid droplets near the subsarcolemma area and intermyofibrillar spaces. The mitochondria contained electron dense granules. The electromyogram was also abnormal. In a random sample of four patients with IMVP and related classic symptoms, we have found low levels of plasma and/or urinary carnitine in each case. This study may be the first step towards L-carnitine therapy for what has previously appeared to be idiopathic cardiomyopathy. Images PMID:15226877

  1. Adenosine can improve the intra-atrial conduction block along the mitral annulus during accessory pathway ablation.

    PubMed

    Yamada, Takumi; Lau, Yung R; McElderry, H Thomas; Doppalapudi, Harish; Kay, G Neal

    2008-03-01

    A 10-year-old boy with a supraventricular tachycardia was referred for catheter ablation. An electrophysiologic study revealed a left lateral concealed accessory pathway (AP). A few radiofrequency (RF) applications targeting the AP resulted in an inadvertent intra-atrial conduction block at the mitral isthmus without any damage to the AP. Adenosine was then administered during left ventricular pacing. Soon after that, the conduction at the mitral isthmus recovered partially, and that change disappeared soon. Those findings suggested that the administration of adenosine may transiently recover the conduction at the mitral isthmus damaged by RF ablation. PMID:18308752

  2. Operative risks of the maze procedure associated with mitral valve surgery

    Microsoft Academic Search

    J. Q. Melo; J. P. Neves; L. M. Abecasis; P. Adragão; R. Ribeiras; R. Seabra-Gomes

    1997-01-01

    Twelve patients were operated on for mitral valve disease with concomitant chronic atrial fibrillation. Valve repair was performed in five patients and replacement in seven. Maze I and maze III procedures were applied in eight and four patients, respectively, and are compared. There was a regular rhythm in all maze I patients with a constant junctional rhythm in three and

  3. Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure

    Microsoft Academic Search

    Néstor Sandoval; Victor M. Velasco; Hernando Orjuela; Victor Caicedo; Hernando Santos; Fernando Rosas; Juan R. Correa; Iván Melgarejo; Carlos A. Morillo

    1996-01-01

    Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has

  4. Lack of association between mitral valve prolapse and history of rheumatic fever

    Microsoft Academic Search

    Alfredo Zuppiroli; Mary J. Roman; Michael O'Grady; Richard B. Devereux

    1996-01-01

    To determine whether rheumatic fever is associated with mitral valve prolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The prevalence of a history of rheumatic fever by modified Jones criteria was determined in 92 probands and 112 affected relatives or spouses with M-mode and two-dimensional echocardiographic findings of MVP, accompanied in

  5. Early Results of Posterior Leaflet Folding Plasty for Mitral Valve Reconstruction

    Microsoft Academic Search

    Eugene A. Grossi; Aubrey C. Galloway; Klaus Kallenbach; Jeffrey S. Miller; Rick Esposito; Daniel S. Schwartz; Stephen B. Colvin

    1998-01-01

    Background. Standard reconstruction for posterior mitral leaflet (PML) disease is quadrangular resection and annular plication; when the PML is excessively high, a sliding plasty is used. We have developed an alternative technique, a posterior leaflet folding plasty. It is performed by folding down the cut vertical edges of the PML. The central height of the PML is reduced, leaflet coaptation

  6. Surface Strains in the Anterior Leaflet of the Functioning Mitral Valve

    Microsoft Academic Search

    M. S. Sacks; Z. He; Lotte Baijens; S. Wanant; P. Shah; H. Sugimoto; A. P. Yoganathan

    2002-01-01

    The mitral valve (MV) is a complex anatomical structure whose function involves a delicate force balance and synchronized function of each of its components. Elucidation of the role of each component and their interactions is critical to improving our understanding of MV function, and to form the basis for rational surgical repair. In the present study, we present the first

  7. Homozygous Factor X Deficiency Associated with Familial Hypercholesterolemia, Mitral Valve Prolapse, and Hypertrophic Cardiomyopathy

    Microsoft Academic Search

    Alton Onat

    1994-01-01

    The family investigated showed the presence of multiple genetic disorders among their members. The presumable defective genes were related to coagulation factor X, familial hypercholesterolemia, mitral valve prolapse, and hypertrophic cardiomyopathy. The parents were offspring of two siblings, and their children comprised a nonidentical twin. While the proband demonstrated factor X deficiency, obstructive hypertrophic cardiomyopathy, and primary hypercholesterolemia, her parents

  8. Commissural dehiscence of Carpentier-Edwards mitral bioprostheses: Explant analysis and pathogenesis

    Microsoft Academic Search

    J. Francisco Nistal; Aquilino Hurlé; J. Antonio Gutiérrez; Francisco Mazorra; José M. Revuelta

    1995-01-01

    Manufacturing factors have seldom been implicated as a direct cause of structural deterioration of valvular bioprostheses; this phenomenon has generally been considered to be of a host-dependent origin. We analyzed the clinical and pathologic data from 12 Carpentier-Edwards mitral bioprostheses removed from 12 patients because of severe dysfunction and showing detachment of the porcine aortic wall from the stent in

  9. Surveillance of human mitral valve cells by autochthonous lymphocytes, in vitro.

    PubMed

    Algard, F T; Van Netten, J P; Montessori, G A; Tan, W C

    1980-12-01

    Analysis of a time-lapse film of cultured human mitral valve endothelium containing autochthonous lymphocytes reveals details of a pattern of interaction suggesting a previously undescribed type of cellular surveillance. Highly mobile lymphocytes rapidly approach individual endothelial cells, slowly circumnavigate the nuclear region, and rapidly move away to repeat this behavior on adjacent cells during the 1-month culture period. PMID:7216236

  10. Mitral valve prolapse and joint hypermobility: evidence for a systemic connective tissue abnormality?

    Microsoft Academic Search

    D Pitcher; R Grahame

    1982-01-01

    Clinical evidence for an abnormally of extracardiac connective tissue was sought in 21 patients with idiopathic mitral valve prolapse and was compared to that in 21 matched controls. The incidence of rheumatic and orthopaedic complaints and the prevalence of hypermobile joints, Marfanoid habitus, and skeletal deformity were compared in the 2 groups. Skin thickness and elasticity were measured, and the

  11. Mitral Valve Prolapse and Panic Disorder: A Review of their Relationship

    Microsoft Academic Search

    JURGEN MARGRAF; ANKE EHLERS; WALTON T. ROTH

    There has been considerable speculation about a possible relationship between panic disorder and mitral valve prolapse syndrome (MVP), although empirical results have been highly in- consistent. Some studies report low frequencies of 0-8%, others high frequencies of 24-35% \\

  12. Angiotensin II type 1 receptor gene polymorphism and mitral valve prolapse syndrome

    Microsoft Academic Search

    Tamás Szombathy; Lívia Jánoskúti; Csaba Szalai; Albert Császár; Miklós Miklósi; Zsuzsa Mészáros; Pál Kempler; Zoltán László; Tamás Fenyvesi; László Romics

    2000-01-01

    Background Mitral valve prolapse syndrome (MVPS), a term applied to patients who have a variety of symptoms, has been associated with autonomic or neuroendocrine dysfunction. Recent evidence suggests that effects of angiotensin II mediated by the angiotensin II type 1 (AT1) receptor are involved in modulation of cardiovascular autonomic control in human beings. Association of a genetic polymorphism (A-C1166) of

  13. Genetic segregation analysis of familial mitral valve prolapse shows no linkage to fibrillar collagen genes

    Microsoft Academic Search

    P Wordsworth; D Ogilvie; F Akhras; G Jackson; B Sykes

    1989-01-01

    Three pedigrees were identified in which mitral valve prolapse seemed to be inherited as a mendelian autosomal dominant trait. The segregation of the genes encoding the major fibrillar collagens present in valve tissue, collagens I and III, was analysed by use of restriction enzyme site variants as genetic markers. In one pedigree there was discordance between the segregation of the

  14. Internal carotid artery occlusion in a young female with mitral valve prolapse.

    PubMed Central

    Saadah, M. A.; Shakir, R. A.; Rudwan, M. A.; Khan, N.

    1986-01-01

    A healthy 28 year old housewife presented with sudden right hemiplegia and aphasia. No predisposing factors could be ascertained apart from posterior cusp mitral value prolapse on two dimensional echocardiography. Extensive investigations confirmed the presence of cerebral infarction and persistent occlusion of the left internal carotid artery near its origin. Images Figure 1 Figure 2 PMID:3658849

  15. Neuroendocrine changes in Dachshunds with mitral valve prolapse examined under different study conditions

    Microsoft Academic Search

    H. D PEDERSEN; L. H OLSEN; T MOW; N. J CHRISTENSEN

    1999-01-01

    Neuroendocrine changes associated with canine mitral valve prolapse (MVP) were studied in 159 Dachshunds older than two years. In study 1, 102 dogs were sampled without controlling diet or fasting period. In good accordance with human findings, theMVPseverity correlated positively with plasma renin activity and tended to correlate negatively with plasma aldosterone. These findings were not attributable to any coexistent

  16. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome

    Microsoft Academic Search

    C E Handler; A Child; N D Light; D E Dorrance

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the

  17. MITRAL VALVE PROLAPSE SYNDROME AND ITS ASSOCIATION WITH ANXIETY AND PANIC STATES

    PubMed Central

    Chatterjee, S.B.; John, M.J.

    1982-01-01

    SUMMARY Mitral Valve Prolapse Syndrome is one of the most frequent cardiac valvular abnormalities in general population. Mostly the patients remain asymptomatic but a few may suffer from hyperadrenergic panic states, similar to anxiety attacks. In psychiatric practice, a number of physicians have come across this finding during the recent past. Present article deals with two such case illustrations. PMID:21965948

  18. Computer-enhanced mitral valve surgery: toward a total endoscopic procedure.

    PubMed

    Falk, V; Autschbach, R; Krakor, R; Walther, T; Diegeler, A; Onnasch, J F; Chitwood, W R; Mohr, F W

    1999-07-01

    The aim of the study was to develop a computer-enhanced, video-assisted approach for mitral valve repair as a potential step toward a complete endoscopic procedure. In 10 patients with nonischemic mitral valve insufficiency, computer-enhanced telemetric mitral valve repair using the Intuitive surgical telemanipulation system was performed. A femorofemoral bypass was initiated using Port-Access (Heartport, Redwood City, CA) cannulation. A small minithoracotomy was made in the right 4th intercostal space, and a custom-made rib retractor was placed. The pericardium was opened manually, and four traction stay sutures were placed to enhance exposure. After endoaortic balloon clamping, the left atrium was opened and stabilized. The end-effectors were placed in the left atrium through two ports (3rd ICS and 6th ICS, midaxillary line). A 30 degrees three-dimensional (3D)-videoscope angled up was placed through the incision. Mitral valve repair was then performed remotely from the surgical console. This included inspection of the valve, leaflet resection, leaflet repair, and ring implantation. After completion of the repair and testing of the valve, the end effectors were withdrawn, and the left atrium was closed manually using standard endoscopic instruments (Heartport). In all but 1 patient, successful repair, including quadrangular resection, chordal shortening, Whooler-plasty, and Alfieri-plasty, could be accomplished using the computer-enhanced telemanipulation system. A partial ring was implanted in 6 patients and a complete ring was implanted in 3 patients, respectively. Time for surgery, CPB, and clamp time were 170 to 330 minutes (median, 185 minutes), 140 to 220 minutes (median, 149 minutes), and 78 to 133 minutes (median, 94 minutes), respectively. In one patient, intraoperative transesophageal echocardiography (TEE) showed insufficient repair, a second surgery was performed via an enlarged left thoracotomy. One patient with recurrent mitral insufficiency had to have a second surgery on postoperative day 3 for a torn-out ring. Median time of hospitalization was 8 days. At 3 months follow-up (completed in 7 patients), all patients had improved clinically. Computer-enhanced mitral valve repair is feasible and can be performed with good functional results. The telemanipulation system offers the potential for true endoscopic mitral valve repair. However, surgical time is prolonged, and a learning curve has to be overcome. PMID:10451255

  19. De Vega Annuloplasty for Functional Tricupsid Regurgitation: Concept of Tricuspid Valve Orifice Index to Optimize Tricuspid Valve Annular Reduction

    PubMed Central

    Hwang, Ho Young; Chang, Hyoung Woo; Jeong, Dong Seop

    2013-01-01

    We evaluated long-term results of De Vega annuloplasty measured by cylindrical sizers for functional tricuspid regurgitation (FTR) and analyzed the impact of measured annular size on the late recurrence of tricuspid valve regurgitation. Between 2001 and 2011, 177 patients (57.9±10.5 yr) underwent De Vega annuloplasty for FTR. Three cylindrical sizers (actual diameters of 29.5, 31.5, and 33.5 mm) were used to reproducibly reduce the tricuspid annulus. Long-term outcomes were evaluated and risk factor analyses for the recurrence of FTR ?3+ were performed. Measured annular diameter indexed by patient's body surface area was included in the analyses as a possible risk factor. Operative mortality occurred in 8 patients (4.5%). Ten-year overall and cardiac death-free survivals were 80.5% and 90.8%, respectively. Five and 10-yr freedom rates from recurrent FTR were 96.5% and 93.1%, respectively. Cox proportional hazard model revealed that higher indexed annular size was the only risk factor for the recurrence of FTR (P=0.006). A minimal P value approach demonstrated that indexed annular diameter of 22.5 mm/m2 was a cut-off value predicting the recurrence of FTR. De Vega annuloplasty for FTR results in low rates of recurrent FTR in the long-term. Tricuspid annulus should be reduced appropriately considering patients' body size to prevent recurrent FTR. PMID:24339705

  20. De Vega annuloplasty for functional tricupsid regurgitation: concept of tricuspid valve orifice index to optimize tricuspid valve annular reduction.

    PubMed

    Hwang, Ho Young; Chang, Hyoung Woo; Jeong, Dong Seop; Ahn, Hyuk

    2013-12-01

    We evaluated long-term results of De Vega annuloplasty measured by cylindrical sizers for functional tricuspid regurgitation (FTR) and analyzed the impact of measured annular size on the late recurrence of tricuspid valve regurgitation. Between 2001 and 2011, 177 patients (57.9±10.5 yr) underwent De Vega annuloplasty for FTR. Three cylindrical sizers (actual diameters of 29.5, 31.5, and 33.5 mm) were used to reproducibly reduce the tricuspid annulus. Long-term outcomes were evaluated and risk factor analyses for the recurrence of FTR ?3+ were performed. Measured annular diameter indexed by patient's body surface area was included in the analyses as a possible risk factor. Operative mortality occurred in 8 patients (4.5%). Ten-year overall and cardiac death-free survivals were 80.5% and 90.8%, respectively. Five and 10-yr freedom rates from recurrent FTR were 96.5% and 93.1%, respectively. Cox proportional hazard model revealed that higher indexed annular size was the only risk factor for the recurrence of FTR (P=0.006). A minimal P value approach demonstrated that indexed annular diameter of 22.5 mm/m(2) was a cut-off value predicting the recurrence of FTR. De Vega annuloplasty for FTR results in low rates of recurrent FTR in the long-term. Tricuspid annulus should be reduced appropriately considering patients' body size to prevent recurrent FTR. PMID:24339705

  1. Non-ejection systolic clicks and mitral systolic murmurs in black schoolchildren of Soweto, Johannesburg.

    PubMed Central

    McLaren, M J; Hawkins, D M; Lachman, A S; Lakier, J B; Pocock, W A; Barlow, J B

    1976-01-01

    A survey was conducted on 12 050 Black schoolchildren, aged 2 to 18 years, in the South Western Townships of Johannesburg (Soweto), and the prevalence of non-ejection systolic clicks and late systolic murmurs was determined. One or both of these auscultatory findings were detected in 168 children, yielding a prevalence rate of 13-99 per 1000 in the school population. A female preponderance of 1-9:1 was present and there was a strong linear increase in prevalence with age, with a peak rate of 29-41 per 1000 in 17-year-old children. A non-ejection click was the only abnormal auscultatory finding in 123 children (73%) and a mitral systolic murmur in 8 (5%), whereas in 37 (22%) both these findings were present. Of the latter 37 children, the murmur was late systolic in 32; in 5 it was early systolic. Auscultation in different postures was important in the detection of both non-ejection clicks and mitral systolic murmurs. Experience in the detection of these auscultatory findings influenced the frequency with which they were heard. Electrocardiographic abnormalities compatible with those previously described in the billowing mitral leaflet syndrome were present in 11 of 158 children. The aetiology of these auscultatory findings in this community remains unknown. In the same survey, a high prevalence rate of rheumatic heart disease was recorded and the epidemiology of the non-ejection clicks and these mitral systolic murmurs showed similarties to that of rheumatic heart disease. Though the specific billowing mitral leaflet syndrome almost certainly accounts for some of these auscultatory findings, a significant proportion may have early rheumatic heart disease. Further elucidation of this problem is necessary. PMID:973897

  2. Mitral valve prolapse in 3-year-old healthy Cavalier King Charles Spaniels. An echocardiographic study.

    PubMed Central

    Pedersen, H D; Kristensen, B O; Lorentzen, K A; Koch, J; Jensen, A L; Flagstad, A

    1995-01-01

    Clinical studies have shown that Cavalier King Charles Spaniels (CKCS) have a high prevalence of mitral valvular insufficiency (MVI). Echocardiography has the potential to disclose early valvular changes, and the present prospective study was designed to investigate the occurrence of mitral valve prolapse (MVP) in young CKCS without heart murmurs, and to correlate the degree of MVP with the clinical status of the dogs by including CKCS with MVI as well. The study was based on blinded evaluations of echocardiographic recordings of mitral valves from 34 CKCS and 30 control dogs. Thirteen (87%) of 15 three-year-old CKCS without heart murmurs had MVP (2 total and 11 partial), as compared with 1 (7%) of 15 three-year-old normal Beagle dogs (P < 0.0001), and none of 15 three-year-old normal Medium Size Poodles (P < 0.0001). Of 19 CKCS with MVI, MVP was found in 84% of the entire group and in 100% of dogs with pulmonary congestion or edema. The occurrence of total MVP tended to be higher in the group with MVI (47%, 9/19), when compared with the younger CKCS without heart murmurs (13%, 2/15, P = 0.06). MVP was positively associated with excessive heart rate variability (P = 0.003). The radius of curvature of the anterior mitral valve leaflet in systole was significantly reduced in dogs with MVP when compared with those without (P < 0.0001). In conclusion, this study shows that CKCS at an early age have a high occurrence of MVP. This suggests: 1) A genetic predisposition of CKCS to MVP; and 2) That MVP is a pathogenetic factor in the development of mitral valvular insufficiency. Follow up studies may add further support to these proposals, and clarify whether echocardiography may be an aid in selecting CKCS for future breeding. Images Fig. 1. PMID:8548691

  3. Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals

    PubMed Central

    Lange, David C.; Glidden, David; Secemsky, Eric A.; Ordovas, Karen; Deeks, Steven G.; Martin, Jeffrey N.; Bolger, Ann F.; Hsue, Priscilla Y.

    2015-01-01

    Background HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals. Methods and Results We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell’s C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all). Conclusion In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death. PMID:26132465

  4. In Vivo Dynamic Deformation of the Mitral Valve Annulus

    PubMed Central

    Eckert, Chad E.; Zubiate, Brett; Vergnat, Mathieu; Gorman, Joseph H.; Gorman, Robert C.; Sacks, Michael S.

    2010-01-01

    Though mitral valve (MV) repair surgical procedures have increased in the United States [Gammie, J. S., et al. Ann. Thorac. Surg. 87(5):1431–1437, 2009; Nowicki, E. R., et al. Am. Heart J. 145(6):1058–1062, 2003], studies suggest that altering MV stress states may have an effect on tissue homeostasis, which could impact the long-term outcome [Accola, K. D., et al. Ann. Thorac. Surg. 79(4):1276–1283, 2005; Fasol, R., et al. Ann. Thorac. Surg. 77(6):1985–1988, 2004; Flameng, W., P. Herijgers, and K. Bogaerts. Circulation 107(12):1609–1613, 2003; Gillinov, A. M., et al. Ann. Thorac. Surg. 69(3):717–721, 2000]. Improved computational modeling that incorporates structural and geometrical data as well as cellular components has the potential to predict such changes; however, the absence of important boundary condition information limits current efforts. In this study, novel high definition in vivo annular kinematic data collected from surgically implanted sonocrystals in sheep was fit to a contiguous 3D spline based on quintic-order hermite shape functions with C2 continuity. From the interpolated displacements, the annular axial strain and strain rate, bending, and twist along the entire annulus were calculated over the cardiac cycle. Axial strain was shown to be regionally and temporally variant with minimum and maximum values of ?10 and 4%, respectively, observed. Similarly, regionally and temporally variant strain rate values, up to 100%/s contraction and 120%/s elongation, were observed. Both annular bend and twist data showed little deviation from unity with limited regional variations, indicating that most of the energy for deformation was associated with annular axial strain. The regionally and temporally variant strain/strain rate behavior of the annulus are related to the varied fibrous-muscle structure and contractile behavior of the annulus and surrounding ventricular structures, although specific details are still unavailable. With the high resolution shape and displacement information described in this work, high fidelity boundary conditions can be prescribed in future MV finite element models, leading to new insights into MV function and strategies for repair. PMID:19585241

  5. Role of modern 3D echocardiography in valvular heart disease

    PubMed Central

    2014-01-01

    Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases. PMID:25378966

  6. Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

    PubMed Central

    Mo?e?ska, Olga; Sypu?a, S?awomir; Celi?ska-Spoder, Ma?gorzata; Walecki, Jerzy; Kosior, Dariusz A.

    2014-01-01

    Summary Background Caseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction. Case Report 76-year old obese (BMI 32 kg/m2), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment. Conclusions Although caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis. PMID:24791181

  7. P-wave signal-averaged electrocardiogram in patients with idiopathic mitral valve prolapse syndrome and supraventricular arrhythmias

    Microsoft Academic Search

    Waldemar Banasiak; Iwona Pajak; Piotr Ponikowski; Wieslaw Lacheta; Krzysztof Wiech; Massimo Piepoli; Czeslaw Telichowski

    1995-01-01

    The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 ± 9 years) were prospectively studied. P-wave triggered SAECG was recorded

  8. Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi

    Microsoft Academic Search

    Yaron Shapira; Itzhak Herz; Mordehay Vaturi; Avital Porter; Yehuda Adler; Yochai Birnbaum; Boris Strasberg; Samuel Sclarovsky; Alex Sagie

    2000-01-01

    OBJECTIVESWe sought to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves in the absence of high-risk thrombi.BACKGROUNDCurrent recommendations for the thrombolytic treatment of stuck prosthetic mitral valves are partially based on older valve models and inclusion of patients in whom high-risk thrombi were either ignored or not sought for. The feasibility and safety of

  9. Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

    PubMed Central

    de Campos, Nelson Leonardo Kerdahi Leite

    2014-01-01

    Introduction Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. Objective To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. Methods We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. Results The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. Conclusion Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature. PMID:24896164

  10. Comparison of the Ventricle Muscle Proteome between Patients with Rheumatic Heart Disease and Controls with Mitral Valve Prolapse: HSP 60 May Be a Specific Protein in RHD

    PubMed Central

    Zheng, Dawei; Xu, Limin; Sun, Lebo; Feng, Qiang; Wang, Zishan; Shao, Guofeng; Ni, Yiming

    2014-01-01

    Objective. Rheumatic heart disease (RHD) is a serious autoimmune heart disease. The present study was aimed at identifying the differentially expressed proteins between patients with RHD and controls with mitral valve prolapse. Methods. Nine patients with RHD and nine controls with mitral valve prolapsed were enrolled for this study. Two-dimensional difference in-gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) were performed. Results. A total of 39 protein spots with differential expressions were identified between the two groups (P < 0.05, Average Ratio > 1.2 or Average Ratio < ?1.2) and four upregulated proteins (including heat shock protein 60 (HSP 60), desmin, PDZ and LIM domain protein 1, and proteasome subunit alpha type-1) and three downregulated proteins (including tropomyosin alpha-1 chain, malate dehydrogenase, and chaperone activity of bc1 complex homolog) were determined. Conclusion. These seven proteins, especially HSP 60, may serve as potential biomarkers for the diagnosis of RHD and provide evidence to explain the mechanisms of this complex disease in the future. PMID:24738046

  11. Spontaneous regurgitation of portal blood flow normalized by meal intake in a patient with alcoholic liver cirrhosis.

    PubMed

    Wen, Yan Ling; Kudo, Masatoshi; Zheng, Rong Qin; Kawasaki, Toshihiko; Chung, Hobyung; Minami, Yasunori; Suetorni, Yoichiro; Onda, Hirokazu; Kitano, Masayuki; Maekawa, Kiyoshi

    2003-02-01

    We report a case with spontaneous regurgitation of portal blood flow (SRPBF) that was normalized by meal intake. A 41-year-old man with long-term alcohol abuse was admitted with a chief complaint of general fatigue. He was diagnosed as having alcoholic liver cirrhosis since his laboratory tests showed the abnormal liver function. Dynamic computed tomography detected numerous portosystemic shunts. Hepatic arterial portography showed the portal vein was narrow and irregular. Color Doppler imaging portrayed the direction of the blood flows in the branches of the portal vein to be retrograde. However, 30 min after meal intake on the same day, color Doppler study showed the direction of the blood flow in the first branch of right and left portal vein became normal. Color Doppler imaging is a useful technique to detect SRPBF and hemodynamic change in portal venous system after meal intake in patient under a completely physiologic condition. PMID:12644050

  12. Giant left atrial myxoma mimicking severe mitral valve stenosis and severe pulmonary hypertension.

    PubMed

    Mouine, Najat N; Asfalou, Ilyass I; Raissouni, Maha M; Benyass, Aatif A; Zbir, El Mehdi E

    2013-01-01

    Myxoma is the most common primary tumor of the heart and can arise in any of the cardiac chambers. This paper reports A 50 -year-old woman without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. Transthoracic echocardiogram showed a giant left atrial myxoma mobile confined to the left atrium in systole, in diastole the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery with good outcome. PMID:23601991

  13. Giant left atrial myxoma mimicking severe mitral valve stenosis and severe pulmonary hypertension

    PubMed Central

    2013-01-01

    Myxoma is the most common primary tumor of the heart and can arise in any of the cardiac chambers. This paper reports A 50 -year-old woman without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. Transthoracic echocardiogram showed a giant left atrial myxoma mobile confined to the left atrium in systole, in diastole the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery with good outcome. PMID:23601991

  14. Accura balloon rupture during percutaneous trans-septal mitral commissurotomy: a rare and potentially fatal complication.

    PubMed

    Singla, Vivek; Patra, Soumya; Patil, Shivanand; Ramalingam, Rangaraj

    2013-01-01

    Percutaneous transseptal mitral commissurotomy (PTMC) is the treatment of choice in rheumatic mitral stenosis. The reuse of sterilised PTMC balloon catheters is widely practised to bring down the procedure cost and have proven safety and efficacy. The reused balloons may deform and are prone to rupture causing fatal complications like embolism either of the torn balloon material or air. We report a first case of Accura balloon rupture during PTMC to the best of our knowledge. Fortunately, there was no complication in our patient. Thus, during the balloon preparation it should be examined for any deformity or tear and air should be removed completely to prevent fatal outcome. The repeated use of the hardware should be limited and an informed consent regarding the possible complications of the reused hardware should be taken. PMID:23704459

  15. Primary Cardiac Synovial Sarcoma Originating from the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

    PubMed

    Veshti, Altin; Prifti, Edvin Mihal; Ikonomi, Majlinda

    2015-01-01

    An 11-year-old boy was admitted due to different episodes of syncope and convulsion. Echocardiogram revealed a mass of 2 × 4 cm originating from the mitral subvalvular apparatus and more precisely from the antero-lateral papillary muscle, protruding in the left ventricle outflow tract causing intermittent obstruction. The patient underwent surgical excision of the left sided mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At 6 months after the operation a small mass in the left ventricle of 1 × 1 cm was detected. The patient underwent reoperation consisting in radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was a cardiac synovial sarcoma. At 1 year after surgery the patient is doing well. PMID:26115156

  16. Stress myocardial imaging in patients with mitral valve prolapse: evidence of a perfusion abnormality

    SciTech Connect

    Butman, S.; Chandraratna, P.A.; Milne, N.; Olson, H.; Lyons, K.; Aronow, W.S.

    1982-01-01

    Twenty-four patients with mitral valve prolapse underwent cardiac catheterization, exercise testing, and exercise /sup 201/T1 scintigraphy. Of 10 patients with coronary artery disease, six had abnormal scintigrams. Two of these six had exercise-induced reversible defects, two had defects that persisted during redistribution, and two had both reversible and persistent defects. Of 14 patients with normal coronary arteries, five had negative scintigrams. Of the remaining nine patients, two had exercise-induced defects, and seven (50%) had defects involving the inferior or posterior wall that persisted during redistribution. Possible mechanisms for this latter finding are discussed. In contrast to previous reports, exercise /sup 201/T1 scintigraphy was not entirely successful in identifying patients with coronary artery disease in our patients with mitral valve prolapse.

  17. Left ventricular non-noncompaction: the mitral valve prolapse of the 21st century?

    PubMed

    Captur, Gabriella; Flett, Andrew S; Jacoby, Daniel L; Moon, James C

    2013-03-20

    A spongiform epidemic is upon us - myocardial trabeculae are everywhere as left ventricular noncompaction (LVNC) ingratiates itself into modern day cardiology. Current understanding of the condition is evolving but remains incomplete, and brings to mind the chronicles of another great cardiac story: mitral valve prolapse. Anecdote suggests that many individuals with prominent trabeculae may be being falsely labelled with a disease - LVNC - using poor echocardiographic and cardiovascular magnetic resonance criteria. Until we have robust diagnostic criteria, aetiology, clinicopathological significance and prognosis, the risk of casualties from ascertainment bias will remain. We should look to history and learn from past mistakes - specifically from the mitral valve prolapse story to show the way forward for LVNC. Meanwhile, clinicians (and patients) should be wary, bearing in mind the possibility that they might be seeing LVNNC - left ventricular non-noncompaction. PMID:22658573

  18. A large cardiac mass: diagnosis of caseous mitral annular calcification and determining optimum management strategy.

    PubMed

    Shapera, Emanuel A; Karimi, Afshin; Castellanos, Luis R

    2014-01-01

    A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a 2.0 × 2.3?cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient's presentation, risk factors, and overall clinical circumstances. PMID:25028589

  19. Calretinin-immunoreactivity in mitral cells of the rat olfactory bulb

    Microsoft Academic Search

    Floris G. Wouterlood; Wolfgang Härtig

    1995-01-01

    We addressed the question whether the projection neurons of the olfactory bulb, i.e. the mitral and tufted cells, are immunoreactive for the calcium-binding protein, calretinin. The following approaches were adopted: (1) light and electron microscopic calretinin-immunocytochemistry; (2) neuroanatomical tracing combined with calretinin-immunocytochemistry according to double-peroxidase and double-fluorescence protocols; (3) unilateral lesion of the olfactory bulb combined with calretinin-immunocytochemistry. The experiments

  20. Limitations of Doppler ultrasound in the assessment of the function of prosthetic mitral valves

    Microsoft Academic Search

    J Chambers; G Jackson; D Jewitt

    1990-01-01

    Pressure half time has been assumed to be a relatively flow-independent measure of orifice area, but it may also be influenced by atrial and ventricular factors. Pressure half time and peak left ventricular inflow velocity were measured by continuous wave Doppler ultrasound in 164 patients with normally functioning Carpentier-Edwards, Björk-Shiley, and Starr-Edwards mitral prostheses. Pressure half time was shorter in