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Sample records for mitral regurgitation methods

  1. Quantification of mitral regurgitation using proximal isovelocity surface area method in dogs.

    PubMed

    Choi, Hojung; Lee, Kichang; Lee, Heechun; Lee, Youngwon; Chang, Dongwoo; Eom, Kidong; Youn, Hwayoung; Choi, Mincheol; Yoon, Junghee

    2004-06-01

    The present study was performed to determine the accuracy and reproducibility of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area (PISA) method in dogs with experimental mitral regurgitation and in canine patients with chronic mitral insufficiency and to evaluate the effect of general anesthesia on mitral regurgitation. Eight adult, Beagle dogs for experimental mitral regurgitation and 11 small breed dogs with spontaneous mitral regurgitation were used. In 8 Beagle dogs, mild mitral regurgitation was created by disrupting mitral chordae or leaflets. Effective regurgitant orifice (ERO) area was measured by the PISA method and compared with the measurements simultaneously obtained by quantitative Doppler echocardiography 4 weeks after creation of mitral regurgitation. The same procedure was performed in 11 patients with isolated mitral regurgitation and in 8 Beagle dogs under two different protocols of general anesthesia. ERO and regurgitant stroke volume (RSV) by the PISA method correlated well with values by the quantitative Doppler technique with a small error in experimental dogs (r = 0.914 and r = 0.839) and 11 patients (r = 0.990 and r = 0.996). The isoflurane anesthetic echocardiography demonstrated a significant decrease of RSV, and there was no significant change in fractional shortening (FS), ERO area, LV end-diastolic and LV end-systolic volume. ERO area showed increasing tendency after ketamine-xylazine administration, but not statistically significant. RSV, LV end-systolic and LV end-diastolic volume increased significantly (p < 0.01), whereas FS significantly decreased (p < 0.01). The PISA method is accurate and reproducible in experimental mitral regurgitation model and in a clinical setting. ERO area is considered and preferred as a hemodynamic-nondependent factor than other traditional measurements. PMID:15192345

  2. [Acute Mitral Regurgitation in Infant].

    PubMed

    Hirata, Yasutaka

    2015-07-01

    The acute mitral regurgitation of the infants are believed to be very rare until recently. However, there have been increasing number of reports of acute massive mitral regurgitation attributable to rupture of the chordae tendaniae escecially in Japan. If undiagnosed or the optimal treatment including surgery is delayed, it may cause cardiogenic shock and death in infants. Thus pediatricians, pediatric cardiologists and pediatric caridiac surgeons should consider this diagnosis when previously healthy infant suddenly develop cardiorespiratory collapse. It is very important to diagnose early and if there is over moderate mitral regurgitation, the 1st choice will be the mitral valve repair if possible. Pediatric cardiac suregon should be skilled at the mitral valve repair and mitral valve replacement. There are several techniques which are different from the adult operation, so pediatric cardiac surgeon also has to be prepared for these techniques including supraannular mitral valve replacement. PMID:26197907

  3. Basic mechanisms of mitral regurgitation.

    PubMed

    Dal-Bianco, Jacob P; Beaudoin, Jonathan; Handschumacher, Mark D; Levine, Robert A

    2014-09-01

    Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral regurgitation (MR). The mechanism responsible for MV malcoaptation and MR can be dysfunction or structural change of the left ventricle, the papillary muscles, the chordae tendineae, the mitral annulus, and the MV leaflets. The rationale for MV treatment depends on the MR mechanism and therefore it is essential to identify and understand normal and abnormal MV and MV apparatus function. PMID:25151282

  4. Basic Mechanisms of Mitral Regurgitation

    PubMed Central

    Dal-Bianco, Jacob P.; Beaudoin, Jonathan

    2014-01-01

    Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral regurgitation (MR). The mechanism responsible for MV malcoaptation and MR can be dysfunction or structural change of the left ventricle, the papillary muscles, the chordae tendineae, the mitral annulus and the MV leaflets. The rationale for MV treatment depends on the MR mechanism and therefore it is essential to identify and understand normal and abnormal MV and MV apparatus function. PMID:25151282

  5. [Surgery for mitral regurgitation in children].

    PubMed

    Fukushima, N; Otake, S; Sawa, Y; Ichikawa, H; Yoshiryu, M; Matsuda, H

    1999-04-01

    In pediatric patients, mitral valve (MV) repair is preferable than MV replacement because of no need for anticoagulation and its feasibility in small children. However, long-term outcome of MV repair is still unclear. In the present study, fifty-two pediatric patients who underwent MV repair (n = 46) and MV replacement (n = 6) against mitral regurgitation (MR) between January 1970 and December 1996 were evaluated. 46 patients had associated diseases. Mitral annuloplasty was applied in 20 patients (by Kay method (n = 14) and Paneth-Burr method (n = 6) before and after 1991, respectively). Freedom from reoperation rate in patients with partial endocardial cushion defect (ECD) was significantly lower than that in other patients after MV repair, which was significantly higher than that in patients with MV replacement. Diameter of mitral annulus grew within normal range after MV repair. In conclusion, MV repair may provide better outcomes with respect to reoperation and growth of MV in pediatric patients except with partial ECD. PMID:10226421

  6. 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

  7. A novel approach to ischemic mitral regurgitation (IMR)

    PubMed Central

    Scoville, David H.

    2015-01-01

    Ischemic mitral regurgitation (IMR) is a complicated medical condition with varying degrees of coronary artery disease and mitral regurgitation (MR). The traditional surgical treatment option for those with indications for intervention is coronary artery bypass grafting (CABG) plus or minus mitral valve repair or replacement (MVR). Percutaneous coronary intervention, hybrid coronary revascularization (HCR), and conventional CABG are three techniques available to address coronary artery disease (CAD). Percutaneous edge-to-edge repair, minimally invasive, and traditional sternotomy are accepted approaches for the treatment of MR. When taken in combination, there are nine methods available to revascularize the myocardium and restore competency to the mitral valve. While most of these treatment options have not been studied in detail, they may offer novel solutions to a widely variable and complex IMR patient population. Thus, a comparative analysis including an examination of potential benefits and risks will be helpful and potentially allow for more patient-specific treatment strategies. PMID:26539349

  8. Mitral Valve Clip for Treatment of Mitral Regurgitation: An Evidence-Based Analysis

    PubMed Central

    Ansari, Mohammed T.; Ahmadzai, Nadera; Coyle, Kathryn; Coyle, Doug; Moher, David

    2015-01-01

    Background Many of the 500,000 North American patients with chronic mitral regurgitation may be poor candidates for mitral valve surgery. Objective The objective of this study was to investigate the comparative effectiveness, harms, and cost-effectiveness of percutaneous mitral valve repair using mitral valve clips in candidates at prohibitive risk for surgery. Data Sources We searched articles in MEDLINE, Embase, and the Cochrane Library published from 1994 to February 2014 for evidence of effectiveness and harms; for economic literature we also searched NHS EED and Tufts CEA registry. Grey literature was also searched. Review Methods Primary studies were sought from existing systematic reviews that had employed reliable search and screening methods. Newer studies were sought by searching the period subsequent to the last search date of the review. Two reviewers screened records and assessed study validity. We used the Cochrane risk of bias tool for randomized, generic assessment for non-randomized studies, and the Phillips checklist for economic studies. Results Ten studies including 1 randomized trial were included. The majority of the direct comparative evidence compared the mitral valve clip repair with surgery in patients not particularly at prohibitive surgical risk. Irrespective of degenerative or functional chronic mitral regurgitation etiology, evidence of effectiveness and harms is inconclusive and of very low quality. Very-low-quality evidence indicates that percutaneous mitral valve clip repair may provide a survival advantage, at least during the first 1 to 2 years, particularly in medically managed chronic functional mitral regurgitation. Because of limitations in the design of studies, the cost-effectiveness of mitral valve clips in patients at prohibitive risk for surgery also could not be established. Limitations Because of serious concerns of risk of bias, indirectness, and imprecision, evidence is of very low quality. Conclusions No meaningful conclusions can be drawn about the comparative effectiveness, harms, and cost-effectiveness of mitral valve clips in the population with chronic mitral regurgitation who are at prohibitive risk for surgery. PMID:26379810

  9. Recommended transoesophageal echocardiographic evaluation of mitral valve regurgitation

    PubMed Central

    Hokken, R.B.; ten Cate, F.J.; van Herwerden, L.A.

    2006-01-01

    Valve replacement in patients with mitral valve regurgitation is indicated when symptoms occur or left ventricular function becomes impaired. Using different surgical techniques, mitral valve reconstruction has lead to earlier interventions with good clinical results. In order to determine the possibility of a mitral valve reconstruction, echocardiographic parameters are necessary. With transoesophageal echocardiography a segmental analysis of the entire mitral valve can be performed; mitral valve motion abnormalities and severity and direction of the regurgitation jet can be judged. From this analysis clues for underlying pathology can be derived as well as the eligibility of a successful mitral valve reconstruction. This article focuses on transoesophageal examination with segmental analysis in patients with mitral valve regurgitation. PMID:25696623

  10. Mitral regurgitation after anthracycline treatment for childhood malignancy

    PubMed Central

    Allen, J; Thomson, J; Lewis, I; Gibbs, J

    2001-01-01

    OBJECTIVE—To investigate the new onset of mitral regurgitation in patients with otherwise normal echocardiograms after anthracycline treatment and to assess its relation to other selected indicators of myocardial damage.?DESIGN—Prospective echocardiographic and electrocardiographic study.?SETTING—Tertiary paediatric cardiac referral centre.?PATIENTS—305 patients, aged 2-33 years (median 14 years), treated with cumulative anthracycline doses of between 150-450 mg/m2 (median 180 mg/m2) for childhood malignancy.?MAIN OUTCOME MEASURES—Colour flow Doppler detection of mitral regurgitation and its relation to changes in echocardiographic indices of left ventricular function (systolic and diastolic dimensions, fractional shortening) and to changes in the 12 lead ECG; and the prevalence of mitral regurgitation in the anthracycline treated patients in comparison with previously studied normal volunteers of similar age.?RESULTS—34 patients (11.6%) developed ultrasound detectable mitral regurgitation, which was not apparent clinically, during or after anthracycline treatment, compared with only 1.8% of a normal population of similar age (p < 0.0001). Nine of the 34 also developed non-specific T wave abnormalities. All 34 patients had normal systolic function at the time of initial detection of mitral regurgitation, but four later developed impaired left ventricular function (5, 11, 20, and 27 months after the first detection of mitral regurgitation).?CONCLUSIONS—Mitral regurgitation occurs much more often in patients treated with anthracyclines than in the normal population. Echocardiographic detection of new mitral regurgitation with or without ECG abnormalities may be an early predictor of anthracycline cardiomyopathy.???Keywords: anthracyclines; mitral regurgitation; cardiomyopathy PMID:11250971

  11. The effect of mitral annuloplasty shape in ischemic mitral regurgitation: a finite element simulation

    PubMed Central

    Wong, Vincent M.; Wenk, Jonathan F.; Zhang, Zhihong; Cheng, Guangming; Acevedo-Bolton, Gabriel; Burger, Mike; Saloner, David A.; Wallace, Arthur W.; Guccione, Julius M.; Ratcliffe, Mark B.; Ge, Liang

    2012-01-01

    Background Undersized mitral annuloplasty (MA) is the preferred surgical treatment for chronic ischemic mitral regurgitation (CIMR). However, the preferred shape of undersized MA is unclear. Methods A previously described finite element (FE) model of the LV with mitral valve based on magnetic resonance images of a sheep with CIMR after postero-lateral MI was used. Saddle shape (Edwards Physio II) and asymmetric (IMR ETlogix) MA rings were digitized and meshed. Virtual annuloplasty was performed using virtual sutures to attach the MA ring. LV diastole and systole were performed before and after virtual MA of each type. Results Both types of MA reduced the septo-lateral dimension of the mitral annulus and abolished mitral regurgitation. The asymmetric MA was associated with lower virtual suture force in the P2 region but higher force in P1 and P3 regions. Although both types of MA reduced fiber stress at the LV base, fiber stress reduction after asymmetric MA was slightly greater. Neither type of MA affected fiber stress at the LV equator or apex. Although both types of MA increased leaflet curvature and reduced leaflet stress, stress reduction with saddle shape MA was slightly greater. Both MA types reduced stress on the mitral chordae. Conclusions The effects of saddle shaped and asymmetric MA rings are similar. FE simulations are a powerful tool that may reduce the need for animal and clinical trials. PMID:22245588

  12. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

    PubMed Central

    2015-01-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process. PMID:26539345

  13. Asymptomatic chronic severe organic mitral regurgitation: contemporary management strategies.

    PubMed

    Chaliki, Hari P; Tajik, A Jamil

    2011-01-01

    Abstract: Chronic organic mitral regurgitation resulting from mitral valve prolapse is increasing in prevalence due to aging of the population. Although "watchful waiting" has been the conventional standard for many years in patients with minimal or no symptoms and chronic severe organic mitral regurgitation, several factors including changing etiology, better understanding of the natural history, improved diagnosis and advances in surgical techniques are now paving the way for earlier mitral valve surgery. The ability to successfully repair the myxomatous mitral valve with low operative risk (< 1%) and advances in imaging in the recent years have led to a major change in the treatment paradigm for organic mitral regurgitation. It is clear from the preponderance of evidence that mitral valve repair in asymptomatic patients with preserved ejection fraction and severe organic mitral regurgitation leads to "cure" or "suppression" of the disease, underscoring the need for early surgery. Whether further advances in imaging, robotic surgery, and percutaneous mitral valve repair lead to even better outcomes remains to be seen. PMID:22734359

  14. 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

  15. Trans-catheter mitral valve implantation for mitral regurgitation: clinical case description and literature review.

    PubMed

    Romeo, Francesco; Cammalleri, Valeria; Ruvolo, Giovanni; Quadri, Arshad; De Vico, Pasquale; Muscoli, Saverio; Marchei, Massimo; Meloni, Sabrina; Conti, Fabio; Ussia, Gian Paolo

    2016-02-01

    Trans-catheter mitral valve implantation (TMVI) is actually the most attractive technique for treating patients with severe mitral regurgitation, who are denied surgical therapy. Recently, trans-catheter implantation of aortic biological prosthesis in mitral position has been done in compassionate cases, and very few experiences of TMVI in native non-calcified valves have been recently reported in very-high-risk patients, mainly with functional mitral regurgitation.Here, we report our case of TMVI using the second-generation CardiAQ prostheisis (CardiAQ Valve Technologies, Irvine, California, USA), reviewing the current state of the art. PMID:26556446

  16. Unusual cause of acute mitral regurgitation: idiopathic hypereosinophilic syndrome.

    PubMed

    Madhwal, Surabhi; Goldberg, Jonathan; Barcena, Julio; Guha, Avirup; Gogate, Prema; Cmolik, Brian; Elgudin, Yakov

    2012-03-01

    Idiopathic hypereosinophilic syndrome (HES) is a rare multisystem condition characterized by dysregulated overproduction of eosinophils. Cardiac involvement in HES is characterized by necrosis from infiltration of eosinophils and thrombus formation and, in the late stage, by fibrosis and chronic valvular regurgitation. We report a very unusual presentation of idiopathic HES with acute mitral regurgitation due to papillary muscle rupture. The transesophageal echocardiogram was suggestive of a flail posterior leaflet and suspicious for endocarditis. Intraoperatively, papillary muscle rupture was seen and the patient underwent mitral valve replacement. The pathologic examination of the valve revealed eosinophilic infiltration of the papillary muscle. The patient was treated with steroids and responded well clinically. PMID:22364989

  17. Severe mitral regurgitation and heart failure due to caseous calcification of the mitral annulus.

    PubMed

    Pozsonyi, Zoltán; Tóth, Attila; Vágó, Hajnalka; Adám, Zsófia; Apor, Astrid; Alotti, Nasri; Sármán, Pál; Merkely, Béla; Karádi, István

    2011-01-01

    Caseous calcification is a rare form of mitral annular calcification. Echocardiography reveals an echodense mass in the inferior mitral annulus with smooth borders and an echolucent inner core. We present a case where caseous calcification of the mitral annulus caused severe mitral regurgitation, atrial fibrillation and heart failure. Transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance and computed tomography were performed and ensured the diagnosis. The mass was surgically removed and a prosthetic valve was implanted. We conclude that caseous calcification of the mitral annulus should be considered not only in the differential diagnosis of cardiac masses but also in the background of mitral regurgitation, atrial fibrillation and heart failure. This case also represents the usefulness of multimodal imaging in identifying cardiac masses. PMID:21508639

  18. Intermittent premature mitral valve closure in combined acute severe aortic and mitral regurgitation.

    PubMed

    Dianzumba, S B; Montello, N J; Joyner, C R

    1984-11-01

    We have described the clinical, hemodynamic, and echocardiographic features of torn aortic cusps with mitral valve fenestration in a patient with infective endocarditis. Hemodynamic studies showed left atrial pressure intermittently exceeding left ventricular end-diastolic pressure. This phenomenon corresponded with intermittent premature mitral valve closure, which may serve as a marker for M-mode echocardiographic diagnosis in combined severe acute aortic and mitral regurgitation. PMID:6494970

  19. The First Finite Element Model of the Left Ventricle with Mitral Valve: Insights into Ischemic Mitral Regurgitation

    PubMed Central

    Wenk, Jonathan F.; Zhang, Zhihong; Cheng, Guangming; Malhotra, Deepak; Acevedo-Bolton, Gabriel; Burger, Mike; Suzuki, Takamaro; Saloner, David A.; Wallace, Arthur W.; Guccione, Julius M.; Ratcliffe, Mark B.

    2010-01-01

    Background Left ventricular remodeling after postero-basal myocardial infarction can lead to ischemic mitral regurgitation. This occurs as a consequence of leaflet tethering due to posterior papillary muscle displacement. Methods A finite element model of the left ventricle, mitral apparatus, and chordae tendineae was created from magnetic resonance images from a sheep that developed moderate mitral regurgitation after postero-basal myocardial infarction. Each region of the model was characterized by a specific constitutive law that captured the material response when subjected to physiological pressure loading. Results The model simulation produced a gap between the posterior and anterior leaflets, just above the infarcted posterior papillary muscle, which is indicative of mitral regurgitation. When the stiffness of the infarct region was reduced, this caused the wall to distend and the gap area between the leaflets to increase by 33%. Additionally, the stress in the leaflets increased around the chordal connection points near the gap. Conclusions The methodology outlined in this work will allow a finite element model of both the left ventricle and mitral valve to be generated using non-invasive techniques. PMID:20417775

  20. Design, Rationale, and Initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial: A Report from the Cardiothoracic Surgical Trials Network

    PubMed Central

    Smith, Peter K.; Michler, Robert E.; Woo, Y. Joseph; Alexander, John H.; Puskas, John D.; D’Alessandro, David A.; Hahn, Rebecca T.; Williams, Judson B.; Dent, John M.; Ferguson, T. Bruce; Moquete, Ellen; Pagé, Pierre; Jeffries, Neal O.; O’Gara, Patrick T.; Ascheim, Deborah D.

    2011-01-01

    Background Patients with moderate ischemic mitral regurgitation have demonstrably poorer outcome compared to coronary artery disease patients without mitral regurgitation. The optimal treatment of this condition has become increasingly controversial and a randomized trial evaluating current practices is warranted. Methods and Results We describe the design and initial execution of the Cardiothoracic Surgical Trials Network moderate ischemic mitral regurgitation trial. This is an ongoing prospective, multi-center, randomized, controlled clinical trial designed to test the safety and efficacy of mitral repair in addition to coronary artery bypass grafting in the treatment of moderate ischemic mitral regurgitation. Conclusion The results of the Cardiothoracic Surgical Trials Network ischemic mitral regurgitation trials will provide long-awaited information on controversial therapies for a morbid disease process. PMID:21788032

  1. Therapeutic decision-making for patients with fluctuating mitral regurgitation.

    PubMed

    Lancellotti, Patrizio; Fattouch, Khalil; La Canna, Giovanni

    2015-04-01

    Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve). PMID:25666403

  2. Acute massive mitral regurgitation from prosthetic valve dysfunction.

    PubMed Central

    Cooper, D K; Sturridge, M F

    1976-01-01

    Two cases of prosthetic valve dysfunction resulting in acute massive mitral regurgitation are reported; emergency operation was successful in both cases. Survival following complete dislodgement of the occluder of a disc valve, as occurred in one case, does not appear to have been reported before. The diffculty in diagnosis of sudden cardiac decompensation in patients with prosthetic valves is stressed, as is the need for urgent operation. Images PMID:973894

  3. [Catheter based mitral valve repair for severe mitral regurgitation: patient selection].

    PubMed

    Naegeli, Barbara; Franzen, Olaf

    2015-09-01

    The catheter-based mitral valve repair is a novel technology for the treatment of severe mitral regurgitation (MR). This technique is suitable for elderly patients with pronounced co-morbidities who are deemed to be high risk for conventional heart surgery. A meaningful reduction of mitral regurgitation leads to improvement of symptoms and quality of life. Studies also demonstrate reverse remodeling of the left ventricle. In heart failure patients with severe MR percutaneous repair reduces re-hospitalization rates>50% in comparison to optimal medical treatment. For degenerative MR conventional surgery is the gold standard, whereas for high surgical risk patients and for severe functional MR percutaneous repair is an alternative. PMID:26331203

  4. Transcatheter treatment of chronic mitral regurgitation with the MitraClip system: an Italian consensus statement.

    PubMed

    Maisano, Francesco; Alamanni, Francesco; Alfieri, Ottavio; Bartorelli, Antonio; Bedogni, Francesco; Bovenzi, Francesco M; Bruschi, Giuseppe; Colombo, Antonio; Cremonesi, Alberto; Denti, Paolo; Ettori, Federica; Klugmann, Silvio; La Canna, Giovanni; Martinelli, Luigi; Menicanti, Lorenzo; Metra, Marco; Oliva, Fabrizio; Padeletti, Luigi; Parolari, Alessandro; Santini, Francesco; Senni, Michele; Tamburino, Corrado; Ussia, Gian P; Romeo, Francesco

    2014-03-01

    New percutaneous technologies are rapidly emerging for the treatment of structural heart disease including mitral valve disease. Preliminary data suggest a potential clinical benefit of percutaneous treatment of mitral regurgitation by the MitraClip procedure in selected patients. Until final data are available from randomized, controlled, multicenter clinical trials, there is an urgent need for a consensus among all the operators involved in the treatment of patients with mitral regurgitation, including clinical cardiologists, heart failure specialists, surgeons, interventional cardiologists, and imaging experts. In the absence of evidence-based guidelines, the heart-team approach is the most reliable method of making proper decisions. This study is the result of multidisciplinary consensus activity, and has the aim of helping physicians in the difficult task of making decisions for the treatment of patients with mitral regurgitation. It is the result of a joint effort of the major Italian Cardiology and Cardiac Surgery Societies, working together to find a proper balance between the points of view of the clinical cardiologist, the interventional cardiologist, and the cardiac surgeon. PMID:24662461

  5. Altered mitral inflow orifice in severe aortic regurgitation: real time three-dimensional echocardiographic findings.

    PubMed

    Bertrand, Philippe B; Verhaert, David; Vandervoort, Pieter

    2014-01-01

    We present the case of a young man with severe eccentric aortic regurgitation, obstructing mitral inflow and provoking an audible Austin Flint murmur at clinical examination. Two-dimensional color Doppler echocardiography depicts the remarkable mechanical interaction between aortic regurgitant jet and anterior mitral leaflet opening. Three-dimensional transesophageal echocardiography aids in understanding the geometric and hemodynamic consequences of the regurgitant jet and in the genesis of the Austin Flint murmur. This case accentuates the incremental value of three-dimensional echocardiography when evaluating valvular pathology, and offers more insight in the interaction between aortic regurgitant flow and mitral leaflet dynamics. PMID:23742271

  6. Optimal Surgical Management of Severe Ischemic Mitral Regurgitation: To Repair or to Replace?

    PubMed Central

    Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

    2013-01-01

    Background Ischemic mitral regurgitation (MR), a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results This paper describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic (CT) Surgical Trials Network. This paper addresses challenges in selecting a feasible primary endpoint, characterizing the target population (including the degree of MR), and analytical challenges in this high mortality disease. Conclusions The paper concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life and cardiac physiology in therapeutic decision-making. PMID:22054660

  7. 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 ...

  8. 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

  9. Chordal Rupture Following MitraClip Implantation Resulting in Massive Mitral Regurgitation.

    PubMed

    Benito-González, Tomás; Estévez-Loureiro, Rodrigo; Gualis, Javier

    2015-10-01

    MitraClip (Abbott Vascular) therapy has been reported to be a safe and effective treatment for mitral regurgitation, even when the commissures are targeted. However, complications during the procedure may occur. We present a 44-year-old patient who underwent MitraClip implantation complicated by chordal rupture, resulting in emergent mitral valve replacement. PMID:26429855

  10. Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Yang, X. S.; Qin, J. X.; Greenberg, N. L.; Zhou, J.; Vazquez, C. J.; Griffin, B. P.; Stewart, W. J.; Thomas, J. D.

    1998-01-01

    OBJECTIVES: To develop and validate an automated noninvasive method to quantify mitral regurgitation. BACKGROUND: Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR). METHODS: First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44+/-5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61+/-14 years, 30 male) with MR were studied. RESULTS: In the canine studies, CO by ACM (1.32+/-0.3 liter/min, y) and flow meter (1.35+/-0.3 liter/min, x) showed good correlation (r=0.95, y=0.89x+0.11) and agreement (deltaCO(y-x)=0.03+/-0.08 [mean+/-SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r=0.90, p < 0.0001, deltaCO=-0.09+/-0.42 liter/min), PD (r=0.87, p < 0.0001, deltaCO=0.12+/-0.49 liter/min) and 2D (r=0.84, p < 0.0001, deltaCO=-0.16+/-0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r= 0.88, y=0.88x+6.6, p < 0.0001, deltaMRV=2.68+/-9.7 ml). CONCLUSIONS: We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

  11. Mild Functional Ischemic Mitral Regurgitation Following Acute Coronary Syndrome: A Retrospective Study

    PubMed Central

    Pant, Sadip; Neupane, Pritam; Pant, Om Biju; Paudel, Raju; Kumar, M. P. Kavin; Vijayashankar, C. S.; Shrestha, Rajendra Man

    2011-01-01

    Background: Ischemic mitral regurgitation is a frequent complication of acute coronary syndrome. It primarily occurs in patients with a prior myocardial infarction but also may be seen with acute ischemia, a setting in which the MR typically resolves after the ischemia resolves. The vast majority of patients have “functional” ischemic MR. In these individuals, the papillary muscles, chordae, and valve leaflets are normal. However, the leaflets do not coapt and restricted leaflet motion is frequently noted on echocardiography. Ischemic mitral regurgitation indicates a poor prognosis after acute myocardial infarction. This study addresses the clinical characteristics of patients of acute coronary syndrome with mild functional ischemic mitral regurgitation and its impact on immediate in-hospital cardiovascular outcomes and death. Patients and Methods: From March 2006 through May 2007, patients who underwent 2-dimensional (2D) color doppler echocardiographic quantification of ischemic mitral regurgitation within 10 days of admission for acute coronary syndrome (ACS) in Manipal Teaching Hospital, a tertiary hospital in the western region of Nepal were noted. The demographic details, conventional risk factors of coronary artery disease, clinical and laboratory findings, treatment course and in-hospital outcomes of all the patients with mild functional ischemic MR following ACS in that time duration were recorded in a designated Performa. A total of 94 patients enrolled in the study were divided into two groups: Group I with mild functional ischemic MR and Group II without MR on 2D echocardigraphic assessment. Patient characteristics, risk factors, ejection fraction, and cardiovascular outcome and death among the two groups were compared and analyzed using software package SPSS 17.0 version. Results: Group I constituted 64.89% of the study population and Group II comprised of 35.11%. The patients in Group I was more likely to be elderly diabetic (P<0.05), and smokers with hypertension (P < 0.05). Mild functional ischemic MR was more common in patients with STEMI as compared to those with unstable angina and NSTEMI (55.7%, 36.1%, and 8.2%; P < 0.05).The mean ejection fraction in the first group was 54.84% in contrast to 58.92% observed in group II (P < 0.05).The type of wall involvement inferred from EKG analysis was homogeneously distributed in both the groups. Finally, there was no difference in immediate in-hospital (within 10 days) mortality or cardiovascular outcomes (heart failure, ventricular tachycardia/fibrillation, hypotension, and cardiogenic shock) between these two groups. Conclusion: Ischemic mitral regurgitation following acute coronary syndromeare more likely in elderly diabetics and hypertensive smokers. It is a more common finding in STEMI. Although mild MR following ACS does reduce ejection fraction, the immediate (within 10 days) in-hospital mortality and cardiovascular outcomes are not significantly altered. PMID:22567194

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

    SciTech Connect

    Iwazawa, Jin; Nakamura, Kenji; Hamuro, Masao; Nango, Mineyoshi; Sakai, Yukimasa; Nishida, Norifumi

    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.

  13. Comparison of N-Terminal Pro B-Natriuretic Peptide and Echocardiographic Indices in Patients with Mitral Regurgitation

    PubMed Central

    Hajsadeghi, Shokoufeh; Samiei, Niloufar; Moradi, Masoud; Majid, Maleki; Kashani, Ladan; Amani, Afsaneh; Salami, Arezoo; Asefi, Melika; Farsi, Negin

    2010-01-01

    Introduction: Echocardiographic indices can form the basis of the diagnosis of systolic and diastolic left ventricular (LV) dysfunction in patients with Mitral regurgitation (MR). However, using echocardiography alone may bring us to a diagnostic dead-end. The aim of this study was to compare N-Terminal pro B-natriuretic peptide (BNP) and echocardiographic indices in patients with mitral regurgitation. Methods: 2D and Doppler echocardiography and BNP serum level were obtained from 54 patients with organic mild, moderate and severe MR. Results: BNP levels were increased with symptoms in patients with mitral regurgitation (NYHAI: 5.7 ± 1.1, NYHAII: 6.9 ± 1.5, NYHAIII: 8.3 ± 2 pg/ml, P < 0.001). BNP plasma level were significantly correlated with MPI (myocardial performance index) (r = 0.399, P = 0.004), and following echocardiographic indices: LVEDV (r = 0.45, P < 0.001), LVESV (r = 0.54, P < 0.001), LVEDD (r = 0.48, P < 0.001), LVESD (r = 0.54, P < 0.001), dp/dt (r = ?0.32, P = 0.019) and SPAP (r = 0.4, P = 0.006). Conclusion: The present study showed that BNP may be useful in patients with MR and may confirm echocardiographic indices. PMID:21151851

  14. Left Ventricular Early Inflow–Outflow Index: A Novel Echocardiographic Indicator of Mitral Regurgitation Severity

    PubMed Central

    Lee, Ming-Ming; Salahuddin, Ayesha; Garcia, Mario J; Spevack, Daniel M

    2015-01-01

    Background No gold standard currently exists for quantification of mitral regurgitation (MR) severity. Classification by echocardiography is based on integrative criteria using color and spectral Doppler and anatomic measurements. We hypothesized that a simple Doppler left ventricular early inflow–outflow index (LVEIO), based on flow velocity into the left ventricle (LV) in diastole and ejected from the LV in systole, would add incrementally to current diagnostic criteria. LVEIO was calculated by dividing the mitral E-wave velocity by the LV outflow velocity time integral. Methods and Results Transthoracic echocardiography reports from Montefiore Medical Center and its referring clinics from July 1, 2011, to December 31, 2011 (n=11 235) were reviewed. The MR severity reported by a cardiologist certified by the National Board of Echocardiography was used as a reference standard. Studies reporting moderate or severe MR (n=550) were reanalyzed to measure effective regurgitant orifice area by the proximal isovelocity surface area method, vena contracta width, MR jet area, and left-sided chamber volumes. LVEIO was 9.3±3.9, 7.0±3.2, and 4.2±1.7 among those with severe, moderate, and insignificant MR, respectively (ANOVA P<0.001). By receiver operating characteristic analysis, area under the curve for LVEIO was 0.92 for severe MR. Those with LVEIO ?8 were likely to have severe MR (likelihood ratio 26.5), whereas those with LVEIO ?4 were unlikely to have severe MR (likelihood ratio 0.11). LVEIO performed better in those with normal LV ejection fraction (?50%) compared with those with reduced LV ejection fraction (<50%) (area under the curve 0.92 versus 0.80, P<0.001). By multivariate logistic regression analysis, LVEIO was independently associated with severe MR when compared with vena contracta width, MR jet area, and effective regurgitant orifice area measured by the proximal isovelocity surface area method. Conclusion LVEIO is a simple-to-use echocardiographic parameter that accurately identifies severe MR, particularly in patients with normal LV ejection fraction. PMID:26071032

  15. 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.

  16. 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

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

    PubMed

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

    2014-01-01

    A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10-20% at one week, 30-40% at two weeks and 90-100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients. PMID:25479001

  18. A Pig Model of Ischemic Mitral Regurgitation Induced by Mitral Chordae Tendinae Rupture and Implantation of an Ameroid Constrictor

    PubMed Central

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

    2014-01-01

    A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10–20% at one week, 30–40% at two weeks and 90–100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients. PMID:25479001

  19. Transapical off-pump Neochord implantation on bileaflet prolapse to treat severe mitral regurgitation.

    PubMed

    Colli, Andrea; Bellu, Roberto; Pittarello, Demetrio; Gerosa, Gino

    2015-10-01

    A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance. Four Neochordae were implanted on the posterior leaflet and two on the anterior leaflet in order to correct a residual anterior prolapse that was not seen at preoperative screening. After 11 months of follow-up, the patient presented with recurrence of symptomatic moderate MR due to rupture of one of two neochordae implanted on the anterior leaflet and new onset of atrial fibrillation. The patient underwent uneventful mitral valve replacement. PMID:26180097

  20. Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure

    NASA Technical Reports Server (NTRS)

    Temporelli, P. L.; Scapellato, F.; Corra, U.; Eleuteri, E.; Firstenberg, M. S.; Thomas, J. D.; Giannuzzi, P.

    2001-01-01

    Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.

  1. 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

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

    PubMed Central

    Facciorusso, Antonio; Vigna, Carlo

    2015-01-01

    Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury. This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms). PMID:26664317

  3. Impact of Duration of Mitral Regurgitation on Outcomes in Asymptomatic Patients With Myxomatous Mitral Valve Undergoing Exercise Stress Echocardiography

    PubMed Central

    Naji, Peyman; Asfahan, Fadi; Barr, Tyler; Rodriguez, L. Leonardo; Grimm, Richard A.; Agarwal, Shikhar; Thomas, James D.; Gillinov, A. Marc; Mihaljevic, Tomislav; Griffin, Brian P.; Desai, Milind Y.

    2015-01-01

    Background Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid?late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). Methods and Results We included 609 consecutive patients with ?III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid?late systole on continuous?wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (60±14 versus 53±14 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (33±11 versus 27±9 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.5±3 versus 10.5±3), compared to the MLS MR group (all P<0.05). There were 54 events during 7.1±3 years of follow?up. On step?wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age? and gender?predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05). Conclusion In patients with ?III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors. PMID:25672368

  4. 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

  5. An Intriguing Case Report of Functional Mitral Regurgitation Treated With MitraClip

    PubMed Central

    Duino, Vincenzo; Fiocca, Luigi; Musumeci, Giuseppe; D’Elia, Emilia; Gori, Mauro; Cerchierini, Elisa; Valsecchi, Orazio; Senni, Michele

    2015-01-01

    Abstract Functional mitral regurgitation (FMR) is frequent in patients with heart failure (HF). It develops as a consequence of left ventricle (LV) geometry alterations, causing imbalance between increased tethering forces and decreased closing forces exerted on the mitral valve apparatus during systole. FMR is known to change at rest and during effort, due to preload–afterload changes, myocardial ischemia, and/or LV dysfunction. Despite optimized medical therapy, an FMR can be responsible of shortness of breath limiting quality of life and decompensation. In this report, we present a case of dynamic FMR treated with MitraClip. MitraClip implantation is a successful and innovative opportunity for HF patients with FMR. PMID:25997036

  6. [Incidentally detected bronchial artery aneurysm with combined operation for mitral regurgitation;report of a case].

    PubMed

    Sato, Hisashi; Oteki, Hitoshi; Naito, Kozo; Yunoki, Junji

    2015-02-01

    A 77-year-old woman was admitted to the hospital for heart failure with orthopnea. Echocardiography revealed massive mitral regurgitation. During preoperative cardiac catheterization, an aneurysm was indentified incidentally just below the tracheal carina. Three dimensional computed tomography showed three bronchial artery aneurysms behind the pulmonary artery and the left atrium. The proximal aneurysm was the largest and was 22 mm in diameter. It was resected by retracting the ascending aorta to the left, the superior vana cava to the right and right pulmonary artery cranially under cardiopulmonary bypass, and mitral valve plasty was performed. We believed that resection of the proximal aneurysm would cause thrombotic occlusion of the other 2 aneurysms. Bronchial artery aneurysm is a rare entity that is observed in fewer than 1% of those who undergo selective bronchial arteriography. In addition, because bronchial artery aneurysm is a potentially life-threatening lesion, it should be treated promptly when diagnosed. PMID:25743361

  7. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging

    PubMed Central

    Strugnell, Wendy; Gaikwad, Niranjan; Ischenko, Matthew; Speranza, Vicki; Chan, Jonathan; Neill, Johanne; Platts, David; Scalia, Gregory M.; Burstow, Darryl J.; Walters, Darren L.

    2015-01-01

    Objective Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. Methods Twenty-five patients underwent successful MitraClip insertion. Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. Results Mean age was 79 years, and mean LVEF was 44%±11% by CMR and 54%±16% by echocardiography. Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (?0.7, 0.74). Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84; BA mean difference ?3.7%, ?38% to 31%). CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98; BA mean difference ?2.4%, ?11.9 to 7.0), with a lower mean difference and narrower limits of agreement compared to echocardiography. Categorical severity grading by CMR using published ranges had good inter-observer agreement (CCC 0.86, 0.62-0.95). Conclusions CMR performs very well in the quantitation of MR after MitraClip insertion, with excellent reproducibility compared to echocardiographic methods. CMR is a useful technique for the comprehensive evaluation of residual regurgitation in patients after MitraClip. Technical limitations exist for both techniques, and quantitation remains a challenge in some patients. PMID:26309843

  8. Insights into the Mechanism of Severe Mitral Regurgitation: RT-3D TEE Guided Management with Pathological Correlation

    PubMed Central

    Anand, Senthil; Hamoud, Naktal; Thompson, Jess; Janardhanan, Rajesh

    2015-01-01

    Mitral valve perforation is an uncommon but important complication of infective endocarditis. We report a case of a 65-year-old man who was diagnosed to have infective endocarditis of his mitral valve. Through the course of his admission he had a rapid development of hemodynamic instability and pulmonary edema secondary to acutely worsening mitral regurgitation. While the TEE demonstrated an increase in the size of his bacterial vegetation, Real Time 3D TEE was ultimately the imaging modality through which the valve perforation was identified. Through this case report we discuss the advantages that RT-3D TEE has over traditional 2D TEE in the management of valve perforation.

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

    PubMed

    Tolis, George; Sundt, Thoralf M

    2015-12-01

    In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient. PMID:26486511

  10. Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis

    PubMed Central

    Goldstone, Andrew B.; Patrick, William L.; Cohen, Jeffrey E.; Aribeana, Chiaka N.; Popat, Rita

    2015-01-01

    Background Discordance between studies drives continued debate regarding the best management of asymptomatic severe mitral regurgitation (MR). The aim of the present study was to conduct a systematic review and meta-analysis of management plans for asymptomatic severe MR, and compare the effectiveness of a strategy of early surgery to watchful waiting. Methods A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were excluded if they: (I) lacked a watchful waiting cohort; (II) included symptomatic patients; or (III) included etiologies other than degenerative mitral valve disease. The primary outcome of the study was all-cause mortality at 10 years. Secondary outcomes included operative mortality, repair rate, repeat mitral valve surgery, and development of new atrial fibrillation. Results Five observational studies were eligible for review and three were included in the pooled analysis. In asymptomatic patients without class I triggers (symptoms or ventricular dysfunction), pooled analysis revealed a significant reduction in long-term mortality with an early surgery approach [hazard ratio (HR) =0.38; 95% confidence interval (CI): 0.21-0.71]. This survival benefit persisted in a sub-group analysis limited to patients without class II triggers (atrial fibrillation or pulmonary hypertension) [relative risk (RR) =0.85; 95% CI: 0.75-0.98]. Aggregate rates of operative mortality did not differ between treatment arms (0.7% vs. 0.7% for early surgery vs. watchful waiting). However, significantly higher repair rates were achieved in the early surgery cohorts (RR =1.10; 95% CI: 1.02-1.18). Conclusions Despite disagreement between individual studies, the present meta-analysis demonstrates that a strategy of early surgery may improve survival and increase the likelihood of mitral valve repair compared with watchful waiting. Early surgery may also benefit patients when instituted prior to the development of class II triggers. PMID:26309823

  11. Efficacy of Artificial Chordal Reconstruction for Idiopathic Severe Mitral Regurgitation Due To Chordal Rupture in Infancy.

    PubMed

    Sai, Sadahiro; Konishi, Akinobu; Sato, Mitsuru; Matsuo, Satoshi; Nitta, Megumi

    2015-01-01

    Early surgical intervention is required for sudden onset, severe mitral regurgitation (MR) due to chordal rupture in infants with normal development younger than 1 year. The condition has been recognized as idiopathic. However, the surgical options in children are limited because of their size and somatic growth. We sought to examine the efficacy of mitral valve plasty by artificial chordal reconstruction for these infants in mid-to-long term. From August 2005 through June 2012, 8 consecutive patients aged 1-7 months underwent mitral valve plasty by chordal reconstruction using expanded polytetrafluoroethylene sutures for MR, owing to leaflet prolapse. The geometric parameters of the diameter of the mitral annulus (D1), the long axis of the left ventricular (LV) chamber (D2), and the length of the papillary muscle including the reconstructed chordae (D3) were measured, as well as MR grade (0-4) and LV end-diastolic dimension, at each time point. The parameters were compared with those in the control group that included Kawasaki disease patients without cardiac lesions and healthy children (n = 51). Mean follow-up period was 5.8 (2.8-9.6) years. Freedom from reoperation was 100%. MR grades were 3.9 ± 0.4 preoperatively, 2.4 ± 0.9 at discharge, and 1.4 ± 0.6 at the latest. Postoperative MR was improved within 1 year in 5 of 6 patients who had grade 2 or higher regurgitation. LV end-diastolic dimensions were 109% (% of normal), 113%, and 107% at discharge, 3, and 5 years, respectively. Geometric configuration indicated by the D1/D2 ratio did not significantly change with time. The length of the papillary muscle including reconstructed chordae (D3) strongly correlated with body surface area (r(2) = 0.65), which seemed to be equivalent to that in the control group. In conclusion, postoperative mitral valve function and geometry was preserved. This procedure with a low morbidity should be an option for pediatric patients with acute severe MR. PMID:26708377

  12. 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

  13. Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

    PubMed Central

    Russo, Antonio; Pasquale, Ferdinando; Biagini, Elena; Barberini, Francesco; Ferlito, Marinella; Leone, Ornella; Rapezzi, Claudio

    2015-01-01

    Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR. PMID:26448820

  14. Aortic regurgitation and mitral valve prolapse with Down's syndrome: a case-control study.

    PubMed

    Goldhaber, S Z; Brown, W D; Robertson, N; Rubin, I L; Sutton, M G

    1988-08-01

    This case-control study was designed to determine whether aortic regurgitation (AR) and mitral valve prolapse (MVP) are specifically associated with Down's syndrome, or occur in a comparably retarded population without Down's syndrome. The 92 control subjects resided at the same institution as the 131 cases, and had mental retardation attributable to low birth weight or perinatal asphyxia. Mean (+/- SD) ages of the cases and the control group were 41 +/- 11 years compared with 40 +/- 13 years, respectively. The relative risk of AR among the cases (those with Down's syndrome) was 2.9 (95% confidence interval, 0.65-13.2; P = 0.16) and that of MVP was 3.5 (95% confidence interval, 1.2-10.2; P = 0.02). The results showed that these two valvular abnormalities are specifically associated with Down's syndrome in adults. PMID:2975337

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

    PubMed

    Cremer, S E; Zois, N E; Moesgaard, S G; Ravn, N; Cirera, S; Honge, J L; Smerup, M H; Hasenkam, J M; Sloth, E; Leifsson, P S; Falk, T; Oyama, M A; Orton, C; Martinussen, T; Olsen, L H

    2015-02-01

    Serotonin (5-hydroxytryptamine, 5-HT) signalling is implicated in the pathogenesis of myxomatous mitral valve disease (MMVD) through 5-HT1B receptor (R), 5-HT2AR and 5-HT2BR-induced myxomatous pathology. Based on increased tryptophan hydroxylase-1 (TPH-1) and decreased serotonin re-uptake transporter (SERT) in MMVD-affected valves, increased valvular 5-HT synthesis and decreased clearance have been suggested. It remains unknown how haemodynamic changes associated with mitral regurgitation (MR) affect 5-HT markers in the mitral valve, myocardium and circulation. Twenty-eight pigs underwent surgically induced MR or sham-operation, resulting in three MR groups: control (CON, n?=?12), mild MR (mMR, n?=?10) and severe MR (sMR, n?=?6). The gene expression levels of 5-HT1BR, 5-HT2AR, 5-HT2BR, SERT and TPH-1 were analysed using quantitative PCR (qPCR) in the mitral valve (MV), anterior papillary muscle (AP) and left ventricle (LV). MV 5-HT2BR was also analysed with immunohistochemistry (IHC) in relation to histological lesions and valvular myofibroblasts. All 5-HTR mRNAs were up-regulated in MV compared to AP and LV (P?<0.01). In contrast, SERT and TPH-1 were up-regulated in AP and LV compared to MV (P?<0.05). In MV, mRNA levels were increased for 5-HT2BR (P?=?0.02) and decreased for SERT (P?=?0.03) in sMR vs. CON. There were no group differences in 5-HT2BR staining (IHC) but co-localisation was found with ?-SMA-positive cells in 91% of all valves and with 33% of histological lesions. In LV, 5-HT1BR mRNA levels were increased in sMR vs. CON (P?=?0.01). In conclusion, these data suggest that MR may affect mRNA expression of valvular 5-HT2BR and SERT, and left ventricular 5-HT1BR in some pigs. PMID:25599900

  16. Assessment of Mitral Valve Adaptation with Gated Cardiac Computed Tomography: Validation with Three-Dimensional Echocardiography and Mechanistic Insight to Functional Mitral Regurgitation

    PubMed Central

    Beaudoin, Jonathan; Thai, Wai-Ee; Wai, Bryan; Handschumacher, Mark D.; Levine, Robert A.; Truong, Quynh A.

    2013-01-01

    Background Mitral valve (MV) enlargement is a compensatory mechanism capable of preventing functional mitral regurgitation (FMR) in dilated ventricles. Total leaflet area and its relation with closure area measured by 3D-echocardiography have been related to FMR. Whether these parameters can be assessed with other imaging modalities is not known. Our objectives are to compare cardiac CT-based measurements of MV leaflets with 3D-echocardiography and determine the relationship of these metrics to the presence of FMR. Methods and Results We used two cohorts of patients who had cardiac CT to measure MV total leaflet, closure and annulus areas. In cohort 1 (26 patients), we validated these CT metrics to 3D-echocardiography. In cohort 2 (66 patients), we assessed the relation of MV size with the presence of FMR in three populations: heart failure with FMR, heart failure without FMR, and normal controls. Cardiac CT and 3D-echocardiography produced similar results for total leaflet (R2=0.97), closure (R2=0.89) and annulus areas (R2=0.84). MV size was largest in heart failure without FMR compared with controls and FMR patients (9.1±1.7 vs 7.5±1.0 vs 8.1±0.9 cm2/m2, p<0.01). FMR patients had reduced ratios of total leaflet:closure areas and total leaflet:annulus areas when compared to patients without FMR (p<0.01). Conclusions MV size measured by CT is comparable to 3D-echocardiography. MV enlargement in cardiomyopathy suggests leaflet adaptation. Patients with FMR have inadequate adaptation as reflected by decreased ratios of leaflet area and areas determined by ventricle size (annulus and closure areas). These measurements provide additional insight into the mechanism of FMR. PMID:23873402

  17. Short-Term and Long-Term Survival After Revascularization with or without Mitral Valve Surgery of Patients with Ischemic Mitral Valve Regurgitation: A Meta-Analysis.

    PubMed

    Zhang, Hua; Liu, Yili; Qiu, Shaodong; Liang, Weixiang; Jiang, Lan

    2015-01-01

    BACKGROUND There is no consensus on whether mitral valve repair or replacement (MVRR) must be performed to treat ischemic mitral regurgitation (MVR) after myocardial infarction. Our objective in this study was to investigate the efficacy of coronary artery bypass grafting (CABG) combined with or without MVRR for the ischemic MVR. MATERIAL AND METHODS An article search was performed in OvidSP, PubMed, Cochrane Library, and Embase. In these articles, researchers compared the efficacy of CABG with or without MVRR in treating patients with ischemic MVR after acute coronary syndrome (ACS). We performed a meta-analysis to compare the differences in the short-term and long-term survival rates of patients treated with CABG only and those treated with both CABG and MVRR. Secondary outcomes were compared with the preoperative and postoperative degree of MVR, left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. RESULTS Out of the 1183 studies, we selected only 5 articles. A total of 3120 patients were enrolled; the CABG and MVRR group included 575 patients, while the CABG only group included 2545 patients. Long-term survival was higher in the CABG only group (hazard ratio [HR], 1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95; P=0.18). No differences were found in the degree of residual MVR, the mean of LVESV, LVEF, or NYHA class. CONCLUSIONS In patients with ischemic MVR, the short-term survival rate was similar in both groups. Moreover, there was no significant improvement in the long-term survival rates of patients treated with both CAG and MVRR. PMID:26635041

  18. Short-Term and Long-Term Survival After Revascularization with or without Mitral Valve Surgery of Patients with Ischemic Mitral Valve Regurgitation: A Meta-Analysis

    PubMed Central

    Zhang, Hua; Liu, Yili; Qiu, Shaodong; Liang, Weixiang; Jiang, Lan

    2015-01-01

    Background There is no consensus on whether mitral valve repair or replacement (MVRR) must be performed to treat ischemic mitral regurgitation (MVR) after myocardial infarction. Our objective in this study was to investigate the efficacy of coronary artery bypass grafting (CABG) combined with or without MVRR for the ischemic MVR. Material/Methods An article search was performed in OvidSP, PubMed, Cochrane Library, and Embase. In these articles, researchers compared the efficacy of CABG with or without MVRR in treating patients with ischemic MVR after acute coronary syndrome (ACS). We performed a meta-analysis to compare the differences in the short-term and long-term survival rates of patients treated with CABG only and those treated with both CABG and MVRR. Secondary outcomes were compared with the preoperative and postoperative degree of MVR, left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. Results Out of the 1183 studies, we selected only 5 articles. A total of 3120 patients were enrolled; the CABG and MVRR group included 575 patients, while the CABG only group included 2545 patients. Long-term survival was higher in the CABG only group (hazard ratio [HR], 1.34; 95% confidence interval [CI] 1.15–1.58, P=0.003). Hospital mortality was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65–9.95; P=0.18). No differences were found in the degree of residual MVR, the mean of LVESV, LVEF, or NYHA class. Conclusions In patients with ischemic MVR, the short-term survival rate was similar in both groups. Moreover, there was no significant improvement in the long-term survival rates of patients treated with both CAG and MVRR. PMID:26635041

  19. Acute hemodynamic effects of MDL19205 on conscious dogs with mitral regurgitation.

    PubMed

    Susawa, T; Kihara, Y; Miyazaki, S; Nakamura, Y; Sasayama, S; Kawai, C

    1988-09-01

    To assess the effects of MDL19205, a combined inotropic-vasodilating agent, or an inodilator, on the left ventricle with subacute volume overload due to mitral regurgitation (MR), seven dogs were instrumented with a left ventricular (LV) micromanometer and a pair of ultrasonic crystals for the measurement of LV circumferential segment length. After examining the effects of this drug in the normal hearts, its effects were observed in the same dogs in which MR was produced by sectioning chordae tendineae. Mitral regurgitation caused increases in LV peak dP/dt (2,384 +/- 256 to 3,090 +/- 622 mmHg/sec; p less than 0.05), mean circumferential shortening velocity (Vcf; 1.41 +/- 0.25 to 1.85 +/- 0.20 sec-1; p less than 0.05), LV end-diastolic pressure (LVEDP; 8.2 +/- 1.6 to 15.8 +/- 3.7 mmHg; p less than 0.001), and LV end-diastolic length (LVEDL; 10 to 10.6 +/- 0.2mm; p less than 0.01). The dogs were intravenously administered MDL19205 7 to 14 days after they had completely recovered from the first and second operations. With 3 mg/kg of MDL19205, peak changes of hemodynamic indices occurred within 5 minutes in the hearts with MR LV dP/dt and mean Vcf significantly rose (from 3,090 +/- 622 to 5,356 +/- 811 mmHg/sec; p less than 0.001, 1.85 +/- 0.20 to 2.65 +/- 0.36 sec-1, p less than 0.001). LVEDP and LVEDL were returned to the control values obtained in the normal hearts (15.8 +/- 3.7 to 6.4 +/- 2.4 mmHg; p less than 0.001, 10.6 +/- 0.2 to 10 +/- 0.4; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3154914

  20. 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. PMID:25559345

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

    PubMed Central

    Wu, Yin; Fan, WuQiang; Chachula, Laura; Costacurta, Gary; Rohatgi, Rajeev; Elmi, Farhad

    2015-01-01

    Introduction Takotsubo cardiomyopathy (TCM) can be complicated by left ventricular outflow tract (LVOT) obstruction and severe acute mitral regurgitation (MR), leading to hemodynamic instability in an otherwise benign disorder. Despite the severity of these complications, there is a paucity of literature on the matter. Because up to 20–25% of TCM patients develop LVOT obstruction and/or MR, it is important to recognize the clinical manifestations of these complications and to adhere to specific management in order to reduce patient morbidity and mortality. We report the clinical history, imaging, treatment strategy, and clinical outcome of a patient with TCM that was complicated with severe MR and LVOT obstruction. We then discuss the pathophysiology, characteristic imaging, key clinical features, and current treatment strategy for this unique patient population. Case report A postmenopausal woman with no clear risk factor for coronary artery disease (CAD) presented to the emergency department with chest pain after an episode of mental/physical stress. Physical examination revealed MR, mild hypotension, and pulmonary vascular congestion. Her troponins were mildly elevated. Cardiac catheterization excluded obstructive CAD, but revealed severe apical hypokinesia and ballooning. Notably, multiple diagnostic tests revealed the presence of severe acute MR and LVOT obstruction. The patient was diagnosed with TCM complicated by underlying MR and LVOT obstruction, and mild hemodynamic instability. The mechanism of her LVOT and MR was attributed to systolic anterior motion of the mitral valve (SAM), which the transesophageal echocardiogram clearly showed during workup. She was treated with beta-blocker, aspirin, and ACE-I with good outcome. Nitroglycerin and inotropes were discontinued and further avoided. Conclusions Our case illustrated LVOT obstruction and MR associated with underlying SAM in a patient with TCM. LVOT obstruction and MR are severe complications of TCM and may result in heart failure and/or pulmonary edema. Timely and accurate identification of these complications is critical to achieve optimal clinical outcomes in patients with TCM. PMID:26653691

  2. Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.

    PubMed

    Chakravarty, Tarun; Van Belle, Eric; Jilaihawi, Hasan; Noheria, Amit; Testa, Luca; Bedogni, Francesco; Rück, Andreas; Barbanti, Marco; Toggweiler, Stefan; Thomas, Martyn; Khawaja, Muhammed Zeeshan; Hutter, Andrea; Abramowitz, Yigal; Siegel, Robert J; Cheng, Wen; Webb, John; Leon, Martin B; Makkar, Raj R

    2015-04-01

    Significant mitral regurgitation (MR) constitutes an important co-existing valvular heart disease burden in the setting of aortic valve stenosis. There are conflicting reports on the impact of significant MR on outcomes after transcatheter aortic valve implantation (TAVI). We evaluated the impact of MR on outcomes after TAVI by performing a meta-analysis of 8 studies involving 8,927 patients reporting TAVI outcomes based on the presence or absence of moderate-severe MR. Risk ratios (RRs) were calculated using the inverse variance random-effects model. None-mild MR was present in 77.8% and moderate-severe MR in 22.2% of the patients. The presence of moderate-severe MR at baseline was associated with increased mortality at 30 days (RR 1.35, 95% confidence interval [CI] 1.14 to 1.59, p = 0.003) and 1 year (RR 1.24, 95% CI 1.13 to 1.37, p <0.0001). The increased mortality associated with moderate-severe MR was not influenced by the cause of MR (functional or degenerative MR; RR 0.90, 95% CI 0.62 to 1.30, p = 0.56). The severity of MR improved in 61 ± 6.0% of patients after TAVI. Moderate-severe residual MR, compared with none-mild residual MR after TAVI, was associated with significantly increased 1-year mortality (RR 1.48, 95% CI 1.31 to 1.68, p <0.00001). In conclusion, baseline moderate-severe MR and significant residual MR after TAVI are associated with an increase in mortality after TAVI and represent an important group to target with medical or transcatheter therapies in the future. PMID:25779617

  3. 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

  4. Impact of preprocedural mitral regurgitation upon mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis

    PubMed Central

    Khawaja, M Z; Williams, R; Hung, J; Arri, S; Asrress, K N; Bolter, K; Wilson, K; Young, C P; Bapat, V; Hancock, J; Thomas, M; Redwood, S

    2014-01-01

    Objective To identify the effects of preprocedural significant mitral regurgitation (MR) and change in MR severity upon mortality after transcatheter aortic valve implantation (TAVI) using the Edwards SAPIEN system. Methods A retrospective analysis of 316 consecutive patients undergoing TAVI for aortic stenosis at a single centre in the UK between March 2008 and January 2013. Patients were stratified into two groups according to severity of MR: ?grade 3 were classed as significant and ?grade 2 were non-significant. Change in MR severity was assessed by comparison of baseline and 30-day echocardiograms. Results 60 patients had significant MR prior to TAVI (19.0%). These patients were of higher perioperative risk (logistic EuroScore 28.7±16.6% vs 20.3±10.7%, p=0.004) and were more dyspnoeic (New York Heart Association class IV 20.0% vs 7.4%, p=0.014). Patients with significant preprocedural MR displayed greater 12-month and cumulative mortality (28.3% vs 20.2%, log-rank p=0.024). Significant MR was independently associated with mortality (HR 4.94 (95% CI 2.07 to 11.8), p<0.001). Of the 60 patients with significant MR only 47.1% had grade 3–4 MR at 30?days (p<0.001). Patients in whom MR improved had lower mortality than those in whom it deteriorated (log-rank p=0.05). Conclusions Significant MR is frequently seen in patients undergoing TAVI and is independently associated with increased all-cause mortality. Yet almost half also exhibit significant improvements in MR severity. Those who improve have better outcomes, and future work could focus upon identifying factors independently associated with such an improvement. PMID:25155800

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

    PubMed Central

    Ojaghi-Haghighi, Zahra; Mostafavi, Atoosa; Moladoust, Hassan; Noohi, Feridoun; Maleki, Majid; Esmaeilzadeh, Maryam; Samiei, Niloofar

    2014-01-01

    Abstract Background: Left ventricular (LV) twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR) on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI). LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38° ± 4.04° vs. 13.95° ± 4.27°; p value = 0.020; and 1.29 ± 0.54 °/cm vs. 1.76 ± 0.56 °/cm; p value = 0.021, respectively), both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (?79.74 ± 35.97 °/s vs.?110.96 ± 34.65 °/s; p value = 0.020), but there was statistically no significant difference in the LV twist rate. Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients. PMID:25861323

  6. Pulmonary venous flow determinants of left atrial pressure under different loading conditions in a chronic animal model with mitral regurgitation

    NASA Technical Reports Server (NTRS)

    Yang, Hua; Jones, Michael; Shiota, Takahiro; Qin, Jian Xin; Kim, Yong Jin; Popovic, Zoran B.; Pu, Min; Greenberg, Neil L.; Cardon, Lisa A.; Eto, Yoko; Sitges, Marta; Zetts, Arthur D.; Thomas, James D.

    2002-01-01

    BACKGROUND: The aim of our study was to quantitatively compare the changes and correlations between pulmonary venous flow variables and mean left atrial pressure (mLAP) under different loading conditions in animals with chronic mitral regurgitation (MR) and without MR. METHODS: A total of 85 hemodynamic conditions were studied in 22 sheep, 12 without MR as control (NO-MR group) and 10 with MR (MR group). We obtained pulmonary venous flow systolic velocity (Sv) and diastolic velocity (Dv), Sv and Dv time integrals, their ratios (Sv/Dv and Sv/Dv time integral), mLAP, left ventricular end-diastolic pressure, and MR stroke volume. We also measured left atrial a, x, v, and y pressures and calculated the difference between v and y pressures. RESULTS: Average MR stroke volume was 10.6 +/- 4.3 mL/beat. There were good correlations between Sv (r = -0.64 and r = -0.59, P <.01), Sv/Dv (r = -0.62 and r = -0.74, P <.01), and mLAP in the MR and NO-MR groups, respectively. Correlations were also observed between Dv time integral (r = 0.61 and r = 0.57, P <.01) and left ventricular end-diastolic pressure in the MR and NO-MR groups. In velocity variables, Sv (r = -0.79, P <.001) was the best predictor of mLAP in both groups. The sensitivity and specificity of Sv = 0 in predicting mLAP 15 mm Hg or greater were 86% and 85%, respectively. CONCLUSION: Pulmonary venous flow variables correlated well with mLAP under altered loading conditions in the MR and NO-MR groups. They may be applied clinically as substitutes for invasively acquired indexes of mLAP to assess left atrial and left ventricular functional status.

  7. Usefulness of Left Atrial Reservoir Size and Left Ventricular Untwisting Rate for Predicting Outcome in Primary Mitral Regurgitation.

    PubMed

    Zito, Concetta; Manganaro, Roberta; Khandheria, Bijoy; Oreto, Giuseppe; Cusmà-Piccione, Maurizio; Todaro, Maria Chiara; Caprino, Alessandra; Pugliatti, Pietro; Di Bella, Gianluca; Carerj, Scipione

    2015-10-15

    The present study proposed to evaluate whether analysis of cardiac mechanics through speckle-tracking imaging is useful for risk stratification in asymptomatic patients with chronic primary mitral regurgitation (MR). We prospectively enrolled 67 patients (mean age 57 ± 18 years) and followed them over time. MR was mild in 20 patients (30%), moderate in 24 (36%), and severe in 23 (34%). After a mean time of 24.8 ± 17 months, 34 patients (51%) remained asymptomatic, whereas 33 (49%) developed events (19 underwent mitral valve surgery, 9 required hospitalization for acute heart failure, and 5 patients died). Compared to asymptomatic patients, those with events at baseline showed more severe MR, larger and spherical ventricles, diastolic dysfunction, and greater systolic pulmonary arterial pressure. Moreover, patients with events had decreased left atrial (LA) reservoir (p <0.001) and left ventricular (LV) untwisting rate (p <0.001). On univariate Cox regression analysis, effective regurgitant orifice area (p <0.001), vena contracta (p <0.001), systolic pulmonary arterial pressure (p = 0.003), LV end-systolic diameter (p <0.001), E/E' ratio (p = 0.004), LA volume (p = 0.001), LA reservoir (p <0.001), and LV untwisting rate (p <0.001) were associated with an increased risk of events. On multivariate analysis, only LA reservoir (p = 0.013) and LV untwisting rate were independent predictors (p = 0.017) of outcome. Moreover, LA reservoir evaluation significantly improved (p = 0.013) risk stratification compared to recommended parameters. In conclusion, impaired cardiac mechanics is more closely associated than severity of MR with the occurrence of events in asymptomatic chronic primary MR. PMID:26279107

  8. [A case of ischemic dilated cardiomyopathy, mitral regurgitation and congestive heart failure successfully treated by Batista operation, coronary artery bypass grafting and mitral valve replacement; usefulness of myocardial scintigraphy].

    PubMed

    Okoshi, T; Ueda, K; Neya, K; Suzuki, Y; Nakajima, H; Akasaka, T; Kaminaga, T

    2002-01-01

    A 75-year-old man diagnosed as having ischemic dilated cardiomyopathy, congestive heart failure and mitral regurgitation underwent left ventricle volume reduction operation (Batista), coronary bypass grafting and mitral valve replacement because myocardial infarction had developed at lateral, inferior and small area of apex wall, not at interventricular septum. Left ventricular endodiastolic volume index and left ventricular endosystolic volume index decreased from pre-operative values of 155, and 128 ml/m2 to post-operative values of 113, and 82 ml/m2, respectively. Left ventricular ejection fraction increased from a pre-operative value of 17% to a post-operative value of 27%. This evaluation was performed by myocardial scintigraphy (quantitative gated spect: QGS). This method was bloodless and useful for determination of indication of left ventricle volume reduction surgery including Batista operation and pre- and post-operative evaluation of this type of surgery. Today, Batista operation is, generally speaking, performed for non-ischemic dilated cardiomyopathy. In this case, however, Batista operation was applied to ischemic dilated cardiomyopathy and was very effective. PMID:11797415

  9. Real-time three-dimensional color doppler evaluation of the flow convergence zone for quantification of mitral regurgitation: Validation experimental animal study and initial clinical experience

    NASA Technical Reports Server (NTRS)

    Sitges, Marta; Jones, Michael; Shiota, Takahiro; Qin, Jian Xin; Tsujino, Hiroyuki; Bauer, Fabrice; Kim, Yong Jin; Agler, Deborah A.; Cardon, Lisa A.; Zetts, Arthur D.; Panza, Julio A.; Thomas, James D.

    2003-01-01

    BACKGROUND: Pitfalls of the flow convergence (FC) method, including 2-dimensional imaging of the 3-dimensional (3D) geometry of the FC surface, can lead to erroneous quantification of mitral regurgitation (MR). This limitation may be mitigated by the use of real-time 3D color Doppler echocardiography (CE). Our objective was to validate a real-time 3D navigation method for MR quantification. METHODS: In 12 sheep with surgically induced chronic MR, 37 different hemodynamic conditions were studied with real-time 3DCE. Using real-time 3D navigation, the radius of the largest hemispherical FC zone was located and measured. MR volume was quantified according to the FC method after observing the shape of FC in 3D space. Aortic and mitral electromagnetic flow probes and meters were balanced against each other to determine reference MR volume. As an initial clinical application study, 22 patients with chronic MR were also studied with this real-time 3DCE-FC method. Left ventricular (LV) outflow tract automated cardiac flow measurement (Toshiba Corp, Tokyo, Japan) and real-time 3D LV stroke volume were used to quantify the reference MR volume (MR volume = 3DLV stroke volume - automated cardiac flow measurement). RESULTS: In the sheep model, a good correlation and agreement was seen between MR volume by real-time 3DCE and electromagnetic (y = 0.77x + 1.48, r = 0.87, P <.001, delta = -0.91 +/- 2.65 mL). In patients, real-time 3DCE-derived MR volume also showed a good correlation and agreement with the reference method (y = 0.89x - 0.38, r = 0.93, P <.001, delta = -4.8 +/- 7.6 mL). CONCLUSIONS: real-time 3DCE can capture the entire FC image, permitting geometrical recognition of the FC zone geometry and reliable MR quantification.

  10. Relationship between systolic and diastolic function with improvements in forward stroke volume following reduction in mitral regurgitation

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    Efforts to improve mitral regurgitation (MR) are often performed in conjunction with coronary revascularization. However, the independent effects of a reduced MR area (MRa) are difficult to quantify. Using a previously developed cardiovascular model, ventricular contractility (elastance 1-8 mmHg/ml) and relaxation (tau: 40-150 msec) were independently adjusted for four grades of MR orifice areas (0.0 to 0.8 cm2). Improvements in forward stroke volume (fSV) were determined for the permutations of reduced MRa. For all conditions, LV end-diastolic pressure and volumes ranged from 7.3-24.2 mmHg and 64.8-174.3 ml, respectively. Overall, fSV ranged from 36.0-89.4 (mean: 64.2 +/- 12.8) ml, improved between 6.4 and 35.3% (mean: 15.6 +/- 8.1%), and was best predicted by (r=0.97, p<0.01) %delta(fSV)[correction of fVS]=34[MRa initial] - 46[MRa final] -0.5[elastance]. Reduced MRa, independent of relaxation and minimally influence by contractility, yield improved fSVs.

  11. Severity of mitral regurgitation predicts risk of death or cardiac transplantation in children with idiopathic dilated cardiomyopathy.

    PubMed

    Patange, Amit; Thomas, Ronald; Ross, Robert D

    2014-02-01

    Clinical outcomes among children with idiopathic dilated cardiomyopathy (IDC) are diverse, which makes the decision as to when a patient should be listed for a cardiac transplantation challenging. This study aimed to determine echocardiographic and clinical variables that can help clinicians identify those at highest risk for death or cardiac transplantation. The study was a single-center, retrospective chart review of children with IDC. Patients younger than 18 years with a diagnosis of IDC, as defined by a left ventricular end-diastolic dimension (LVEDD) z-score higher than 2, and fractional shortening of less than 28 % on the initial echocardiogram, were included in the study. Echocardiographic parameters including mitral regurgitation (MR) grade and certain clinical parameters at the time of presentation were assessed. A follow-up echocardiogram was similarly studied. The study included 49 children with IDC. Those who died or underwent cardiac transplantation were grouped as "nonsurvivors" (n = 26). The remaining children who either completely recovered or experienced chronic dilated cardiomyopathy were grouped as "survivors" (n = 23). The median age overall was 1.25 years (range 0.1-17 years). The follow-up echocardiograms of the survivors showed significant improvement in left ventricle size, systolic function, left atrial volume, and MR grade, whereas these parameters did not change in the nonsurvivor group. The use of inotropic medications at initial presentation was an independent predictor of death or cardiac transplantation (p < 0.05). The presence of moderate to severe MR at diagnosis also was predictive of a worse outcome. PMID:23917522

  12. Catheter-based intervention for symptomatic patient with severe mitral regurgitation and very poor left ventricular systolic function - Safe but no room for complacency

    PubMed Central

    Loh, Poay Huan; Bourantas, Christos V; Chan, Pak Hei; Ihlemann, Nikolaj; Gustafsson, Fin; Clark, Andrew L; Price, Susanna; Mario, Carlo Di; Moat, Neil; Alamgir, Farqad; Estevez-Loureiro, Rodrigo; Søndergaard, Lars; Franzen, Olaf

    2015-01-01

    Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation (MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous MitraClip® can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures. PMID:26635930

  13. Safety and feasibility of a novel adjustable mitral annuloplasty ring: a multicentre European experience†

    PubMed Central

    Andreas, Martin; Doll, Nicolas; Livesey, Steve; Castella, Manuel; Kocher, Alfred; Casselman, Filip; Voth, Vladimir; Bannister, Christina; Encalada Palacios, Juan F.; Pereda, Daniel; Laufer, Guenther; Czesla, Markus

    2016-01-01

    OBJECTIVES Recurrent mitral regurgitation is a significant problem after mitral valve repair in patients with functional valve disease. We report the safety and feasibility of a novel adjustable mitral annuloplasty device that permits downsizing of the anterior–posterior diameter late after initial surgery. METHODS In this multicentre, non-randomized, observational register, patients with moderate or severe mitral regurgitation undergoing surgical mitral valve repair with the MiCardia EnCorSQ™ Mitral Valve Repair system were evaluated. Patient characteristics, operative specifications and results as well as postoperative follow-up were collected for all five centres. RESULTS Ninety-four patients with a median age of 71 (64–75) years (EuroSCORE II 6.7 ± 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and 15% degenerative disease) were included. Operative mortality was 1% and the 1-year survival was 93%. Ring adjustment was attempted in 12 patients at a mean interval of 9 ± 6 months after surgery. In three of these attempts, a technical failure occurred. In 1 patient, mitral regurgitation was reduced two grades, in 2 patients mitral regurgitation was reduced one grade and in 6 patients, mitral regurgitation did not change significantly. The mean grade of mitral regurgitation changed from 2.9 ± 0.9 to 2.1 ± 0.7 (P = 0.02). Five patients were reoperated after 11 ± 9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION We conclude that this device may provide an additional treatment option in patients with functional mitral regurgitation, who are at risk for reoperation due to recurrent mitral regurgitation. Clinical results in this complex disease were ambiguous and patient selection seems to be a crucial step for this device. Further trials are required to estimate the clinical value of this therapeutic concept. PMID:25694471

  14. 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

  15. Mitral valve regurgitation

    MedlinePLUS

    ... or dexfenfluramine. The drug was removed from the market by the U.S. Food and Drug Administration (FDA) ... ultrasound examination of the heart) - transthoracic or transesophageal Magnetic resonance imaging (MRI) Cardiac catheterization may be done if heart ...

  16. Lifting posterior mitral annuloplasty for enhancing leaflet coaptation in mitral valve repair: midterm outcomes

    PubMed Central

    Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok; Yang, Hyun Suk

    2015-01-01

    Background We evaluated the midterm outcomes of lifting posterior mitral annuloplasty for enhancing leaflet coaptation in mitral valve repair. Methods Between October 2007 and December 2012, 341 consecutive patients with significant mitral regurgitation underwent lifting posterior mitral annuloplasty using a specially designed fabric annuloplasty strip that lifts the middle portion of the posterior annulus. Associated procedures for mitral valve repairs, such as patch valvuloplasty for posterior leaflet prolapse (n=80), new chord placement for anterior leaflet prolapse (n=33), commissurotomy (n=29), and posterior leaflet extension (n=23), were performed in 141 patients (41.3%). Results Thirty-day mortality was 0.9%. Nine late deaths (2.6%) occurred. Mean overall survival at 5 years was 96.0%±1.1%. During the mean follow-up period of 38±17 months, six patients (1.8%) underwent valve-related reoperation (5-year freedom from valve-related reoperation, 98.1%±0.8%). At 5 years, mean freedom from recurrence of mitral regurgitation grade 3+ to 4+ (moderate to severe) was 95.1%±1.6%. The mean valve pressure gradient (PG) was 3.2±1.5 mmHg across all strip sizes at the time of follow-up. Conclusions Lifting posterior mitral annuloplasty using an innovative annuloplasty strip in mitral valve repair has a low rate of recurrent regurgitation or valve-related reoperation with rare relevant complications. PMID:26309826

  17. [A simplified method for estimating mitral valve area by Doppler].

    PubMed

    Cobos Gil, M A; Rada, I; Gili, M; Camacho, I; Asín, E; Yuste, P

    1991-01-01

    Based upon geometrical considerations we have developed a new method for estimation of valve area in patients with mitral stenosis. A special ruler enables us to read the valve area from the Doppler record. We prove that our new method is more precise and rapid than original Hatle's procedure. In 35 patients, we found a good correlation between the result of our method and the valve area obtained by 2D-Echo. Thus the new method is very useful for Doppler evaluation of mitral stenosis patients. PMID:1953210

  18. 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

  19. 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

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

    PubMed Central

    Trepte, Ulrike; Seeger, Julia; Gonska, Birgid; Koenig, Wolfgang; Rottbauer, Wolfgang

    2015-01-01

    Background It is not known whether biomarkers of hemodynamic stress, myocardial necrosis, and renal function might predict adverse outcome in patients undergoing percutaneous repair of severe mitral valve insufficiency. Thus, we aimed to assess the predictive value of various established and emerging biomarkers for major adverse cardiovascular events (MACE) in these patients. Methods Thirty-four patients with symptomatic severe mitral valve insufficiency with a mean STS-Score for mortality of 12.6% and a mean logistic EuroSCORE of 19.7% undergoing MitraClip therapy were prospectively included in this study. Plasma concentrations of mid regional-proatrial natriuretic peptide (MR-proANP), Cystatin C, high-sensitive C-reactive protein (hsCRP), high-sensitive troponin T (hsTnT), N-terminal B-type natriuretic peptide (NT-proBNP), galectin-3, and soluble ST-2 (interleukin 1 receptor-like 1) were measured directly before procedure. MACE was defined as cardiovascular death and hospitalization for heart failure (HF). Results During a median follow-up of 211 days (interquartile range 133 to 333 days), 9 patients (26.5%) experienced MACE (death: 7 patients, rehospitalization for HF: 2 patients). Thirty day MACE-rate was 5.9% (death: 2 patients, no rehospitalization for HF). Baseline concentrations of hsTnT (Median 92.6 vs 25.2 ng/L), NT-proBNP (Median 11251 vs 1974 pg/mL) and MR-proANP (Median 755.6 vs 318.3 pmol/L, all p<0.001) were clearly higher in those experiencing an event vs event-free patients, while other clinical variables including STS-Score and logistic EuroSCORE did not differ significantly. In Kaplan-Meier analyses, NT-proBNP and in particular hsTnT and MR-proANP above the median discriminated between those experiencing an event vs event-free patients. This was further corroborated by C-statistics where areas under the ROC curve for prediction of MACE using the respective median values were 0.960 for MR-proANP, 0.907 for NT-proBNP, and 0.822 for hsTnT. Conclusions MR-proANP and hsTnT strongly predict cardiovascular death and rehospitalization for HF in patients undergoing percutaneous repair of mitral valve insufficiency. Both markers might be useful components in new scoring systems to better predict short- and potentially long-term mortality and morbidity after MitraClip procedure. PMID:26368980

  1. Mitral Regurgitation (Beyond the Basics)

    MedlinePLUS

    ... Am J Cardiol 2001; 87:298. Joint Task Force on the Management of Valvular Heart Disease of ... American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; ...

  2. 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. PMID:25258184

  3. Minimally invasive robotic mitral valve surgery.

    PubMed

    Atluri, Pavan; Woo, Y Joseph

    2011-01-01

    Over the past two decades, significant advances have been made in mitral valve surgery. Cardiac surgeons have successfully repaired degenerative and ischemic regurgitant mitral valves via a traditional midline sternotomy. In recent years, alternate incisions have yielded minimally invasive approaches to the mitral valve. Technological advances have made robotically assisted minimally invasive mitral valve surgery feasible. Decreased pain, more rapid return to work, diminished blood loss and reduced length of hospitalization have been witnessed following robotic mitral valve surgery when compared with a traditional sternotomy. Equivalent long-term mortality and freedom from recurrent mitral regurgitation are evident between mitral valve repair performed via a traditional sternotomy and minimally invasive and robotic techniques. As a result, an increasing number of patients and referring cardiologists are seeking minimally invasive approaches to mitral valve surgery. PMID:21158546

  4. Current challenges in interventional mitral valve treatment.

    PubMed

    Taramasso, Maurizio; Candreva, Alessandro; Pozzoli, Alberto; Guidotti, Andrea; Gaemperli, Oliver; Nietlispach, Fabian; Barthelmes, Jens; Emmert, Maximilian Y; Weber, Alberto; Benussi, Stefano; Alfieri, Ottavio; Maisano, Francesco

    2015-09-01

    Transcatheter mitral valve therapies have emerged as an alternative option in high surgical risk or inoperable patients with severe and symptomatic mitral regurgitation (MR). As multiple technologies and different approaches will become available in the field of mitral valve interventions, different challenges are emerging, both patient- (clinical challenges) and procedure-related (technical challenges). This review will briefly explore the current open challenges in the evolving fields of interventional mitral valve treatment. PMID:26543599

  5. Current challenges in interventional mitral valve treatment

    PubMed Central

    Candreva, Alessandro; Pozzoli, Alberto; Guidotti, Andrea; Gaemperli, Oliver; Nietlispach, Fabian; Barthelmes, Jens; Emmert, Maximilian Y.; Weber, Alberto; Benussi, Stefano; Alfieri, Ottavio; Maisano, Francesco

    2015-01-01

    Transcatheter mitral valve therapies have emerged as an alternative option in high surgical risk or inoperable patients with severe and symptomatic mitral regurgitation (MR). As multiple technologies and different approaches will become available in the field of mitral valve interventions, different challenges are emerging, both patient- (clinical challenges) and procedure-related (technical challenges). This review will briefly explore the current open challenges in the evolving fields of interventional mitral valve treatment. PMID:26543599

  6. Rate of repair in minimally invasive mitral valve surgery

    PubMed Central

    Hohenberger, Wolfgang; Lakew, Fitsum; Batz, Gerhard; Diegeler, Anno

    2013-01-01

    Background Valve repair has been shown to be the method of choice in the treatment of patients with severe mitral valve regurgitation. Minimally invasive surgery has raised skepticism regarding the rate of repair especially for supposedly complex lesions, when anterior leaflet involvement or bileaflet prolapse is present. We sought to review our experience of all our patients presenting with degenerative mitral valve regurgitation and operated on minimally invasively. Method From September 2006 to December 2012, 842 patients (mean age 56.12±11.62 years old) with degenerative mitral valve regurgitation and anterior leaflet (n=82, 9.7%), posterior leaflet (n=688, 81.7%) and bileaflet (n=72, 8.6%) prolapses were operated on using a minimally invasive approach. Results 836 patients had a valve repair (99.3%) and received a concomitant ring annuloplasty (mean size, 33.7; range, 28-40). Six patients (0.7%) underwent valve replacement. Two patients had a re-repair due to MR progression or infective endocarditis. Thirty-day mortality was 0.2% (two patients). There were 60 major adverse events (MAE) (7.1%). Conclusions A minimally invasive approach allows repair of almost all degenerative valves with good short-term outcomes in a tertiary referral center, when using proven and efficient surgical techniques. PMID:24349977

  7. Mitral valve repair without mitral annuloplasty with extensive mitral annular calcification.

    PubMed

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

    2014-12-01

    In mitral valve repair, removal of mitral annular calcification (MAC) is necessary to secure the artificial ring but may cause rupture of the left ventricle or injury to the circumflex coronary artery. We experienced 3 cases of mitral valve regurgitation with extensive MAC. Patient 1, an 83-year old woman, had P1-P2 prolapse due to tendon rupture. We performed mitral valve repair with triangular resection of P2 and patch reconstruction, artificial-chordal reconstruction to P2 and anterolateral commissural edge-to-edge suturing. Patient 2 was a 76-year old man with P3 prolapse due to tendon rupture. We performed A3-P3 edge-to-edge suturing and small annular plication of the posteromedial commissure. Patient 3, an 84-year old woman with a non-specific coaptation defect in the anterolateral commissure and tenting of the anterior mitral leaflet due to a secondary chorda, underwent cutting of the secondary chorda of the anterior mitral leaflet and A1-P1 edge-to-edge suturing. We performed tricuspid annuloplasty in Patient 1 and aortic valve replacement in Patients 2 and 3. Postoperative echocardiography showed good control of mitral valve regurgitation, which we were able to regulate by repairing the leaflets and chordae without decalcification of the mitral annulus or implantation of an artificial ring. PMID:25205783

  8. 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

    2016-01-01

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

  9. Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement.

    PubMed

    Zarrini, Parham; Elboudwarej, Omeed; Luthringer, Daniel; Siegel, Robert

    2015-09-01

    Mycotic aneurysms can be a rare, but serious complication of infectious endocarditis. We report the case of a 20-year-old woman who presented with fever and malaise from streptococcal bacteremia and found to have vegetation on the anterior leaflet of the mitral valve. On follow-up visit, the patient was noted to have a mycotic aneurysm of the anterior mitral valve without aortic involvement. Her clinical course was complicated by mitral valve chordal rupture, severe mitral regurgitation, and dyspnea from severe mitral regurgitation for which she underwent successful surgical repair of the mitral valve. PMID:25881967

  10. Mitral Valve Area During Exercise After Restrictive Mitral Valve Annuloplasty

    PubMed Central

    Bertrand, Philippe B.; Verbrugge, Frederik H.; Verhaert, David; Smeets, Christophe J.P.; Grieten, Lars; Mullens, Wilfried; Gutermann, Herbert; Dion, Robert A.; Levine, Robert A.; Vandervoort, Pieter M.

    2015-01-01

    BACKGROUND Restrictive mitral valve annuloplasty (RMA) for secondary mitral regurgitation might cause functional mitral stenosis, yet its clinical impact and underlying pathophysiological mechanisms remain debated. OBJECTIVES The purpose of our study was to assess the hemodynamic and clinical impact of effective orifice area (EOA) after RMA and its relationship with diastolic anterior leaflet (AL) tethering at rest and during exercise. METHODS Consecutive RMA patients (n = 39) underwent a symptom-limited supine bicycle exercise test with Doppler echocardiography and respiratory gas analysis. EOA, transmitral flow rate, mean transmitral gradient, and systolic pulmonary arterial pressure were assessed at different stages of exercise. AL opening angles were measured at rest and peak exercise. Mortality and heart failure readmission data were collected for at least 20 months after surgery. RESULTS EOA and AL opening angle were 1.5 ± 0.4 cm2 and 68 ± 10°, respectively, at rest (r = 0.4; p = 0.014). EOA increased significantly to 2.0 ± 0.5 cm2 at peak exercise (p < 0.001), showing an improved correlation with AL opening angle (r = 0.6; p < 0.001). Indexed EOA (EOAi) at peak exercise was an independent predictor of exercise capacity (maximal oxygen uptake, p = 0.004) and was independently associated with freedom from all-cause mortality or hospital admission for heart failure (p = 0.034). Patients with exercise EOAi <0.9 cm2/m2 (n = 14) compared with ?0.9 cm2/m2 (n = 25) had a significantly worse outcome (p = 0.048). In multivariate analysis, AL opening angle at peak exercise (p = 0.037) was the strongest predictor of exercise EOAi. CONCLUSIONS In RMA patients, EOA increases during exercise despite fixed annular size. Diastolic AL tethering plays a key role in this dynamic process, with increasing AL opening during exercise being associated with higher exercise EOA. EOAi at peak exercise is a strong and independent predictor of exercise capacity and is associated with clinical outcome. Our findings stress the importance of maximizing AL opening by targeting the subvalvular apparatus in future repair algorithms for secondary mitral regurgitation. PMID:25660923

  11. Management of tricuspid regurgitation

    PubMed Central

    Taramasso, Maurizio; Lapenna, Elisabetta; Alfieri, Ottavio

    2014-01-01

    Secondary tricuspid regurgitation is the most frequent type of tricuspid insufficiency in western countries. Its surgical treatment is still an object of debate both in terms of timing and surgical techniques. Until recently, the avoidance of surgery for tricuspid repair was commonly accepted in patients with less than severe secondary tricuspid regurgitation undergoing left-sided valve surgery. More recently, compelling evidence in favour of a more aggressive surgical approach in this setting has emerged. The surgical technique should be tailored to the stage of disease. Ring annuloplasty is more durable than suture annuloplasty and represents the method of choice in the presence of isolated annular dilatation. In patients in whom the dilatation of the tricuspid annulus is combined with significant leaflet tethering, annuloplasty alone is unlikely to be durable and additional procedures have been proposed in order to achieve a more durable repair. In this review, pathophysiology, surgical indications, techniques of repair and outcomes of secondary tricuspid regurgitation will be discussed. We will also focus on the challenging issue of significant tricuspid regurgitation occurring late after left-sided valve surgery. Finally, the current and future role of percutaneous tricuspid valve technologies will be briefly described. PMID:25184048

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

    PubMed

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

    2015-07-01

    A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant. PMID:26422945

  13. 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.

  14. Using a double-plicated posterior leaflet as an anchor for mitral valve replacement: a case of mitral annular calcification

    PubMed Central

    2013-01-01

    We present a 62-year-old man with mitral regurgitation whose posterior annulus had severe calcification. Mitral valve replacement was performed by anchoring the cuff on a double-plicated posterior leaflet, and reinforcing with an equine pericardium. The patient is doing well 13 years after surgery with echocardiography showing no problems. PMID:23547886

  15. Mass attached to mechanical mitral valve mimicking a thrombus.

    PubMed

    Calvo-Taracido, Manuel; Bustamante, Sergio; Adasme, Óscar; Kara, Sergio; Merino, Jaime; Pivetta, Rodolfo; Macedo, Matías; Marrero, Roberto; Fernández, Ricardo; Puccio, José Miguel

    2015-12-15

    Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function. This advantage has been demonstrated in functional mitral valve regurgitation as well as mitral valve regurgitation due to rheumatic disease. Regarding complications of this technique, several of them have been reported, papillary muscle rupture being one of them. We describe a clinical case of this weird but possible kind of complication. PMID:26298382

  16. A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation

    PubMed Central

    Blanke, Philipp; Dvir, Danny; Cheung, Anson; Ye, Jian; Levine, Robert A.; Precious, Bruce; Berger, Adam; Stub, Dion; Hague, Cameron; Murphy, Darra; Thompson, Christopher; Munt, Brad; Moss, Robert; Boone, Robert; Wood, David; Pache, Gregor; Webb, John; Leipsic, Jonathon

    2015-01-01

    Background The nonplanar, saddle-shaped structure of the mitral annulus has been well established through decades of anatomic and echocardiographic study. Its relevance for mitral annular assessment for transcatheter mitral valve implantation is uncertain. Objective Our objectives are to define the methodology for CT-based simplified “D-shaped” mitral annular assessment for transcatheter mitral valve implantation and compare these measurements to traditional “saddle-shaped” mitral annular assessment. Methods The annular contour was manually segmented, and fibrous trigones were identified using electrocardiogram-gated diastolic CT data sets of 28 patients with severe functional mitral regurgitation, yielding annular perimeter, projected area, trigone-to-trigone (TT) distance, and septal-lateral distance. In contrast to the traditional saddle-shaped annulus, the D-shaped annulus was defined as being limited anteriorly by the TT distance, excluding the aortomitral continuity. Hypothetical left ventricular outflow tract (LVOT) clearance was assessed. Results Projected area, perimeter, and septal-lateral distance were found to be significantly smaller for the D-shaped annulus (11.2 ± 2.7 vs 13.0 ± 3.0 cm2; 124.1 ± 15.1 vs 136.0 ± 15.5 mm; and 32.1 ± 4.0 vs 40.1 ± 4.9 mm, respectively; P < .001). TT distances were identical (32.7 ± 4.1 mm). Hypothetical LVOT clearance was significantly lower for the saddle-shaped annulus than for the D-shaped annulus (10.7 ± 2.2 vs 17.5 ± 3.0 mm; P < .001). Conclusion By truncating the anterior horn of the saddle-shaped annular contour at the TT distance, the resulting more planar and smaller D-shaped annulus projects less onto the LVOT, yielding a significantly larger hypothetical LVOT clearance than the saddle-shaped approach. CT-based mitral annular assessment may aid preprocedural sizing, ensuring appropriate patient and device selection. PMID:25467833

  17. Transfemoral aortic valve implantation in severe aortic stenosis patients with prior mitral valve prosthesis

    PubMed Central

    Sar?, Cenk; Ba?tu?, Serdal; Kasapkara, Hac? Ahmet; Durmaz, Tahir; Kele?, Telat; Akçay, Murat; Aslan, Abdullah Nabi; Bayram, Nihal Akar; Bozkurt, Engin

    2015-01-01

    Introduction Transcatheter aortic valve implantation for severe symptomatic aortic stenosis in patients with a previous mitral valve prosthesis is technically challenging, and pre-procedural comprehensive assessment of these patients before transcatheter aortic valve implantation is vital for an uncomplicated and successful procedure. Aim We want to share our experience with transcatheter aortic valve implantation in patients with a preexisting functional mitral valve prosthesis and describe a series of important technical and pre-procedural details. Material and methods At our center, 135 patients with symptomatic severe aortic stenosis were treated with transcatheter aortic valve implantation. Six of them with a preexisting mitral valve prosthesis received an Edwards SAPIEN XT valve through the transfemoral route. Results Transcatheter aortic valve implantation was performed successfully in all 6 patients without any deformation of the cobalt-chromium/steel stents of the aortic valve bioprosthesis. Also no distortion or malfunction in the mitral valve prosthesis was observed after the procedure. There were no complications during the hospitalization period. Post-procedural echocardiography revealed no or mild aortic paravalvular regurgitation and normal valve function in all the patients. In addition, serial echocardiographic examination demonstrated that both the stability and function of the aortic and mitral prosthetic valves were normal without any deterioration in the gradients and the degree of the regurgitation at long-term follow-ups. Conclusions Our experience confirms that transcatheter aortic valve implantation is technically feasible in patients with previous mitral valve replacement but comprehensive evaluation of patients by multimodal imaging techniques such as transesophageal echocardiography and multislice computed tomography is mandatory for a successful and safe procedure. PMID:26677380

  18. Comparison of the novel Medtentia double helix mitral annuloplasty system with the Carpentier-Edwards Physio annuloplasty ring: morphological and functional long-term outcome in a mitral valve insufficiency sheep model

    PubMed Central

    2013-01-01

    Background The prevalence of mitral regurgitation in cardiac diseases requires annuloplasty systems that can be implanted without excessive patient burden. This study was designed to examine the morphological and functional outcome of a new double helix mitral annuloplasty ring in an ovine model in comparison to the classical Carpentier-Edwards (CE) annuloplasty ring as measured by reduction of mitral regurgitation and tissue integration. The Medtentia annuloplasty ring (MAR) is a helical device that is rotated into the annulus self-restoring the valve geometry, enabling a faster fixation without the need of elaborate repair of the valve geometry. The ventricular part of the helical ring encircles the valve chords. Methods Twenty adult sheep were overpaced until 2+ level mitral valve regurgitation was achieved. Seven animals per group received either the MAR or the CE ring. Implantation was performed on-pump in a beating heart through the left atrial appendix. The animals were sacrificed 3.6?±?0.3 months after surgery following an echocardiography for assessing mitral regurgitation as primary endpoint. The annuloplasty rings with surrounding tissue were harvested for histological analyses as secondary endpoints. The remaining six sheep received the MAR system and were sampled seven, nine or 12 months after surgery. Results Implantation time (p?Mitral valve regurgitation is effectively stopped both by restricting the pathological expansion of the annulus and by gathering the chords without thrombus formation. PMID:23566678

  19. Intraoperative echocardiographic detection of regurgitant jets after valve replacement

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

    BACKGROUND: Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. METHODS: Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. RESULTS: Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. CONCLUSIONS: Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.

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

    PubMed Central

    Lee, Seong; Chee, Hyun Keun; Kim, Jun Seok; Song, Myong Gun; Park, Jae Bum; Shin, Je Kyoun

    2015-01-01

    Background There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods In this study, we assessed 15 patients (mean age, 47.7±9.7 years; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5±7 years. The mean preoperative Wilkins score was 9.4±2.6. Results The mean mitral valve area obtained using planimetry increased from 1.16±0.16 cm2 to 1.62±0.34 cm2 (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from 202.4±58.6 ms to 152±50.2 ms (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4±4.0 mmHg to 5.8±1.5 mmHg (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39±16 months). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467–64.866). Conclusion On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair. PMID:26509126

  1. Mitral valve plasty for a hammock mitral valve in an adult patient.

    PubMed

    Ito, Toshiaki; Tokoro, Masayoshi; Yanagisawa, Jyunji

    2015-09-01

    A 50-year old woman presented with arterial thrombosis in the right leg. Echocardiography revealed a mobile left atrial thrombus and severe mitral stenosis. She underwent a left atrial thrombectomy, the maze procedure and mitral valve plasty. Anterior and posterior mitral leaflets arose directly from the anterior papillary muscle, and from the posterior papillary muscle intervened by short chordae. This suggested a hammock mitral valve. A posterior papillary muscle division and commissurotomy were performed. The anterior leaflet was divided off the anterior papillary muscle, then extended by a triangular-shaped autologous pericardial patch and apically reattached. The postoperative mean pressure gradient of the mitral valve was 2.2 mmHg, and there was no regurgitation. The patient was in NYHA Class 1 and in sinus rhythm, 14 months after the operation. PMID:26034223

  2. 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

  3. Mitral valve disease-morphology and mechanisms.

    PubMed

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

    2015-12-01

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

  4. Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets.

    PubMed

    Pouleur, Anne-Catherine; le Polain de Waroux, Jean-Benoît; Goffinet, Céline; Vancraeynest, David; Pasquet, Agnès; Gerber, Bernhard L; Vanoverschelde, Jean-Louis

    2008-08-15

    Proximal isovelocity surface area (PISA) has been proposed as a quantitative method to assess the severity of aortic regurgitation (AR). Yet the accuracy of this method in patients with eccentric AR jets is unknown. The aims of this study were to compare the accuracy of the PISA method for the quantification of AR severity in patients with central versus eccentric AR jets and to verify whether imaging from the left parasternal instead of the apical window improves the accuracy of the PISA method in patients with eccentric jets. Fifty patients with AR (21 with central jets and 29 with eccentric jets) underwent PISA and phase-contrast cardiac magnetic resonance (CMR) measurements of AR volume. In patients with eccentric AR jets, PISA measurements obtained from the left parasternal and apical windows were compared. In patients with central AR jets, CMR- and PISA-derived AR volumes were similar (28 +/- 19 vs 30 +/- 20 ml, p = 0.34), were strongly correlated (r = 0.92, p <0.0001), and differed minimally from each other (by 2 +/- 8 ml). In patients with eccentric AR jets, PISA-derived AR volumes underestimated those measured by CMR (38 +/- 22 vs 51 +/- 27 ml, bias -13 +/- 20 ml) and were correlated only fairly (r = 0.69, p <0.001). Imaging from the left parasternal window eliminated the differences between CMR- and PISA-derived AR volumes (51 +/- 27 vs 53 +/- 26 ml, p = 0.24) and improved the correlation between the 2 measures (r = 0.95). In conclusion, in patients with eccentric AR jets imaged from the apical window, the PISA method significantly underestimated AR severity. This was no longer the case when imaging was performed from the left parasternal instead of the apical window. PMID:18678309

  5. Mitral valve repair over five decades

    PubMed Central

    2015-01-01

    It has become evident that mitral valve (MV) repair is the preferable treatment for the majority of patients presenting with severe mitral regurgitation (MR). This success clearly testifies that the surgical procedure is accessible, reproducible and is carrying excellent long-lasting results. From the pre-extracorporeal circulation’s era to the last percutaneous approaches, a large variety of techniques have been proposed to address the different features of MV diseases. This article aimed at reviewing chronologically the development of these dedicated techniques through their origins and the debates that they generated in the literature. PMID:26309841

  6. [Assessment of systolic function in patients with poor echogenicity: echocardiographic methods].

    PubMed

    Weidemann, F; Liu, D; Niemann, M; Herrmann, S; Hu, H; Gaudron, P D; Ertl, G; Hu, K

    2015-04-01

    The visual echocardiographic evaluation of left ventricular (LV) systolic function can be cumbersome, especially in patients with poor image quality. This review describes several alternative echocardiographic methods to determine LV systolic function: endocardial border delineation by contrast agents, mitral annular plane systolic excursion, mitral annular velocity derived from tissue Doppler, myocardial performance index, mitral regurgitation derived LV dP/dtMax and estimation of cardiac output by Doppler echocardiography. The review introduces the respective methods along with the presentation of suitable measurements, clinical implications and methodological limitations. PMID:23942734

  7. Repair for mitral valve aneurysm using autologous pericardium: a case of our experience.

    PubMed

    Zhang, Hongqiang; Chen, Hao; Sun, Xiaoning; Yang, Shouguo; Wang, Chunsheng

    2014-01-01

    Mitral Valve Aneurysm (MVA) is rarely reported and occurs most in association with infective endocarditis of the aortic valve. In our case, the 46-yr-old Chinese man was referred to our hospital with dyspnea and orthopnea. Transesophageal echocardiography during operation revealed a localized, thin-walled saccular structure in the anterior leaflet that bulged into the left atrium, and severe mitral and aortic regurgitation. Aortic valve was replaced with mechanical prostheses and mitral valve was repaired with autologous pericardium. Transesophageal echocardiography during operation and transthoracic echocardiography 3 months later showed mild regurgitation. PMID:25230935

  8. How has robotic repair changed the landscape of mitral valve surgery?

    PubMed

    Taggarse, Amit K; Suri, Rakesh M; Daly, Richard C

    2015-07-01

    The introduction of robotic technology has revolutionized the performance of certain cardiac surgical procedures such as mitral valve (MV) repair. The foundation of modern MV repair was laid by Dr. Dwight C. McGoon in 1958. The operation was first performed with robotic assistance by Carpentier in 1998 using rudimentary motion-assisted equipment. Today, four generations later, telemanipulation technology enables surgeons to carry out all known methods of MV repair traditionally performed by conventional sternotomy; utilizing tiny port access incisions to safely and reliably eliminate mitral regurgitation. Extubation in the operating room following robotic MV repair is now routine and its benefits are well-documented, including transfer to the step-down from the intensive care unit several hours after surgery. This, in turn, translates into diminished usage of blood products, decreased need for pain medication, earlier dismissal from hospital, more rapid return to work and improved patient satisfaction. In addition, smaller, more cosmetically appealing scars and comparable short and mid-term outcomes of robotic and open MV repair have made the robotic approach a preferred option for many patients who meet appropriate safety criteria. As these procedures become more commonplace in large structural heart practices, it is important to reflect upon how the robotic approach has changed the landscape of MV surgery. We discuss the evolution and current status of robotic MV repair founded upon the principles of safe and effective open mitral valvuloplasty techniques. We will explore the potential of the robotic platform to improve both early referral and patient acceptance of interventions to eliminate severe degenerative mitral regurgitation. PMID:26309846

  9. How has robotic repair changed the landscape of mitral valve surgery?

    PubMed Central

    Taggarse, Amit K.; Daly, Richard C.

    2015-01-01

    The introduction of robotic technology has revolutionized the performance of certain cardiac surgical procedures such as mitral valve (MV) repair. The foundation of modern MV repair was laid by Dr. Dwight C. McGoon in 1958. The operation was first performed with robotic assistance by Carpentier in 1998 using rudimentary motion-assisted equipment. Today, four generations later, telemanipulation technology enables surgeons to carry out all known methods of MV repair traditionally performed by conventional sternotomy; utilizing tiny port access incisions to safely and reliably eliminate mitral regurgitation. Extubation in the operating room following robotic MV repair is now routine and its benefits are well-documented, including transfer to the step-down from the intensive care unit several hours after surgery. This, in turn, translates into diminished usage of blood products, decreased need for pain medication, earlier dismissal from hospital, more rapid return to work and improved patient satisfaction. In addition, smaller, more cosmetically appealing scars and comparable short and mid-term outcomes of robotic and open MV repair have made the robotic approach a preferred option for many patients who meet appropriate safety criteria. As these procedures become more commonplace in large structural heart practices, it is important to reflect upon how the robotic approach has changed the landscape of MV surgery. We discuss the evolution and current status of robotic MV repair founded upon the principles of safe and effective open mitral valvuloplasty techniques. We will explore the potential of the robotic platform to improve both early referral and patient acceptance of interventions to eliminate severe degenerative mitral regurgitation. PMID:26309846

  10. Minimally invasive surgery of mitral valve (MIS-MV).

    PubMed

    Kudo, Mikihiko; Yozu, Ryohei

    2014-06-01

    Following the revision of the therapeutic guideline of ACC/AHA in (Circulation 114:450-527, 2006), the incidence of mitral valve repair in asymptomatic patients with moderate or severe mitral valve regurgitation has increased. For mitral valve repair, the quality and outcomes as well as lower invasive procedure are important to obtain the confidence of cardiologists and ensure request of early phase operation from cardiologists. With recent innovations of technologies and the development of revolutionary techniques, minimally invasive surgery of the mitral valve (MIS-MV) has become a widespread surgical option of mitral valve repair. It is vital, however, that careful preoperative assessment, and planning of the approach and perfusion strategy are put in place to perform MIS-MV safely. PMID:24722958

  11. Genetic association analyses highlight biological pathways underlying mitral valve prolapse.

    PubMed

    Dina, Christian; Bouatia-Naji, Nabila; Tucker, Nathan; Delling, Francesca N; Toomer, Katelynn; Durst, Ronen; Perrocheau, Maelle; Fernandez-Friera, Leticia; Solis, Jorge; Le Tourneau, Thierry; Chen, Ming-Huei; Probst, Vincent; Bosse, Yohan; Pibarot, Philippe; Zelenika, Diana; Lathrop, Mark; Hercberg, Serge; Roussel, Ronan; Benjamin, Emelia J; Bonnet, Fabrice; Lo, Su Hao; Dolmatova, Elena; Simonet, Floriane; Lecointe, Simon; Kyndt, Florence; Redon, Richard; Le Marec, Hervé; Froguel, Philippe; Ellinor, Patrick T; Vasan, Ramachandran S; Bruneval, Patrick; Markwald, Roger R; Norris, Russell A; Milan, David J; Slaugenhaupt, Susan A; Levine, Robert A; Schott, Jean-Jacques; Hagege, Albert A; Mvp-France; Jeunemaitre, Xavier

    2015-10-01

    Nonsyndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown etiology that predisposes to mitral regurgitation, heart failure and sudden death. Previous family and pathophysiological studies suggest a complex pattern of inheritance. We performed a meta-analysis of 2 genome-wide association studies in 1,412 MVP cases and 2,439 controls. We identified 6 loci, which we replicated in 1,422 cases and 6,779 controls, and provide functional evidence for candidate genes. We highlight LMCD1 (LIM and cysteine-rich domains 1), which encodes a transcription factor and for which morpholino knockdown of the ortholog in zebrafish resulted in atrioventricular valve regurgitation. A similar zebrafish phenotype was obtained with knockdown of the ortholog of TNS1, which encodes tensin 1, a focal adhesion protein involved in cytoskeleton organization. We also showed expression of tensin 1 during valve morphogenesis and describe enlarged posterior mitral leaflets in Tns1(-/-) mice. This study identifies the first risk loci for MVP and suggests new mechanisms involved in mitral valve regurgitation, the most common indication for mitral valve repair. PMID:26301497

  12. 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

  13. PREVALENCE OF VALVULAR REGURGITATIONS IN CLINICALLY HEALTHY CAPTIVE LEOPARDS AND CHEETAHS: A PROSPECTIVE STUDY FROM THE WILDLIFE CARDIOLOGY (WLC) GROUP (2008-2013).

    PubMed

    Chai, Norin; Petit, Thierry; Kohl, Muriel; Bourgeois, Aude; Gouni, Vassiliki; Trehiou-Sechi, Emilie; Misbach, Charlotte; Petit, Amandine; Damoiseaux, Cécile; Garrigou, Audrey; Guepin, Raphaëlle; Pouchelon, Jean Louis; Chetboul, Valérie

    2015-09-01

    The purpose of this prospective study was to evaluate transthoracic echocardiograms from clinically healthy large felids for the presence of valvular regurgitations (VR). Physiologic VR commonly occur in normal dogs and cats, but the percentage of large felids with VR has not been previously reported. During a 5-yr study period (2008-2013), 28 healthy animals were evaluated under general anesthesia: 16 cheetahs (Acinonyx jubatus soemmeringuii) with a mean age of 1.5±0.8 yr (range 0.7-3.5 yr), 5 Amur leopards (Panthera pardus orientalis), 1 snow leopard (Uncia uncia), and 6 clouded leopards (Neofelis nebulosa). For this study, all the leopards were gathered in one so-called "leopards group" with a mean age of 2.8±3.4 yr (range 0.3-10.7 yr). All valves observed in each view were examined for evidence of regurgitant jets and turbulent blood flow using the color-flow Doppler mode. Valves were also examined for structural changes. Mitral valve and aortic cusp abnormalities were considered to be of congenital origin. Mitral valve lesions led to mitral insufficiency in all the felids. Aortic cusp abnormalities led to aortic regurgitation in 94% of the cheetahs and 67% of the leopards. Leopards showed a predominance of early systolic mitral regurgitations, whereas all the mitral regurgitation jets in cheetahs were holosystolic. Tricuspid regurgitation was found in 81% of the cheetahs and in 50% of the leopards, whereas pulmonic regurgitation was detected in 44% of the cheetahs and 33% of the leopards. Interestingly, none of these tricuspid and pulmonic regurgitations were associated with two-dimensional structural valve abnormalities, thus suggesting their physiologic origin, as described in humans, cats, and dogs. In conclusion, subclinical valvular diseases are common in apparently healthy leopards and cheetahs. Longitudinal follow-up of affected animals is therefore required to assess their clinical outcome. PMID:26352956

  14. Current state of transcatheter mitral valve repair with the MitraClip

    PubMed Central

    Downs, Emily A.; Lim, D. Scott; Saji, Mike

    2015-01-01

    Background Many patients affected with mitral valve regurgitation suffer from multiple comorbidities. The MitraClip device provides a safe means of transcatheter valve repair in patients with suitable mitral valve anatomy who are at prohibitive risk for surgery. We describe our early procedural outcomes and present a summary of the current state of MitraClip technology in the United States. Methods We performed a retrospective chart review of initial high-risk or inoperable patients who underwent MitraClip placement at our institution after completion of the EVEREST II study. We examined the primary outcome of 30-day mortality, and secondary outcomes included extent of reduction of mitral regurgitation (MR), New York Heart Association (NYHA) functional class improvement, length of stay, and major complications. Results A total of 115 high-risk patients (mean Society of Thoracic Surgeons predicted risk of mortality 9.4%±6.1%) underwent the MitraClip procedure at our institution between March 2009 and April 2014. Co-morbidities including coronary artery disease (67.8%), pulmonary disease (39.1%) and previous cardiac surgery (44.3%) were common. The device was placed successfully in all patients with a 30-day mortality of 2.6%. All patients demonstrated 3+ or 4+ MR on preoperative imaging, and 80.7% of patients had trace or 1+ MR at hospital discharge. NYHA class improved substantially, with 79% of patients exhibiting class III or IV symptoms pre-procedure and 81% reporting class I or II symptoms at one month follow-up. Conclusions The MitraClip procedure provides a safe alternative to surgical or medical management for high-risk patients with MR and suitable valve anatomy. A comprehensive heart team approach is essential, with surgeons providing critical assessment of patient suitability for surgery versus percutaneous therapy as well as performance of the valve procedure. PMID:26309842

  15. 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

  16. Mitral Annulus Segmentation From 3D Ultrasound Using Graph Cuts

    E-print Network

    Schneider, Robert J.

    The shape of the mitral valve annulus is used in diagnostic and modeling applications, yet methods to accurately and reproducibly delineate the annulus are limited. This paper presents a mitral annulus segmentation algorithm ...

  17. Unravelling the proteome of degenerative human mitral valves.

    PubMed

    Tan, Hwee Tong; Lim, Teck Kwang; Richards, Arthur Mark; Kofidis, Theodoros; Teoh, Kristine Leok-Kheng; Ling, Lieng H; Chung, Maxey C M

    2015-09-01

    Degenerative mitral valve disease (DMVD), which includes the syndromes of mitral valve prolapse (MVP) and flail leaflet, is a common valvular condition which can be complicated by mitral regurgitation and adverse cardiovascular outcomes. Although several genetic and other studies of MVP in dog models have provided some information regarding the underlying disease mechanisms, the proteins and molecular events mediating human MVP pathogenesis have not been unraveled. In this study, we report the first large-scale proteome profiling of mitral valve tissue resected from patients with MVP. A total of 1134 proteins were identified, some of which were validated using SWATH-MS and western blotting. GO annotation of these proteins confirmed the validity of this proteome database in various cardiovascular processes. Among the list of proteins, we found several structural and extracellular matrix proteins, such as asporin, biglycan, decorin, lumican, mimecan, prolargin, versican, and vinculin, that have putative roles in the pathophysiology of MVP. These proteins could also be involved in the cardiac remodeling associated with mitral regurgitation. All MS data have been deposited in the ProteomeXchange with identifier PXD000774 (http://proteomecentral.proteomexchange.org/dataset/PXD000774). PMID:25914152

  18. 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

  19. [Robot-assisted Mitral Valve Plasty].

    PubMed

    Ishikawa, Norihiko; Watanabe, Gou

    2015-01-01

    In April 2014, Team Watanabe have completed 249 robot-assisted cardiac surgeries. Wide range of procedures include internal thoracic artery harvesting, totally endoscopic coronary artery bypass grafting(CABG), atrial septal defect closure, mitral valve plasty, cardiac tumor resection. The major benefit of robot-assisted cardiac surgery, which differentiates it from minimally invasive cardiac surgery, is that it only requires a few ports instead of small thoracotomy. Mitral valve plasty for regurgitation is one of the most suitable indication, which represents the advantage of robot-assisted cardiac surgery. The da Vinci surgical system completely changed the modality of cardiac surgeries from median sternotomy to endoscopic approach. Endoscopic surgery is expected not only to provide superior cosmesis but also to reduce complications and improve post-operative quality of life. In addition, we consider that sharing the same surgical view on the screen monitor is another great benefit from the educational point of view for the next-generation. PMID:25595158

  20. Quantitative analysis of aortic regurgitation: real-time 3-dimensional and 2-dimensional color Doppler echocardiographic method--a clinical and a chronic animal study

    NASA Technical Reports Server (NTRS)

    Shiota, Takahiro; Jones, Michael; Tsujino, Hiroyuki; Qin, Jian Xin; Zetts, Arthur D.; Greenberg, Neil L.; Cardon, Lisa A.; Panza, Julio A.; Thomas, James D.

    2002-01-01

    BACKGROUND: For evaluating patients with aortic regurgitation (AR), regurgitant volumes, left ventricular (LV) stroke volumes (SV), and absolute LV volumes are valuable indices. AIM: The aim of this study was to validate the combination of real-time 3-dimensional echocardiography (3DE) and semiautomated digital color Doppler cardiac flow measurement (ACM) for quantifying absolute LV volumes, LVSV, and AR volumes using an animal model of chronic AR and to investigate its clinical applicability. METHODS: In 8 sheep, a total of 26 hemodynamic states were obtained pharmacologically 20 weeks after the aortic valve noncoronary (n = 4) or right coronary (n = 4) leaflet was incised to produce AR. Reference standard LVSV and AR volume were determined using the electromagnetic flow method (EM). Simultaneous epicardial real-time 3DE studies were performed to obtain LV end-diastolic volumes (LVEDV), end-systolic volumes (LVESV), and LVSV by subtracting LVESV from LVEDV. Simultaneous ACM was performed to obtain LVSV and transmitral flows; AR volume was calculated by subtracting transmitral flow volume from LVSV. In a total of 19 patients with AR, real-time 3DE and ACM were used to obtain LVSVs and these were compared with each other. RESULTS: A strong relationship was found between LVSV derived from EM and those from the real-time 3DE (r = 0.93, P <.001, mean difference (3D - EM) = -1.0 +/- 9.8 mL). A good relationship between LVSV and AR volumes derived from EM and those by ACM was found (r = 0.88, P <.001). A good relationship between LVSV derived from real-time 3DE and that from ACM was observed (r = 0.73, P <.01, mean difference = 2.5 +/- 7.9 mL). In patients, a good relationship between LVSV obtained by real-time 3DE and ACM was found (r = 0.90, P <.001, mean difference = 0.6 +/- 9.8 mL). CONCLUSION: The combination of ACM and real-time 3DE for quantifying LV volumes, LVSV, and AR volumes was validated by the chronic animal study and was shown to be clinically applicable.

  1. The evolution from surgery to percutaneous mitral valve interventions: the role of the edge-to-edge technique.

    PubMed

    Maisano, Francesco; La Canna, Giovanni; Colombo, Antonio; Alfieri, Ottavio

    2011-11-15

    The edge-to-edge technique is a versatile procedure for mitral valve repair. Its technical simplicity has been the prerequisite for the development of a number of transcatheter technologies to perform percutaneous mitral valve repair. The evolution from a standard open heart surgical to percutaneous procedure involved the application of the technique in minimally invasive robotic surgery and direct access (transatrial) off-pump suture-based repair and finally in the fully percutaneous approach with either suture-based or device (clip)-based approach. The MitraClip (Abbott Vascular, Menlo Park, California) is currently available for clinical use in Europe, and it is mainly applied to treat high-risk patients with functional mitral regurgitation. A critical review of the surgical as well as the early percutaneous repair data is necessary to elucidate the clinical role and the potential for future developments of the edge-to-edge repair in the treatment of mitral regurgitation. PMID:22078423

  2. [Fever, malaise and new onset mitral valve insufficiency. Subacute Streptococcus bovis mitral valve endocarditis ].

    PubMed

    Burri, E; Laffer, R; Steuerwald, M; Cathomas, G; Zimmerli, W

    2004-05-01

    A 62-year-old patient with low grade fever, fatigue, arthralgia and newly discovered mitral regurgitation was diagnosed with subacute endocarditis. Streptococcus bovis grew from all six blood culture bottles. Streptococcus bovis is known to be associated with gastrointestinal neoplasias. Therefore a colonoscopy was performed and two polyps were removed. Histological analysis revealed a tubulovillous adenoma and a serrated adenoma. Colonoscopy is mandatory for all patients with Streptococcus bovis endocarditis even without any symptoms for colorectal neoplasia. The significance of Streptococcus bovis for the carcinogenesis of colorectal neoplasias and the possible alternative pathway for colorectal carcinomas through serrated adenomas will be discussed. PMID:15185488

  3. Safety and Efficacy of Percutaneous Mitral Valve Repair Using the MitraClip® System in Patients with Diabetes Mellitus

    PubMed Central

    Balzer, Jan; van Hall, Silke; Rammos, Christos; Wagstaff, Rabea; Kelm, Malte; Rassaf, Tienush

    2014-01-01

    Background Patients with diabetes mellitus show a negative outcome in percutaneous coronary intervention, aortic valve replacement and cardiac surgery. The impact of diabetes on patients undergoing treatment of severe mitral regurgitation (MR) using the MitraClip system is not known. We therefore sought to assess whether percutaneous mitral valve repair with the MitraClip system is safe and effective in patients with diabetes mellitus. Methods and Results We included 58 patients with severe and moderate-to-severe MR in an open-label observational single-center study. Ninteen patients were under oral medication or insulin therapy for type II diabetes mellitus. MitraClip devices were successfully implanted in all patients with diabetes and in 97.4% (n?=?38) of patients without diabetes (p?=?0.672). Periprocedural major cardiac adverse and cerebrovascular events (MACCE) occurred in 5.1% (n?=?2) of patients without diabetes whereas patients with diabetes did not show any MACCE (p?=?0.448). 30-day mortality was 1.7% (n?=?1) with no case of death in the diabetes group. Short-term follow up of three months showed a significant improvement of NYHA class and quality of life evaluated by the Minnesota Living with Heart Failure Questionnaire in both groups, with no changes in the 6-minute walk test. Conclusions Mitral valve repair with the MitraClip system is safe and effective in patients with type II diabetes mellitus. Trial Registration MitraClip Registry NCT02033811 PMID:25375257

  4. 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

  5. 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

  6. Placement of Neochords in Mitral Valve Repair: Enhanced Exposure of the Papillary Muscles Using a Standard Valve Sizer.

    PubMed

    Erlebach, Magdalena; Lange, Ruediger; Mazzitelli, Domenico

    2016-01-01

    Minimally invasive mitral valve repair with placement of artificial chordae for mitral valve regurgitation has become the standard of care. In some cases, such as Barlow's disease or bileaflet prolapse, papillary muscle exposure may be difficult. By using a valve sizer to retract both leaflets, visualization can be optimized, thus simplifying suture placement and thereby minimizing cross-clamp and cardiopulmonary bypass times. This technique is simple, is cost effective, and can be applied quickly. PMID:26694289

  7. Giant Thrombus Formation Immediately After Mitral Valvuloplasty.

    PubMed

    Aizawa, Yoshihiro; Nakai, Toshiko; Kurosawa, Takafumi; Saito, Yuki; Monno, Koyuru; Hatta, Takumi; Hiro, Takafumi; Arimoto, Munehito; Osaka, Shunji; Hata, Hiroaki; Shiono, Motomi; Hirayama, Atsushi

    2015-12-01

    Patients with atrial fibrillation (AF) are at risk of cardioembolism.(1,2)) Atrial thrombus formation associated with AF typically occurs in the left atrial appendage (LAA);(3)) therefore, transesophageal echocardiography (TEE) is important for detection of such a thrombus and measurement of LAA flow velocity.(4,5)) LAA closure is routinely performed during mitral valve surgery in patients with AF to prevent cardiogenic stroke.(6)) We report the case of a 65-year-old woman with severe mitral regurgitation (MR) and AF in whom a giant thrombus formed almost immediately after mitral and tricuspid valvuloplasty and concurrent LAA resection. No atrial thrombus or spontaneous echo contrast (SEC) was detected by TEE before the surgery. However, a giant intramural thrombus was detected in the left atrium 7 days after surgery. It was thought that the atrial dysfunction as well as the change in morphology of the left atrium resulting from the severe MR complicated by AF and congestive heart failure produced a thrombotic substrate. This case suggests that careful surveillance for thrombus formation and careful maintenance of anticoagulation therapy are needed throughout the perioperative period even if no SEC or thrombus is detected before surgery. PMID:26549289

  8. Severe pulmonic valve regurgitation due to histoplasma endocarditis

    PubMed Central

    Bremer, Merri; Lin, Peter T; Pislaru, Sorin V

    2015-01-01

    Summary A 67-year-old man with myelodysplastic syndrome, disseminated histoplasmosis, and mitral valve replacement presented with dyspnea and peripheral edema. Transthoracic echocardiography demonstrated abnormal pulmonic valve with possible vegetation. Color flow imaging showed laminar flow from main pulmonary artery into right ventricular outflow tract (RVOT) in diastole. The continuous wave Doppler signal showed dense diastolic envelope with steep deceleration slope. These findings were consistent with severe pulmonic valve regurgitation, possibly due to endocarditis. Transesophageal echocardiography demonstrated an echodense mass attached to the pulmonic valve. The mitral valve bioprosthesis appeared intact. Bacterial and fungal blood cultures were negative; however, serum histoplasma antigen was positive. At surgery, the valve appeared destroyed by vegetations. Gomori methenamine silver-stains showed invasive fungal hyphae and yeast consistent with a dimorphic fungus. Valve cultures grew one colony of filamentous fungus. Itraconazole was continued based on expert infectious diseases diagnosis. After surgery, dyspnea and ankle edema resolved. To the best of our knowledge, histoplasma endocarditis of pulmonic valve has not been previously reported. Isolated pulmonic valve endocarditis is rare, accounting for about 2% of infectious endocarditis (IE) cases. Fungi account for about 3% of cases of native valve endocarditis. Characterization of pulmonary valve requires thorough interrogation with 2D and Doppler echocardiography techniques. Parasternal RVOT view allowed visualization of the pulmonary valve and assessment of regurgitation severity. As an anterior structure, it may be difficult to image with transesophageal echocardiography. Mid-esophageal right ventricular inflow–outflow view clearly showed the pulmonary valve and vegetation. Learning points Identification and characterization of pulmonary valve abnormalities require thorough interrogation with 2D and Doppler echocardiography techniques.Isolated pulmonary valve IE is rare and requires high index of suspicion. Histoplasma capsulatum IE is rare and requires high index of suspicion. PMID:26693325

  9. Iatrogenic mitral valve chordal rupture during placement of an inflatable and repositionable percutaneous aortic valve prosthesis.

    PubMed

    D'Ancona, Giuseppe; Ince, Hüseyin; Ortak, Jasmin; Stoeckicht, Yannik; Kische, Stephan

    2015-03-01

    A case is reported of iatrogenic mitral valve chordal rupture occurring during transcatheter aortic valve implantation (TAVI) with an inflatable and repositionable valve (Direct Flow; Direct Flow Medical, Santa Rosa, CA, USA). The specific implantation technique requires initial valve advancement into the left ventricular cavity, valve inflation within the ventricular cavity, and a final finely tuned valve upward pulling through the left ventricular outflow tract until contact with the aortic annulus is achieved. During this phase of the procedure, entangling with the mitral subvalvular apparatus should be excluded, to avoid inadvertent tissue tearing and consequent mitral valve malfunction. The present patient underwent TAVI but then developed symptomatic severe mitral valve regurgitation resulting from chordal rupture. The condition was successfully treated percutaneously by implanting a Mitra-Clip. PMID:26204679

  10. Review of Congenital Mitral Valve Stenosis: Analysis, Repair Techniques and Outcomes.

    PubMed

    Baird, Christopher W; Marx, Gerald R; Borisuk, Michele; Emani, Sitram; Del Nido, Pedro J

    2015-06-01

    The spectrum of congenital mitral valve stenosis (MS) consists of a complex of defects that result in obstruction to left ventricular inflow. This spectrum includes patients with underdeveloped left heart structures (Fig. 1) to those with isolated congenital MS. The specific mitral valve defects can further be divided into categories based on the relationship to the mitral valve annulus including valvar, supravalvar and subvalvar components. Clinically, these patients present based on the degree of obstruction, associated mitral regurgitation, secondary pulmonary hypertension, associated lung disease and/or associated cardiac lesions. There are a number of factors that contribute to the successful outcomes in these patients including pre-operative imaging, aggressive surgical techniques and peri-operative management. Figure 1 (a) Image representing a parachute mitral valve with a small left ventricular cavity. Supra-mitral ring with a fibrous rim of tissue attaches to the mitral annulus and extends on the surfaces of the mitral leaflets. Stenosing mitral membranes or the thickened fribrotic rim of tissue grows on to the atrial aspects of the mitral leaflets restricting the effective orifice area. This thickened fibrous anterior leaflet tissue can extend down onto the chordae tendenae towards the papillary muscle creating an "arcade" like structure. Additional valvar components include commissural fusion and thickened fibrous leaflets that can lead to restricted leaflet motion. Note the sub-valvar or papillary muscle components of congenital MS including the shortened chordae tendenae, reduced inter-chordal space and tethering of the papillary muscles to the ventricle. (b) Pathologic specimen of a parachute mitral valve with a single papillary muscle. PMID:26577233

  11. Scintigraphic diagnosis of tricuspid regurgitation

    SciTech Connect

    Tu'meh, S.S.; Tracy, D.A.; Wynne, J.; Konstam, M.A.; Kozlowski, J.F.; Neumann, A.L.; Holman, B.L.

    1982-11-01

    The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with /sup 99m/Tc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p<0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.

  12. Mitral Valve Repair

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Mitral Valve Replacement Aortic Valve Mitral Valve Repair Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

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

    PubMed

    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

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

    PubMed Central

    Tan, Timothy C.

    2015-01-01

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

  15. Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse: Virtual repair using a patient specific finite element simulation

    PubMed Central

    Ge, Liang; Morrel, William G.; Ward, Alison; Mishra, Rakesh; Zhang, Zhihong; Guccione, Julius M.; Grossi, Eugene A.; Ratcliffe, Mark B.

    2014-01-01

    Background Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and re-operation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial post-operative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair. Methods Magnetic resonance imaging was performed before and intra-operative 3D trans-esophageal echocardiography was performed before and after repair of posterior leaflet (P2) prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced and a 3D finite element (FE) model was created. Elements of the P2 region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring. Results The principal findings of the current study are 1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation, 2) average posterior leaflet stress is increased, and 3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty. Conclusions We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape. PMID:24630767

  16. Nutritional management of regurgitation in infants.

    PubMed

    Vandenplas, Y; Lifshitz, J Z; Orenstein, S; Lifschitz, C H; Shepherd, R W; Casaubón, P R; Muinos, W I; Fagundes-Neto, U; Garcia Aranda, J A; Gentles, M; Santiago, J D; Vanderhoof, J; Yeung, C Y; Moran, J R; Lifshitz, F

    1998-08-01

    Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development. PMID:9710837

  17. Mitral Valve Prolapse

    MedlinePLUS

    ... is due to small, usually harmless, tumor-like growths of collagen on the valve leaflets (called myxomatous changes). Mitral valve prolapse occurs in 2 percent to 3 percent of the population. A person can be born with the genetic ...

  18. Mitral Valve Repair Surgery

    MedlinePLUS Videos and Cool Tools

    ... end, where the valve doesn’t leak, the stress is taken off the chordal structure. But as ... on and as patients are put under increased stress and strain. Another question: “I will have mitral ...

  19. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    Mitral valve prolapse is the most common heart disease seen in college and university health services. It underlies most arrhythmia and many chest complaints. Activity and exercise restrictions are usually unnecessary. (Author/CJ)

  20. 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

  1. Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease

    PubMed Central

    Baran, Cagdas; Durdu, Serkan; Eryilmaz, Sadik; Sirlak, Mustafa; Akar, A. Ruchan

    2015-01-01

    We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation. PMID:26649221

  2. Concomitant Repair of Mitral Valve Papillary Muscle Rupture and Tricuspid Valve Avulsion in a Pediatric Patient after a Motor Vehicle Collision

    PubMed Central

    Hodge, Ashley; Forbus, Geoff; Hsia, Tain Yen

    2009-01-01

    Abstract: We report the case of an 8-year-old patient with severe acute mitral regurgitation and tricuspid regurgitation after a motor vehicle collision caused by traumatic injuries of the supporting structures of both valves. An echocardiogram showed avulsion of the posteromedial papillary muscle of the mitral valve and a severely prolapsed anterior tricuspid valve leaflet. In addition, there was a near-complete defect in the left ventricular side of the interventricular septum, with diffuse hematoma of the akinetic septal muscle. After emergency mitral and tricuspid valve repairs, consisting of re-implantation of the posteromedial papillary muscle and anterior tricuspid leaflet chordal support, the patient completely recovered with no residual valvular pathology. PMID:19806802

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

    PubMed

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

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants. PMID:26197828

  4. Heart valve surgery

    MedlinePLUS

    ... Aortic stenosis Congenital heart valve disease Mitral regurgitation - acute Mitral regurgitation - chronic Mitral stenosis Mitral valve prolapse Pulmonary valve stenosis Tricuspid regurgitation Tricuspid valve stenosis

  5. When what appears to be mitral stenosis is not: diagnostic and therapeutic implications.

    PubMed

    Almeida, Inês; Caetano, Francisca; Trigo, Joana; Mota, Paula; Cachulo, Maria do Carmo; Antunes, Manuel; Leitão Marques, António

    2014-01-01

    The authors report the case of a 53-year-old man, with a long-standing history of mild mitral stenosis, admitted for worsening fatigue. Transthoracic echocardiography (limited by poor image quality) showed mitral annular calcification, leaflets that were difficult to visualize and an estimated mitral valve area of 1.8 cm(2) by the pressure half-time method. However, elevated mean transmitral and right ventricle/right atrium gradients were identified (39 and 117 mmHg, respectively). This puzzling discrepancy in the echocardiographic findings prompted investigation by transesophageal echocardiography, which revealed an echogenic structure adjacent to the mitral annulus, causing severe obstruction (effective orifice area 0.7 cm(2)). The suspicion of supravalvular mitral ring was confirmed during surgery. Following ring resection and mitral valve replacement there was significant improvement in the patient's clinical condition and normalization of the left atrium/left ventricle gradient. Supravalvular mitral ring is an unusual cause of congenital mitral stenosis, characterized by an abnormal ridge of connective tissue on the atrial side of the mitral valve, which often obstructs mitral valve inflow. Few cases have been reported, most of them in children with concomitant congenital abnormalities. Diagnosis of a supravalvular mitral ring is challenging, since it is very difficult to visualize in most diagnostic tests. It was the combination of clinical and various echocardiographic findings that led us to suspect this very rare condition, enabling appropriate treatment, with excellent long-term results. PMID:25108561

  6. Safety and efficacy of enalapril in multivalvular heart disease with significant mitral stenosis--SCOPE-MS.

    PubMed

    Chockalingam, Anand; Venkatesan, S; Dorairajan, Smrita; Chockalingam, V; Subramaniam, T; Jaganathan, V; Elangovan, S; Alagesan, R; Gnanavelu, G; Arul, A S

    2005-01-01

    Angiotensin-converting enzyme inhibitors (ACEI) are often used in preventing and treating heart failure due to regurgitant valve disease. The majority of patients with symptomatic rheumatic heart disease (RHD) have significant mitral stenosis (MS) and are denied ACEI therapy, because of the fear of hypotension in the presence of fixed obstruction. The authors assessed the safety and efficacy of ACEI in 109 consecutive patients with RHD and with significant mitral stenosis (mitral valve orifice, MVO < 1.5 cm2)and with NYHA class III or IV heart failure symptoms. Mean age was 33.1+/-12 years, systolic blood pressure (BP) was 111+/-10, and diastolic BP was 73+/-8 mm Hg. MS was significant in 100 patients with mitral regurgitation in 46, aortic regurgitation in 19, and pulmonary hypertension in 60 patients. After initial stabilization, enalapril 2.5 mg bid was started in hospital and titrated up to 10 mg bid over 2 weeks. NYHA status, Borg score, and 6-minute walk test were assessed at baseline, and at 1, 2, and 4 weeks. Seventy-nine of the 100 patients who completed the study had severe MS (MVO < 1.0 cm2). Enalapril was well tolerated by all study patients without hypotension or worsening of symptoms. NYHA class (3.2+/-0.5 baseline vs 2.3+/-0.5 at 4 weeks, p < 0.01) Borg Dyspnea Index (7.6+/-1.3 vs 5.6+/-1.3, p < 0.01), and 6-minute walk distance (226+/-106 vs 299+/-127 m, p < 0.01) improved significantly with enalapril. Patients with associated regurgitant lesions showed more improvement in exercise capacity (120+/-93 vs 39+/-56 m, p < 0.001). Enalapril was well tolerated in patients with RHD with moderate and severe MS. Irrespective of the valve pathology, enalapril improved functional status and exercise capacity with maximum benefit in patients with concomitant regurgitant valvular heart disease. PMID:15793604

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

    PubMed

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

    2015-12-01

    Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 ± 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 ± 2.3 years, which was significantly different from that of dogs without MVI (5.1 ± 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 ± 2.8 kg) and those without MVI (12.8 ± 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature. PMID:26599093

  8. [Prenatal diagnosis of fetal aortic stenosis with mitral insufficiency. Review of the ultrasound diagnosis and perinatal prognosis: a case report].

    PubMed

    Iglesias-Román, Nuria; Alvarez, Teresa; Bravol, Coral; Pérez, Ricardo; Gámez, Francisco; De León Luis, Juan

    2014-09-01

    This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options. PMID:25412557

  9. Lipomatous hamartoma of mitral valve.

    PubMed

    Bhat, Seetharama Ps; Gowda Sl, Girish; Chikkatur, Raghavendra; Nanjappa, Manjunath C

    2016-01-01

    Primary cardiac tumors are very rare, and tumors arising from cardiac valves are extremely rare. We present a case of lipomatous hamartoma of the mitral valve in a young female. This is the 6th case of lipomatous hamartoma of the mitral valve to be reported. We discuss the operative and histopathological findings. PMID:24821963

  10. Surgical repair of congenital aortic regurgitation by aortic root reduction: A finite element study.

    PubMed

    Hammer, Peter E; Berra, Ignacio; Del Nido, Pedro J

    2015-11-01

    During surgical reconstruction of the aortic valve in the child, the use of foreign graft material can limit durability of the repair due to inability of the graft to grow with the child and to accelerated structural degeneration. In this study we use computer simulation and ex vivo experiments to explore a surgical repair method that has the potential to treat a particular form of congenital aortic regurgitation without the introduction of graft material. Specifically, in an aortic valve that is regurgitant due to a congenitally undersized leaflet, we propose resecting a portion of the aortic root belonging to one of the normal leaflets in order to improve valve closure and eliminate regurgitation. We use a structural finite element model of the aortic valve to simulate the closed, pressurized valve following different strategies for surgical reduction of the aortic root (e.g., triangular versus rectangular resection). Results show that aortic root reduction can improve valve closure and eliminate regurgitation, but the effect is highly dependent on the shape and size of the resected region. Only resection strategies that reduce the size of the aortic root at the level of the annulus produce improved valve closure, and only the strategy of resecting a large rectangular portion-extending the full height of the root and reducing root diameter by approximately 12% - is able to eliminate regurgitation and produce an adequate repair. Ex vivo validation experiments in an isolated porcine aorta corroborate simulation results. PMID:26456424

  11. A case of ventricular septal defect and mitral insufficiency after blunt trauma.

    PubMed

    Masuoka, Ayumu; Kimura, Naritaka; Katogi, Toshiyuki; Suzuki, Takaaki

    2014-09-01

    Few reports have described traumatic heart injury in children. We describe a case of acute mitral regurgitation associated with papillary muscle rupture, traumatic ventricular septal defect, and impending left ventricular free wall rupture due to blunt trauma in a 2-year-old girl. The papillary muscle was sutured to the left ventricular free wall. The septal defect and surrounding ruptured muscle were covered with a pericardial patch, and a Hemashield patch was used to close the ventriculotomy. A residual defect caused by dehiscence of the pericardial patch necessitated reoperation 10 months later. The patient is currently being observed on an outpatient basis. PMID:24887820

  12. 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

  13. Late embolization of a vascular plug III device after mitral paravalvular leak closure.

    PubMed

    Arzamendi, Dabit; Li, Chi Hion; Serra, Antoni

    2013-11-15

    We present a case report of an 80-year-old frail woman with hemolytic anemia and cardiac failure secondary to mitral severe paravalvular regurgitation. Her clinical history was significant for mitral valve replacement that was complicated with a paravalvular leak two months after surgery. The leak was closed percutaneously with an Amplatzer Vascular Plug III single device. A year later she is readmitted with heart failure and the transesophageal echocardiogram revealed a severe paravalvular leak beside the Vascular Plug III device that seemed to be dislodged and rocking. During a new attempt of percutaneous leak closure, while trying to lasso the old device, it embolized to the iliac bifurcation. The old device could be removed from the right femoral artery and the leak could be closed with two new Vascular Plug III devices deployed simultaneously. To our knowledge this is the first reported case of a late embolization of a Vascular Plug III device. PMID:23729270

  14. Macrophage involvement in mitral valve pathology in mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome).

    PubMed

    Brands, Marion; Roelants, Jorine; de Krijger, Ronald; Bogers, Ad; Reuser, Arnold; van der Ploeg, Ans; Helbing, Wim

    2013-10-01

    Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) is a rare lysosomal storage disorder in which the pathologic storage of glycosaminoglycans in various tissues can lead to severe symptoms, including cardiomyopathy. We report on a child with Maroteaux-Lamy syndrome whose cardiac condition deteriorated and eventually led to cardiac failure at the age of 7 years due to severe mitral regurgitation. She received a mitral valve replacement and tricuspid repair with successful outcome. Histologic examination of the mitral valve showed abundant "clear" cells in both the leaflets and chordae tendineae. In Hurler disease (MPS I), similar cells have been identified as activated valvular interstitial cells (VICs, a myofibroblast like cell type). Here we report that the "clear" cells are CD68 positive, a frequently used marker of macrophage lineage. The "clear" cells remained unstained with the more specific macrophage marker CD14 while persistent staining of other cells demonstrated macrophage infiltration. From these observations, we infer that macrophages are involved in mitral valve pathology in MPS VI. PMID:23949968

  15. Acute congestive heart failure due to ruptured mitral chordae tendineae in late pregnancy.

    PubMed

    Ohishi, Sugiko; Nitta, Hayase; Chinen, Yukiko; Kinjo, Tadatsugu; Masamoto, Hitoshi; Sakumoto, Kaoru; Maeda, Tatsuya; Kuniyoshi, Yukio; Aoki, Yoichi

    2013-03-01

    A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928?g with Apgar scores of 7 and 8 at 1 and 5?min, respectively. The patient was managed in the intensive care unit and underwent open-heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life-threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus. PMID:23106781

  16. Caseous Necrosis of Mitral Annulus

    PubMed Central

    Balci, Sinan; Akkaya, Selcuk; Ardali, Selin; Hazirolan, Tuncay

    2015-01-01

    Masses or mass-like lesions located in proximity to mitral valve encompass a wide range of differential diagnoses including neoplasias, abscesses, thrombi, and rarely caseous calcification of mitral annulus. Due to asymptomatic presentation, its diagnosis is usually incidental. Echocardiography is the first choice of imaging in evaluation. Cardiac computed tomography (CT) is helpful in establishing diagnosis by showing dense calcifications while cardiac magnetic resonance imaging (MRI) is used primarily as a problem solving tool. Imaging in evaluation of mitral annulus caseous calcification is essential in order to prevent unnecessary operations. PMID:26355421

  17. Severe tricuspid regurgitation mimicking constrictive pericarditis

    PubMed Central

    Ozpelit, Ebru; Akdeniz, Bahri; Ozpelit, Mehmet Emre; Göldeli, Özhan

    2014-01-01

    Patient: Female, 62 Final Diagnosis: Tricuspid regurgitation Symptoms: Dyspnea exertional • fatigue • leg edema Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Challenging differential diagnosis Background: Tricuspid regurgitation (TR) can mimic some hemodynamic findings of constrictive pericarditis (CP), due to the restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. In this article, we report a case of severe tricuspid regurgitation in which hemodynamic findings were consistent with CP. Case Report: A 62-year-old Caucasian woman presented with right heart failure symptoms. Echocardiography showed enlarged right heart chambers and severe tricuspid regurgitation. Right heart catheterization surprisingly demonstrated a constrictive physiology. Diastolic pressures of both ventricles were elevated and equalized, with a prominent deep and plateau pattern. The patient was re-evaluated with a further focus on constrictive pericarditis. However, echocardiography, thorax CT, and cardiac MRI did not demonstrate any pathological finding related to pericardium. The remaining explanation was that the severe TR itself and secondary right heart enlargement caused the restraining effect on the intact pericardium and on the left ventricle. The pericardium was normal and tricuspid annulus was severely dilated on surgical inspection. The tricuspid valve was replaced with a bioprosthetic valve. The patient did well just after the surgery, with a rapid decrease in cardiac pressures; however, she died due to respiratory failure on the 15th postoperative day. Conclusions: This was a case with right heart failure symptoms in which invasive hemodynamic findings were consistent with constrictive pericarditis and the noninvasive imaging modalities were not. This case illustrates that severe TR can mimic some hemodynamic findings of constrictive pericarditis, due to restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. Lack of significant respiratory changes in hemodynamic parameters that can safely be demonstrated by echocardiography and cardiac MRI suggest a normal pericardium. PMID:24995118

  18. 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 ...

  19. Assisted auscultation : creation and visualization of high dimensional feature spaces for the detection of mitral regurgitation

    E-print Network

    Leeds, Daniel Demeny

    2006-01-01

    Cardiac auscultation, listening to the heart using a stethoscope, often constitutes the first step in detection of common heart problems. Unfortunately, primary care physicians, who perform this initial screening, often ...

  20. Collaborative Research: Advancing the Diagnosis and Quantification of Mitral Valve Regurgitation with

    E-print Network

    Canic, Suncica

    and Stephen Little throughout the internship. · One cardiology post-doctoral fellow (Dimitrios Maragiannis by Stephen Little through out his time at Methodist. He is in the process of completing a PhD in Cardiology at the 1st Department of Cardiology, National and KA Podistrian University of Athens, Hipokration General

  1. Fast Simulation of Mitral Annuloplasty for Surgical Planning

    E-print Network

    valve closure post-annuloplasty using a mass-spring tissue model and subject-specific valve geometry, or regurgitation, decreasing cardiac ef- ficiency and potentially leading to heart failure if left untreated. Valve repair, the surgical modification of the native valve tissue, is the preferred method of treatment

  2. TexMi: development of tissue-engineered textile-reinforced mitral valve prosthesis.

    PubMed

    Moreira, Ricardo; Gesche, Valentine N; Hurtado-Aguilar, Luis G; Schmitz-Rode, Thomas; Frese, Julia; Jockenhoevel, Stefan; Mela, Petra

    2014-09-01

    Mitral valve regurgitation together with aortic stenosis is the most common valvular heart disease in Europe and North America. Mechanical and biological prostheses available for mitral valve replacement have significant limitations such as the need of a long-term anticoagulation therapy and failure by calcifications. Both types are unable to remodel, self-repair, and adapt to the changing hemodynamic conditions. Moreover, they are mostly designed for the aortic position and do not reproduce the native annular-ventricular continuity, resulting in suboptimal hemodynamics, limited durability, and gradually decreasing ventricular pumping efficiency. A tissue-engineered heart valve specifically designed for the mitral position has the potential to overcome the limitations of the commercially available substitutes. For this purpose, we developed the TexMi, a living textile-reinforced mitral valve, which recapitulates the key elements of the native one: annulus, asymmetric leaflets (anterior and posterior), and chordae tendineae to maintain the native annular-ventricular continuity. The tissue-engineered valve is based on a composite scaffold consisting of the fibrin gel as a cell carrier and a textile tubular structure with the twofold task of defining the gross three-dimensional (3D) geometry of the valve and conferring mechanical stability. The TexMi valves were molded with ovine umbilical vein cells and stimulated under dynamic conditions for 21 days in a custom-made bioreactor. Histological and immunohistological stainings showed remarkable tissue development with abundant aligned collagen fibers and elastin deposition. No cell-mediated tissue contraction occurred. This study presents the proof-of-principle for the realization of a tissue-engineered mitral valve with a simple and reliable injection molding process readily adaptable to the patient's anatomy and pathological situation by producing a patient-specific rapid prototyped mold. PMID:24665896

  3. Use of barbed suture in robot-assisted mitral valvuloplasty.

    PubMed

    Watanabe, Go; Ishikawa, Norihiko

    2015-01-01

    Robot-assisted annuloplasty using a mitral band has a major issue: suturing is time consuming because knot tying is performed mechanically under endoscopic view. We suture the mitral band to the native valve by running sutures using the V-Loc barbed suture nonabsorbable wound closure device (Covidien, Mansfield, MA) with 3-0 monofilament. This technique allows rapid suturing of the band to the valve. Although conventional interrupted sutures leave multiple knots protruding on the band, using the V-Loc eliminates the need to tie surgical knots and leaves a clean surface, which may potentially reduce the risk of thrombogenesis. This method is highly useful for robotic mitral annuloplasty. PMID:25555967

  4. Dietary treatment for regurgitation--recommendations from a working party.

    PubMed

    Vandenplas, Y; Belli, D; Cadranel, S; Cucchiara, S; Dupont, C; Heymans, H; Polanco, I

    1998-04-01

    Regurgitation is a common manifestation in infants below the age of 1 y, and is a frequent reason for counselling of general practitioners and paediatricians. Current recommended therapeutic management starts with parental reassurance and dietary measures, followed by prokinetics. In this paper, the efficacy, safety and nutritional implications of the dietary treatment of regurgitation are evaluated. Industrially prepared thickened feeds may contain cereals of fibres; some have a low lipid content and are casein-predominant. Milk-thickened agents can also be added to regular infant feeding. Formulae claimed as "anti-regurgitation formulae", or positioned as such, should be considered as medical foods or therapeutic diets, and only be available on medical prescription. It is proposed to limit the "anti-regurgitation" (AR) label to those diets which have been proven clinically effective on regurgitation and which are nutritionally safe. PMID:9628309

  5. Importance of mitral valve repair associated with left ventricular reconstruction for patients with ischemic cardiomyopathy: a real-time three-dimensional echocardiographic study

    NASA Technical Reports Server (NTRS)

    Qin, Jian Xin; Shiota, Takahiro; McCarthy, Patrick M.; Asher, Craig R.; Hail, Melanie; Agler, Deborah A.; Popovic, Zoran B.; Greenberg, Neil L.; Smedira, Nicholas G.; Starling, Randall C.; Young, James B.; Thomas, James D.

    2003-01-01

    BACKGROUND: Left ventricular (LV) reconstruction surgery leads to early improvement in LV function in ischemic cardiomyopathy (ICM) patients. This study was designed to evaluate the impact of mitral valve (MV) repair associated with LV reconstruction on LV function 1-year after surgery in ICM patients assessed by real-time 3-dimensional echocardiography (3DE). METHODS AND RESULTS: Sixty ICM patients who underwent the combination surgery (LV reconstruction in 60, MV repair in 30, and revascularization in 52 patients) were studied. Real-time 3DE was performed and LV volumes were obtained at baseline, discharge, 6-month and >or=12-month follow-up. Reduction in end-diastolic volumes (EDV) by 29% and in end-systolic volumes by 38% were demonstrated immediately after surgery and remained at subsequent follow-up (P<0.0001). The LV ejection fraction significantly increased by about 10% at discharge and was maintained >or=12-month (P<0.0001). Although the LV volumes were significantly larger in patients with MV repair before surgery (EDV, 235+/-87 mL versus 193+/-67 mL, P<0.05), they were similar to LV volumes of the patients without MV repair at subsequent follow-ups. However, the EDV increased from 139+/-24 mL to 227+/-79 mL (P<0.01) in 7 patients with recurrent mitral regurgitation (MR). Improvement in New York Heart Association functional class occurred in 81% patients during late follow-up. CONCLUSIONS: Real-time 3DE demonstrates that LV reconstruction provides significant reduction in LV volumes and improvement in LV function which is sustained throughout the 1-year follow-up with 84% cardiac event free survival. If successful, MV repair may prevent LV redilation, while recurrent MR is associated with increased LV volumes.

  6. Dynamic simulation of heart mitral valve with transversely isotropic material model

    E-print Network

    Weinberg, Eli, 1979-

    2005-01-01

    This thesis develops two methods for simulating, in the finite element setting, the material behavior of heart mitral valve leaflet tissue. First, a mixed pressure-displacement formulation is used to implement the constitutive ...

  7. 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.

  8. Diagnosis and Treatment of Left-Sided Prosthetic Paravalvular Regurgitation.

    PubMed

    Lampropoulos, Konstantinos; Aggeli, Constantina; Megalou, Aikaterini; Barbetseas, John; Budts, Werner

    2016-01-01

    Paravalvular leak (PVL) is a complication related to the surgical implantation of left-sided prosthetic valves. The prevalence of paravalvular regurgitation ranges between 5 and 20%. Left-sided prosthetic paravalvular regurgitation presents with a wide constellation of signs and symptoms ranging from asymptomatic murmur to heart failure, hemolysis and cardiac cachexia. Echocardiography plays a key role in imaging the PVL and can help in guiding the closure procedure with both transesophageal and intracardiac probes. Transcatheter closure of paravalvular regurgitations is an appealing prospect. PMID:26414284

  9. 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

  10. A critical appraisal of current management practices for infant regurgitation.

    PubMed

    Vandenplas, Y

    1997-01-01

    Regurgitation is a common manifestation in infants below the age of one year and a frequent reason of counseling of general practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics. Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastro-oesophageal reflux in a subset of infants receiving milk thickeners or thickened "anti-regurgitation formula" challenge the established approach. Therefore, the clinical practices for management of infant regurgitation have been critically evaluated with respect to their efficacy, safety and practical implications. The updated recommendations on the management of infant regurgitation contain 5 phases: (1A) parental reassurance; (1B) milk-thickening agents; (2) prokinetics; (3) positional therapy as an adjuvant therapy; (4A) H2-blockers; (4B) proton pump inhibitors; (5) surgery. PMID:9230536

  11. 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. PMID:26150860

  12. Alternative approaches for mitral valve repair

    PubMed Central

    Goldstone, Andrew B.

    2015-01-01

    Unique situations arise in which alternative exposures for mitral valve surgery offer distinct advantages over traditional approaches. Each exposure facilitates both mitral valve repair and replacement, although the standard repair procedures must be modified to accommodate these non-traditional exposures. Here, we detail the technical considerations required to perform transventricular and transaortic mitral valve repair as well as discuss the advantages for employing these less conventional approaches. PMID:26539353

  13. 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.

  14. 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.

  15. 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

    2015-08-01

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of trans- catheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26170468

  16. 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

  17. 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.

  18. The Circulating Levels of Selenium, Zinc, Midkine, Some Inflammatory Cytokines, and Angiogenic Factors in Mitral Chordae Tendineae Rupture.

    PubMed

    Aydemir, Birsen; Akdemir, Ramazan; Vatan, M Bulent; Cinemre, F Behice; Cinemre, Hakan; Kiziler, Ali Riza; Bahtiyar, Nurten; Buyukokuroglu, M Emin; Gurol, Gonul; Ogut, Selim

    2015-10-01

    Chordae tendineae rupture process is associated with increased production of inflammatory and angiogenesis mediators in connective tissues, which contributes to chronic inflammation and pathogenesis of degenerative chordae. A few trace elements are known to possess antioxidant, anti-inflammatory, and antiangiogenic properties. Therefore, the aim of this study was to determine whether zinc, selenium, midkine (MK), interleukin-1? (IL-1?), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-?), vascular endothelial growth factor-A (VEGF-A), platelet-derived growth factor-BB (PDGF-BB), and reduced glutathione (GSH) levels are associated with inflammation and angiogenesis processes in the context of a potential etiology causing aggravation of mitral regurgitation and/or ruptured chordae tendineae. Seventy-one subjects comprising 34 patients with mitral chordae tendineae rupture (MCTR) and 37 healthy controls diagnosed on the basis of their clinical profile and transthoracic echocardiography were included in this study. The levels of GSH, MK, selenium, and zinc were found to be lower in the patients group when compared to control group. There were no significant difference in plasma TNF-?, IL-1?, IL-6, IL-8, VEGF-A, and PDGF-BB levels between two groups. There were positive significant correlations between MK and GSH, MK, and selenium levels in patients with MCTR. According to our data in which selenium, zinc, MK, and GSH decreased in MCTR patients, inflammatory response, oxidative stress, and trace element levels may contribute to etiopathogenesis of mitral regurgitation and/or ruptured chordae tendineae. PMID:25787827

  19. 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

  20. 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.

  1. Isolated Tricuspid Regurgitation: Initial Manifestation of Cardiac Amyloidosis

    PubMed Central

    Yoon, Dong Woog; Park, Byung-Jo; Kim, In Sook; Jeong, Dong Seop

    2015-01-01

    Amyloid deposits in the heart are not exceptional in systemic amyloidosis. The clinical manifestations of cardiac amyloidosis may include restrictive cardiomyopathy, characterized by progressive diastolic and eventually systolic bi-ventricular dysfunction; arrhythmia; and conduction defects. To the best of our knowledge, no previous cases of isolated tricuspid regurgitation as the initial manifestation of cardiac amyloidosis have been reported. We describe a rare case of cardiac amyloidosis that initially presented with severe tricuspid regurgitation in a 42-year-old woman who was successfully treated with tricuspid valve replacement. Unusual surgical findings prompted additional evaluation that established a diagnosis of plasma cell myeloma. PMID:26665112

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

    PubMed

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

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation. PMID:25963782

  3. 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

  4. 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

  5. Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography: a validation study with cardiac magnetic resonance imaging.

    PubMed

    Choi, Jaehuk; Hong, Geu-Ru; Kim, Minji; Cho, In Jeong; Shim, Chi Young; Chang, Hyuk-Jae; Mancina, Joel; Ha, Jong-Won; Chung, Namsik

    2015-10-01

    Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging (PC-CMR) as the reference method. Automated AR quantification using 3D-FVCDE was feasible in 30 of the 32 patients. 2D-PISA underestimated the AR volume compared to 3D-FVCDE and PC-CMR (38.6 ± 9.9 mL by 2D-PISA; 49.5 ± 10.2 mL by 3D-FVCDE; 52.3 ± 12.6 mL by PC-CMR). The AR volume assessed by 3D-FVCDE showed better correlation and agreement with PC-CMR (r = 0.93, p < 0.001, 2SD: 9.5 mL) than did 2D-PISA (r = 0.76, p < 0.001, 2SD: 15.7 mL). When used to classify AR severity, 3D-FVCDE agreed better with PC-CMR (k = 0.94) than did 2D-PISA (k = 0.53). In patients with eccentric jets, only 30% were correctly graded by 2D-PISA. Conversely, almost all patients with eccentric jets (86.7%) were correctly graded by 3D-FVCDE. In patients with multiple jets, only 3 out of 10 were correctly graded by 2D-PISA, while 3D-FVCDE correctly graded 9 out of 10 of these patients. Automated quantification of AR using the 3D-FVCDE method is clinically feasible and more accurate than the current 2D-based method. AR quantification by 2D-PISA significantly misclassified AR grade in patients with eccentric or multiple jets. This study demonstrates that 3D-FVCDE is a valuable tool to accurately measure AR volume regardless of AR characteristics. PMID:26164059

  6. Quantitative mitral valve anatomy and pathology

    PubMed Central

    Monaghan, Mark J

    2015-01-01

    Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications.

  7. 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. PMID:26140149

  8. Study of collagen structure in canine myxomatous mitral valve disease 

    E-print Network

    Hadian, Mojtaba

    2009-01-01

    Myxomatous mitral valve disease (MMVD) is the single most common acquired cardiac disease of dogs, and is a disease of significant veterinary importance. It also bears close similarities to mitral valve prolapse in humans ...

  9. Distribution of Mitral Annular and Aortic Valve Calcium as Assessed by Unenhanced Multidetector Computed Tomography.

    PubMed

    Koshkelashvili, Nikoloz; Codolosa, Jose N; Goykhman, Igor; Romero-Corral, Abel; Pressman, Gregg S

    2015-12-15

    Aging is associated with calcium deposits in various cardiovascular structures, but patterns of calcium deposition, if any, are unknown. In search of such patterns, we performed quantitative assessment of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a broad clinical sample. Templates were created from gated computed tomography (CT) scans depicting the aortic valve cusps and mitral annular segments in relation to surrounding structures. These were then applied to CT reconstructions from ungated, clinically indicated CT scans of 318 subjects, aged ?65 years. Calcium location was assigned using the templates and quantified by the Agatston method. Mean age was 76 ± 7.3 years; 48% were men and 58% were white. Whites had higher prevalence (p = 0.03) and density of AVC than blacks (p = 0.02), and a trend toward increased MAC (p = 0.06). Prevalence of AVC was similar between men and women, but AVC scores were higher in men (p = 0.008); this difference was entirely accounted for by whites. Within the aortic valve, the left cusp was more frequently calcified than the others. MAC was most common in the posterior mitral annulus, especially its middle (P2) segment. For the anterior mitral annulus, the medial (A3) segment calcified most often. In conclusion, AVC is more common in whites than blacks, and more intense in men, but only in whites. Furthermore, calcium deposits in the mitral annulus and aortic valve favor certain locations. PMID:26517948

  10. Bioprosthetic mitral valve dysfunction due to native valve preserving procedure.

    PubMed

    Matsuno, Yukihiro; Mori, Yoshio; Umeda, Yukio; Takiya, Hiroshi

    2014-11-12

    Mitral valve replacement with preservation of the mitral leaflets and subvalvular apparatus is considered to maintain left ventricular geometry and function and reduce the risk of myocardial rupture. However, the routine use of this technique may lead to early complications such as left ventricular outflow tract obstruction and even mitral inflow obstruction, requiring reoperation. We describe a rare case of bioprosthetic mitral valve dysfunction caused by a native valve preserving procedure. PMID:25392048

  11. 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…

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

    E-print Network

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

    2015-01-01

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

  13. [Left Ventricular Rupture following Mitral Valve Replacement].

    PubMed

    Yamaguchi, Atsushi

    2015-07-01

    Left ventricular rupture is a rare but lethal complication after mitral valve replacement (MVR). Between 1989 and 2014, of 850 patients who underwent MVR, 6 developed left ventricular rupture in Saitama Medical Center, Jichi Medical University. Treasure type I rupture occurred in 5 patients and Miller type III in 1. Four cases developed ventricular rupture right after declamping of the ascending aorta, and the remaining 2 after the transfer to the intensive care unit( ICU). Prompt surgical therapy was achieved for the instant closure of the muscular wall defect under the cardiopulmonary bypass and cardiac arrest, however, leading to the disappointing result of 66.7% of hospital death. It is the most important to relieving the stress of the posterior wall of the left ventricle during mitral surgery by using the modification techniques with the preservation of posterior mitral leaflet and avoiding pre and afterload of the left ventricle right after the MVR. PMID:26197900

  14. [Mitral Valvuloplasty of Infective Endocarditis During Pregnancy].

    PubMed

    Miyaki, Yasuko; Higami, Tetsuya; Ishikawa, Natsuya; Takagi, Nobuyuki; Tachibana, Kazutoshi; Hagiwara, Takayuki

    2015-11-01

    This report describes a case in which we treated a patient who developed infective endocarditis in the mitral valve at 28 weeks' gestation. The condition was resolved by performing mitral valvuloplasty 2 days after an emergency cesarean section. Although the patient was in a relatively stable period at 32 weeks' gestation, the mother had an extremely high risk of embolism;thus, emergency surgery was required. We believe that an accurate diagnosis in a timely manner and a valvuloplasty shortly after cesarean section saved the life of the mother and child. PMID:26555912

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

    PubMed Central

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

    2015-01-01

    Objectives The present study is the first meta-analysis to compare the surgical outcomes of robotic vs. conventional mitral valve surgery in patients with degenerative mitral valve disease. Methods A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic vs. conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalization and duration of intensive care unit (ICU) stay. Echocardiographic outcomes were assessed when possible. Results Six relevant retrospective studies with comparative data for robotic vs. conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalization and ICU stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. Conclusions Current evidence on comparative outcomes of robotic vs. conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety. PMID:26309839

  16. Reference values for mitral and tricuspid annular dimensions using two-dimensional echocardiography

    PubMed Central

    Dwivedi, Girish; Mahadevan, Ganadevan; Jimenez, Donie; Frenneaux, Michael

    2014-01-01

    Only limited data are available from which normal ranges of mitral annular (MA) and tricuspid annular (TA) dimensions have been established. Normative data are important to assist the echocardiographer in defining the mechanism of atrioventricular valve regurgitation and to inform surgical planning. This study was conceived to establish normal MA and TA dimensions. Consecutive healthy subjects over the age of 60 were randomly recruited from the community as part of a screening project within South Birmingham. MA and TA dimensions in end-systole and end-diastole were evaluated in the parasternal and apical acoustic windows views using transthoracic echocardiography. Gender (males (M) and females (F))-specific dimensions were then assessed. A total of 554 subjects were screened and 74 with pathology considered to have an effect on annular dimensions were excluded from analysis. The mean age of the remaining 480 subjects was 70±7 years and the majority were female (56%). Dimensions were larger in men than in women and greater at end-diastole than end-systole (both P<0.05). Mean MA diameters at end-systole in the parasternal long axis view (cm) were 3.44?cm (M) and 3.11?cm (F) and at end-diastole 3.15?cm (M) and 2.83?cm (F) respectively. Mean TA diameters (cm) at end-systole in the apical 4 chamber view were 2.84 (M) and 2.80 (F) and at end-diastole 3.15 (M) and 3.01 (F) respectively. The reference ranges derived from this study differ from current published standards and should help to improve distinction of normal from pathological findings, in identifying aetiology and defining the mechanism of regurgitation.

  17. Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure in Postpartum Woman With Rheumatic Mitral Valve Disease: Benefit, Factors Furthering the Success of This Procedure, and Review of the Literature

    PubMed Central

    Fayad, Georges; Larrue, Benoît; Modine, Thomas; Azzaoui, Richard; Regnault, Alexi; Koussa, Mohammad; Gourlay, Terry; Fourrier, François; Decoene, Christophe; Warembourg, Henri

    2007-01-01

    Abstract: Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40°C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient’s medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support. PMID:17672195

  18. Application of color Doppler flow mapping to calculate orifice area of St Jude mitral valve

    NASA Technical Reports Server (NTRS)

    Leung, D. Y.; Wong, J.; Rodriguez, L.; Pu, M.; Vandervoort, P. M.; Thomas, J. D.

    1998-01-01

    BACKGROUND: The effective orifice area (EOA) of a prosthetic valve is superior to transvalvular gradients as a measure of valve function, but measurement of mitral prosthesis EOA has not been reliable. METHODS AND RESULTS: In vitro flow across St Jude valves was calculated by hemispheric proximal isovelocity surface area (PISA) and segment-of-spheroid (SOS) methods. For steady and pulsatile conditions, PISA and SOS flows correlated with true flow, but SOS and not PISA underestimated flow. These principles were then used intraoperatively to calculate cardiac output and EOA of newly implanted St Jude mitral valves in 36 patients. Cardiac output by PISA agreed closely with thermodilution (r=0.91, Delta=-0.05+/-0.55 L/min), but SOS underestimated it (r=0.82, Delta=-1.33+/-0.73 L/min). Doppler EOAs correlated with Gorlin equation estimates (r=0.75 for PISA and r=0.68 for SOS, P<0.001) but were smaller than corresponding in vitro EOA estimates. CONCLUSIONS: Proximal flow convergence methods can calculate forward flow and estimate EOA of St Jude mitral valves, which may improve noninvasive assessment of prosthetic mitral valve obstruction.

  19. Juvenile severe mitral stenosis predisposing Eisenmenger syndrome in a case with ventricular septal defect, patent ductus arteriosus, coarctation of aorta & hypoplastic aortic arch: Report of first case of rare association

    PubMed Central

    Patra, Soumya; Kumar, Basant; Sadananda, Kanchanahalli Siddegowda; Krishnappa, Santhosh; Basappa, Harsha; Nanjappa, Manjunath Cholenahalli

    2013-01-01

    We are reporting the first case of rare association between multiple congenital cardiac malformations with severe rheumatic mitral stenosis which is an acquired structural cardiac disease. A 16 years old female patient presented with progressive dyspnoea & cyanosis for the last one month with past history of recurrent pneumonia since infancy. Physical examination revealed presence of cyanosis, grade I clubbing, radio-radial & radio-femoral delay, loud & single second heart sound, apical long mid diastolic murmur and left parasternal ejection systolic murmur. Transthoracic echocardiography revealed severe rheumatic mitral stenosis, multiple ventricular septal defects (VSD) with bidirectional shunt, hypoplastic aortic arch, Coarctation of aorta and severe pulmonary hypertension. Transesophageal echocardiography revealed the same findings along with the presence of moderate mitral regurgitation and 9 mm perimembranous VSD extending into muscular septum. Cardiac catheterization study confirmed the echocardiographic findings and demonstrated large patent ductus arteriosus (PDA). We have planned for high-risk percutaneous transmitral commissurotomy (PTMC) for this patient to decrease the back pressure on pulmonary vasculature. So that right to left shunt will be decreased and cyanosis will also improve. But parents refused to give consent for PTMC. She was on treatment with regular penicillin prophylaxis, diuretics, sildenafil and infective endocarditic prophylaxis. We should be aware of this kind of complex association between congenital and acquired structure heart disease. Eisenmenger syndrome could also be a presentation of juvenile severe rheumatic mitral stenosis when it is associated with congenital shunt lesion like VSD/PDA in our case. PMID:24396261

  20. 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…

  1. 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

    2015-08-01

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of 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:26170467

  2. 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

  3. Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery

    PubMed Central

    Gillinov, A. Marc; Gelijns, Annetine C.; Parides, Michael K.; DeRose, Joseph J.; Moskowitz, Alan J.; Voisine, Pierre; Ailawadi, Gorav; Bouchard, Denis; Smith, Peter K.; Mack, Michael J.; Acker, Michael A.; Mullen, John C.; Rose, Eric A.; Chang, Helena L.; Puskas, John D.; Couderc, Jean-Philippe; Gardner, Timothy J.; Varghese, Robin; Horvath, Keith A.; Bolling, Steven F.; Michler, Robert E.; Geller, Nancy L.; Ascheim, Deborah D.; Miller, Marissa A.; Bagiella, Emilia; Moquete, Ellen G.; Williams, Paula; Taddei-Peters, Wendy C.; O’Gara, Patrick T.; Blackstone, Eugene H.; Argenziano, Michael

    2015-01-01

    Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.) PMID:25853744

  4. Paravalvular leak closure for persisting aortic regurgitation after implantation of the CoreValve transcatheter valve.

    PubMed

    Poliacikova, Petra; Hildick-Smith, David

    2014-07-01

    Significant aortic regurgitation after TAVI results in lack of symptomatic and prognostic benefit from the procedure and generally requires intervention. While most of the regurgitations can be successfully targeted with standard techniques, occasional patients have restrictive calcification resistant to post-dilatation and significant regurgitation persists. We present a case of refractory aortic regurgitation successfully treated with percutaneous paravalvular leak closure. An 81-year-old man with symptomatic severe aortic stenosis underwent a transfemoral CoreValve TAVI in December 2009. He had significant aortic regurgitation refractory to medical and interventional therapy including balloon post-dilatation, valve repositioning and valve-in-valve reimplantation. Aortic regurgitation remained severe and therefore in early 2013, we proceeded with an attempted percutaneous closure of the residual paraprosthetic leak. Using 6-French femoral access and a Terumo wire, the defect was successfully crossed with a 4-French Multipurpose catheter and an 8 mm Amplatzer Vascular Plug 4 device (St. Jude Medical) was deployed through this catheter, resulting in abolition of aortic regurgitation on aortography and TOE, with associated excellent clinical response. Refractory paravalvular aortic regurgitation post CoreValve implantation can be successfully treated using the Amplatzer Vascular Plug 4 device. PMID:24130146

  5. 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

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

    PubMed Central

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

    2013-01-01

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

  7. 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

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

    PubMed

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

    2016-01-01

    Although finite element analysis has been used to model simple mitral repair, it has not been used to model complex repair. A virtual mitral valve model was successful in simulating normal and abnormal valve function. Models were then developed to simulate an edge-to-edge repair and repair employing quadrangular resection. Stress contour plots demonstrated increased stresses along the mitral annulus, corresponding to the annuloplasty. The role of finite element analysis in guiding clinical practice remains undetermined. PMID:24904177

  9. Evolution of the concept and practice of mitral valve repair

    PubMed Central

    Tchantchaleishvili, Vakhtang; Rajab, Taufiek K.

    2015-01-01

    The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, cardiologists and cardiac anesthesiologists has resulted in excellent outcomes. In spite of this, the etiology of mitral valve pathology ultimately determines the outcome of mitral valve repair. PMID:26309840

  10. Surgical Management of Caseous Calcification of the Mitral Annulus.

    PubMed

    Wehman, Brody; Dawood, Murtaza; Ghoreishi, Mehrdad; Cheema, Faisal; Jones, Jace W; Kane, Maureen A; Ward, Christopher W; Gammie, James S

    2015-06-01

    Caseous calcification of the mitral annulus is a rare variant of mitral annular calcification where liquefaction and caseation result in formation of a mass at the border of the calcified annulus. Limited reports of operative therapy for caseous calcification of the mitral annulus describe wide excision and gross débridement of the mass, a technique that can cause perioperative stroke. We present a strategy of limited incision and drainage of the liquid material, closure of the incision, and subsequent suture obliteration of the cavity and mitral valve repair or replacement. In our experience, this technique is safe and has not been associated with perioperative stroke. PMID:26046892

  11. Effect of the mitral valve on diastolic flow patterns

    SciTech Connect

    Seo, Jung Hee; Vedula, Vijay; Mittal, Rajat; Abraham, Theodore; Dawoud, Fady; Luo, Hongchang; Lardo, Albert C.

    2014-12-15

    The leaflets of the mitral valve interact with the mitral jet and significantly impact diastolic flow patterns, but the effect of mitral valve morphology and kinematics on diastolic flow and its implications for left ventricular function have not been clearly delineated. In the present study, we employ computational hemodynamic simulations to understand the effect of mitral valve leaflets on diastolic flow. A computational model of the left ventricle is constructed based on a high-resolution contrast computed-tomography scan, and a physiological inspired model of the mitral valve leaflets is synthesized from morphological and echocardiographic data. Simulations are performed with a diode type valve model as well as the physiological mitral valve model in order to delineate the effect of mitral-valve leaflets on the intraventricular flow. The study suggests that a normal physiological mitral valve promotes the formation of a circulatory (or “looped”) flow pattern in the ventricle. The mitral valve leaflets also increase the strength of the apical flow, thereby enhancing apical washout and mixing of ventricular blood. The implications of these findings on ventricular function as well as ventricular flow models are discussed.

  12. Robotically assisted minimally invasive mitral valve surgery.

    PubMed

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

    2013-11-01

    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

  13. HOW DO ANNULOPLASTY RINGS AFFECT MITRAL LEAFLET DYNAMIC MOTION?

    PubMed Central

    Bothe, Wolfgang; Kvitting, John-Peder Escobar; Swanson, Julia C.; Göktepe, Serdar; Vo, Kathy N.; Ingels, Neil B.; Miller, D. Craig

    2010-01-01

    Objectives To define the effects of annuloplasty rings (ARs) on the dynamic motion of anterior and posterior mitral leaflets (AML, PML). Methods Sheep had radiopaque markers inserted: 8 around the mitral annulus, four along the central meridian (from edge to annulus) of the AML (#A1–#A4) and one on the PML edge (#P1). True-sized Edwards Cosgrove (COS, n=12), St Jude RSAR (n=12), Carpentier-Edwards Physio (PHYSIO, n=12), Edwards IMR ETlogix (ETL, n=10) or Edwards GeoForm (GEO, n=12) ARs were implanted in a releasable fashion. Under acute open-chest conditions, 4-D marker coordinates were obtained using biplane videofluoroscopy with the ARs inserted (COS, RSAR, PHYSIO, ETL, GEO) and after release (COS-CONTROL, RSAR-CONTROL, PHYSIO-CONTROL, ETL-CONTROL, GEO-CONTROL). AML and PML excursions were calculated as the difference between minimum and maximum angles between the central mitral annular septal-lateral chord and the anterior mitral leaflet edge markers (?1exc – ?4exc) and PML edge marker (?1exc) during the cardiac cycle. Results Relative to CONTROL, 1.) RSAR, PHYSIO, ETL and GEO increased excursion of the AML annular (?4exc: 13±6° vs. 16±7°*, 16±7° vs. 23±10°*, 12±4° vs. 18±9°*, 15±1° vs. 20±9°*, respectively) and belly region (?2exc: 41±10° vs. 45±10°*, 42±8° vs. 45±6°, n.s., 33±13° vs. 42±14°*, 39±6° vs. 44±6°*, respectively, ?3exc: 24±9° vs. 29±11°*, 28±10° vs. 33±10°*, 16±9° vs. 21±12°*, 25±7° vs. 29±9°*, respectively), but not of the AML edge (?1exc: 42±8° vs. 44±8°, 43±8° vs. 41±6°, 42±11 vs. 46±10°, 39±9° vs. 38±8°, respectively, all n.s.). COS did not affect AML excursion (?1exc: 40±8° vs. 37±8°, ?2exc: 43±9° vs. 41±9°, ?3exc: 27±11° vs. 27±10°, ?4exc: 18±8° vs. 17±7°,, all n.s.). 2.) PML excursion (?1exc) was reduced with GEO (53±5° vs. 43±6°*), but unchanged with COS, RSAR, PHYSIO or ETL (53±13° vs. 52±15°, 50±13° vs. 49±10°, 55±5° vs. 55±7°, 52±8° vs. 58±6°, respectively, all n.s). *=p<0.05 Conclusions RSAR, PHYSIO, ETL and GEO rings, but not COS, increase AML excursion of the AML annular and belly region suggesting higher anterior mitral leaflet bending stresses with rigid rings, which potentially could be deleterious with respect to repair durability. The decreased PML excursion observed with GEO could impair LV filling. Clinical studies are needed to validate these findings in patients. PMID:20335042

  14. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa.

    PubMed

    Lin, Albert; Poppas, Athena; Mansoor, Atizaz; Fernandez, Antonio B

    2015-01-01

    A pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare but potentially fatal complication seen primarily in the context of infective endocarditis. In this study, we discuss a case of infective endocarditis that was complicated by the rupture of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa. We review the salient echocardiographic findings of this clinical condition. PMID:25050527

  15. Heme oxygenase derived carbon monoxide and iron mediated plasmatic hypercoagulability in a patient with calcific mitral valve disease.

    PubMed

    Thompson, Jess L; Nielsen, Vance G; Castro, Allison R; Chen, Andrew

    2015-05-01

    We present a case of a patient with calcific mitral valve stenosis and plasmatic hypercoagulability. Using thrombelastography, the patient was determined to have an abnormally large velocity of plasma thrombus growth and strength with reduced vulnerability to lysis. Critically, increased carboxyhemoglobin concentration (2.4 %) was present, likely secondary to hemolysis from mitral stenosis and engagement of systemic heme oxygenase. It was determined that the patient's plasmatic hypercoagulability was in part due to carboxyhemefibrinogen formation and iron-enhancement of coagulation via two thrombelastographic methods. In conclusion, future investigation of the involvement of both carbon monoxide and iron mediated hypercoagulability in the setting of stenotic valve disease is warranted. PMID:25169134

  16. [Left ventricular rupture of mitral valve prosthesis implantation treated using an intra-aortic balloon pump counterpulsation].

    PubMed

    García-Villarreal, Ovidio Alberto; Ramírez-González, Bertín; Saldaña-Becerra, Martín A

    2015-01-01

    Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. In spite of the fact that several methods of repair have previously been described, the mortality rate remains nearly 85%. The use of the intra-aortic balloon pump counterpulsation may increase the possibilities of success in the repair of this dreaded complication. We present here three cases of left ventricular rupture associated to mitral valve prosthesis implantation successfully treated with the aid of intra-aortic balloon pump counterpulsation. PMID:26581539

  17. Review of the endovascular approach to mitral valve disease.

    PubMed

    Bergsland, Jacob; Mirtaheri, Peyman; Hiorth, Nikolai; Fosse, Erik

    2015-01-01

    The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be briefly described. PMID:26201541

  18. ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation

    PubMed Central

    Helbing, W A; Roest, A A W; Niezen, R A; Vliegen, H W; Hazekamp, M G; Ottenkamp, J; de Roos, A; van der Wall, E E

    2002-01-01

    Background: In patients with the tetralogy of Fallot, QRS prolongation predicts malignant ventricular arrhythmias. QRS prolongation may result from right ventricular dilatation. The relation of ECG markers to biventricular wall mass and volumes has not been assessed. Objective: To investigate the relations of surface ECG markers of depolarisation and repolarisation to right and left ventricular volume and biventricular wall mass. Methods: 37 Fallot patients (mean (SD) age 17 (9) years) were studied 14 (8) years after surgical repair; 34 had important pulmonary regurgitation. Left and right ventricular size was assessed from tomographic magnetic resonance imaging (MRI), and the amount of pulmonary regurgitation by velocity mapping MRI. QT, QRS, and JT duration and interlead dispersion markers were derived from a standard 12 lead ECG. Results: Mean QRS duration was significantly prolonged (133 (31) v 91 (11) ms in controls), as were dispersion of QRS (36 (17) v 20 (6) ms), QT interval (87 (48) v 42 (20) ms), and JT interval (93 (48) v 42 (19) ms). Biventricular volumes were increased (right ventricular end diastolic volume, 129 (41) v 70 (9) ml/m2; left ventricular end diastolic volume, 83 (16) v 69 (10) ml/m2), as was right ventricular wall mass (24 (7) v 17 (2) g/m2). QRS duration correlated best with right ventricular mass (r = 0.55, p < 0.01). Conclusions: In patients operated on for tetralogy of Fallot and with pulmonary regurgitation, ECG predictors of ventricular arrhythmias are influenced by several mechanical factors that may occur simultaneously. These include increased right ventricular volume, but also increases in left ventricular volume and in right and left ventricular wall mass. PMID:12381647

  19. A critical appraisal of current management practices for infant regurgitation--recommendations of a working party.

    PubMed

    Vandenplas, Y; Belli, D; Benhamou, P; Cadranel, S; Cezard, J P; Cucchiara, S; Dupont, C; Faure, C; Gottrand, F; Hassall, E; Heymans, H; Kneepkens, C M; Sandhu, B

    1997-05-01

    Regurgitation is a common manifestation in infants below the age of 1 year and a frequent reason of counselling of general practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics. Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastro-oesophageal reflux in a subset of infants receiving milk thickeners or thickened "anti-regurgitation formula" challenge the established approach. Therefore, the clinical practices for management of infant regurgitation have been critically evaluated with respect to their efficacy, safety and practical implications. The updated recommendations reached by the working party on the management of infant regurgitation contain five phases: (1 A) parental reassurance; (1 B) milk-thickening agents; (2) prokinetics; (3) positional therapy as an adjuvant therapy; (4 A) H2-blockers; (4 B) proton pump inhibitors; (5) surgery. PMID:9177975

  20. Multi-Scale Biomechanical Remodeling in Aging and Genetic Mutant Murine Mitral Valve Leaflets: Insights into Marfan Syndrome

    PubMed Central

    Gould, Russell A.; Sinha, Ravi; Aziz, Hamza; Rouf, Rosanne; Dietz, Harry C.; Judge, Daniel P.; Butcher, Jonathan

    2012-01-01

    Mitral valve degeneration is a key component of the pathophysiology of Marfan syndrome. The biomechanical consequences of aging and genetic mutation in mitral valves are poorly understood because of limited tools to study this in mouse models. Our aim was to determine the global biomechanical and local cell-matrix deformation relationships in the aging and Marfan related Fbn1 mutated murine mitral valve. To conduct this investigation, a novel stretching apparatus and gripping method was implemented to directly quantify both global tissue biomechanics and local cellular deformation and matrix fiber realignment in murine mitral valves. Excised mitral valve leaflets from wild-type and Fbn1 mutant mice from 2 weeks to 10 months in age were tested in circumferential orientation under continuous laser optical imaging. Mouse mitral valves stiffen with age, correlating with increases in collagen fraction and matrix fiber alignment. Fbn1 mutation resulted in significantly more compliant valves (modulus 1.34±0.12 vs. 2.51±0.31 MPa, respectively, P<.01) at 4 months, corresponding with an increase in proportion of GAGs and decrease in elastin fraction. Local cellular deformation and fiber alignment change linearly with global tissue stretch, and these slopes become more extreme with aging. In comparison, Fbn1 mutated valves have decoupled cellular deformation and fiber alignment with tissue stretch. Taken together, quantitative understanding of multi-scale murine planar tissue biomechanics is essential for establishing consequences of aging and genetic mutations. Decoupling of local cell-matrix deformation kinematics with global tissue stretch may be an important mechanism of normal and pathological biomechanical remodeling in valves. PMID:22984535

  1. Detection of seed DNA in regurgitates of granivorous carabid beetles.

    PubMed

    Wallinger, C; Sint, D; Baier, F; Schmid, C; Mayer, R; Traugott, M

    2015-12-01

    Granivory can play a pivotal role in influencing regeneration, colonization as well as abundance and distribution of plants. Due to their high abundance, nutrient content and longevity, seeds are an important food source for many animals. Among insects, carabid beetles consume substantial numbers of seeds and are thought to be responsible for a significant amount of seed loss. However, the processes that govern which seeds are eaten and are therefore prevented from entering the seedbank are poorly understood. Here, we assess if DNA-based diet analysis allows tracking the consumption of seeds by carabids. Adult individuals of Harpalus rufipes were fed with seeds of Taraxacum officinale and Lolium perenne allowing them to digest for up to 3 days. Regurgitates were tested for the DNA of ingested seeds at eight different time points post-feeding using general and species-specific plant primers. The detection of seed DNA decreased with digestion time for both seed species, albeit in a species-specific manner. Significant differences in overall DNA detection rates were found with the general plant primers but not with the species-specific primers. This can have implications for the interpretation of trophic data derived from next-generation sequencing, which is based on the application of general primers. Our findings demonstrate that seed predation by carabids can be tracked, molecularly, on a species-specific level, providing a new way to unravel the mechanisms underlying in-field diet choice in granivores. PMID:26271284

  2. A new approach to the interventional therapy of tricuspid regurgitation.

    PubMed

    Amerini, Andrea Luigi; Malasa, Margarita; Hatam, Nima; Safi, Yara; Steinseifer, Ulrich; Mahnken, Andreas; Goetzenich, Andreas; Haushofer, Marcus; Hildinger, Martin; Autschbach, Rudiger; Carpi, Angelo; Spillner, Jan Wilhelm

    2013-01-01

    Currently, there are no fully developed interventional approaches for the treatment of tricuspid regurgitation (TR). The aim of this study was to evaluate the feasibility of orthotopic interventional placement of a biological prosthetic valve in the tricuspid position by inserting, with a transvenous approach, a self-expandable valve-bearing stent into the right atrium. Based on findings of computerized tomography (CT), a model of the porcine right heart was obtained. A self-expanding vascular endoprosthesis, carrying a prosthetic heart valve, was reshaped to fit the superior vena cava and the tricuspid annulus. Fenestrations were created to allow blood flow from the inferior vena cava and coronary sinus. This new device ("tricuspid endoprosthesis": TE) was implanted operatively into the superior vena cava, right atrium, and tricuspid annulus in six pigs. CT demonstrated proper fitting of the device, and echocardiography demonstrated correct positioning and function of the TE. Five animals were successfully weaned from cardiopulmonary bypass. Autopsy confirmed correct positioning of the TE without major trauma to surrounding tissues. These findings demonstrate a complete interventional approach for treating TR. PMID:23277010

  3. On the effects of leaflet microstructure and constitutive model on the closing behavior of the mitral valve.

    PubMed

    Lee, Chung-Hao; Rabbah, Jean-Pierre; Yoganathan, Ajit P; Gorman, Robert C; Gorman, Joseph H; Sacks, Michael S

    2015-11-01

    Recent long-term studies showed an unsatisfactory recurrence rate of severe mitral regurgitation 3-5 years after surgical repair, suggesting that excessive tissue stresses and the resulting strain-induced tissue failure are potential etiological factors controlling the success of surgical repair for treating mitral valve (MV) diseases. We hypothesized that restoring normal MV tissue stresses in MV repair techniques would ultimately lead to improved repair durability through the restoration of MV normal homeostatic state. Therefore, we developed a micro- and macro- anatomically accurate MV finite element model by incorporating actual fiber microstructural architecture and a realistic structure-based constitutive model. We investigated MV closing behaviors, with extensive in vitro data used for validating the proposed model. Comparative and parametric studies were conducted to identify essential model fidelity and information for achieving desirable accuracy. More importantly, for the first time, the interrelationship between the local fiber ensemble behavior and the organ-level MV closing behavior was investigated using a computational simulation. These novel results indicated not only the appropriate parameter ranges, but also the importance of the microstructural tuning (i.e., straightening and re-orientation) of the collagen/elastin fiber networks at the macroscopic tissue level for facilitating the proper coaptation and natural functioning of the MV apparatus under physiological loading at the organ level. The proposed computational model would serve as a logical first step toward our long-term modeling goal-facilitating simulation-guided design of optimal surgical repair strategies for treating diseased MVs with significantly enhanced durability. PMID:25947879

  4. Left ventricular pseudoaneurysm after mitral valve replacement: Review of pseudoaneurysms late after mitral valve replacement.

    PubMed

    ?ahan, Ekrem; ?ahan, Suzan; Karamanl?o?lu, Murat; Gül, Murat; Tüfekçio?lu, Omac

    2015-08-01

    Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is a rare condition but can be life threatening if it develops into perdicardial tamponade. LVPA may develop de novo after the surgical procedure or may be a sequela of an earlier rupture. Clinical presentation includes shortness of breath, heart failure, chest pain, endocarditis, and pericardial tamponade. However, it can also have an asymptomatic course. The recommended treatment for LVPA is surgical repair. Conservative follow-up is an alternative for patients who refuse surgical treatment or are considered high risk for re-operation. We conducted a review of all the available literature on cases of LVPA after mitral valve replacement and present the findings here. PMID:25939434

  5. Dissecting intramyocardial hematoma after robotic mitral valve repair.

    PubMed

    McGrath, Tory; Ushukumari, Deepu; Canale, Leonardo; Gillinov, Marc

    2015-03-01

    We report the first case of a dissecting intramyocardial hematoma discovered intraoperatively after robotic mitral valve repair, potential etiologies relevant to robotic surgery, and its successful management. PMID:25742825

  6. 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

  7. 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

  8. How to start a minimal access mitral valve program.

    PubMed

    Hunter, Steven

    2013-11-01

    The seven pillars of governance established by the National Health Service in the United Kingdom provide a useful framework for the process of introducing new procedures to a hospital. Drawing from local experience, the author present guidance for institutions considering establishing a minimal access mitral valve program. The seven pillars of governance apply to the practice of minimally invasive mitral valve surgery, based on the principle of patient-centred practice. The author delineate the benefits of minimally invasive mitral valve surgery in terms of: "clinical effectiveness", including reduced length of hospital stay, "risk management effectiveness", including conversion to sternotomy and aortic dissection, "patient experience" including improved cosmesis and quicker recovery, and the effectiveness of communication, resources and strategies in the implementation of minimally invasive mitral valve surgery. Finally, the author have identified seven learning curves experienced by surgeons involved in introducing a minimal access mitral valve program. The learning curves are defined as: techniques of mitral valve repair, Transoesophageal Echocardiography-guided cannulation, incisions, instruments, visualization, aortic occlusion and cardiopulmonary bypass strategies. From local experience, the author provide advice on how to reduce the learning curves, such as practising with the specialised instruments and visualization techniques during sternotomy cases. Underpinning the NHS pillars are the principles of systems awareness, teamwork, communication, ownership and leadership, all of which are paramount to performing any surgery but more so with minimal access surgery, as will be highlighted throughout this paper. PMID:24349981

  9. Open-Heart Surgery for Mitral Valve Disease

    PubMed Central

    Gerein, Alfred N.; Gourlay, Robert H.; Kavanagh-Gray, Doris

    1965-01-01

    The findings in and experiences with 19 consecutive patients subjected to open mitral valve surgery are described. All patients underwent a right-heart catheterization. In order to exclude multivalvular heart disease, a left-heart catheterization was performed in 10 patients and angiographic studies of the aortic valve area in 12. Pulmonary function studies were performed on 11 patients. The FEV (0.75 sec.) and the MMFR were found to correlate well with existing pulmonary reserves. Fourteen of the 19 patients subjected to open mitral valve surgery survived the operation and have been followed up for three months to 2½ years. Four patients had a mitral valvuloplasty. Three of these four have deteriorated and will require a valvular replacement. Ten of 15 patients subjected to a mitral valve replacement are alive; five of these 10 have had signs and symptoms indicating peripheral embolization. Mitral valvuloplasty is preferable to a valvular replacement as far as embolic complications are concerned, while valvular replacements result in a more perfect and lasting hemodynamic repair. The high incidence of peripheral embolization following valvular replacements focuses attention on the need for improved mitral valve prostheses. PMID:14346463

  10. Tissue-engineered canine mitral valve constructs as In vitro research models for myxomatous mitral valve disease 

    E-print Network

    Liu, Mengmeng

    2014-11-28

    Myxomatous mitral valve disease (MMVD) is one of the most common degenerative cardiac diseases affecting humans and dogs; however, its pathogenesis is not completely understood. This study focussed on developing ...

  11. Insect regurgitant and wounding elicit similar defense responses in poplar leaves: not something to spit at?

    PubMed

    Major, Ian T; Constabel, C Peter

    2007-01-01

    How plants perceive insect attacks is an area of active research. Numerous studies have shown that regurgitant from feeding insects elicits a defense response in plants, which is often assumed to be distinct from a wound response. We have characterized the inducible defense response in hybrid poplar and found it to be qualitatively similar between wounding and application of regurgitant from forest tent caterpillar. We suggest that this is likely attributable to our wounding treatment which is much more intense compared to most other studies. These overlapping responses appear to be activated via jasmonic acid signaling, and we speculate that they are both triggered by elicitors of plant origin. Wounding would release such elicitor molecules when leaf cells are disrupted, and regurgitant may contain them in a modified or processed form. This hypothesis could explain why some other necrosis-inducing stresses also induce herbivore defense genes. PMID:19704794

  12. Morphological, cellular and proteomic features of canine myxomatous mitral valve disease 

    E-print Network

    Han, Richard I-Ming

    2009-01-01

    Myxomatous mitral valve degeneration (MMVD) is the single most common cardiac disease of the dog, and is analogous to Mitral Valve Prolapse in humans. Very little is known about the aetiopathogenesis of this disease or ...

  13. Early and Mid-Term Outcome of Pediatric Congenital Mitral Valve Surgery

    PubMed Central

    Baghaei, Ramin; Tabib, Avisa; Jalili, Farshad; Totonchi, Ziae; Mahdavi, Mohammad; Ghadrdoost, Behshid

    2015-01-01

    Background: Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. Objectives: The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. Patients and Methods: In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgery Results: Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Conclusions: Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis. PMID:26446282

  14. 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. PMID:26089881

  15. 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

  16. Accurate assessment of mitral valve area in patients with mitral stenosis by three-dimensional echocardiography.

    PubMed

    Chen, Q; Nosir, Y F; Vletter, W B; Kint, P P; Salustri, A; Roelandt, J R

    1997-03-01

    The accuracy of measurements of mitral valve orifice area (MVA) from three-dimensional echocardiographic (3DE) image data sets obtained by a transthoracic or transesophageal rotational imaging probe was studied in 15 patients with native mitral stenosis. The smallest MVA was identified from a set of eight parallel short-axis cut planes of the mitral valve between the anulus and the tips of leaflets (paraplane echocardiography) and measured by planimetry. In addition, MVA was measured from the two-dimensional short-axis view (2DE). Values of MVA measured by 3DE and 2DE were compared with those calculated from Doppler pressure half-time (PHT) as a gold standard. Observer variabilities were studied for 3DE. MVA measured from PHT ranged between 0.55 and 3.19 cm2 (mean +/- SD 1.57 +/- 0.73 cm2), from 3DE between 0.83 and 3.23 cm2 (mean +/- SD 1.55 +/- 0.67 cm2), and from 2DE between 1.27 and 4.08 cm2 (mean +/- SD 1.9 +/- 0.7 cm2). The variability of intraobserver and interobserver measurements for 3DE measurements was not significantly different (p = 0.79 and p = 0.68, respectively); for interobserver variability, standard error of the estimate = 0.25. There was excellent correlation, close limits of agreement (mean difference +/- 2 SD), and nonsignificant differences between 3DE and PHT for MVA measurements (r = 0.98 [0.02 +/- 0.3] and p = 0.6), respectively. There was moderate correlation, wider limits of agreement, and significant difference between 2DE and PHT for MVA measurements (r = 0.89 [0.32 +/- 0.66] and p = 0.002), respectively. This may be related to the difficulties in visualization of the smallest orifice in precordial short-axis views. This study suggests that three-dimensional image data sets, by providing the possibility of "computer slicing" to generate equidistant parallel cross sections of the mitral valve independently from physically dictated ultrasonic windows, allow accurate and reproducible measurement of the MVA. PMID:9083968

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

    SciTech Connect

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

    1986-12-01

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

  18. Cardiac magnetic resonance 'virtual catheterization' for the quantification of valvular regurgitations and cardiac shunt.

    PubMed

    Aquaro, Giovanni Donato; Barison, Andrea; Todiere, Giancarlo; Festa, Pierluigi; Ait-Ali, Lamia; Lombardi, Massimo; Di Bella, Gianluca

    2015-10-01

    Cardiac magnetic resonance (CMR) is considered the gold-standard noninvasive technique for the quantification of ventricular volumes by cine-imaging and of vascular flows by velocity-encoded phase contrast (VENC). In routine CMR scans, it is common to found clinical conditions, as valve regurgitations and cardiac shunts, producing a volume overload and significant mismatch between the right and left ventricular stroke volumes (RSV and LSV). In the presence of a valve regurgitation, the volume overload involves the respective ventricular chamber, whereas in cardiac shunts, the location of the volume overload depends on the site of the anatomic defect. Moreover, when a cardiac shunt is present, pulmonary and systemic cardiac outputs are different (Qp/Qs??1), whereas in the presence of valve regurgitation, Qp/Qs?=?1. Therefore, by combining the cine-imaging with the VENC technique, it is possible to investigate the cardiac physiology underlying different pathological conditions producing volume overload, and to quantify this overload (the regurgitant volume and/or shunt volume). In this report, we discussed the technical, theoretical and methodological aspects of this sort of 'virtual catheterization' by CMR, providing a simple algorithm to make the correct diagnosis. PMID:25643193

  19. Clinical and echocardiographic results of the Kalangos biodegradable tricuspid ring for moderate and severe functional tricuspid regurgitation treatment

    PubMed Central

    Goncu, Tugrul; Alur, Ihsan; Gucu, Arif; Tenekecioglu, Erhan; Toktas, Faruk; Kahraman, Nail; Vural, Hakan; Yavuz, Senol

    2015-01-01

    Introduction: The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring®, Bioring SA, Lonay, Switzerland) is a biodegradable prothesis in the treatment of functional tricuspid regurgitation (FTR). In this study, we aimed to determine the clinical and echocardiographic results of this prosthesis for moderate and severe FTR treatment and compare this technique with the results of semicircular DeVega annuloplasty. Materials and methods: From January 2005 through January 2010 we retrospectively studied the data on 64 consecutive patients underwent annuloplasty procedures for FTR treatment. The patients were assigned to 2 groups: (1) Kalangos BTR annuloplasty was performed in 32 patients, and (2) Semicircular DeVega annuloplasty was performed in the 32 patients. All patients were evaluated clinically and by echocardiography preoperatively, at the end of the 1st week, 3rd and 6th month following surgery. Results: No complications related to the prosthesis or the procedures within the follow-up period were recorded. At the follow-up period, systolic pulmonary arterial pressure and tricuspid valve area diameter were found to be significantly lower than the preoperative values in both groups (p < 0.0001). At the follow-up period residual tricuspid regurgitation and the Tei index (Myocardial performance index) was significantly lower in group 1 compared to group 2 (p < 0.05). Three-quarters of the annuloplasty ring had degraded in the postoperative 6-months period. Discussion: We conclude that Kalangos BTR is an efficient and safe prosthesis with easy implantation technique for FTR treatment, with encouraging midterm results. PMID:25932243

  20. Reoperative minimally invasive mitral valve replacement for bovine pericardial valve thrombosis secondary to idiopathic hypereosinophilic syndrome.

    PubMed

    Chu, Michael W A; Adams, Corey; Yared, Kibar; Ball, Warren; Dhingra, Sanjay; Rosenbloom, Andrea

    2011-01-01

    Bioprosthetic mitral valves rarely obstruct. We present an older woman who presented with rapidly progressive dyspnea 4 years after bovine mitral replacement. Investigations demonstrated severe mitral stenosis with large, obstructive masses within the previous mitral prosthesis and an elevated eosinophil count. She underwent urgent reoperative mitral replacement and tricuspid valve repair through a 4-cm right minithoracotomy under hypothermic, fibrillatory arrest. Pathologic analysis revealed eosinophilic infiltrates in the obstructive masses and normal endomyocardial biopsies. She made an uneventful recovery and was discharged on steroids to suppress the eosinophilia. Repeat echocardiography demonstrated a well-functioning porcine valve without leaflet restriction or obstruction. PMID:21664795

  1. Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR.

    PubMed

    Goffinet, Céline; Kersten, Valérie; Pouleur, Anne-Catherine; le Polain de Waroux, Jean-Benoit; Vancraeynest, David; Pasquet, Agnès; Vanoverschelde, Jean-Louis; Gerber, Bernhard L

    2010-02-01

    Recent studies have suggested that both cardiac magnetic resonance (MR) and multidetector computed tomography (MDCT) can quantify aortic regurgitation (AR) by planimetry of the anatomical regurgitant orifice (ARO). However, this measurement was not compared with quantitative assessment of AR such as the effective regurgitant orifice (ERO) by proximal isosurface area (PISA) transthoracic echocardiography (TTE) or phase contrast MR. In 42 patients (34 men, age 54 +/- 11 years) we compared planimetered ARO by MDCT and MR with ERO and regurgitant volume by PISA TTE and phase contrast MR. ARO by MDCT (r = 0.87, p < 0.001) and MR (r = 0.81, p < 0.001) correlated highly with ERO by TTE. However, ARO by MDCT (27 +/- 15 mm(2), p < 0.001), but not by MR (23 +/- 13 mm(2), p = 0.58), were larger than PISA ERO (22 +/- 11 mm(2)). ARO by MDCT (r = 0.78, p < 0.001; r = 0.85, p < 0.001) and MR (r = 0.85, p < 0.001; r = 0.87 p < 0.001) correlated well with regurgitant volume by PISA and phase contrast MR. Both MDCT (small ka, Cyrillic = 0.80, p < 0.001) and MR (small ka, Cyrillic = 0.84, p < 0.001) demonstrated excellent agreement in correctly assessing the mechanisms of AR, i.e. aortic root dilatation (type I), cusp prolapse (type II) and restrictive cusp motion (type III), using surgical inspection as a reference. Measurement of ARO by both MDCT and MR allows accurate quantitative assessment of AR. Both techniques can also accurately determine the mechanism of AR. PMID:19652976

  2. 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 (rSR(R)). 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 rSR(R) 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 rSR(R) (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 rSR(R), 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 rSR(R) 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

  3. Prognostic Impact of Tricuspid Regurgitation in Patients Undergoing Aortic Valve Surgery for Aortic Stenosis

    PubMed Central

    Mascherbauer, Julia; Kammerlander, Andreas A.; Marzluf, Beatrice A.; Graf, Alexandra; Kocher, Alfred; Bonderman, Diana

    2015-01-01

    Background The prognostic significance of tricuspid regurgitation (TR) and right ventricular (RV) function in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis (AS) is unknown. The aim of the present study was to evaluate the impact of TR and RV systolic dysfunction on early and late mortality in this setting. Methods This was a prospective single-center observational study. 465 consecutive patients who were referred to AVR for severe AS were investigated. Significant TR was defined as TR?moderate by transthoracic echocardiography. Results At baseline, significant TR was present in 26 (5.6%) patients. Patients with TR presented with a higher EuroSCORE I (p = 0.001), a higher incidence of previous cardiac surgery (p<0.001), pulmonary hypertension (p = 0.003), more dilated RVs (p = 0.001), and more frequent RV dysfunction (p = 0.001). Patients were followed for an average of 5.2 (±2.8 SD) years. By multivariable Cox regression analysis TR (p = 0.014), RV dysfunction (p = 0.046), age (p = 0.001) and concomitant coronary artery bypass graft surgery (CABG, p = 0.003) were independently associated with overall mortality. By Kaplan-Meier analysis, survival rates were significantly worse in patients with significant than with non-significant TR (log rank p = 0.001). Conclusions TR, RV dysfunction, age, and concomitant CABG are associated with outcome in patients undergoing AVR for severe AS. This finding underlines the importance of a thorough echocardiographic evaluation with particular consideration of the right heart in these patients. PMID:26291082

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

    PubMed Central

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

    2015-01-01

    Cardiac surgery for Jehovah's Witness (JW) patients is considered to be high risk because of patients' refusal to receive blood transfusion. We report a successful mitral valve replacement for recurrent mitral stenosis after OMC with minimally invasive right thoracotomy, without any transfusion of allogeneic blood or blood products. This minimally invasive mitral valve replacement through right thoracotomy was an excellent approach for JW patients. PMID:26618021

  5. Past, present, and future of minimally invasive mitral valve surgery.

    PubMed

    Schmitto, Jan D; Mokashi, Suyog A; Cohn, Lawrence H

    2011-09-01

    Minimally invasive mitral valve surgery (mini-MVS) has evolved into a safe and efficient surgical option for many patients. The overall complication rate is reduced, patient satisfaction increased, and hospital costs are lower with this approach, while providing safe and durable surgery. The repair/replacement of mitral valves via a minimally invasive technique represents a significant recent paradigm shift in cardiac surgery. The rapid development and refinement of minimally invasive valve surgery has enabled the repair of complex valves and, most importantly, has yielded similar results to those provided by standard surgical approaches. PMID:22066352

  6. Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation.

    PubMed

    Rahman, M T; Rahman, M M; Islam, M M; Khan, M R; Haque, S A; Chowdhury, A W; Majumder, A S; Rahman, A; Islam, Q I

    2015-07-01

    Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC. PMID:26329959

  7. Total percutaneous femoral vessels cannulation for minimally invasive mitral valve surgery

    PubMed Central

    Pozzi, Matteo; Henaine, Roland; Grinberg, Daniel; Robin, Jacques; Saroul, Christine; Delannoy, Bertrand; Desebbe, Olivier

    2013-01-01

    Background Minimally invasive mitral valve surgery (MIMVS) has experienced several technological changes in the last two decades. Our aim was to describe one of the most recent improvements, the utilization of a total percutaneous femoral vessels cannulation technique during MIMVS. Methods We performed a retrospective observational analysis of this technique among 300 consecutive MIMVS patients, with particular focus on cannulation aspects of MIMVS, its success rate and potential complications. Results From October 2008 to December 2012, 300 patients (60% males) were operated on. Mean age was 62.9±16.4 years. Indications for operation included mitral valve repair (93%) and mitral valve replacement (7%). Two femoral arterial catheterizations failed and required conversion to sternotomy. The complications on the arterial side were: 5 (1.6%) cases of bleeding during the introduction of Prostar leading to a preoperative surgical hemostasis; 2 (0.6%) retroperitoneal bleeds during cardiopulmonary bypass requiring difficult surgical control but with an uneventful follow-up; 6 (2%) bleeding episodes after removal of the arterial cannula easily controlled by direct surgical revision; 1 (0.3%) arterio-venous fistula requiring a surgical correction on postoperative day 32; 1 (0.3%) patient had a transitory claudication due to a superficial femoral artery thrombosis progressively compensated by the collateral circulation. There were no postoperative bleeding complications. There were no other complications linked to the femoral cannulations or to the groin occurred during the follow-up. The percentage of uneventful arterial cannulations was 80% among the first 50 patients (N=10 out of 50) and 98.8% thereafter (N=3 out of 250). Conclusions Total percutaneous femoral vessels cannulation technique is particularly suitable for MIMVS with a high success rate and few complications after a short learning curve. With the advent of the percutaneous approach, the traditional complications of the groin incision have completely disappeared in modern operations with no groin infection, hematoma or lymphocele. PMID:24349975

  8. 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. PMID:26107453

  9. 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.

  10. 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.

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

    PubMed

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

    2014-10-01

    Mitral valve plasty has superseded valve replacement as the standard technique for treating degenerative mitral valve prolapse. Quadrangular resection is considered the gold standard for posterior leaflet prolapse. Chordal replacement was first developed to treat the anterior leaflet and subsequently became widely used for the posterior leaflet, after which a new version of posterior leaflet resection was developed that did not involve local annular plication. In the era of the mini-thoracotomy, the premeasured loop technique is simple to adopt and is as durable as quadrangular resection. However, there is controversy surrounding whether resection or chordal replacement is the optimal technique. The resection technique is curative because it removes the main pathologic lesion. The disadvantage of the resection is that it can be complicated and often requires advanced surgical skills. In contrast, chordal replacement is not pathologically curative because it leaves behind a redundant leaflet. However, the long-term results appear to be equivalent in many reports. Functionally, chordal replacement retains greater posterior leaflet motion with a lower trans-mitral pressure gradient than quadrangular resection. Moreover, chordal replacement is simple and yields uniform results. The optimal technique depends on whether the anterior leaflet or posterior leaflet is involved, the Barlow or non-Barlow disease state, and whether a mini-thoracotomy or standard sternotomy approach is used. For mitral valve repair, the most superior and reliable technique for the posterior leaflet is resection using the newer resection technique with a sternotomy approach, which requires a skilled surgeon. PMID:25112793

  12. A finite strain nonlinear human mitral valve model with fluid-structure interaction

    PubMed Central

    Gao, Hao; Ma, Xingshuang; Qi, Nan; Berry, Colin; Griffith, Boyce E; Luo, Xiaoyu

    2014-01-01

    A computational human mitral valve (MV) model under physiological pressure loading is developed using a hybrid finite element immersed boundary method, which incorporates experimentally-based constitutive laws in a three-dimensional fluid-structure interaction framework. A transversely isotropic material constitutive model is used to characterize the mechanical behaviour of the MV tissue based on recent mechanical tests of healthy human mitral leaflets. Our results show good agreement, in terms of the flow rate and the closing and opening configurations, with measurements from in vivo magnetic resonance images. The stresses in the anterior leaflet are found to be higher than those in the posterior leaflet and are concentrated around the annulus trigons and the belly of the leaflet. The results also show that the chordae play an important role in providing a secondary orifice for the flow when the valve opens. Although there are some discrepancies to be overcome in future work, our simulations show that the developed computational model is promising in mimicking the in vivo MV dynamics and providing important information that are not obtainable by in vivo measurements. © 2014 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. PMID:25319496

  13. Severe aortic regurgitation and partial anomalous pulmonary venous connection in a Turner syndrome patient

    PubMed Central

    Yin, Kanhua; Li, Jun; Zhu, Kai; Wang, Yulin

    2015-01-01

    Turner syndrome (TS) is one of the most common sex chromosome diseases. Short stature (if untreated) and ovarian dysgenesis (streak ovary) are two typical clinical manifestations of these patients. A variety of cardiovascular abnormalities has been found associated with TS. We report a 29-year-old TS patient with severe aortic regurgitation, bicuspid aortic valve (BAV) and partial anomalous pulmonary venous connection (PAPVC). We discuss the diagnostic and surgical management of cardiovascular complications in TS patients. PMID:26716053

  14. Comparison of the accuracy of cardiac computed tomography angiography and transthoracic echocardiography in the diagnosis of mitral valve prolapse

    PubMed Central

    Moradi, Maryam; Nazari, Masoud; Khajouei, Amir Sajjadieh; Esfahani, Morteza Abdar

    2015-01-01

    Background: Cardiac multidetector computed tomography (MDCT) has been mainly applied in the diagnosis of valvular heart morphology and function along with the assessment of coronary artery disease. This study aimed to evaluate the diagnostic performance of coronary MDCT angiography for the diagnosis of mitral valve prolapse (MVP), as compared to transthoracic echocardiography (TTE). Materials and Methods: A total of 40 patients who had undergone both TTE and MDCT within a three-month period were included in the study. Two parameters of mitral valve leaflet thickness and leaflet billowing were measured using both techniques. The MDCT results were compared with those of TTE, which was the reference standard. Results: Implementing the Receiver Operating Characteristic (ROC) test on the data for MDCT-measured leaflet billowing received from MDCT angiography suggests that the area under the ROC curve is 96% for a declared variable, which is absolutely significant (P < 0.001), and MDCT-measured leaflet billowing is an appropriate index for the diagnosis of mitral valve prolapse. On the basis of the achieved cut-off point from the ROC analysis (which equals 2.5 mm leaftlet billowing) the MDCT-measured leaflet billowing takes a sensitivity and specificity of 68.4 and 95.2%. The false positive and false negative results are 4.8 and 31.6%. The positive and negative predictive values (PPV and NPV) of the revealed test indicate 92.9 and 76.9%, respectively. Finally, the consistency of the MDCT measured leaflet billowing for diagnosing the mitral valve prolapse is 82.5%. Based on the mentioned test, the consistency of the MDCT-measured leaflet thickness test is 47.5%. Conclusion: Along with the assessment of coronary arteries, the presence or absence of MVP can be reliably evaluated by MDCT angiography. PMID:26623397

  15. Transcatheter Aortic and Mitral Valve Implantation (TAMVI) in Native Rheumatic Valves.

    PubMed

    Akujuo, Adanna C; Dellis, Sophia L; Britton, Lewis W; Bennett, Edward V

    2015-11-01

    A 68-year-old female with moderate to severe aortic stenosis and severe mitral stenosis, deemed too high risk for surgery (STS mortality risk?=?12.3%) with a porcelain aorta, was successfully treated with a transcatheter aortic and mitral valve implantation (TAMVI) via a transapical approach. A 23?mm Sapien valve (Edwards Lifesciences, Irvine, CA, USA) was placed in the aortic position and a 29?mm inverted Sapien valve (Edwards Lifesciences) in the mitral position. PMID:26347492

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

    PubMed

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

    2013-12-01

    The rapid motion of the heart presents a significant challenge to the surgeon during intracardiac beating heart procedures. We present a 3D ultrasound-guided motion compensation system that assists the surgeon by synchronizing instrument motion with the heart. The system utilizes the fact that certain intracardiac structures, like the mitral valve annulus, have trajectories that are largely constrained to translation along one axis. This allows the development of a real-time 3D ultrasound tissue tracker that we integrate with a 1 degree-of-freedom (DOF) actuated surgical instrument and predictive filter to devise a motion tracking system adapted to mitral valve annuloplasty. In vivo experiments demonstrate that the system provides highly accurate tracking (1.0 mm error) with 70% less error than manual tracking attempts. PMID:23973122

  17. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan

    PubMed Central

    Nieto Estrada, Victor H.; Molano Franco, Daniel L.; Valencia Moreno, Albert Alexander; Rojas Gambasica, Jose A.; Jaller Bornacelli, Yamil E.; Martinez Del Valle, Anacaona

    2015-01-01

    Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient’s signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context. PMID:26566415

  18. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan.

    PubMed

    Nieto Estrada, Victor H; Molano Franco, Daniel L; Valencia Moreno, Albert Alexander; Rojas Gambasica, Jose A; Jaller Bornacelli, Yamil E; Martinez Del Valle, Anacaona

    2015-12-01

    Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient's signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context. PMID:26566415

  19. 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.

  20. Maze permutations during minimally invasive mitral valve surgery

    PubMed Central

    2015-01-01

    Surgical ablation for atrial fibrillation is most frequently done in the concomitant setting, and most commonly with mitral valve surgery. Minimally invasive surgical techniques for the treatment of atrial fibrillation have developed contemporaneously with techniques for minimally invasive mitral valve surgery. As in traditional surgery for atrial fibrillation, there are many different permutations of ablations for the less invasive approaches. Lesion sets can vary from simple pulmonary vein isolation (PVI) to full bi-atrial lesions that completely reproduce the traditional cut-and-sew Cox Maze III procedure with variable efficacy in restoring sinus rhythm. Additionally, treatment of the atrial appendage can be done through minimally invasive approaches without any ablation at all in an attempt to mitigate the risk of stroke. Finally, hybrid procedures combining minimally invasive surgery and catheter-based ablation are being developed that might augment surgical treatment of atrial fibrillation at the time of minimally invasive mitral valve repair. These various permutations and their results are reviewed. PMID:26539352

  1. Material properties of aged human mitral valve leaflets.

    PubMed

    Pham, Thuy; Sun, Wei

    2014-08-01

    This study aimed to characterize the mechanical properties of aged human anterior mitral leaflets (AML) and posterior mitral leaflets (PML). The AML and PML samples from explanted human hearts (n = 21, mean age of 82.62 ± 8.77-years-old) were subjected to planar biaxial mechanical tests. The material stiffness, extensibility, and degree of anisotropy of the leaflet samples were quantified. The microstructure of the samples was assessed through histology. Both the AML and PML samples exhibited a nonlinear and anisotropic behavior with the circumferential direction being stiffer than the radial direction. The AML samples were significantly stiffer than the PML samples in both directions, suggesting that they should be modeled with separate sets of material properties in computational studies. Histological analysis indicated the changes in the tissue elastic constituents, including the fragmented and disorganized elastin network, the presence of fibrosis and proteoglycan/glycosaminoglycan infiltration and calcification, suggesting possible valvular degenerative characteristics in the aged human leaflet samples. Overall, stiffness increased and areal strain decreased with calcification severity. In addition, leaflet tissues from hypertensive individuals also exhibited a higher stiffness and low areal strain than normotensive individuals. There are significant differences in the mechanical properties of the two human mitral valve leaflets from this advanced age group. The morphologic changes in the tissue composition and structure also infer the structural and functional difference between aged human valves and those of animals. PMID:24039052

  2. 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.

  3. [Necrotising endocarditis of mitral valve due to Staphylococcus lugdunensis].

    PubMed

    Celebi, Güven; Büyükate?, Mustafa; Do?an, Sait Mesut; Pi?kin, Nihal; Aydemir, Hande; Oztoprak, Nefise; Akta?, Elif; Bekta?, Sibel; Keskin, Ay?egül; Akduman, Deniz

    2009-04-01

    Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis. PMID:19621620

  4. Aortitis with severe aortic regurgitation in Behcet's disease: a case report.

    PubMed

    Chiu, Hsin-Hui; Wang, Shoei-Shen; Wu, Mei-Hwan; Wang, Jou-Kou

    2010-01-01

    Behcets aortitis is a rare, but one of the most severe complications of Behcets disease. We report a 24-year old woman who was noted initially to have aortitis and severe aortic regurgitation caused by Behcets disease. After receiving aortic valve replacement, aortoplasty and immunosuppressant therapy, her condition became stationary. As far as we are aware, she is the youngest case that has undergone surgery. The early onset of hemodynamic decompensation is considered to be related to delay in diagnosis and lack of steroid treatment. PMID:20123590

  5. Traumatic aortic regurgitation combined with descending aortic pseudoaneurysm secondary to blunt chest trauma.

    PubMed

    Kim, Siho; Park, Joon Suk; Yoo, Seung Min; Kim, Kyung Ho; Yang, Woo-In; Sung, Jung-Hoon; Kim, In Jai; Lim, Sang-Wook; Cha, Dong-Hun; Moon, Jae-Youn

    2014-01-01

    Rupture of the aorta is a relatively rare complication of blunt chest trauma, and traumatic rupture of the aortic valve is even rarer. Even though both result from blunt chest trauma, the causative mechanisms of aortic valve injury differ from those of descending aortic rupture. There are no previous reports in the literature of simultaneous injuries to both the descending aorta and the aortic valve. We report a case of a 70-year-old man who presented with traumatic aortic regurgitation combined with traumatic pseudoaneurysm of the aortic isthmus following blunt chest trauma, and its successful repair with a hybrid surgical strategy. PMID:25625558

  6. Tachycardia-Induced Right Heart Failure and Severe Tricuspid Regurgitation That Improved with Medication

    PubMed Central

    Yang, Young Ae; Kim, Hong Nyun; Kwon, Sang Hoon; Jang, Se Young; Bae, Myung Hwan; Lee, Jang Hoon; Chae, Shung Chull

    2015-01-01

    Secondary tricuspid regurgitation (TR) primarily develops due to left heart failure or primary pulmonary diseases. Tricuspid annular dilation, which is commonly caused by right ventricular volume and pressure overload followed by right ventricle dilation, is believed to be the main mechanism underlying secondary TR. It is reported that once the tricuspid annulus is dilated, its size cannot spontaneously return to normal, and it may continue to dilate. These reports also suggest the use of an aggressive surgical approach for secondary TR. In the present report, we describe a case of tachycardia-induced severe TR that was completely resolved without the need for surgery.

  7. Robotic Tissue Tracking for Beating Heart Mitral Valve Surgery Shelten G. Yuena

    E-print Network

    Robotic Tissue Tracking for Beating Heart Mitral Valve Surgery Shelten G. Yuena , Nikolay V. Keywords: 3D ultrasound, real-time tissue tracking, motion compensation, medical robotics, beating heart-pump animal trials indicate that beating heart modification of the mitral valve can- not be performed reliably

  8. Pax6 regulates Tbr1 and Tbr2 expression in olfactory bulb mitral cells

    PubMed Central

    Imamura, Fumiaki; Greer, Charles A.

    2013-01-01

    Tracking olfactory bulb mitral cell development with BrdU labeling, we find that mitral cells are generated from Pax6+ radial glial cells in the ventricular zone of the embryonic olfactory bulb. Unlike cortical projection neurons, postmitotic mitral cell precursors express both Tbr1 and Tbr2. Our tracking experiments revealed that down-regulation of Pax6 preceded up-regulation of Tbrs, and that Tbr1 emerged earlier than Tbr2. Using in utero electroporation, we also show that Pax6 negatively regulates the expression of Tbr1 and Tbr2 in postmitotic mitral cell precursors. Exogenous expression of Pax6 in embryonic olfactory bulb postmitotic precursors decreased the number of cells that progressed to a mitral cell fate. In contrast, exogenous expression of Pax6 resulted in an increase of GABAergic and/or dopaminergic interneurons. These results indicate that Pax6 is a regulator of fate determination of precursor cells. PMID:23353076

  9. Mitral valvuloplasty with the Inoue balloon tracked over an arteriovenous wire.

    PubMed

    Tandar, Anwar; Badger, Rodney; Whisenant, Brian K

    2012-11-15

    Mitral stenosis is associated with significant morbidity and mortality. Percutaneous balloon mitral valvuloplasty is a standard treatment option for severe mitral stenosis, and in some patients may be the only feasible option. In patients with suitable valve anatomy and morphology, and with requisite physician expertise the procedure has a high success rate and good long-term outcomes. Nonetheless, even in appropriately selected patients the procedure can pose significant technical challenges. The transeptal antegrade approach using the Inoue Balloon system may be associated with difficulty and rarely with failure to cross the stenotic mitral valve. We report a case of initial Inoue balloon failure to cross followed by successful Inoue mitral valvuloplasty tracked over an arteriovenous wire loop. PMID:22109970

  10. [Mitral valve prolapse in residents of different altitudes in the Tien Shan and Pamirs].

    PubMed

    Aldasheva, N M; Moldotashev, I K

    1986-01-01

    A study was made of mitral valve prolapse (MVP) in 1197 Kirghiz mountain-dwellers aged 16 to 22 living constantly at different altitudes of the Tien Shan and the Pamirs. MVP was detected in 24 persons (10.9%) living at an altitude of 3600-4200 m above sea level using the method of echocardiography. At middle altitudes (2020 m) it was detected in 23 persons (3.1%) and at foothills (760 m) in 4 persons (1.7%). It was shown that MVP in inhabitants at high altitudes was accompanied by more pronounced subjective symptomatology, frequently with various rhythm disorders, hypertrophy of the right ventricle and interventricular septum. It was found appropriate that mountain-dwellers with MVP should be attributed to a risk group with adequate prophylactic medical examination. PMID:2938294

  11. Evidence that ribonuclease activity present in beetle regurgitant is found to stimulate virus resistance in plants.

    PubMed

    Musser, Richard O; Hum-Musser, Sue M; Slaten-Bickford, Shannon E; Felton, Gary W; Gergerich, Rose C

    2002-08-01

    Phaseolus vulgaris L. cv. 'Pinto' bean is a local lesion host for the plant pathogen Southern bean mosaic virus (SBMV) and its vector is the Mexican bean beetle, Epilachna varivestis Mulsant. The objective of this study was to determine if prior feeding by the beetle would affect 'Pinto' bean's resistance to SBMV and determine if ribonuclease (RNase), a major constituent of beetle regurgitant, mediated the plant's response to the virus. 'Pinto' bean plants fed upon by beetles had increased resistance to plant viruses compared to non-wounded or mechanically wounded and buffer-treated plants. Plants that were mechanically wounded and treated with RNase had increased resistance to plant viruses that was equal to plants fed upon by adult beetles. The induction of plant pathogen defenses could be a good adaptation for the plant in the presence of a beetle and pathogen threat. This evidence suggests that RNase activity in the beetle regurgitant could function as an insect-derived elicitor of plant resistance to viruses. PMID:12371820

  12. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly. PMID:26096823

  13. New echocardiographic windows for quantitative determination of aortic regurgitation volume using color Doppler flow convergence and vena contracta

    NASA Technical Reports Server (NTRS)

    Shiota, T.; Jones, M.; Agler, D. A.; McDonald, R. W.; Marcella, C. P.; Qin, J. X.; Zetts, A. D.; Greenberg, N. L.; Cardon, L. A.; Sun, J. P.; Sahn, D. J.; Thomas, J. D.

    1999-01-01

    Color Doppler images of aortic regurgitation (AR) flow acceleration, flow convergence (FC), and the vena contracta (VC) have been reported to be useful for evaluating severity of AR. However, clinical application of these methods has been limited because of the difficulty in clearly imaging the FC and VC. This study aimed to explore new windows for imaging the FC and VC to evaluate AR volumes in patients and to validate this in animals with chronic AR. Forty patients with AR and 17 hemodynamic states in 4 sheep with strictly quantified AR volumes were evaluated. A Toshiba SSH 380A with a 3.75-MHz transducer was used to image the FC and VC. After routine echo Doppler imaging, patients were repositioned in the right lateral decubitus position, and the FC and VC were imaged from high right parasternal windows. In only 15 of the 40 patients was it possible to image clearly and measure accurately the FC and VC from conventional (left decubitus) apical or parasternal views. In contrast, 31 of 40 patients had clearly imaged FC regions and VCs using the new windows. In patients, AR volumes derived from the FC and VC methods combined with continuous velocity agreed well with each other (r = 0.97, mean difference = -7.9 ml +/- 9.9 ml/beat). In chronic animal model studies, AR volumes derived from both the VC and the FC agreed well with the electromagnetically derived AR volumes (r = 0.92, mean difference = -1.3 +/- 4.0 ml/beat). By imaging from high right parasternal windows in the right decubitus position, complementary use of the FC and VC methods can provide clinically valuable information about AR volumes.

  14. Role of Mitral Annulus Diastolic Geometry on Intraventricular Filling Dynamics.

    PubMed

    Okafor, Ikechukwu U; Santhanakrishnan, Arvind; Raghav, Vrishank S; Yoganathan, Ajit P

    2015-12-01

    The mitral valve (MV) is a bileaflet valve positioned between the left atrium and ventricle of the heart. The annulus of the MV has been observed to undergo geometric changes during the cardiac cycle, transforming from a saddle D-shape during systole to a flat (and less eccentric) D-shape during diastole. Prosthetic MV devices, including heart valves and annuloplasty rings, are designed based on these two configurations, with the circular design of some prosthetic heart valves (PHVs) being an approximation of the less eccentric, flat D-shape. Characterizing the effects of these geometrical variations on the filling efficiency of the left ventricle (LV) is required to understand why the flat D-shaped annulus is observed in the native MV during diastole in addition to optimizing the design of prosthetic devices. We hypothesize that the D-shaped annulus reduces energy loss during ventricular filling. An experimental left heart simulator (LHS) consisting of a flexible-walled LV physical model was used to characterize the filling efficiency of the two mitral annular geometries. The strength of the dominant vortical structure formed and the energy dissipation rate (EDR) of the measured fields, during the diastolic period of the cardiac cycle, were used as metrics to quantify the filling efficiency. Our results indicated that the O-shaped annulus generates a stronger (25% relative to the D-shaped annulus) vortical structure than that of the D-shaped annulus. It was also found that the O-shaped annulus resulted in higher EDR values throughout the diastolic period of the cardiac cycle. The results support the hypothesis that a D-shaped mitral annulus reduces dissipative energy losses in ventricular filling during diastole and in turn suggests that a symmetric stent design does not provide lower filling efficiency than an equivalent asymmetric design. PMID:26502376

  15. DIFFERENTIAL ACTIVITY AND DEGRADATION OF PLANT VOLATILE ELICITORS PRESENT IN THE REGURGITANT OF TOBACCO HORNWORM (MANDUCA SEXTA) LARVAE

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Plants respond to insect herbivory by emitting volatile compounds that attract natural enemies of the herbivores. Using a standardized corn seedling bioassay, components of tobacco hornworm (THW) regurgitant were investigated for their efficacy as elicitors of volatiles. Two components, that elici...

  16. Simultaneous in- and out-of-plane Mitral Valve Annular Force Measurements.

    PubMed

    Skov, Søren N; Røpcke, Diana M; Telling, Kristine; Ilkjær, Christine; Tjørnild, Marcell J; Nygaard, Hans; Nielsen, Sten L; Jensen, Morten O

    2015-06-01

    Mitral valve repair with annuloplasty is often favoured over total valve replacement. In order to develop and optimize new annuloplasty ring designs, it is important to study the complex biomechanical behaviour of the valve annulus and the subvalvular apparatus with simultaneous in- and out-of-plane restraining force measurements. A new flat D-shaped mitral valve annular force transducer was developed. The transducer was mounted with strain gauges to measure strain and calibrated to provide simultaneous restraining forces in- and out of the mitral annular plane. The force transducer was implanted and evaluated in an 80 kg porcine experimental model. Accumulation of out-of-plane restraining forces, creating strain in the anterior segment were 0.7 ± 0.0 N (towards apex) and an average force accumulation of 1.5 ± 0.3 N, creating strain in the commissural segments (away from apex). The accumulations of in-plane restraining forces, creating strain on the inner side of the ring were 1.7 ± 0.2 N (away from ring center). A new mitral annular force transducer was successfully developed and evaluated in vivo. The transducer was able to measure forces simultaneously in different planes. Initial indications point towards overall agreement with previous individual force measurements in- and out-of the mitral annular plane. This can provide more detailed insight into the annular force distribution, and could potentially improve the level of evidence based mitral valve repair and support the development of future mitral annuloplasty devices. PMID:26577234

  17. Effect of Right Ventricular Pacing on Right Ventricular Mechanics and Tricuspid Regurgitation in Patients With High-Grade Atrioventricular Block and Sinus Rhythm (from the Protection of Left Ventricular Function During Right Ventricular Pacing Study).

    PubMed

    Saito, Makoto; Iannaccone, Andrea; Kaye, Gerry; Negishi, Kazuaki; Kosmala, Wojciech; Marwick, Thomas H

    2015-12-15

    Right ventricular (RV) pacing has been linked with lead-induced tricuspid regurgitation (TR), left ventricular (LV) dysfunction, and dyssynchrony, but the effect of pacing on RV function is unclear. We sought to investigate the effect of pacing on RV synchrony, RV function, and TR, and their association with LV function. In this substudy of the PROTECT-PACE (Protection of left ventricular function during right ventricular pacing) study of the effects of RV pacing in patients with preserved ejection fraction, 145 patients (76 RV apex and 69 non-RV apex pacing) had measurable RV parameters. We assessed tricuspid annular plane systolic excursion (TAPSE), time difference between peak TAPSE and peak mitral annular plane systolic excursion (TM-APSE-dif), global LV longitudinal strain, E/e', TR vena contracta, and TR peak gradient. Echocardiography was performed just after implantation and at 2 years. TR parameters significantly worsened after 2 years, but pacing site was not associated with changes in RV and TR parameters. No temporal change in TAPSE and TM-APSE-dif was observed overall, but worsening of TM-APSE-dif was associated with worsening TAPSE. Global longitudinal strain and E/e' both deteriorated over 2 years; these changes were significantly associated. In a multivariate regression, worsening global longitudinal strain and worsening TM-APSE-dif were significantly associated with deterioration of TAPSE. Furthermore, increased E/e' and its deterioration were associated with worsening TR vena contracta and TR peak gradient, respectively. Decreased TAPSE was also associated with deterioration of TR vena contracta. In conclusion, RV pacing appears to worsen TR, an effect which might be caused by elevated LV filling pressure due to LV dysfunction. In this study, RV pacing did not affect RV function during 2-year follow-up, but such an effect might occur if RV dyssynchrony or LV dysfunction occurred after pacing. The effect of RV pacing site on RV and TR mechanics was minor. PMID:26517949

  18. Analysis of growth rate variables and postfeeding regurgitation in hand-reared Spix's macaw (Cyanopsitta spixii) chicks.

    PubMed

    Groffen, Heidi; Watson, Ryan; Hammer, Sven; Raidal, Shane R

    2008-09-01

    The Spix's macaw, or little blue macaw (Cyanopsitta spixii), is one of the most critically endangered bird species in the world. In 1990, the Brazilian Nature Conservation Authority established a permanent committee to oversee the captive breeding of about 20 individual Spix's macaws held in various locations throughout the world. Al Wabra Wildlife Preservation (AWWP) successfully bred 10 Spix's macaws in the 2005 and 2006 breeding seasons but intermittent episodes of postfeeding regurgitation in hand-raised chicks prompted the need to better understand and monitor the nutritional and physiologic requirements of growing nestlings. To ascertain and rank the possible causes of regurgitation in chicks, we undertook a critical analysis of the feeding, growth, and health data recorded for each individual hand-raised chick. Factors such as the total daily food intake (TDFI), growth curves, nursery room climate (temperature and humidity), and nutritional requirements were investigated as well as any health issues. Chicks attained a maximum body weight of 375 +/- 25 g at 45 days and then gradually lost weight until they reached a weaning weight of 300 +/- 30 g. The maximum daily volume of food that each chick received was 101 +/- 29 g at 42 days of age, which was also the age at which a peak in postfeeding regurgitation episodes occurred. The TDFI as a percentage of body weight peaked (83.1 +/- 12.3%) at day 3 of age and dropped to 30.1 +/- 2.3% by day 45 and then to 19.6 +/- 1.1% at day 92. Detailed analyses of the 2005 and 2006 records indicate that the regurgitation episodes may be primarily the result of overfeeding during the second trimester of hand-rearing. Our results indicate that smaller meals during the period when chicks are attaining their maximum body weights may contribute to a decrease in the occurrence of regurgitation episodes in hand-reared Spix's macaws. PMID:19014091

  19. Exertional abdominal pain as a symptom of secondary pulmonary hypertension in mitral stenosis.

    PubMed

    Najafian, J; Toghianifar, N; Khosravi, A

    2013-01-01

    We report a rare presentation of mitral stenosis (MS). MS is a common valvular disease, the first manifestation of which is usually easy fatigability and exertional dyspnea. As the disease progresses in severity, other signs and symptoms appear, such as orthopnea, hemoptysis, and peripheral edema. This is the first report of a case of mitral stenosis presenting with exertional abdominal pain as the first manifestation. This case report describes the clinical characteristics of a 55-year-old woman with mitral stenosis and severe pulmonary hypertension, whose first symptom was exertional abdominal pain. PMID:23377483

  20. Resistance to secondary thrombosis of the On-X mitral prosthesis.

    PubMed

    Jiritano, Federica; Serraino, Giuseppe F; Rossi, Michele; Pisano, Giuseppe; Renzulli, Attilio

    2013-09-01

    A 60-year-old man underwent aortic and mitral valve replacement with mechanical On-X prostheses, plus tricuspid annuloplasty ring and maze radiofrequency ablation. Two years later, he was admitted to hospital with severe orthopnea and hemolysis. Echocardiography revealed a blocked prosthetic mitral leaflet due to interference of the preserved subvalvular apparatus. Intraoperatively, one leaflet was found to be blocked by the native mitral apparatus, but no thrombus and/or pannus was present. Although, despite an abnormal blood flow, the On-X prosthesis is resistant to secondary thrombosis, even under adverse hemodynamic conditions, interference of the valve with cardiac structures remains a possibility. PMID:24383391

  1. Forty-year durability of a Smeloff-Cutter ball valve prosthesis in the mitral position.

    PubMed

    Nakajima, Masato; Tsuchiya, Koji; Ichihara, Yuki; Amenomori, Shunsuke; Koshiyama, Hiroshi; Kaku, Yuji

    2011-12-01

    A rare case requiring replacement of an intact Smeloff-Cutter ball prosthesis in the mitral position 40 years after implantation is presented. The Smeloff-Cutter ball valve prosthesis was designed to have two open cages. It has two potential advantages: a relatively large, effective orifice area and its self-washing effect that prevents thrombus formation. There have been only a few reports of survivors with ball valve prostheses in place for more than three decades especially in the mitral position. This is a valuable report describing the long-term durability of a Smeloff-Cutter ball valve prosthesis in the mitral position. PMID:22173679

  2. Percutaneous tricuspid valve-In-ring replacement for the treatment of recurrent severe tricuspid regurgitation.

    PubMed

    Condado, Jose; Leonardi, Robert; Babaliaros, Vasilis

    2015-12-01

    Percutaneous tricuspid valve-in-ring replacement can be an alternative to surgery for high-risk patients with symptomatic severe tricuspid regurgitation that recurs after surgical ring repair. Practitioners must pay attention to the specific technical details associated with this procedure that include: using the ring as a fluoroscopic landmark, sizing the valve area with multi-modality imaging, choosing the appropriate device based on the patients anatomy, and dealing with the inevitable paravalvular leak (created by the ring deformation in the absence of valve-specific devices). Our case demonstrates that percutaneous tricuspid valve-in-ring replacement is a feasible treatment that can result in both hemodynamic and symptomatic improvement. © 2015 Wiley Periodicals, Inc. PMID:26011752

  3. First transcatheter aortic valve implantation for severe pure aortic regurgitation in Asia

    PubMed Central

    Chiam, Paul Toon-Lim; Ewe, See Hooi; Chua, Yeow Leng; Lim, Yean Teng

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia's first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months. PMID:24570320

  4. 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. PMID:26157464

  5. Wallstent migration into the right ventricle causing severe tricuspid regurgitation and right ventricular perforation.

    PubMed

    Cohen, Mabelle H; Kyriazis, Dimitris K

    2012-01-01

    Endovascular stents are being used with increasing frequency for various problems of the venous system, but they have been associated with numerous complications. We report the case of an 88-year-old woman who presented with persistent, progressive dyspnea. Imaging revealed a migrated stent lodged in the tricuspid valve and extending into the right ventricle, causing severe tricuspid regurgitation. After a failed attempt at endovascular retrieval, emergent surgical removal was successful. During surgery, the stent was found to be embedded in the tricuspid leaflets, and part of the stent had also perforated the right ventricle. Review of the patient's records revealed that 2 WALLSTENT venous endoprostheses had been placed 6 months earlier to treat stenosis of the left brachiocephalic vein and, further, that the migrated stent had been visible on outpatient chest radiography performed 4 months after the stent placement. This case emphasizes the need to consider the possibility of stent migration in patients who present with unusual symptoms. PMID:22740751

  6. The Effects of Pulmonary Valve Replacement for Severe Pulmonary Regurgitation on Exercise Capacity and Cardiac Function.

    PubMed

    Ho, Jason G; Schamberger, Marcus S; Hurwitz, Roger A; Johnson, Tiffanie R; Sterrett, Lauren E; Ebenroth, Eric S

    2015-08-01

    Patients may develop hemodynamic abnormalities after right ventricular outflow tract (RVOT) repair. Re-intervention timing remains a dilemma. This study evaluates exercise capacity and RV function before and after intervention using age-related comparisons. Twenty-six patients with severe pulmonary regurgitation (PR) after initial repair scheduled for pulmonary valve replacement (PVR) were enrolled. Metabolic treadmill testing (EST) and MRI were obtained before and after surgery. EST results were compared with matched controls. Preoperative exercise time and peak oxygen consumption (VO2 max) were significantly diminished compared with controls but were not significantly different postoperatively. The patients were then split into age-related cohorts. When comparing pre-PVR and post-PVR exercise time and VO2 max among themselves, neither cohort showed significant differences. However, patients younger than 25 years had better postoperative results, an age-related difference not seen in the controls. Preoperative MRI showed significantly dilated RV, PR, and low normal function. After PVR, the right to left ventricular end-diastolic volume ratio (RVEDV:LVEDV) and pulmonary artery regurgitant fraction (RF) significantly decreased. There was no change in ventricular ejection fractions (EF). Severe PR, decreased RVEF, and RV dilation can significantly diminish exercise capacity. PVR improves RVEDV:LVEDV and RF, but not EF. Younger patients had better exercise capacity that was maintained postoperatively. This age-related difference was not seen in the controls, indicating that earlier intervention may preserve exercise capacity. Serial ESTs in patients with severe PR following RVOT repair may identify deteriorating exercise capacity as an early indicator for the need for PVR. PMID:25753686

  7. The effects of cryogenic blockade of the centrifugal, bulbopetal pathways on the dynamic and static response characteristics of goldfish olfactory bulb mitral cells.

    PubMed

    Fischer, T; Zippel, H P

    1989-01-01

    The responses of single goldfish olfactory bulb mitral cells were studied by extracellular recordings before and during cryogenic blockade of the efferent, centrifugal pathways in the ipsilateral olfactory tract. In each experiment the same odour was presented 40 times before and then 40 times during cooling. Each stimulus period (at least 30 s) was preceded by a stimulus-free interval (at least 30 s), during which a steady stream of tap water was applied. These procedures allow the investigation of activity changes of single neurons and of cell ensembles using statistical methods. i) In comparison with the pre-cooling activity, cooling of the efferent pathways did not cause a generalized disinhibition in mitral cell responses. Significant disinhibitory, significant inhibitory and indifferent effects occurred in about the same proportion during repetitive water and odour applications. ii) Abrupt or slow changes of single mitral cell discharge patterns during the 40 water and odour applications were observed before and during blocking of the efferent fibre systems: These pattern changes are therefore not necessarily a consequence of the efferent signals, and may thus have been a result of intrabulbar plasticity. iii) The most notable effect of efferent fibre blockade across all experiments was a significant (Wilcoxon-rank-test, P = 0.01) decrease of the signal to noise ratio i.e., the ratio between the activity during the "spontaneous" (water) and the stimulus (odour) phase, which could be demonstrated for both the phasic (immediately after stimulus onset) and tonic (during long term stimulation) components of the mitral cell responses. PMID:2721617

  8. Left ventricular rupture after embolic myocardial infarction due to mitral valve endocarditis.

    PubMed

    Caspar, Thibault; Delabranche, Xavier; Mazzucotelli, Jean-Philippe; Samet, Hafida; Morel, Olivier; Ohlmann, Patrick

    2014-04-01

    We report a very rare case of a 43-year-old patient with fatal left ventricular subepicardial aneurysm rupture complicating embolic myocardial infarction due to mitral valve infective endocarditis. PMID:24447262

  9. Transapical implantation of an Edwards SAPIEN XT in a degenerated mitral bioprosthesis without fluoroscopic landmarks.

    PubMed

    Salizzoni, Stefano; Barbero, Cristina; Grosso Marra, Walter; Moretti, Claudio; Rinaldi, Mauro

    2014-09-01

    An 84-year-old male with degeneration of a radiolucent mitral bioprosthesis was successfully treated with transapical valve-in-valve implantation exclusively guided by transesophageal echocardiography. The techniques involved in performing this procedure are reviewed. PMID:24641319

  10. Live 3D TEE demonstrates and guides the management of prosthetic mitral valve obstruction.

    PubMed

    Chahal, Mangeet; Pandya, Utpal; Adlakha, Satjit; Khouri, Samer J

    2011-08-01

    A 43-year-old woman, with a remote history of rheumatic mitral stenosis and a St. Jude prosthetic mitral valve replacement, presented with shortness of breath and palpitations, shortly after a long flight. On admission, atrial fibrillation with a rapid ventricular response was noted in the setting of a long history of noncompliance with her anticoagulation. Transesophageal echocardiography (TEE) demonstrated multiple laminated thrombi in the left atrial appendage. Live three-dimensional (3D) TEE confirmed this diagnosis and demonstrated an immobile posterior leaflet of the mitral prosthesis, which had direct implications in her management. She successfully underwent surgery for mitral valve replacement, left atrial appendage ligation, and a Maze procedure on the following day. The multiple thrombi within the atrial appendage were confirmed intraoperatively and pannus formation was determined to be the etiology of the leaflet immobility. PMID:21752090

  11. The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs. replacement?

    PubMed

    Maisano, Francesco; Alfieri, Ottavio; Banai, Shmuel; Buchbinder, Maurice; Colombo, Antonio; Falk, Volkmar; Feldman, Ted; Franzen, Olaf; Herrmann, Howard; Kar, Saibal; Kuck, Karl-Heinz; Lutter, Georg; Mack, Michael; Nickenig, Georg; Piazza, Nicolo; Reisman, Mark; Ruiz, Carlos E; Schofer, Joachim; Søndergaard, Lars; Stone, Gregg W; Taramasso, Maurizio; Thomas, Martyn; Vahanian, Alec; Webb, John; Windecker, Stephan; Leon, Martin B

    2015-07-01

    Transcatheter mitral interventions has been developed to address an unmet clinical need and may be an alternative therapeutic option to surgery with the intent to provide symptomatic and prognostic benefit. Beyond MitraClip therapy, alternative repair technologies are being developed to expand the transcatheter intervention armamentarium. Recently, the feasibility of transcatheter mitral valve implantation in native non-calcified valves has been reported in very high-risk patients. Acknowledging the lack of scientific evidence to date, it is difficult to predict what the ultimate future role of transcatheter mitral valve interventions will be. The purpose of the present report is to review the current state-of-the-art of mitral valve intervention, and to identify the potential future scenarios, which might benefit most from the transcatheter repair and replacement devices under development. PMID:25870204

  12. Designing innovative retractors and devices to facilitate mitral valve repair surgery

    PubMed Central

    Yozu, Ryohei

    2015-01-01

    Various devices have been developed to facilitate mitral valve surgery, including those that improve mitral valve exposure and assist surgeons with associated procedures. Choosing appropriate supporting devices when performing minimally invasive mitral valve surgery (MIMVS) through a minithoracotomy with endoscopic assistance is critical. Depending on the surgeon’s preference, trans-thoracic or trans-working-port left atrial retractors can be utilized. Although the trans-thoracic retractors provide a simple and orderly working space around the minithoracotomy working port, the positioning of the shaft is difficult and there is an implicit risk of chest wall bleeding. On the other hand, the trans-working-port type provides excellent exposure, is easily handled and manipulated, and facilitates surgeries involving various anatomical structures without special training. A great deal of understanding and knowledge about retractors is necessary to achieve the optimal exposure required to facilitate surgical techniques, and to maintain a reproducible and safe surgical system during mitral valve surgery. PMID:26309847

  13. Anomalous chord of the left atrium without involvement of the mitral valve.

    PubMed

    Arya, Bhawna; Challenger, Margaret; Lai, Wyman W

    2012-08-01

    An anomalous chord from the left side of the atrial septum to the left atrial free wall was incidentally noted on transthoracic echocardiography in a 14-year-old boy with vasovagal syncope. Previously reported cases of anomalous chords in the left atrium were associated with the mitral valve leaflets in all but two cases. This is the first reported case of an echocardiographic diagnosis of anomalous left atrial chord without insertion of the chord into the mitral valve. PMID:22404153

  14. Mitral valve-in-valve with the lotus mechanically expanding platform.

    PubMed

    Feldman, Ted; Reardon, Michael J

    2015-12-01

    Disadvantages of existing balloon expandable or self-expanding transcatheter platforms for mitral valve-in-valve include the potential for malposition during deployment and for LV outflow tract obstruction Controlled mechanical valve expansion, the option to reposition, and stable hemodynamics throughout the procedure make the LOTUS valve an attractive option for mitral valve-in-valve Correct sizing remains a critical aspect of all trancatheter valve implant procedures, including valve-in-valve implants. PMID:26582326

  15. [Intracardiac mass: Why not a liquefaction necrosis of a mitral annulus calcification?].

    PubMed

    Leddet, P; Couppié, P; De Poli, F; Uhry, S; Hanssen, M

    2015-11-01

    We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication. PMID:26482628

  16. Replacement of the mitral valve in an infant with group B streptococcal endocarditis.

    PubMed

    Walker, T A; Aru, G M; Ebeid, M R

    2001-01-01

    Endocarditis due to group B streptococcus is very rare in infants, and may be associated with significant morbidity and mortality. Review of the literature reveals only a single reported case of an infant with this type of streptococcal endocarditis involving the mitral valve. This infant had underlying congenital heart disease, and died shortly after catheterization. We now report group B streptococcal endocarditis occurring in an infant with a structurally normal heart who was treated successfully by replacement of the mitral valve. PMID:11233405

  17. [State of the cardiovascular system in patients with decompensated mitral valve defect under conditions of high altitude].

    PubMed

    Iusupova, N Ia; Kuda?berdiev, E M; Narbekov, O N

    1976-06-01

    A clinical study was conducted in 236 patients with decompensated mitral valve disease--permanent residents of the areas located at various altitudes in the Pamirs and Tien Shan (760 to 4,200 m above the sea level). The main parameters of haemodynamics were studied by means of the dye dilution method in 158 of them, as well as the indices of cardiodynamics by way of polycardiography. The data obtained in 120 normal individuals living in foothills (760 m) served as control. It was demonstrated that with the same stages of cardiac insufficiency, the most striking changes in the haemo- and cardiodynamics were noted among the residents of the high altitude areas. Among those living at medium altitudes (1,650 to 2,020 m), the cardiac output and the left ventricular function appeared to be reduced most distinctly. These patients also exhibited a clear relationship between the main variables of the cardiovascular functions and the severity of cardiac insufficiency. The revealed clinical and functional peculiarities of the decompensated mitral valve disease in mountaneers are atrributable to the effect of hypoxic hyposy upon the regulation of the respiration and the pulmonary circulation. PMID:139491

  18. CC-chemokine receptor 7 and its ligand CCL19 promote mitral valve interstitial cell migration and repair

    PubMed Central

    Wang, Xiaozhi; Wang, Liang; Miao, Liping; Zhao, Rong; Wu, Yanhu; Kong, Xiangqing

    2015-01-01

    Abstract The effect of CC-chemokine receptor 7 (CCR7) and CC-chemokine ligand 19 (CCL19) on rheumatic mitral stenosis is unknown. This study aimed to explore the roles of CCR7 and CCL19 in rheumatic mitral stenosis by measuring the expression of CCR7 and CCL19 in human mitral valves from rheumatic mitral stenosis patients. Additionally, we examined their effects on human mitral valve interstitial cells (hMVICs) proliferation, apoptosis and wound repair. CCR7 and CCL19 expression was measured in the mitral valves from rheumatic mitral stenosis patients (n?=?10) and compared to normal mitral valves (n?=?5). CCR7 was measured in cultured hMVICs from rheumatic mitral stenosis patients and normal donors by RT-PCR and immunofluorescence. The cells were also treated with exogenous CCL19, and the effects on wound healing, proliferation and apoptosis were assayed. In the rheumatic mitral valves, valve interstitial cells expressed CCR7, while mononuclear cells and the endothelium expressed CCL19. Healthy mitral valves did not stain positive for CCR7 or CCL19. CCR7 was also detected in cultured rheumatic hMVICs or in normal hMVICs treated with CCL19. In a wound healing experiment, wound closure rates of both rheumatic and normal hMVICs were significantly accelerated by CCL19. These effects were abrogated by a CCR7 neutralizing antibody. The CCR7/CCL19 axis did not influence the proliferation or apoptosis of hMVICs, indicating that wound healing was due to increased migration rates rather than increased proliferation. In conclusion, CCR7 and CCL19 were expressed in rheumatic mitral valves. The CCR7/CCL19 axis may regulate remodeling of rheumatic valve injury through promoting migratory ability of hMVICs. PMID:26668580

  19. 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

  20. Belching, regurgitation, chest tightness and dyspnea: Not gastroesophageal reflux disease but asthma

    PubMed Central

    Zhang, Jing-Xi; Zhan, Xian-Bao; Bai, Chong; Li, Qiang

    2015-01-01

    Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (?FEV1 260 mL, ?FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting ?2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma. PMID:25663791

  1. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective

    PubMed Central

    Griffin, William F.; Gudimella, Preeti; O’Neal, Wesley T.; Davies, Stephen W.; Crane, Patricia B.; Anderson, Ethan J.; Kindell, Linda C.; Landrine, Hope; O’Neal, Jason B.; Alwair, Hazaim; Kypson, Alan P.; Nifong, Wiley L.; Chitwood, W. Randolph

    2015-01-01

    Background Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). Methods Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. Results Non-smoking men (?65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. Conclusions In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures. PMID:26539348

  2. 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.

  3. Mitral valve prolapse associated with celiac artery stenosis: a new ultrasonographic syndrome?

    PubMed Central

    Arcari, Luciano

    2004-01-01

    Background Celiac artery stenosis (CAS) may be caused by atherosclerotic degeneration or compression exerted by the arched ligament of the diaphragm. Mitral valve prolapse (MVP) is the most common valvular disorder. There are no reports on an association between CAS and MVP. Methods 1560 (41%) out of 3780 consecutive patients undergoing echocardiographic assessment of MVP, had Doppler sonography of the celiac tract to detect CAS. Results CAS was found in 57 (3.7%) subjects (23 males and 34 females) none of whom complained of symptoms related to visceral ischemia. MVP was observed in 47 (82.4%) subjects with and 118 (7.9%) without CAS (p < 0.001). The agreement between MVP and CAS was 39% (95% CI 32–49%). PSV (Peak Systolic Velocity) was the only predictor of CAS in MPV patients (OR 0.24, 95% CI 0.08–0.69) as selected in a multivariate logistic model. Conclusion CAS and MVP seem to be significantly associated in patients undergoing consecutive ultrasonographic screening. PMID:15588321

  4. 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.

  5. 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

  6. Canine model for long-term evaluation of prosthetic mitral valves.

    PubMed

    Bianco, R W; St Cyr, J A; Schneider, J R; Rasmussen, T M; Clack, R M; Shim, H S; Sandstad, J; Rysavy, J; Foker, J E

    1986-08-01

    The evaluation of mechanical prosthetic heart valves would be aided by a more satisfactory animal model. For acute assessment, a variety of animals have been used, but for chronic studies, only larger animals (pigs, calves, baboons) have been employed, creating an expensive model with laboratory management difficulties. Previously, the use of dogs for chronic evaluation has been unsatisfactory because of the frequent occurrence of early sepsis and valve-related thrombotic deaths. We have modified our existing acute dog protocol to produce a successful chronic model. Our model employs perioperative systemic antibiotics, short cardiopulmonary bypass period (range 35-60 min), a minimum of perioperative intravenous lines, postoperative anticoagulation therapy, and strict postoperative antiseptic technique for blood sampling. To evaluate this model, 11 consecutive mongrel dogs underwent mitral valve replacement with either a standard Dacron sewing skirt or a newly devised carbon-coated Teflon sewing skirt No. 23 mm Bjork-Shiley Convexo Concave (CC) prosthetic valve. Nine animals (82%) survived and were evaluated after a predetermined observation interval of either 3 or 6 months for valve function, pannus formation, and possible carbon particle migration. At sacrifice, all animals had good hemodynamics and valve function, minimal pannus formation and no carbon washout. Consequently, this model provides a relatively inexpensive, reproducible method of chronic in vivo evaluation of prosthetic valve modifications. PMID:3762124

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

    PubMed

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

    2015-12-01

    Recurrent wheezing is a very common clinical ailment throughout infancy and childhood. The most common diagnosis in children with wheezing is asthma. However, some other causes should be considered in the differential diagnosis such as a congenital cardiac defect. We present a case of a four year old boy presenting with recurrent wheezing who was referred to our institution for cardiac evaluation. Severe mitral stenosis secondary to an anomalous mitral arcade was diagnosed by physical examination, chest X-ray, electrocardiogram and mainly transthoracic and transesophageal echocardiography. Anomalous mitral arcade is a rare congenital malformation of the mitral tensor apparatus which comprises the chordae tendineae and papillary muscles. This abnormal anatomy leads to increased filling pressure of the left ventricle, a retrograde post capillary pulmonary hypertension and interstitial aedema. The patient was referred to cardiac surgery and underwent a successful procedure with complete removal of the obstructive mitral lesion. PMID:26593807

  8. Transmitral exclusion of a giant congenital left ventricular aneurysm associated with mitral insufficiency in adult.

    PubMed

    El Malki, Hicham; El Kandoussi, Tahar; Rhissassi, Jaafar; Laaroussi, Mohamed

    2015-12-01

    Congenital left ventricular aneurysm is rare, poorly understood and potentially lethal. It usually occurs in isolation. Its combination with mitral insufficiency is an uncommon entity. Because the literature on this kind of aneurysms consists of case reports and small series described especially in children, we report here an interesting and unique case of an adult aged 35 years bearing simultaneously a congenital left ventricular aneurysm and mitral insufficiency. Without medical past history, he consults for palpitations and dyspnoea. Once diagnosis was made by chest X-ray, echocardiography and computed tomography, an open heart surgery was necessary to prevent complications. Through a transmitral approach, aneurysmal exclusion was performed by closing the aneurysmal collar with a Dacron patch and mitral replacement was accomplished. At 12 months, follow-up was favourable without residual communication between aneurysm and ventricle or paraprosthetic leak. PMID:26399261

  9. Recurrent native and prosthetic mitral valve thrombosis in idiopathic hypereosinophilic syndrome.

    PubMed

    Zakhama, Lilia; Slama, Iskander; Boussabah, Elhem; Harbegue, Basma; Mimouni, Majdi; Abdelaali, Nabil; Sioua, Sana; Thameur, Moez; Benyoussef, Soraya

    2014-03-01

    Hypereosinophilic syndrome (HES) is defined as a prolonged, unexplained peripheral eosinophilia. Endomyocardial fibrosis and mural thrombus formation are common occurrences such that patients are exposed to lethal thromboembolic complications. The valvular damage described is mainly related to iterative valve thromboses that are amenable to surgery. Here, the case is reported of a 39-year-old woman suffering from HES with mitral valve thrombosis and mechanical prosthetic mitral valve replacement, in whom a new thrombosis of the inserted prosthesis occurred one month postoperatively, concomitant with severe hypereosinophilia and despite adequate anticoagulation. The patient had received a new bioprosthetic mitral valve replacement, and her eosinophil count had been normalized after treatment with corticosteroids. Oral anticoagulation with warfarin was maintained. Subsequently, no recurrent thromboembolic events were reported, and echocardiography performed at the one-year follow up showed the bioprosthesis to have a normal hemodynamic profile. PMID:25076546

  10. Large free-floating left atrial thrombus with normal mitral valve

    PubMed Central

    Chidambaram, Sundar; Rajkumar, Arunkumar; Ganesan, Gnanavelu; Sangareddi, Venkatesan; Ramasamy, Alagesan; Dhandapani, V.E.; Ravi, M.S.

    2013-01-01

    Left atrial thrombus in the presence of diseased mitral valve and atrial fibrillation is a well known entity. But it is very rare to occur in the presence of normal mitral valve apparatus. We report the case of a 36 year old female who presented with left atrial ball valve thrombus and normal mitral valve apparatus and underwent surgery. This patient with gangrene of right lower limb came for cardiac evaluation. She had infarct in left middle cerebral artery territory- ten months prior to this admission and was on treatment for infertility. She had atrial fibrillation. Emergency surgery to remove the thrombus should be considered given its potential life threatening embolic nature. PMID:23438617

  11. Idiopathic mitral valve chordae rupture in an infant: importance of rapid diagnosis and surgery.

    PubMed

    Okada, Yuki; Inoue, Nobuaki; Fukushima, Naoya; Yoshikawa, Tadahiro; Takahashi, Yukihiro; Matsubara, Shigeki; Hasegawa, Yukihiro

    2015-04-01

    Mitral valve chordae rupture in infancy is a rare, but life-threatening disease. The progression of acute cardiac failure has been reported, with emergency surgery being required in most cases. Mitral valve chordae rupture typically occurs at the age of 4-6 months. Echocardiography is needed to diagnose this disease, and accurate diagnosis is difficult for general pediatricians. We herein describe the case of an acutely ill 4-month-old infant, who was saved and discharged without neurological sequelae due to the early diagnosis of mitral valve chordae rupture, life support, and surgery. We confirm the importance of acute pre-surgery treatment and immediate surgery for the survival and good outcome of infants. PMID:25712749

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

    PubMed

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

    2014-09-16

    Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2 years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings. PMID:25224154

  13. On the bending properties of porcine mitral, tricuspid, aortic, and pulmonary valve leaflets.

    PubMed

    Brazile, Bryn; Wang, Bo; Wang, Guangjun; Bertucci, Robbin; Prabhu, Raj; Patnaik, Sourav S; Butler, J Ryan; Claude, Andrew; Brinkman-Ferguson, Erin; Williams, Lakiesha N; Liao, Jun

    2015-01-01

    The atrioventricular valve leaflets (mitral and tricuspid) are different from the semilunar valve leaflets (aortic and pulmonary) in layered structure, ultrastructural constitution and organization, and leaflet thickness. These differences warrant a comparative look at the bending properties of the four types of leaflets. We found that the moment-curvature relationships in atrioventricular valves were stiffer than in semilunar valves, and the moment-curvature relationships of the left-side valve leaflets were stiffer than their morphological analog of the right side. These trends were supported by the moment-curvature curves and the flexural rigidity analysis (EI value decreased from mitral, tricuspid, aortic, to pulmonary leaflets). However, after taking away the geometric effect (moment of inertia I), the instantaneous effective bending modulus E showed a reversed trend. The overall trend of flexural rigidity (EI: mitral > tricuspid > aortic > pulmonary) might be correlated with the thickness variations among the four types of leaflets (thickness: mitral > tricuspid > aortic > pulmonary). The overall trend of the instantaneous effective bending modulus (E: mitral < tricuspid < aortic < pulmonary) might be correlated to the layered fibrous ultrastructures of the four types of leaflets, of which the fibers in mitral and tricuspid leaflets were less aligned, and the fibers in aortic and pulmonary leaflets were highly aligned. We also found that, for all types of leaflets, moment-curvature relationships are stiffer in against-curvature (AC) bending than in with-curvature bending (WC), which implies that leaflets tend to flex toward their natural curvature and comply with blood flow. Lastly, we observed that the leaflets were stiffer in circumferential bending compared with radial bending, likely reflecting the physiological motion of the leaflets, i.e., more bending moment and movement were experienced in radial direction than circumferential direction. PMID:25955006

  14. 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

  15. 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

  16. Transesophageal echocardiographic imaging of multiple complications following mitral valve replacement

    PubMed Central

    Brassard, Charles L; Viens, Claudia; Denault, André

    2015-01-01

    Summary We present a case of mitral valve (MV) replacement that resulted in multiple complications, as diagnosed by transesophageal echocardiography (TEE), including left ventricular outflow tract obstruction, aortic dissection and left ventricular rupture. We also describe that identification of bleeding originating from the posterior aspect of the heart by the surgical team should trigger a complete TEE evaluation for adequate diagnosis. An 84-year-old woman underwent a MV replacement. Weaning from cardiopulmonary bypass (CPB) revealed a late-peaking gradient of 44 mmHg over the left ventricular outflow tract caused by obstruction from a bioprosthetic strut. After proper surgical correction, TEE evaluation showed a type A aortic dissection that was subsequently repaired. After separation from CPB, the surgical team identified a major bleed that originated from the posterior aspect of the heart. Although the initial suspicion was injury to the atrioventricular groove, a complete TEE evaluation confirmed a left ventricular free wall rupture by showing the dissecting jet using colour-flow Doppler. TEE is an essential component in cardiac surgery for assessment of surgical repair and potential complications. Posterior bleeding should trigger a complete TEE examination with assessment of nearby structures to rule out a life-threatening pathology. Left ventricular free wall rupture can be identified using colour-flow Doppler. Learning points Multiple complications may occur after MVR.TEE is an essential component in the evaluation of surgical repair and its potential associated complications, including LVOT obstruction, aortic dissection and LV rupture.Posterior bleeding, from the region of AV groove, should trigger a complete TEE examination with assessment of nearby structures such as the atria, coronary sinus and myocardium to rule out a life threatening pathology.The diagnosis of a LV rupture can be confirmed with 2-D imaging and colour-flow Doppler demonstrating a dissecting jet through the myocardium.

  17. Perinatal Changes in Mitral and Aortic Valve Structure and Composition

    PubMed Central

    Stephens, Elizabeth H.; Post, Allison D.; Laucirica, Daniel R.; Grande-Allen, K. Jane

    2015-01-01

    At birth, the mechanical environment of valves changes radically as fetal shunts close and pulmonary and systemic vascular resistances change. Given that valves are reported to be mechanosensitive, we investigated remodeling induced by perinatal changes by examining compositional and structural differences of aortic and mitral valves (AVs, MVs) between 2-day-old and 3rd fetal trimester porcine valves using immunohistochemistry and Movat pentachrome staining. Aortic valve composition changed more with birth than the MV, consistent with a greater change in AV hemodynamics. At 2 days, AV demonstrated a trend of greater versican and elastin (P = 0.055), as well as greater hyaluronan turnover (hyaluronan receptor for endocytosis, P = 0.049) compared with the 3rd-trimester samples. The AVs also demonstrated decreases in proteins related to collagen synthesis and fibrillogenesis with birth, including procollagen I, prolyl 4-hydroxylase, biglycan (all P ? 0.005), and decorin (P = 0.059, trend). Both AVs and MVs demonstrated greater delineation between the leaflet layers in 2-day-old compared with 3rd-trimester samples, and AVs demonstrated greater saffron-staining collagen intensity, suggesting more mature collagen in 2-day-old compared with 3rd-trimester samples (each P < 0.05). The proportion of saffron-staining collagen also increased in AV with birth (P < 0.05). The compositional and structural changes that occur with birth, as noted in this study, likely are important to proper neonatal valve function. Furthermore, normal perinatal changes in hemodynamics often do not occur in congenital valve disease; the corresponding perinatal matrix maturation may also be lacking and could contribute to poor function of congenitally malformed valves. PMID:20536360

  18. Mitral isthmus conduction block: intriguing result of radiofrequency catheter ablation for a left concealed accessory pathway.

    PubMed

    Bulava, Alan; Hanis, Jiri; Sitek, David

    2010-04-01

    We report on our experience with complete mitral isthmus conduction block achieved inadvertently during radiofrequency (RF) catheter ablation for a left lateral concealed accessory pathway (AP) mimicking concentric retrograde activation. This rare condition should be acknowledged to avoid misdiagnosis of another concomitant AP and to avoid RF applications in inappropriate areas. PMID:20019014

  19. Asymptotic Model of Fluid-Tissue Interaction for Mitral Valve Dynamics.

    PubMed

    Domenichini, Federico; Pedrizzetti, Gianni

    2015-06-01

    The vortex formation process inside the left ventricle is intrinsically connected to the dynamics of the mitral leaflets while they interact with the flow crossing the valve during diastole. The description of the dynamics of a natural mitral valve still represents a challenging issue, especially because its material properties are not measurable in vivo. Medical imaging can provide some indications about the geometry of the valve, but not about its mechanical properties. In this work, we introduce a parametric model of the mitral valve geometry, whose motion is described in the asymptotic limit under the assumption that it moves with the flow, without any additional resistance other than that given by its shape, and without the need to specify its material properties. The mitral valve model is coupled with a simple description of the left ventricle geometry, and their dynamics is solved numerically together with the equations ruling the blood flow. The intra-ventricular flow is analyzed in its relationship with the valvular motion. It is found that the initial valve opening anticipates the peak velocity of the Early filling wave with little influence of the specific geometry; while subsequent closure and re-opening are more dependent on the intraventricular vortex dynamics and thus on the leaflets' geometry itself. The limitations and potential applications of the proposed model are discussed. PMID:26577230

  20. Acute Renal Infarction Secondary to Calcific Embolus from Mitral Annular Calcification

    SciTech Connect

    Bande, Dinesh; Abbara, Suhny; Kalva, Sanjeeva P.

    2011-06-15

    We report a case of a 62-year-old man who presented with right groin pain who subsequently was found to have a renal infarct secondary to calcific embolus from mitral annular calcification on CT and angiography. We briefly review the literature and discuss the importance of this entity in clinical practice.

  1. Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery

    PubMed Central

    Devabhaktuni, Subodh; Sunkara, Nirmal; Ahsan, Chowdhury

    2015-01-01

    Key Clinical Message LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery. PMID:26576286

  2. Anisotropic Diffusion in Mitral Cell Dendrites Revealed by Fluorescence Correlation Spectroscopy

    E-print Network

    of tetramethylrhodamine (TMR)-dextran (10 kDa) in dendrites of cultured mitral cells of Xenopus laevis tadpoles of anisotropic diffusion. As compared to diffusion in water, diffusion of the 10-kDa TMR-dextran along dimensions and 1.2­2.6 times slower than in water. INTRODUCTION Fluorescence correlation spectroscopy (FCS

  3. Using Real-Time Three-Dimensional Ultrasound to Characterize Mitral Valve Motion

    E-print Network

    Ayache, Nicholas

    for the visualization, characterization, and tracking of heart tissue, whether from an imaging or mechanical pointUsing Real-Time Three-Dimensional Ultrasound to Characterize Mitral Valve Motion Paul M. Novotnya of Engineering and Applied Sciences, Harvard University, Cambridge MA, USA b Department of Cardiology, Children

  4. Developing a Training Tool for Intraoperative Mitral Valve Analysis Neil A. Tenenholtz, Robert D. Howe

    E-print Network

    @seas.harvard.edu INTRODUCTION The mitral valve is one of the four valves of the human heart. Serving as a passive check valve the native valve tissue through a series of tissue resections and suturing. While the goal is to restore as the heart is arrested during the operation. As a result, rather than being directly observed, closed valve

  5. 3D Ultrasound-Guided Motion Compensation System for Beating Heart Mitral Valve Repair

    E-print Network

    3D Ultrasound-Guided Motion Compensation System for Beating Heart Mitral Valve Repair Shelten G with the tissue for longer periods. 1 Introduction Beating heart intracardiac repairs are now feasible clear benefits, heart motion can make the safe manipulation of its tissues extremely challenging

  6. Cellular/Molecular Dopamine Inhibits Mitral/Tufted3Granule Cell Synapses in

    E-print Network

    Delaney, Kerry R.

    Cellular/Molecular Dopamine Inhibits Mitral/Tufted3Granule Cell Synapses in the Frog Olfactory Bulb show that dopamine, presum- ably released by TH-positive local interneurons, reduces synaptic transmission from MTs to GCs. MT neurons express D2-like receptors (D2Rs), and both dopamine and the D2 agonist

  7. Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

    PubMed Central

    Sutaria, N; Elder, A; Shaw, T

    2000-01-01

    OBJECTIVE—To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years.?DESIGN—Pre- and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact.?SETTING—Tertiary referral centre in Scotland.?SUBJECTS—80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved.?MAIN OUTCOME MEASURES—Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up.?RESULTS—Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1.59 (0.67) cm2. There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years.?CONCLUSIONS—Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement.???Keywords: mitral valve stenosis; balloon valvotomy; elderly patients PMID:10722546

  8. 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

  9. 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

  10. Expression of COLLAGEN 1 and ELASTIN Genes in Mitral Valvular Interstitial Cells within Microfiber Reinforced Hydrogel

    PubMed Central

    Eslami, Maryam; Javadi, Gholamreza; Agdami, Nasser; Shokrgozar, Mohammad Ali

    2015-01-01

    Objective The incidence of heart valve disease is increasing worldwide and the number of heart valve replacements is expected to increase in the future. By mimicking the main tissue structures and properties of heart valve, tissue engineering offers new options for the replacements. Applying an appropriate scaffold in fabricating tissue-engineered heart valves (TEHVs) is of importance since it affects the secretion of the main extracellular matrix (ECM) components, collagen 1 and elastin, which are crucial in providing the proper mechanical properties of TEHVs. Materials and Methods Using real-time polymerase chain reaction (PCR) in this experi- mental study, the relative expression levels of COLLAGEN 1 and ELASTIN were obtained for three samples of each examined sheep mitral valvular interstitial cells (MVICs)-seeded onto electrospun poly (glycerol sebacate) (PGS)-poly (?-caprolactone) (PCL) microfibrous, gelatin and hyaluronic acid based hydrogel-only and composite (PGS-PCL/hydrogel) scaffolds. This composite has been shown to create a synthetic three-dimensional (3D) microenvironment with appropriate mechanical and biological properties for MVICs. Results Cell viability and metabolic activity were similar among all scaffold types. Our results showed that the level of relative expression of COLLAGEN 1 and ELASTIN genes was higher in the encapsulated composite scaffolds compared to PGS-PCL-only and hydrogel-only scaffolds with the difference being statistically significant (P<0.05). Conclusion The encapsulated composite scaffolds are more conducive to ECM secretion over the PGS-PCL-only and hydrogel-only scaffolds. This composite scaffold can serve as a model scaffold for heart valve tissue engineering. PMID:26464819

  11. Mitral valve dynamics in structural and fluid–structure interaction models

    PubMed Central

    Lau, K.D.; Diaz, V.; Scambler, P.; Burriesci, G.

    2010-01-01

    Modelling and simulation of heart valves is a challenging biomechanical problem due to anatomical variability, pulsatile physiological pressure loads and 3D anisotropic material behaviour. Current valvular models based on the finite element method can be divided into: those that do model the interaction between the blood and the valve (fluid–structure interaction or ‘wet’ models) and those that do not (structural models or ‘dry’ models). Here an anatomically sized model of the mitral valve has been used to compare the difference between structural and fluid–structure interaction techniques in two separately simulated scenarios: valve closure and a cardiac cycle. Using fluid–structure interaction, the valve has been modelled separately in a straight tubular volume and in a U-shaped ventricular volume, in order to analyse the difference in the coupled fluid and structural dynamics between the two geometries. The results of the structural and fluid–structure interaction models have shown that the stress distribution in the closure simulation is similar in all the models, but the magnitude and closed configuration differ. In the cardiac cycle simulation significant differences in the valvular dynamics were found between the structural and fluid–structure interaction models due to difference in applied pressure loads. Comparison of the fluid domains of the fluid–structure interaction models have shown that the ventricular geometry generates slower fluid velocity with increased vorticity compared to the tubular geometry. In conclusion, structural heart valve models are suitable for simulation of static configurations (opened or closed valves), but in order to simulate full dynamic behaviour fluid–structure interaction models are required. PMID:20702128

  12. 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

  13. Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

    PubMed Central

    Islam, AKM Monwarul; Salam, Md. Abdus; Sayeed, Md. Zahidus; Kibria, Md. Golam

    2015-01-01

    Spontaneous echo contrast (SEC) and thrombus in enlarged left atrium (LA) are common in mitral valvular disease (MVD) and SEC is considered to be a prethrombotic condition. Reliable exclusion of LA thrombus is important before any definitive curative attempts like percutaneous transluminal mitral commissurotomy (PTMC), closed mitral commissurotomy (CMC) or innovative therapies like pulmonary vein isolation and percutaneous closure of the LA appendage. Echocardiography, particularly the transesophageal echocardiography (TEE) is considered to be the gold standard for the diagnosis and to exclude LA thrombus. However, LA thrombus may remain rarely undetected even by TEE potentially making the interventions a risky job. We present a case of mitral stenosis (MS) with giant LA where profuse, dense SEC masked the underlying thrombus in the LA cavity. PMID:26649032

  14. Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis.

    PubMed

    Islam, Akm Monwarul; Salam, Md Abdus; Sayeed, Md Zahidus; Kibria, Md Golam

    2015-01-01

    Spontaneous echo contrast (SEC) and thrombus in enlarged left atrium (LA) are common in mitral valvular disease (MVD) and SEC is considered to be a prethrombotic condition. Reliable exclusion of LA thrombus is important before any definitive curative attempts like percutaneous transluminal mitral commissurotomy (PTMC), closed mitral commissurotomy (CMC) or innovative therapies like pulmonary vein isolation and percutaneous closure of the LA appendage. Echocardiography, particularly the transesophageal echocardiography (TEE) is considered to be the gold standard for the diagnosis and to exclude LA thrombus. However, LA thrombus may remain rarely undetected even by TEE potentially making the interventions a risky job. We present a case of mitral stenosis (MS) with giant LA where profuse, dense SEC masked the underlying thrombus in the LA cavity. PMID:26649032

  15. New recessive truncating mutation in LTBP3 in a family with oligodontia, short stature, and mitral valve prolapse.

    PubMed

    Dugan, Sarah L; Temme, Renee T; Olson, Rebecca A; Mikhailov, Anna; Law, Rosalind; Mahmood, Huda; Noor, Abdul; Vincent, John B

    2015-06-01

    Latent TGFB-binding protein 3 (LTBP3) is known to increase bio-availability of TGFB. A homozygous mutation in this gene has previously been associated with oligodontia and short stature in a single family. We report on two sisters with homozygous truncating mutations in LTBP3. In addition to oligodontia and short stature, both sisters have mitral valve prolapse, suggesting a link between truncating LTBP3 mutations and mitral valve disease mediated through the TGFB pathway. PMID:25899461

  16. Mitral peak early diastolic filling velocity to deceleration time ratio as a predictor of prognosis in patients with chronic heart failure and preserved or reduced ejection fraction

    PubMed Central

    Pirozzi, Flora; Paglia, Antonella; Sasso, Laura; Abete, Pasquale; Carlomagno, Angelo; Tocchetti, Carlo G; Bonaduce, Domenico; Petretta, Mario

    2015-01-01

    Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio (E/DT) has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conventional echocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure (HF). Methods We analyzed 95 HF patients (mean age 64.8 ± 12.2 years) hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up (median 37.7 months) 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association (NYHA) functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration time and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis (hazard ratio = 1.02, P = 0.018), giving incremental prognostic information to clinical and other echocardio-graphic measures (global chi-square from 15.4 to 25.2; P = 0.032). Conclusions E/DT gives independent and incremental prognostic information in HF patients. PMID:26346482

  17. Simulation Based Design and Evaluation of a Transcatheter Mitral Heart Valve Frame

    PubMed Central

    Young, Melissa; Erdemir, Ahmet; Stucke, Samantha; Klatte, Ryan; Davis, Brian; Navia, Jose L.

    2013-01-01

    In certain populations, open heart surgery to replace a diseased mitral valve is not an option, leaving percutaneous delivery a viable alternative. However, a surgical transcatheter based delivery of a metallic support frame incorporating a tissue derived valve puts considerable constraints on device specifications. Expansion to a large diameter from the catheter diameter without mechanical fracture involves advanced device design and appropriate material processing and selection. In this study, a new frame concept is presented with a desirable feature that incorporates wings that protrude during expansion to establish adequate fixation. Expansion characteristics of the design in relation to annulus fixation were quantified through finite element analysis predictions of the frame wing span and angles. Computational modeling and simulation was used to identify many favorable design features for the transcatheter mitral valve frame and obtain desired expansion diameters (35–45mm), acceptable radial stiffness (2.7N/mm), and ensure limited risk of failure based on predicted plastic deformations. PMID:23372624

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

    PubMed Central

    Tamse, Tiffany; Rampersad, Avind; Jordan-Villegas, Alejandro; Ireland, Jill

    2015-01-01

    Idiopathic Hypereosinophilic Syndrome (IHES) is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO) as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses. PMID:26640733

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

    PubMed

    Tamse, Tiffany; Rampersad, Avind; Jordan-Villegas, Alejandro; Ireland, Jill

    2015-01-01

    Idiopathic Hypereosinophilic Syndrome (IHES) is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO) as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses. PMID:26640733

  20. Finite element modeling of mitral leaflet tissue using a layered shell approximation

    PubMed Central

    Ratcliffe, Mark B.; Guccione, Julius M.

    2012-01-01

    The current study presents a finite element model of mitral leaflet tissue, which incorporates the anisotropic material response and approximates the layered structure. First, continuum mechanics and the theory of layered composites are used to develop an analytical representation of membrane stress in the leaflet material. This is done with an existing anisotropic constitutive law from literature. Then, the concept is implemented in a finite element (FE) model by overlapping and merging two layers of transversely isotropic membrane elements in LS-DYNA, which homogenizes the response. The FE model is then used to simulate various biaxial extension tests and out-of-plane pressure loading. Both the analytical and FE model show good agreement with experimental biaxial extension data, and show good mutual agreement. This confirms that the layered composite approximation presented in the current study is able to capture the exponential stiffening seen in both the circumferential and radial directions of mitral leaflets. PMID:22971896

  1. Finite element modeling of mitral leaflet tissue using a layered shell approximation.

    PubMed

    Wenk, Jonathan F; Ratcliffe, Mark B; Guccione, Julius M

    2012-10-01

    The current study presents a finite element model of mitral leaflet tissue, which incorporates the anisotropic material response and approximates the layered structure. First, continuum mechanics and the theory of layered composites are used to develop an analytical representation of membrane stress in the leaflet material. This is done with an existing anisotropic constitutive law from literature. Then, the concept is implemented in a finite element (FE) model by overlapping and merging two layers of transversely isotropic membrane elements in LS-DYNA, which homogenizes the response. The FE model is then used to simulate various biaxial extension tests and out-of-plane pressure loading. Both the analytical and FE model show good agreement with experimental biaxial extension data, and show good mutual agreement. This confirms that the layered composite approximation presented in the current study is able to capture the exponential stiffening seen in both the circumferential and radial directions of mitral leaflets. PMID:22971896

  2. Primary Cardiac Synovial Sarcoma Originating From the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

    PubMed

    Prifti, Edvin; Veshti, Altin; Ikonomi, Majlinda; Demiraj, Aurel

    2015-10-01

    An 11-year-old boy was admitted with complaints of syncope and convulsion. Echocardiogram revealed a mass measuring 2 × 4 cm related to the mitral subvalvular apparatus. The mass, which appeared to be attached to the anterolateral papillary muscle, protruded into the left ventricular outflow tract causing intermittent obstruction. The patient underwent surgical excision of the mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At six months following the operation, a small mass measuring 1 × 1 cm was detected in the left ventricle. The patient underwent reoperation consisting of radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was cardiac synovial sarcoma. One year after surgery, the patient is doing well. PMID:26467881

  3. Mitral Subvalvular Aneurysm in a Patient with Chagas Disease and Recurrent Episodes of Ventricular Tachycardia

    PubMed Central

    Grillo, Tereza Augusta; Athayde, Guilherme Rafael S.; Belfort, Ana Flávia L.; Miranda, Reynaldo C.; Beaton, Andrea Z.; Nascimento, Bruno R.

    2015-01-01

    Subvalvular left ventricular aneurysm is a rare disease of obscure origin suggesting unique causes such as congenital, traumatic, and inflammatory or infectious diseases. Its mortality is closely related to heart failure, mitral insufficiency, thromboembolic phenomena, and cardiac arrhythmias. Although association with coronary artery disease is not described, the compression of epicardial vessels by the aneurysm may lead to ischemic manifestations. We report here a case of mitral subvalvular left ventricular aneurysm of probable chagasic origin, in a patient with normal left ventricular function evolving with repeated episodes of monomorphic ventricular tachycardia, despite noninducible electrophysiological testing and the use of optimal medical treatment, including amiodarone. The indication for implantable cardioverter-defibrillator in patients with Chagas cardiomyopathy and segmental wall motion abnormalities but without global systolic dysfunction remains unclear in literature, even in the presence of complex ventricular arrhythmias. A brief review of the literature on morphological features, diagnosis, prognosis, and treatment will be also discussed. PMID:26634158

  4. An inverse modeling approach for stress estimation in mitral valve anterior leaflet valvuloplasty for in-vivo valvular biomaterial assessment.

    PubMed

    Lee, Chung-Hao; Amini, Rouzbeh; Gorman, Robert C; Gorman, Joseph H; Sacks, Michael S

    2014-06-27

    Estimation of regional tissue stresses in the functioning heart valve remains an important goal in our understanding of normal valve function and in developing novel engineered tissue strategies for valvular repair and replacement. Methods to accurately estimate regional tissue stresses are thus needed for this purpose, and in particular to develop accurate, statistically informed means to validate computational models of valve function. Moreover, there exists no currently accepted method to evaluate engineered heart valve tissues and replacement heart valve biomaterials undergoing valvular stresses in blood contact. While we have utilized mitral valve anterior leaflet valvuloplasty as an experimental approach to address this limitation, robust computational techniques to estimate implant stresses are required. In the present study, we developed a novel numerical analysis approach for estimation of the in-vivo stresses of the central region of the mitral valve anterior leaflet (MVAL) delimited by a sonocrystal transducer array. The in-vivo material properties of the MVAL were simulated using an inverse FE modeling approach based on three pseudo-hyperelastic constitutive models: the neo-Hookean, exponential-type isotropic, and full collagen-fiber mapped transversely isotropic models. A series of numerical replications with varying structural configurations were developed by incorporating measured statistical variations in MVAL local preferred fiber directions and fiber splay. These model replications were then used to investigate how known variations in the valve tissue microstructure influence the estimated ROI stresses and its variation at each time point during a cardiac cycle. Simulations were also able to include estimates of the variation in tissue stresses for an individual specimen dataset over the cardiac cycle. Of the three material models, the transversely anisotropic model produced the most accurate results, with ROI averaged stresses at the fully-loaded state of 432.6±46.5 kPa and 241.4±40.5 kPa in the radial and circumferential directions, respectively. We conclude that the present approach can provide robust instantaneous mean and variation estimates of tissue stresses of the central regions of the MVAL. PMID:24275434

  5. Sizing for mitral annuloplasty: where does science stop and voodoo begin?

    PubMed

    Bothe, Wolfgang; Miller, D Craig; Doenst, Torsten

    2013-04-01

    The implantation of an improperly sized annuloplasty ring may result in an incompetent valve after surgical mitral valve repair. Consequently, the procedure of ring size selection is considered critical. Although a plethora of sizing strategies are described, the opinions on how to select the appropriate ring size differ widely and often appear arbitrary (ie, without scientific justification). These inconsistencies raise the question where, with respect to ring sizing, science stops and voodoo begins. PMID:23481703

  6. Left atrial high-grade undifferentiated pleomorphic sarcoma protruding through the mitral valve.

    PubMed

    Bégué, Celine; Barreda, Eleodoro; Hammoudi, Nadjib; Fouret, Pierre; Toledano, Dan; Isnard, Richard; Leprince, Pascal; Montalescot, Gilles; Barthélémy, Olivier

    2014-12-01

    Primary cardiac tumors are uncommon. Malignant neoplasms account for 25%, including 75% of cardiac sarcomas. A 53-year-old female complained of exertional dyspnea and orthopnea. Chest computed tomography revealed a mass within the left atrium. Echocardiography confirmed a bilobed left atrial mass protruding through the mitral valve orifice. The tumor was completely resected and was histologically diagnosed as a high-grade pleomorphic sarcoma. A 13-month follow-up was achieved without any recurrence on magnetic resonance imaging. PMID:25468101

  7. Increased frequency of mitral valve prolapse in patients with deviated nasal septum.

    PubMed

    Arslan, Hasan Huseyin; Aparci, Mustafa; Arslan, Zekeriya; Ozturk, Cengiz; Isilak, Zafer; Balta, Sevket; Celik, Turgay; Iyisoy, Atila

    2015-07-01

    Any abnormality of collagen may affect the tissues with higher collagen content, e.g., joints, heart valves, and great arteries. Mitral valve prolapse (MVP) is a characteristic of generalized collagen abnormality. Nasal septum (NS) is constituted by osseous and cartilaginous septums that are highly rich in collagen. We evaluated the co-existence of deviation of NS (DNS) in patients with MVP. We retrospectively evaluated the recordings of echocardiographic and nasal examinations of subjects with MVP and DNS. We analyzed the features of MVP and anatomical classification of DNS among subjects. Totally, 74 patients with DNS and 38 subjects with normal nasal passage were enrolled to the study. Presence of MVP was significantly higher in patients with DNS compared to normal subjects (63 vs 26%, p < 0.001). Prolapse of anterior, posterior and both leaflets was higher in patients with DNS. Thickness of anterior mitral leaflet was significantly increased in patients with DNS (3.57 ± 0.68 vs 4.59 ± 1.1 mm, p < 0.001) compared to normal subjects. Type I, II, and III, IV DNS were higher in frequency in patients with MVP while type V and VI were higher in normal subjects. DNS is highly co-existent with MVP and increased thickness of mitral anterior leaflet. Generalized abnormality of collagen which is the main component of mitral valves and nasal septum may be accounted for co-existence of MVP and DNS. Also co-existence of them may exaggerate the symptoms of patients with MVP due to limited airflow through the nasal passage. PMID:25129374

  8. Percutaneous Coronary Intervention for Coronary Thrombo-embolism during Balloon Mitral Valvuloplasty in a Pregnant Woman.

    PubMed

    Chikkabasavaiah, Nagamani; Rajendran, Ravindran; P, Beeresha; B, Ramesh

    2016-02-01

    Coronary embolism as a cause of acute myocardial infarction is considered rarer than it actually is because of the difficulties associated with its documentation. Equally rare is the event of a clot embolising to the coronary artery during balloon mitral valvuloplasty (BMV). We had a unique and a rare opportunity to encounter, recognise, document and successfully manage this rare complication during BMV in a pregnant woman. PMID:26602228

  9. Assessment of aortic and mitral annuli dynamics during the cardiac cycle using speckle tracking echocardiography

    PubMed Central

    Bai, Wenjuan; Li, Hui; Tang, Hong; Zhang, Qing; Zhu, Ye

    2014-01-01

    The aims of this study were i) to evaluate mitral and aortic annuli excursion, and aortomitral angle (AMA) during the cardiac cycle in healthy adults using two-dimensional speckle tracking echocardiography, ii) to assess two annuli dynamics and coupling behaviors as an integral, and iii) to detect the relation between two annuli and left ventricular ejection fraction (LVEF). A total of 74 healthy adults underwent transthoracic echocardiography. In the parasternal long-axis view, a number of points were extracted, including right coronary aortic annular, aortomitral fibrous junction, and posterior mitral annular points. The annuli excursion and AMA were measured using a speckle tracking-derived software during the cardiac cycle. During the isovolumic contraction and the isovolumic relaxation phase, annuli excursion and AMA remain stable for a short time. During the systole, annuli excursion increased sharply to the maximum, while AMA narrowed quickly to the minimum value. During the diastole, there are three patterns of decrease in annuli excursion and AMA expansion in different phases. The annuli excursion of three points correlates well with the LVEF (right coronary aortic annulus excursion, r=0.71, P<0.05; non-coronary aortic annulus excursion, r=0.70, P<0.05; posterior mitral annulus excursion, r=0.82, P<0.05). Moreover, there are positive correlations between annuli excursion and the variation of AMA (r=0.60, P<0.05). The annuli excursion and AMA have various regular patterns in healthy adults. The interactions of mitral and aortic annuli correlate with the left ventricular function. Our findings may have relevance to the evaluation of left ventricular function and presurgical planning of patients with valvular diseases.

  10. Mitral and aortic valve sclerosis/calcification and carotid atherosclerosis: results from 1065 patients.

    PubMed

    Rossi, Andrea; Faggiano, Pompilio; Amado, Alexandra E; Cicoira, Mariantonietta; Bonapace, Stefano; Franceschini, Lorenzo; Dini, Frank L; Ghio, Stefano; Agricola, Eustachio; Temporelli, Pier Luigi; Vassanelli, Corrado

    2014-11-01

    This study assesses whether aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are associated with carotid artery atherosclerosis, independently of traditional cardiovascular risk factors. A total of 1065 patients underwent both echocardiography and carotid artery ultrasound scanning. AVS and MAC were defined as focal areas of increased echogenicity and thickening of the aortic leaflets or mitral valve annulus. Carotid artery atherosclerosis was defined as presence/absence of any atherosclerotic plaque or presence/absence of plaque >50 %. Of 1065 patients (65 ± 9 years; 38 % female) who comprised the study population, 642 (60 %) had at least one atherosclerotic plaque. AVS, but not mitral valve sclerosis; was associated with the presence of carotid atherosclerosis (odds ratio (OR) 1.9, 95 % confidence interval (CI) 1.2-3.9; P = 0.005) and the degree of carotid atherosclerosis (OR 2.1, 95 % CI 1.2-3.9; P = 0.01) in a multivariate model including age, gender, previous ischemic heart disease, hypertension, dyslipidemia, smoking, diabetes, family cardiovascular history, left ventricular size, mass, and ejection fraction, and left atrial size. AVS is a significant predictor of carotid atherosclerosis, independently of other cardiovascular clinical and echocardiographic risk factors. PMID:24196525

  11. Tag1 deficiency results in olfactory dysfunction through impaired migration of mitral cells.

    PubMed

    Bastakis, George G; Savvaki, Maria; Stamatakis, Antonis; Vidaki, Marina; Karagogeos, Domna

    2015-12-15

    The olfactory system provides mammals with the abilities to investigate, communicate and interact with their environment. These functions are achieved through a finely organized circuit starting from the nasal cavity, passing through the olfactory bulb and ending in various cortical areas. We show that the absence of transient axonal glycoprotein-1 (Tag1)/contactin-2 (Cntn2) in mice results in a significant and selective defect in the number of the main projection neurons in the olfactory bulb, namely the mitral cells. A subpopulation of these projection neurons is reduced in Tag1-deficient mice as a result of impaired migration. We demonstrate that the detected alterations in the number of mitral cells are well correlated with diminished odor discrimination ability and social long-term memory formation. Reduced neuronal activation in the olfactory bulb and the corresponding olfactory cortex suggest that Tag1 is crucial for the olfactory circuit formation in mice. Our results underpin the significance of a numerical defect in the mitral cell layer in the processing and integration of odorant information and subsequently in animal behavior. PMID:26525675

  12. A comparative study of the morphology of mammalian chordae tendineae of the mitral and tricuspid valves

    PubMed Central

    Hutchison, Jennifer; Rea, Paul

    2015-01-01

    It is assumed that the human heart is almost identical to domestic mammalian species, but with limited literature to support this. One such area that has been underinvestigated is that of the subvalvular apparatus level. The authors set out to examine the morphology of the subvalvular apparatus of the mammalian atrioventricular valves through gross dissection and microscopic analysis in a small-scale pilot study. The authors examined the chordae tendineae of the mitral and tricuspid valves in sheep, pig and bovine hearts, comparing the numbers of each of these structures within and between species. It was found that the number of chordae was up to twice as many for the tricuspid valve compared with the mitral valve. The counts for the chordae on the three valve leaflets of the tricuspid valve, as well as the two mitral valve leaflets, were almost identical between species. However, the chordae attaching onto the posterior papillary muscle were almost double compared with the septal and anterior papillary muscles. Histological analysis demonstrated an abrupt transitional zone. In conclusion, the authors have shown that there is no gross morphological difference between, or within, these species at the subvalvular apparatus level. PMID:26644912

  13. Premeasured neochordae loop maker: a new technology in mitral valve repair.

    PubMed

    Ghavidel, Alireza Alizadeh; Samiei, Niloofar; Javadikasgari, Hoda; Bashirpour, Kamiar

    2013-01-01

    The exact length of neochordae loops plays the major role in the success of mitral valve repair. The Neochordae Loop Maker is a novel device that models the left ventricular structure in an individual patient. Preoperative transthoracic echocardiography is used to identify the geometry of each papillary muscle and set up the device for the patient. All required neochordae loops are made in the operating room before initiating the cardiopulmonary bypass. In the calibration phase, seven consecutive patients who were candidates for mitral valve replacement underwent transthoracic echocardiography. The device was set up for each patient, and the length of their normal chordae and their respective neochordae was compared by the Bland-Altman analysis. From seven excised mitral valves, 21 chordae were considered normal (gold standard). The length of these gold standards (1.92 ± 0.67 cm) and their respective neochordae (1.93 ± 0.69 cm) showed agreement by the Bland-Altman analysis. The proposed technology showed satisfactory preliminary results in creating the premeasured neochorda loops inasmuch as it reduced the complexity of minimally invasive surgeries. PMID:24356435

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

    PubMed

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

    2015-03-01

    High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery. PMID:25549635

  15. Simultaneous transapical aortic and mitral valve-in-valve implantation for double prostheses dysfunction: case report and technical insights.

    PubMed

    D'Onofrio, Augusto; Zucchetta, Fabio; Gerosa, Gino

    2014-09-01

    Transcatheter "Valve-in-Valve" implantation (ViV) has shown promising results in high-risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. We present a case of a 68-year-old woman with a history of three previous cardiac operations on the aortic and mitral valve. At the time of admission she was severely symptomatic due to a simultaneous SVD of a 23 mm aortic and of a 29 mm mitral St. Jude Biocor bioprosthesis. Because of the history of several cardiac operations and to her comorbidities, the patient was considered with an extremely high surgical risk profile and was therefore scheduled for double concomitant mitral and aortic ViV. Through a trans-apical approach, the patient underwent 23 and 29 mm Edwards Sapien XT implantation in the aortic and mitral bioprosthesis, respectively. The procedure was uneventful as well as the following hospital stay. At 6-months follow-up the patient is in NYHA class I. Echocardiography shows that the aortic bioprosthesis has no leak and the mean gradient is 20 mm Hg while the mitral valve has mild leak and maximum and mean gradients are 21 and 10 mm Hg, respectively. The three main technical aspects that should be carefully considered in double concomitant ViV are: sequence of valve deployment (whether to implant the mitral or the aortic valve first), choice of access and valve sizing. In conclusion, double simultaneous trans-apical mitral and aortic ViV is technically feasible. © 2014 Wiley Periodicals, Inc. PMID:24677811

  16. A novel left heart simulator for the multi-modality characterization of native mitral valve geometry and fluid mechanics.

    PubMed

    Rabbah, Jean-Pierre; Saikrishnan, Neelakantan; Yoganathan, Ajit P

    2013-02-01

    Numerical models of the mitral valve have been used to elucidate mitral valve function and mechanics. These models have evolved from simple two-dimensional approximations to complex three-dimensional fully coupled fluid structure interaction models. However, to date these models lack direct one-to-one experimental validation. As computational solvers vary considerably, experimental benchmark data are critically important to ensure model accuracy. In this study, a novel left heart simulator was designed specifically for the validation of numerical mitral valve models. Several distinct experimental techniques were collectively performed to resolve mitral valve geometry and hemodynamics. In particular, micro-computed tomography was used to obtain accurate and high-resolution (39 ?m voxel) native valvular anatomy, which included the mitral leaflets, chordae tendinae, and papillary muscles. Three-dimensional echocardiography was used to obtain systolic leaflet geometry. Stereoscopic digital particle image velocimetry provided all three components of fluid velocity through the mitral valve, resolved every 25 ms in the cardiac cycle. A strong central filling jet (V ~ 0.6 m/s) was observed during peak systole with minimal out-of-plane velocities. In addition, physiologic hemodynamic boundary conditions were defined and all data were synchronously acquired through a central trigger. Finally, the simulator is a precisely controlled environment, in which flow conditions and geometry can be systematically prescribed and resultant valvular function and hemodynamics assessed. Thus, this work represents the first comprehensive database of high fidelity experimental data, critical for extensive validation of mitral valve fluid structure interaction simulations. PMID:22965640

  17. Greater excitability and firing irregularity of tufted cells underlies distinct afferent-evoked activity of olfactory bulb mitral and tufted cells.

    PubMed

    Burton, Shawn D; Urban, Nathaniel N

    2014-05-15

    Mitral and tufted cells, the two classes of principal neurons in the mammalian main olfactory bulb, exhibit morphological differences but remain widely viewed as functionally equivalent. Results from several recent studies, however, suggest that these two cell classes may encode complementary olfactory information in their distinct patterns of afferent-evoked activity. To understand how these differences in activity arise, we have performed the first systematic comparison of synaptic and intrinsic properties between mitral and tufted cells. Consistent with previous studies, we found that tufted cells fire with higher probability and rates and shorter latencies than mitral cells in response to physiological afferent stimulation. This stronger response of tufted cells could be partially attributed to synaptic differences, as tufted cells received stronger afferent-evoked excitation than mitral cells. However, differences in intrinsic excitability also contributed to the differences between mitral and tufted cell activity. Compared to mitral cells, tufted cells exhibited twofold greater excitability and peak instantaneous firing rates. These differences in excitability probably arise from differential expression of voltage-gated potassium currents, as tufted cells exhibited faster action potential repolarization and afterhyperpolarizations than mitral cells. Surprisingly, mitral and tufted cells also showed firing mode differences. While both cell classes exhibited regular firing and irregular stuttering of action potential clusters, tufted cells demonstrated a greater propensity to stutter than mitral cells. Collectively, stronger afferent-evoked excitation, greater intrinsic excitability and more irregular firing in tufted cells can combine to drive distinct responses of mitral and tufted cells to afferent-evoked input. PMID:24614745

  18. [An unconscious patients with ascending aortic aneurysm accompanied by aortic regurgitation successfully treated by emergency operation after cardiopulmonary resuscitation].

    PubMed

    Hashimoto, T; Moro, H; Sogawa, M; Saitoh, M; Namura, O; Hanzawa, K; Kitamura, M; Hayashi, J

    2001-10-01

    A-37-year-old woman in shock condition was transferred to our hospital after cardiopulmonary resuscitation for ventricular fibrillation. She was unconscious and suspected of suffering ischemic brain damage, with pathologic reflexes and weak brain stem reflexes. Brain CT scan showed cerebral edema without hemorrhage or infarction and an electroencephalograph revealed slow alpha-theta waves. Chest CT scan and echocardiogram showed ascending aortic aneurysm with sever aortic regurgitation. An emergent operation was performed for progression of heart failure. There were no distortion or dilatation of the sinus of Valsalva and annuloaortic ectasia and aortic valve leaflets were almost normal. We considered that the aortic valve dysfunction was cause by dilatation of the sinotubular junction. Ascending aortic and aortic valve replacement were carried out to shorten cardiopulmonary bypass time and to prevent the progression of brain damage. Mild hypothermia was employed as a neuroprotective procedure for three days after surgery. The patient's neurological symptoms, which were right hemiparesis, facial apraxia and motor aphasia, improved and she was discharged from the hospital on foot without any neurological complications on the 47th postoperative day and returned to work after two months. PMID:11593740

  19. Persistent tricuspid regurgitation and its predictor in adults after percutaneous and isolated surgical closure of secundum atrial septal defect.

    PubMed

    Toyono, Manatomo; Krasuski, Richard A; Pettersson, Gosta B; Matsumura, Yoshiki; Yamano, Tetsuhiro; Shiota, Takahiro

    2009-09-15

    The fate of functional tricuspid regurgitation (TR) after closure of a secundum atrial septal defect (ASD) without any corrective tricuspid valve (TV) surgery remains unclear. We investigated this and the predictors of persistent TR after ASD closure. Thirty-two consecutive patients with moderate or severe TR before ASD closure were examined. Of these, 23 underwent percutaneous ASD closure, and 9 underwent isolated surgical ASD closure. The left ventricular end-diastolic volume, left ventricular ejection fraction, right ventricular end-diastolic area, right ventricular fractional area change, right ventricular spherical index, right atrial area, TV annular diameter, TV tethering height, pulmonary artery systolic pressure, and pulmonary/systemic blood flow ratio were determined by echocardiography before and early after ASD closure. The color Doppler maximal jet area was used to assess the severity of TR. After ASD closure, the jet area decreased for all patients (p = 0.009); however, 16 patients (50%) had persistent TR. Multivariate analysis revealed that only pulmonary artery systolic pressure before ASD closure was related to the TR jet area after ASD closure (p = 0.003). A pulmonary artery systolic pressure of >60 mm Hg predicted persistent TR with 100% sensitivity and 63% specificity. In conclusion, functional TR was ameliorated after percutaneous and isolated surgical ASD closure, although persistent TR was common. The presence of pulmonary hypertension before ASD closure predicted persistent TR; therefore, corrective TV surgery should be considered at ASD closure in adult patients with moderate or severe TR and concomitant pulmonary hypertension. PMID:19733724

  20. Velocity of closure of Björk-Shiley Convexo-Concave mitral valves: effect of mitral annulus orientation and rate of left ventricular pressure rise.

    PubMed

    Blick, E F; Wieting, D W; Inderbitzen, R; Schreck, S; Stein, P D

    1995-07-01

    The purpose of this study was to determine analytically the hemodynamic factors that affect the closing velocity of the disc of Björk-Shiley convexo-concave (BSCC) prosthetic mitral valves. The motion of the BSCC disk was modelled by Newton's second law written in the form of a second order differential equation which expressed the instantaneous angle of the disc with respect to the valve ring as a function of the instantaneous pressure drop across the mitral valve, delta P(t), and the angle of the pressure gradient vector acting upon the disc during closure. The disc closes in response to the negative pressure drop created by the crossover of left atrial and left ventricular (LV) pressures. The rate of closure depends on the rate of development of the pressure drop across the valve, d delta P/dt, which is largely dependent upon the rate of change of left ventricular pressure during isovolumic contraction, LV dP/dt. The closure rate is also strongly dependent on the initial angle of the pressure drop vector with respect to the disc. The disc was predicted to reach its highest velocity at the moment of impact, based on the Runge-Kutta solution. Modelling suggests that a high LV dP/dt during valve closure or distorted LV geometry, causing the angle between the fully open disc and the pressure drop vector to shift, will cause the valve to have a high velocity at the moment of impact and may produce high impact loads. PMID:8581208

  1. Culture and characterisation of canine mitral valve interstitial and endothelial cells.

    PubMed

    Liu, M-M; Flanagan, T C; Lu, C-C; French, A T; Argyle, D J; Corcoran, B M

    2015-04-01

    Valve interstitial cells (VICs) have an important role in the aetiopathogenesis of myxomatous mitral valve disease (MMVD) in the dog. Furthermore, there is evidence that valve endothelial cells (VECs) also contribute to disease development. In addition to examining native valve tissue to understand MMVD, another strategy is to separately examine VIC and VEC biology under in vitro culture conditions. The aim of this study was to isolate and characterise canine mitral VICs and VECs from normal dog valves using a combination of morphology, immunohistochemistry and reverse transcription PCR (RT-PCR). Canine mitral VECs and VICs were isolated and cultured in vitro. The two cell populations exhibited different morphologies and growth patterns. VECs, but not VICs, expressed the endothelial markers, platelet endothelial cell adhesion molecule (PECAM-1 or CD31) and acetylated low density lipoprotein (Dil-Ac-LDL). Both VECs and VICs expressed vimentin and embryonic non-smooth muscle myosin heavy chain (SMemb), an activated mesenchymal cell marker. The myofibroblast marker, alpha smooth muscle actin (?-SMA), was detected at the mRNA level in both VEC and VIC cultures, but only at the protein level in VIC cultures. The morphological heterogeneity and expression of non-endothelial phenotypic markers in VEC cultures suggested that a mixture of cell types was present, which might be due to cell contamination and/or endothelial-mesenchymal transition (EndoMT). The use of a specific endothelial culture medium for primary VEC cultures enhanced the endothelial properties of the cells and reduced ?-SMA and SMemb expression. PMID:25747697

  2. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

    PubMed Central

    Prifti, Edvin; Ademaj, Fadil; Ikonomi, Majlinda; Demiraj, Aurel

    2015-01-01

    The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. PMID:26187170

  3. Ventricular fibrillation during general anaesthesia in a seven-year-old patient with mitral valve prolapse.

    PubMed

    Casthely, P A; Dluzneski, J; Resurreccion, M A; Kleopoulos, N; Redko, V

    1986-11-01

    A case report is presented of a seven-year-old boy who developed ventricular fibrillation during general anaesthesia with atracurium, O2, N2O and halothane, following tracheal intubation for hypospadias revision. He spontaneously defibrillated and the surgery was cancelled. Echocardiography done two days later was normal. The patient returned two weeks later for the same procedure. He developed nodal tachycardia, and premature ventricular contractions, which responded to lidocaine. A second echocardiographic examination done postoperatively while the child was crying showed mitral valve prolapse. PMID:3779501

  4. A note on the critical flow to initiate closure of pivoting disc mitral valve prostheses.

    PubMed

    Reif, T H; Huffstutler, M C

    1985-01-01

    Newton's second law of motion for rotating bodies and potential flow theory is used to mathematically model the closing process of a pivoting disc prosthetic heart valve in mitral position. The model predicts closure to be dependent upon disc curvature, eccentricity, mass, diameter, density, opening angle and fluid properties. Experiments using two commercially available prostheses are shown to give good correlation with the theory for large opening angles. Divergence between theory and experiment occur at small opening angles because of the limitation of the potential flow assumption. PMID:3988784

  5. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation.

    PubMed

    Prifti, Edvin; Ademaj, Fadil; Ikonomi, Majlinda; Demiraj, Aurel

    2015-01-01

    The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. PMID:26187170

  6. An Electronic Stethoscope with Diagnosis Capability Wah W. Myint

    E-print Network

    , sinus arrhythmia, tachycardia, bradycardia, aortic stenosis and mitral regurgitation. I. INTRODUCTION of extracting heart rate as well as diagnosing abnormal heart rate conditions: sinus arrhythmia, bradycardra

  7. A case report of papillary fibroelastoma attached to chorda tendineae of mitral valve.

    PubMed

    Yamaguchi, Masaomi; Yagi, Kentaro; Ikeya, Eriko; Fujimura, Takabumi; Taguchi, Junichi; Shibuya, Makoto; Inamura, Shunichi; Kanabuchi, Kazuo

    2006-07-01

    The case was a Japanese man of 62 years old. A bulbar mass attached to mitral valve anterior leaflet was discovered in an echocardiography within detailed examination of ischemic heart disease accidentally. We diagnosed him as ischemic heart disease and doubt of heart tumor. We thought about the danger of future embolism, surgical treatment was decided. We dissected the tumor together with one chorda tendineae of mitral valve, and a performed aorta - coronary bypass surgery. We diagnosed the tumor as papillary fibroelastoma by pathological diagnosis. Papillary fibroelastoma is extremely rare with 7-9% of benign tumor of heart primary. Most of the papillary fibroelastoma is incidentally discovered by echocardiography or autopsy. Or it is discovered for systemic embolism. The tumor is benign, but there is a problem to cause embolism. Therefore, when we discovered papillary fibroelastoma, surgical resection of the tumor is the first-line therapy. A problem on surgical therapy is the range of resection area. Papillary fibroelastoma is benign tumor, but the pathological characteristic is still unidentified. Further epidemiological and pathological studies are necessary to determine the extent of surgical excision in associated with characteristics of papillary fibroelastoma. PMID:21302223

  8. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

    PubMed Central

    Prifti, Edvin; Ikonomi, Majlinda; Veshti, Altin; Demiraj, Aurel; Xhaxho, Roland

    2015-01-01

    Introduction The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves. Case presentation We describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast’s surgery. A preoperative echocardiography demonstrated a mass >1 cm2 originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE. Discussion With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences. Conclusion To summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis. PMID:26209756

  9. Aspergillus Flavus Endocarditis of the Native Mitral Valve in a Bone Marrow Transplant Patient

    PubMed Central

    Demir, Tolga; Ergenoglu, Mehmet Umit; Ekinci, Abdurrahman; Tanrikulu, Nursen; Sahin, Mazlum; Demirsoy, Ergun

    2015-01-01

    Patient: Male, 36 Final Diagnosis: Aspergillus flavus endocarditis Symptoms: Malaise • fatigue and dyspnea Medication: — Clinical Procedure: Mitral vale replacemnet Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection. Case Report: We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome. Conclusions: Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment. PMID:25603977

  10. Prolonged Intracellular Na+ Dynamics Govern Electrical Activity in Accessory Olfactory Bulb Mitral Cells

    PubMed Central

    Zylbertal, Asaph; Kahan, Anat; Ben-Shaul, Yoram; Yarom, Yosef; Wagner, Shlomo

    2015-01-01

    Persistent activity has been reported in many brain areas and is hypothesized to mediate working memory and emotional brain states and to rely upon network or biophysical feedback. Here, we demonstrate a novel mechanism by which persistent neuronal activity can be generated without feedback, relying instead on the slow removal of Na+ from neurons following bursts of activity. We show that mitral cells in the accessory olfactory bulb (AOB), which plays a major role in mammalian social behavior, may respond to a brief sensory stimulation with persistent firing. By combining electrical recordings, Ca2+ and Na+ imaging, and realistic computational modeling, we explored the mechanisms underlying the persistent activity in AOB mitral cells. We found that the exceptionally slow inward current that underlies this activity is governed by prolonged dynamics of intracellular Na+ ([Na+]i), which affects neuronal electrical activity via several pathways. Specifically, elevated dendritic [Na+]i reverses the Na+-Ca2+ exchanger activity, thus modifying the [Ca2+]i set-point. This process, which relies on ubiquitous membrane mechanisms, is likely to play a role in other neuronal types in various brain regions. PMID:26674618

  11. Effect of the Mitral Valve's Anterior Leaflet on Axisymmetry of Transmitral Vortex Ring.

    PubMed

    Falahatpisheh, Ahmad; Pahlevan, Niema M; Kheradvar, Arash

    2015-10-01

    The shape and formation of transmitral vortex ring are shown to be associated with diastolic function of the left ventricle (LV). Transmitral vortex ring is a flow feature that is observed to be non-axisymmetric in a healthy heart and its inherent asymmetry in the LV assists in efficient ejection of the blood during systole. This study is a first step towards understanding the effects of the mitral valve's anterior leaflet on transmitral flow. We experimentally study a single-leaflet model of the mitral valve to investigate the effect of the anterior leaflet on the axisymmetry of the generated vortex ring based on the three-dimensional data acquired using defocusing digital particle image velocimetry. Vortex rings form downstream of a D-shaped orifice in presence or absence of the anterior leaflet in various physiological stroke ratios. The results of the statistical analysis indicate that the formed vortex ring downstream of a D-shaped orifice is markedly non-axisymmetric, and presence of the anterior leaflet improves the ring's axisymmetry. This study suggests that the improvement of axisymmetry in presence of the anterior leaflet might be due to coupled dynamic interaction between rolling-up of the shear layer at the edges of the D-shaped orifice and the borders of the anterior leaflet. This interaction can reduce the non-uniformity in vorticity generation, which results in more axisymmetric behavior compared to the D-shaped orifice without the anterior leaflet. PMID:25821111

  12. Effect of mitral orifice shape on intra-ventricular filling fluid dynamics

    NASA Astrophysics Data System (ADS)

    Okafor, Ikechukwu; Angirish, Yagna; Yoganathan, Ajit; Santhanakrishnan, Arvind

    2013-11-01

    The natural geometry of the mitral orifice is D-shaped. However, most current designs of prosthetic valves employ O-shaped orifice geometry. The goal of this study was to compare the effect of geometrical modification between the D and O orifice on the intra-ventricular fluid dynamics during diastolic filling. The different mitral orifice geometries were incorporated into an in vitro left heart simulator consisting of a flexible-walled anatomical left ventricle (LV) physical model enclosed in an acrylic housing. Physiological flow rates and pressures were obtained via tuning systemic resistance and compliance elements in the flow loop. A programmable piston pump was used to generate the LV model wall motion. 2D Particle image velocimetry measurements were conducted along multiple longitudinal planes perpendicular to the annulus plane. During peak diastole, the incoming jet width at the LV central plane was smaller for the D-orifice than that of the O-orifice. Further, the core of the vortex ring in the D-orifice was reduced in size compared to that of the O-orifice. The spatiotemporal spreading of the inflow jet as well as the propagation of the vortex ring will be discussed. This study was funded by a grant from the National Heart, Lung and Blood Institute (RO1HL70262).

  13. Differentiating the aging of the mitral valve from human and canine myxomatous degeneration

    PubMed Central

    Connell, Patrick S.; Han, Richard I.; Grande-Allen, K. Jane

    2012-01-01

    During the course of both canine and human aging, the mitral valve remodels in generally predictable ways. The connection between these aging changes and the morbidity and mortality that accompany pathologic conditions has not been made clear. By exploring work that has investigated the specific valvular changes in both age and disease, with respect to the cells and the extracellular matrix found within the mitral valve, heretofore unexplored connections between age and myxomatous valve disease can be found. This review addresses several studies that have been conducted to explore such age and disease related changes in extracellular matrix, valvular endothelial and interstitial cells, and valve innervation, and also reviews attempts to correlate aging and myxomatous disease. Such connections can highlight avenues for future research and help provide insight as to when an individual diverts from an aging pattern into a diseased pathway. Recognizing these patterns and opportunities could result in earlier intervention and the hope of reduced morbidity and mortality for patients. PMID:22364720

  14. Left atrial rupture secondary to myxomatous mitral valve disease in 11 dogs.

    PubMed

    Nakamura, Reid K; Tompkins, Emily; Russell, Nicholas J; Zimmerman, Sarah A; Yuhas, Danielle L; Morrison, Thomas J; Lesser, Michael B

    2014-01-01

    The purpose of this retrospective study was to evaluate the long-term outcome in dogs with left atrial rupture secondary to myxomatous mitral valve disease. Eleven client-owned dogs met the inclusion criteria for the study. Median age was 11.6 yr (range, 8.3-17.8 yr), and median weight was 5.8 kg (range, 3.8-15.2 kg). Of the 11 dogs, 10 survived the initial 24 hr after diagnosis and 5 of the dogs were still alive at the conclusion of data collection. The median survival of all dogs was 203 days. Dogs with no previous history of congestive heart failure (CHF) at the time of diagnosis had a significantly longer median survival time (345 days) compared with dogs with a previous history of CHF (160 days, P = 0.0038). Outcome of dogs with myxomatous mitral valve disease presenting with left atria rupture was more favorable than previously reported, and dogs without previous CHF survived the longest. PMID:25251426

  15. Staphylococcus lugdunensis Endocarditis Complicated by Embolism in an 18-Year-Old Woman with Mitral Valve Prolapse

    PubMed Central

    Pecoraro, Rosaria; Tuttolomondo, Antonino; Parrinello, Gaspare; Pinto, Antonio; Licata, Giuseppe

    2013-01-01

    Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS). It is a major cause of prosthetic valve endocarditis; mitral valve prolapse (MVP) has emerged as a prominent predisposing structural cardiac abnormality. We describe a case of Staphylococcus lugdunensis endocarditis in an 18-year-old woman with preexisting mitral valve prolapse complaining of fever, a one-month history of continuous-remittent fever (Tmax 38.6°C). The transthoracic echocardiogram revealed large vegetation on the anterior mitral valve leaflet flopping from the atrial side to the ventricular side. Five sets of blood cultures were positive for coagulase-negative staphylococci. During hospitalization, after two weeks of antibiotic therapy, the patient complained of sudden pain in her right leg associated with numbness. Lower limb arterial Doppler ultrasound showed an arterial thrombosis of right common iliac artery. Transfemoral iliac embolectomy was promptly performed and on septic embolus S. lugdunensis with the same antibiotic sensitivity and the same MIC values was again isolated. Our patient underwent cardiac surgery: triangular resection of the A2 with removal of infected tissue including vegetation. Our case is an example of infective endocarditis by S. lugdunensis on native mitral valve in a young woman of 18 with anamnesis valve prolapse. PMID:23424690

  16. Immediate effect of balloon valvuloplasty on hemostatic changes in mitral stenosis.

    PubMed

    Zaki, A; Salama, M; El Masry, M; Abou-Freikha, M; Abou-Ammo, D; Sweelum, M; Mashhour, E; Elhendy, A

    2000-02-01

    This study was conducted to assess right and left atrial hemostatic function in patients with mitral stenosis (MS) and to investigate the immediate effect of balloon mitral valvuloplasty (BMV) on hemostatic function. BMV was performed in 28 patients with MS (age 29 +/- 8 years) who had sinus rhythm and no left atrial (LA) thrombus. Right and left atrial biochemical markers of platelet activity (platelet factor 4 [PF4] and B thromboglobulin [BTG]), coagulation (thrombin-antithrombin III complex [TAT]), and fibrinolytic activity (D-dimer) were measured before and 30 minutes after BMV. Right atrial levels of these markers were also measured in 20 control subjects. Compared with control subjects, patients with MS had higher right atrial levels of PF4 (30 +/- 15 vs 5 +/- 2 IU/ml), BTG (231 +/- 53 vs 30 +/- 8 IU/ml), TAT (7 +/- 4 vs 2 +/- 0.3 microg/L), and D-dimer (380 +/- 145 vs 160 +/- 35 ng/ml, p < 0.0001 in all). TAT levels were higher in the left atrium than in the right atrium of patients before BMV (8 +/- 4 vs 7 +/- 4 microg/L, p < 0.0001). BMV was successful (final mitral valve area > or = 1.5 cm2 and > or = 50% increase of the initial valve area) in all patients. There was a significant reduction of LA levels of PF4 (35 +/- 8 to 26 +/- 9 IU/ml, p < 0.0001), BTG (225 +/- 41 to 196 +/- 28 IU/ml, p < 0.001), and TAT (10 +/- 5 to 7 +/- 1 microg/L, p < 0.05) in the 16 patients with LA pressure < 10 mm Hg after BMV, whereas these markers were not reduced in the 12 patients with left atrial pressure > or = 10 mm Hg after BMV. These data indicate that platelet function, coagulation status, and fibrinolytic activity are increased regionally in the left atrium and in the systemic circulation in patients with MS and sinus rhythm in the absence of LA thrombus. Successful BMV induces a significant reduction of prethrombotic status in patients with low LA pressure after the procedure. Patients with high LA pressure after BMV maintain a high prethrombotic state and may be considered at an increased risk of thromboembolism after the procedure. PMID:11078309

  17. Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction.

    PubMed

    Kronen, P W; Levionnois, O L; Eckstein, F S; Moens, Y P S

    2005-10-01

    A sheep was anaesthetized for implantation of a novel device (MitroFast) to replace the posterior leaflet of the mitral valve. Anaesthetic management included a balanced anaesthetic protocol and consisted of propofol or isoflurane combined with fentanyl infusion (0.15-0.4 microg/kg/min). Deliberate hypothermia during cardiopulmonary bypass was set at 34.5-35.5 degrees C. Surgery proceeded uneventfully. Total time of aortic cross-clamping was 35 min and total time on extracorporeal circulation was 60 min. Visual inspection, intracardiac pressure testing and transesophageal echocardiography indicated proper functioning of the device. The anaesthetic period was uneventful, but recovery was prolonged with central nervous and respiratory depression and marked hypoxaemia. Administration of naloxone (1.5 microg/kg, repeated twice at 15-20 min intervals) reversed the central nervous and attenuated the respiratory depressions. An initially low rate of urine production normalized after rewarming and a single intravenous administration of furosemide. PMID:16197710

  18. Increased systolic load causes adverse remodeling of fetal aortic and mitral valves.

    PubMed

    Tibayan, Frederick A; Louey, Samantha; Jonker, Sonnet; Espinoza, Herbert; Chattergoon, Natasha; You, Fanglei; Thornburg, Kent L; Giraud, George

    2015-12-15

    While abnormal hemodynamic forces alter fetal myocardial growth, little is known about whether such insults affect fetal cardiac valve development. We hypothesized that chronically elevated systolic load would detrimentally alter fetal valve growth. Chronically instrumented fetal sheep received either a continuous infusion of adult sheep plasma to increase fetal blood pressure, or a lactated Ringer's infusion as a volume control beginning on day 126 ± 4 of gestation. After 8 days, mean arterial pressure was higher in the plasma infusion group (63.0 mmHg vs. 41.8 mmHg, P < 0.05). Mitral annular septal-lateral diameter (11.9 mm vs. 9.1 mm, P < 0.05), anterior leaflet length (7.7 mm vs. 6.4 mm, P < 0.05), and posterior leaflet length (P2; 4.0 mm vs. 3.0 mm, P < 0.05) were greater in the elevated load group. mRNA levels of Notch-1, TGF-?2, Wnt-2b, BMP-1, and versican were suppressed in aortic and mitral valve leaflets; elastin and ?1 type I collagen mRNA levels were suppressed in the aortic valves only. We conclude that sustained elevated arterial pressure load on the fetal heart valve leads to anatomic remodeling and, surprisingly, suppression of signaling and extracellular matrix genes that are important to valve development. These novel findings have important implications on the developmental origins of valve disease and may have long-term consequences on valve function and durability. PMID:26354842

  19. Is robotic mitral valve surgery more expensive than its conventional counterpart?

    PubMed

    Canale, Leonardo Secchin; Colafranceschi, Alexandre Siciliano

    2015-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If amortization is taken into consideration, robotic cases are considerably more expensive. PMID:25757475

  20. Mitral stenosis

    MedlinePLUS

    ... disease that can develop after an illness with strep throat that was not properly treated. The valve ... is becoming rare in the United States because strep infections are most often treated. This has made ...

  1. Transcatheter ACURATE-TA Aortic Valve Implantation in a Patient With a Previous Mechanical Mitral Valve.

    PubMed

    Bagur, Rodrigo; Kiaii, Bob; Teefy, Patrick J; Diamantouros, Pantelis; Harle, Christopher; Goela, Aashish; Chan, Ian; Chu, Michael W A

    2015-11-01

    Transcatheter aortic valve implantation (TAVI) in the presence of a mechanical mitral valve (MMV) prosthesis is still challenging because of the rigid mitral frame within the aortomitral curtain. Moreover, low-lying coronary ostia represent a hazardous problem of coronary obstruction, especially in narrow or porcelain aortic roots. The present case demonstrates the successful management of 2 challenging anatomical issues, the rigid cage of the MMV and the low-lying left main coronary ostium (LMCO), with the implantation of the ACURATE-TA bioprosthesis (Symetis SA, Ecublens, Switzerland). It also highlights the importance of having multiple TAVI devices in order to choose the ideal transcatheter aortic bioprosthesis to fit the unique anatomical presentation of the patient. PMID:26522576

  2. The non-specificity of the left/right ventricular amplitude ratio (LV/RV) for mitral insufficiency

    SciTech Connect

    Preston, D.F.; Reinsel, M.S.; Martin, N.L.; Robinson, R.G.

    1984-01-01

    The purpose of this study was to determine the specificity of the LV/RV for mitral insufficiency. One hundred and sixty patients underwent MUGA studies as part of their diagnostic evaluation. Phase analysis was performed. In the amplitude image, the LV/RV was measured. Patients were divided into 11 clinical groups based on chart review after adequate follow-up. The groups were compared by Duncan's Multiple Comparsion Test. Patients with mitral insufficiency (N = 12, mean LV/RV = 2.36), those with idiopathic myocardiopathy (8, 2.29) and those with normal hearts having lung disease on chest x-ray (22, 1.78) formed a group which at the p < .05 level were not different from one another. Patients with idiopathic myocardiography, normal hearts with lung disease on chest x-ray, normal hearts with lung disease (23, 1.71) formed a second group which partially overlapped with both the first and third groups. The third group consisted of normal hearts with lung disease, normal hearts not taking adriamycin (18, 1.53), normal hearts taking adriamycin (22, 1.50), congestive heart failure (19, 1.50), arteriosclerotic heart disease, normal hearts (15, 1.29), chronic obstructive pulmonary disease and acute myocardial infarction. The LV/RV is not specific for mitral insufficiency. Idiopathic myocardiography, and normal hearts with lung disease on chest x-ray (metastases, cancer of the lung, infiltrates, fibrosis, and/or COPD) cannot be differentiated on a statistical basis. The mitral insufficiency group had the greatest values of LV/RV. It appears that decreased RV amplitude seen with diseases causing strain on the right ventricle will result in elevated LV/RV ratios.

  3. Percutaneous retrograde transfemoral closure of mitral paravalvular leak in 3 patients without construction of an arteriovenous wire loop.

    PubMed

    Kilic, Teoman; Sahin, Tayfun; Ural, Ertan

    2014-04-01

    Percutaneous closure of paravalvular leaks has emerged as an alternative to repeated surgeries. Different percutaneous techniques and various devices have been used, off-label, for paravalvular leak closure. For mitral leaks, antegrade transseptal, retrograde transfemoral, and retrograde transapical techniques have been developed. In the antegrade transseptal approach, an arteriovenous guidewire loop is often created to advance the delivery sheath. In retrograde transfemoral closure, the wire in the left atrium is usually snared after transseptal puncture, to pull it from the femoral vein. The delivery sheath and closure device will subsequently be deployed from the left atrium. Each of these procedures takes time, is costly, and increases the risk of complications. We present the cases of 3 patients in whom we closed mitral paravalvular leaks by means of a retrograde transfemoral approach, with use of an Amplatzer™ Duct Occluder II device and without the construction of an arteriovenous wire loop. We think that this approach can be very useful in a specific group of patients-reducing costs, fluoroscopy times, and complications related to transseptal puncture and construction of an arteriovenous wire loop. In our institution, this reported technique is routinely used for mitral paravalvular leak closure. PMID:24808777

  4. Surgical experience for prolapse of both atrioventricular valves in a patient with filamin A mutation.

    PubMed

    Hoashi, Takaya; Shiraishi, Isao; Ichikawa, Hajime

    2015-02-01

    A 21-year-old man underwent mitral valve replacement and tricuspid annuloplasty for severe mitral regurgitation and moderate tricuspid regurgitation. Until the operation, he had been treated for hypermobility type Ehlers-Danlos syndrome. Gene examination revealed a mutation in filamin A gene, which is the gene responsible for X-linked myxomatous valvular dystrophy. PMID:24521555

  5. Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man

    PubMed Central

    Nezafati, Pouya; Nezafati, Mohammad Hassan; Hoseinikhah, Hamid

    2015-01-01

    Introduction. Unruptured sinus of valsalva aneurysm (SVA) is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD) and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery. PMID:26236342

  6. National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999–2010

    PubMed Central

    Dodson, John A.; Wang, Yun; Murugiah, Karthik; Dharmarajan, Kumar; Cooper, Zack; Hashim, Sabet; Nuti, Sudhakar V.; Spatz, Erica; Desai, Nihar; Krumholz, Harlan M.

    2015-01-01

    Background Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals. Methods We included 100% of Medicare Fee-for-Service patients ?65 years of age who underwent MVS between 1999–2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race). Results The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999–2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65–74: 47.4% to 44.4%; 75–84: 51.4% to 49.2%, ?85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18). Conclusions Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks. PMID:26147225

  7. Dynamic Heterogeneity of the Heart Valve Interstitial Cell Population in Mitral Valve Health and Disease

    PubMed Central

    Sauls, Kimberly; Koenig, Sara N.; Anstine, Lindsey J.; Garg, Vidu; Norris, Russell A.; Lincoln, Joy

    2015-01-01

    The heart valve interstitial cell (VIC) population is dynamic and thought to mediate lay down and maintenance of the tri-laminar extracellular matrix (ECM) structure within the developing and mature valve throughout life. Disturbances in the contribution and distribution of valve ECM components are detrimental to biomechanical function and associated with disease. This pathological process is associated with activation of resident VICs that in the absence of disease reside as quiescent cells. While these paradigms have been long standing, characterization of this abundant and ever-changing valve cell population is incomplete. Here we examine the expression pattern of Smooth muscle ?-actin, Periostin, Twist1 and Vimentin in cultured VICs, heart valves from healthy embryonic, postnatal and adult mice, as well as mature valves from human patients and established mouse models of disease. We show that the VIC population is highly heterogeneous and phenotypes are dependent on age, species, location, and disease state. Furthermore, we identify phenotypic diversity across common models of mitral valve disease. These studies significantly contribute to characterizing the VIC population in health and disease and provide insights into the cellular dynamics that maintain valve structure in healthy adults and mediate pathologic remodeling in disease states. PMID:26527432

  8. Image-based mass-spring model of mitral valve closure for surgical planning

    NASA Astrophysics Data System (ADS)

    Hammer, Peter E.; Perrin, Douglas P.; del Nido, Pedro J.; Howe, Robert D.

    2008-03-01

    Surgical repair of the mitral valve is preferred in most cases over valve replacement, but replacement is often performed instead due to the technical difficulty of repair. A surgical planning system based on patient-specific medical images that allows surgeons to simulate and compare potential repair strategies could greatly improve surgical outcomes. In such a surgical simulator, the mathematical model of mechanics used to close the valve must be able to compute the closed state quickly and to handle the complex boundary conditions imposed by the chords that tether the valve leaflets. We have developed a system for generating a triangulated mesh of the valve surface from volumetric image data of the opened valve. We then compute the closed position of the mesh using a mass-spring model of dynamics. The triangulated mesh is produced by fitting an isosurface to the volumetric image data, and boundary conditions, including the valve annulus and chord endpoints, are identified in the image data using a graphical user interface. In the mass-spring model, triangle sides are treated as linear springs, and sides shared by two triangles are treated as bending springs. Chords are treated as nonlinear springs, and self-collisions are detected and resolved. Equations of motion are solved using implicit numerical integration. Accuracy was assessed by comparison of model results with an image of the same valve taken in the closed state. The model exhibited rapid valve closure and was able to reproduce important features of the closed valve.

  9. Effects of Bileaflet Mechanical Mitral Valve Rotational Orientation on Left Ventricular Flow Conditions

    PubMed Central

    Westerdale, John C; Adrian, Ronald; Squires, Kyle; Chaliki, Hari; Belohlavek, Marek

    2015-01-01

    We studied left ventricular flow patterns for a range of rotational orientations of a bileaflet mechanical heart valve (MHV) implanted in the mitral position of an elastic model of a beating left ventricle (LV). The valve was rotated through 3 angular positions (0, 45, and 90 degrees) about the LV long axis. Ultrasound scans of the elastic LV were obtained in four apical 2-dimensional (2D) imaging projections, each with 45 degrees of separation. Particle imaging velocimetry was performed during the diastolic period to quantify the in-plane velocity field obtained by computer tracking of diluted microbubbles in the acquired ultrasound projections. The resulting velocity field, vorticity, and shear stresses were statistically significantly altered by angular positioning of the mechanical valve, although the results did not show any specific trend with the valve angular position and were highly dependent on the orientation of the imaging plane with respect to the valve. We conclude that bileaflet MHV orientation influences hemodynamics of LV filling. However, determination of ‘optimal’ valve orientation cannot be made without measurement techniques that account for the highly 3-dimensional (3D) intraventricular flow. PMID:26312080

  10. DNA Repair Gene Polymorphism and the Risk of Mitral Chordae Tendineae Rupture.

    PubMed

    Yigin, Aysel Kalayci; Vatan, Mehmet Bulent; Akdemir, Ramazan; Aksoy, Muhammed Necati Murat; Cakar, Mehmet Akif; Kilic, Harun; Erkorkmaz, Unal; Karacan, Keziban; Kaleli, Suleyman

    2015-01-01

    Polymorphisms in Lys939Gln XPC gene may diminish DNA repair capacity, eventually increasing the risk of carcinogenesis. The aim of the present study was to evaluate the significance of polymorphism Lys939Gln in XPC gene in patients with mitral chordae tendinea rupture (MCTR). Twenty-one patients with MCTR and thirty-seven age and sex matched controls were enrolled in the study. Genotyping of XPC gene Lys939Gln polymorphism was carried out using polymerase chain reaction- (PCR-) restriction fragment length polymorphism (RFLP). The frequencies of the heterozygote genotype (Lys/Gln-AC) and homozygote genotype (Gln/Gln-CC) were significantly different in MCTR as compared to control group, respectively (52.4% versus 43.2%, p = 0.049; 38.15% versus 16.2%, p = 0.018). Homozygote variant (Gln/Gln) genotype was significantly associated with increased risk of MCTR (OR = 2.059; 95% CI: 1.097-3.863; p = 0.018). Heterozygote variant (Lys/Gln) genotype was also highly significantly associated with increased risk of MCTR (OR = 1.489; 95% CI: 1.041-2.129; p = 0.049). The variant allele C was found to be significantly associated with MCTR (OR = 1.481; 95% CI: 1.101-1.992; p = 0.011). This study has demonstrated the association of XPC gene Lys939Gln polymorphism with MCTR, which is significantly associated with increased risk of MCTR. PMID:26604426

  11. DNA Repair Gene Polymorphism and the Risk of Mitral Chordae Tendineae Rupture

    PubMed Central

    Kalayci Yigin, Aysel; Bulent Vatan, Mehmet; Akdemir, Ramazan; Necati Murat Aksoy, Muhammed; Cakar, Mehmet Akif; Kilic, Harun; Erkorkmaz, Unal; Karacan, Keziban; Kaleli, Suleyman

    2015-01-01

    Polymorphisms in Lys939Gln XPC gene may diminish DNA repair capacity, eventually increasing the risk of carcinogenesis. The aim of the present study was to evaluate the significance of polymorphism Lys939Gln in XPC gene in patients with mitral chordae tendinea rupture (MCTR). Twenty-one patients with MCTR and thirty-seven age and sex matched controls were enrolled in the study. Genotyping of XPC gene Lys939Gln polymorphism was carried out using polymerase chain reaction- (PCR-) restriction fragment length polymorphism (RFLP). The frequencies of the heterozygote genotype (Lys/Gln-AC) and homozygote genotype (Gln/Gln-CC) were significantly different in MCTR as compared to control group, respectively (52.4% versus 43.2%, p = 0.049; 38.15% versus 16.2%, p = 0.018). Homozygote variant (Gln/Gln) genotype was significantly associated with increased risk of MCTR (OR = 2.059; 95% CI: 1.097–3.863; p = 0.018). Heterozygote variant (Lys/Gln) genotype was also highly significantly associated with increased risk of MCTR (OR = 1.489; 95% CI: 1.041–2.129; p = 0.049). The variant allele C was found to be significantly associated with MCTR (OR = 1.481; 95% CI: 1.101–1.992; p = 0.011). This study has demonstrated the association of XPC gene Lys939Gln polymorphism with MCTR, which is significantly associated with increased risk of MCTR. PMID:26604426

  12. Mass-spring systems for simulating mitral valve repair using 3D ultrasound images.

    PubMed

    Skornitzke, Stephan; Schummers, Georg; Schreckenberg, Marcus; Ender, Jörg; Eibel, Sarah; Bungartz, Hans-Joachim; Kauczor, Hans-Ulrich; Stiller, Wolfram

    2015-10-01

    Mitral valve (MV) diseases are among the most common types of heart diseases, while heart diseases are the most common cause of death worldwide. MV repair surgery is connected to higher survival rates and fewer complications than the total replacement of the MV, but MV repair requires extensive patient-specific therapy planning. The simulation of MV repair with a patient-specific model could help to optimize surgery results and make MV repair available to more patients. However, current patient-specific simulations are difficult to transfer to clinical application because of time-constraints or prohibitive requirements on the resolution of the image data. As one possible solution to the problem of patient-specific MV modeling, we present a mass-spring MV model based on 3D transesophageal echocardiographic (TEE) images already routinely acquired for MV repair therapy planning. Our novel approach to the rest-length estimation of springs allows us to model the global support of the MV leaflets through the chordae tendinae without the need for high-resolution image data. The model is used to simulate MV annuloplasty for five patients undergoing MV repair, and the simulated results are compared to post-surgical TEE images. The comparison shows that our model is able to provide a qualitative estimate of annuloplasty surgery. In addition, the data suggests that the model might also be applied to simulating the implantation of artificial chordae. PMID:26241162

  13. Transcatheter valve-in-ring implantation after a failed surgical mitral repair using a transseptal approach and a veno-arterial loop for valve placement.

    PubMed

    Wunderlich, Nina C; Kische, Stephan; Ince, Hüseyin; Bozda?-Turan, Ilkay

    2014-12-01

    A failure of a mitral valve repair, which includes the implantation of a mitral annuloplasty ring in the majority of cases, is associated with relevant mortality. Surgery is considered as the standard treatment for these patients. For patients who have an unacceptable high peri-surgical risk a transcatheter valve-in-ring (TVIR) procedure might be an option. Isolated case reports and small case series report on the feasibility of a TVIR implantation in mitral position. We present a case where a 29-mm Edwards Sapien valve was placed in a 32-mm Carpentier Edwards ring. To our knowledge no valve has been implanted so far in this ring size and this is the first case where a veno-arterial loop was used as guide rail for valve implantation and helped considerably to position the valve properly. PMID:24307006

  14. [High technology examination methods in athletes with tricuspidal insufficiency].

    PubMed

    Firsakova, V Iu; Maslennikova, O M

    2013-01-01

    The article exemplifies solving problem of permit for coaching and contest in athletes with marked tricuspidal regurgitation. Invasive study analysis of intracardiac hemodynamic parameters at rest and during electrostimulation-induced tachycardia helps to differentiate primary and functional tricuspidal insufficiency, to reveal latent cardiac insufficiency and unfavorable disorders of cardiac rhythm and conductivity. This investigation method has to be used in cases when other modalities are unable to assess the risk of fatal events at the highest submaximal heart rate. PMID:24340772

  15. En bloc aortic and mitral valve replacement and left ventricular outflow tract enlargement using a combined transaortic and trans-septal atrial approach.

    PubMed

    Hassan, Mohammed; Windsor, Jimmy; Ricci, Marco

    2015-12-01

    Aortic and mitral valve replacement with division and reconstruction of the inter-valvular fibrous body has been described in clinical situations involving infective endocarditis, extensive annular calcifications and diminutive valve annuli. Herein, we describe a combined transaortic and trans-septal approach with division of the inter-valvular fibrosa for combined aortic and mitral valve replacement. The reconstruction of the inter-valvular fibrous body, atrial walls and aortic root was carried out using a 'three-patch' technique with bovine pericardium. PMID:26409564

  16. Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction

    NASA Technical Reports Server (NTRS)

    Flachskampf, F. A.; Chandra, S.; Gaddipatti, A.; Levine, R. A.; Weyman, A. E.; Ameling, W.; Hanrath, P.; Thomas, J. D.

    2000-01-01

    The shape and dynamics of the mitral annulus of 10 patients without heart disease (controls), 3 patients with dilated cardiomyopathy, and 5 patients with hypertrophic obstructive cardiomyopathy and normal systolic function were analyzed by transesophageal echocardiography and 3-dimensional reconstruction. Mitral annular orifice area, apico-basal motion of the annulus, and nonplanarity were calculated over time. Annular area was largest in end diastole and smallest in end systole. Mean areas were 11.8 +/- 2.5 cm(2) (controls), 15.2 +/- 4.2 cm(2) (dilated cardiomyopathy), and 10.2 +/- 2.4 cm(2) (hypertrophic cardiomyopathy) (P = not significant). After correction for body surface, annuli from patients with normal left ventricular function were smaller than annuli from patients with dilated cardiomyopathy (5.9 +/- 1.2 cm(2)/m(2) vs 7.7 +/- 1.0 cm(2)/m(2); P <.02). The change in area during the cardiac cycle showed significant differences: 23.8% +/- 5.1% (controls), 13.2% +/- 2.3% (dilated cardiomyopathy), and 32.4% +/- 7.6% (hypertrophic cardiomyopathy) (P <.001). Apico-basal motion was highest in controls, followed by those with hypertrophic obstructive and dilated cardiomyopathy (1.0 +/- 0.3 cm, 0.8 +/- 0.2 cm, 0.3 +/- 0.2 cm, respectively; P <.01). Visual inspection and Fourier analysis showed a consistent pattern of anteroseptal and posterolateral elevations of the annulus toward the left atrium. In conclusion, although area changes and apico-basal motion of the mitral annulus strongly depend on left ventricular systolic function, nonplanarity is a structural feature preserved throughout the cardiac cycle in all three groups.

  17. Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prostheses and quantitation of visceral microembolism in dogs

    SciTech Connect

    Dewanjee, M.K.; Fuster, V.; Rao, S.A.; Forshaw, P.L.; Kaye, M.P.

    1983-05-01

    A noninvasive technique has been developed in the dog model for imaging, with a gamma camera, the platelet deposition on Bjoerk-Shiley mitral valve prostheses early postoperatively. At 25 hours after implantation of the prosthesis and 24 hours after intravenous administration of 400 to 500 microCi of platelets labeled with indium-111, the platelet deposition in the sewing ring and perivalvular cardiac tissue can be clearly delineated in a scintiphotograph. An in vitro technique was also developed for quantitation of visceral microemboli in brain, lungs, kidneys, and other tissues. Biodistribution of the labeled platelets was quantitated, and the tissue/blood radioactivity ratio was determined in 22 dogs in four groups: unoperated normal dogs, sham-operated dogs, prosthesis-implanted dogs, and prosthesis-implanted dogs treated with dipyridamole before and aspirin and dipyridamole immediately after operation. Fifteen to 20% of total platelets were consumed as a consequence of the surgical procedure. On quantitation, we found that platelet deposition on the components of the prostheses was significantly reduced in prosthesis-implanted animals treated with dipyridamole and aspirin when compared with prosthesis-implanted, untreated dogs. All prosthesis-implanted animals considered together had a twofold to fourfold increase in tissue/blood radioactivity ratio in comparison with unoperated and sham-operated animals, an indication that the viscera work as filters and trap platelet microemboli that are presumably produced in the region of the mitral valve prostheses. In the dog model, indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of platelet deposition on mechanical mitral valve prostheses, in vitro evaluation of platelet microembolism in viscera, in vitro quantitation of surgical consumption of platelets, and evaluation of platelet-inhibitor drugs.

  18. Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prosthesis and renal microembolism in dogs

    SciTech Connect

    Dewanjee, M.K.; Kaye, M.P.; Fuster, V.; Rao, S.A.

    1980-01-01

    At 24 hrs after implantation of Bjoerk-Shiley mitral prosthesis in 5 dogs, in vivo images were obtained with a gamma camera after intravenous administration (0.5-0.6 mCi) one hour postoperatively of autologous Indium-111-labeled platelets. The site of platelet deposition in the teflon ring and perivascular damaged cardiac tissue is clearly delineated in the scintiphoto. In vitro biodistribution (mean % +/- SD of injected dose) at 24 hrs after injection of the 5 implanted and 7 normal dogs performed with a gamma counter demonstrated that (45.1 +/- 10.6)% and (0.7 +/- 0.4)% were in blood and kidneys in normal dogs and (28.5 +/- 6.8)%, (1.6 +/- 0.6)%, (0.3 +/- 0.1)%, and (0.2 +/- 0.1)% were in blood, kidneys, teflon rings, and perivascular damaged cardiac tissue, respectively. The strut and pyrolytic carbon-coated disc retained only (0.0033 +/- 0.0004)% and (0.0031 +/- 0.0003)%, respectively. There was a 2.3-fold increase of labeled platelets in kidneys of implanted dogs due to renal trapping of microembolism. Also, three- to fivefold increase in ratios of lung, brain, cardiac, and skeletal muscle to blood indicates that internal organs and whole body work as filter for microembolism generated by cardiovascular surgery and mitral prosthesis. Twenty percent of the administered platelets are consumed in surgical repair of damaged tissue. Indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of Bjoerk-Shiley mitral prosthesis, thromboembolism after implantation of prosthetic device, and in vitro quantitation of surgical consumption.

  19. Pattern of rat olfactory bulb mitral and tufted cell connections to the anterior olfactory nucleus pars externa.

    PubMed

    Scott, J W; Ranier, E C; Pemberton, J L; Orona, E; Mouradian, L E

    1985-12-15

    The pattern of output of mitral and tufted cells of the rat olfactory bulb (OB) to layer Ia overlying the pars externa (pE) of the anterior olfactory nucleus (AON) has been studied in the rat by iontophoresis of horseradish peroxidase and Phaseolus vulgaris-leucoagglutinin. These agents labeled mitral and tufted cells and at least the proximal portion of their axons. In most cases we observed small branches from axons of the lateral olfactory tract that appear to terminate in the region of the pE AON, while the main axon could often be traced for considerable distances past these branches. These branches are assumed to terminate in the pE AON because they could not be traced to other terminal regions, because they ramify in layer Ia, and because they usually show small swellings characteristic of axons in terminal regions. Although each ramification could be extensive, we found that the positions of these small branches were related to the positions of the injections within the OB. Dorsal medial injections labeled dorsal branches. Ventral medial injections labeled ventral branches. Injections on the lateral face of the OB labeled intermediate branches. The centers of the regions within which branches were labeled were strongly correlated with the positions of the injection around the circumference. Comparison of the anterior-posterior axis of the OB produced no such strong correlation. Reconstructions of axons showed that terminal branches arise from both mitral and tufted cells, although at least some mitral cells are shown not to have such branches in the pE AON. Studies of the patterns of dendrites and terminals in the pE AON indicate that this region has the same pattern of layer Ia and Ib terminals seen in other olfactory cortical regions. The pE AON cell layer is intercalated just below the boundary between layers Ia and Ib. Since dendrites of the underlying pars lateralis of the AON (pL AON) penetrate into layer Ia over much of the pE AON, it is necessary to remember that at least part of the pL AON may also receive topographically organized inputs. PMID:4086669

  20. Severity of Mitral Valve Degeneration Is Associated with Chromosome 15 Loci in Whippet Dogs.

    PubMed

    Stern, Joshua A; Hsue, Weihow; Song, Kun-Ho; Ontiveros, Eric S; Luis Fuentes, Virginia; Stepien, Rebecca L

    2015-01-01

    Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs. This phenomenon makes a traditional case versus control genetic study prone to phenotyping error. This study sought to avoid these common pitfalls by identifying genetic loci associated with severity of MVD in Whippets through a genome-wide association study (GWAS). 138 Whippet dogs were characterized for MVD by echocardiographic examination and a novel disease severity score was developed and adjusted for age in each subject. Single nucleotide polymorphism (SNP) genotype data (170k Illumina CanineHD SnpChip) was obtained for DNA isolated from blood of each study subject. Continuous variable genome wide association was performed after correction for population stratification by efficient mixed model association expedited (EMMAX) in 130 dogs. A genome wide significant association was identified on chromosome 15 (peak locus 57,770,326; Padj = 0.049) and secondary loci of suggestive association were identified on chromosome 2 (peak locus 37,628,875; Padj = 0.079). Positional candidate genes were identified within the primary and secondary loci including follistatin-related protein 5 precursor (FSTL5) and Rho GTPase-activating protein 26 (ARHGAP26). These results support the hypothesis that severity of MVD in whippets has a genetic basis and warrants further study by either candidate gene sequencing or next-generation techniques. PMID:26509595

  1. Postnatal development attunes olfactory bulb mitral cells to high-frequency signaling.

    PubMed

    Yu, Yiyi; Burton, Shawn D; Tripathy, Shreejoy J; Urban, Nathaniel N

    2015-11-15

    Mitral cells (MCs) are a major class of principal neurons in the vertebrate olfactory bulb, conveying odor-evoked activity from the peripheral sensory neurons to olfactory cortex. Previous work has described the development of MC morphology and connectivity during the first few weeks of postnatal development. However, little is known about the postnatal development of MC intrinsic biophysical properties. To understand stimulus encoding in the developing olfactory bulb, we have therefore examined the development of MC intrinsic biophysical properties in acute slices from postnatal day (P)7-P35 mice. Across development, we observed systematic changes in passive membrane properties and action potential waveforms consistent with a developmental increase in sodium and potassium conductances. We further observed developmental decreases in hyperpolarization-evoked membrane potential sag and firing regularity, extending recent links between MC sag heterogeneity and firing patterns. We then applied a novel combination of statistical analyses to examine how the evolution of these intrinsic biophysical properties specifically influenced the representation of fluctuating stimuli by MCs. We found that immature MCs responded to frozen fluctuating stimuli with lower firing rates, lower spike-time reliability, and lower between-cell spike-time correlations than more mature MCs. Analysis of spike-triggered averages revealed that these changes in spike timing were driven by a developmental shift from broad integration of inputs to more selective detection of coincident inputs. Consistent with this shift, generalized linear model fits to MC firing responses demonstrated an enhanced encoding of high-frequency stimulus features by mature MCs. PMID:26354312

  2. Severity of Mitral Valve Degeneration Is Associated with Chromosome 15 Loci in Whippet Dogs

    PubMed Central

    Stern, Joshua A.; Hsue, Weihow; Song, Kun-Ho; Ontiveros, Eric S.

    2015-01-01

    Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs. This phenomenon makes a traditional case versus control genetic study prone to phenotyping error. This study sought to avoid these common pitfalls by identifying genetic loci associated with severity of MVD in Whippets through a genome-wide association study (GWAS). 138 Whippet dogs were characterized for MVD by echocardiographic examination and a novel disease severity score was developed and adjusted for age in each subject. Single nucleotide polymorphism (SNP) genotype data (170k Illumina CanineHD SnpChip) was obtained for DNA isolated from blood of each study subject. Continuous variable genome wide association was performed after correction for population stratification by efficient mixed model association expedited (EMMAX) in 130 dogs. A genome wide significant association was identified on chromosome 15 (peak locus 57,770,326; Padj = 0.049) and secondary loci of suggestive association were identified on chromosome 2 (peak locus 37,628,875; Padj = 0.079). Positional candidate genes were identified within the primary and secondary loci including follistatin-related protein 5 precursor (FSTL5) and Rho GTPase-activating protein 26 (ARHGAP26). These results support the hypothesis that severity of MVD in whippets has a genetic basis and warrants further study by either candidate gene sequencing or next-generation techniques. PMID:26509595

  3. Biology of mitral valve prolapse: the harvest is big, but the workers are few.

    PubMed

    Loardi, Claudia; Alamanni, Francesco; Trezzi, Matteo; Kassem, Samer; Cavallotti, Laura; Tremoli, Elena; Pacini, Davide; Parolari, Alessandro

    2011-09-01

    Mitral valve prolapse (MVP) represents a common degenerative disease, often requiring surgery. If untreated, MVP with considerable valve incompetence can lead to cardiovascular and systemic complications causing substantial morbidity and mortality. In contrast with the wide knowledge concerning clinical and physiological features, currently available data regarding its molecular bases are very limited. We review current knowledge concerning MVP biological mechanisms, focusing on specific aspects of haemostasis, platelet function, oxidative stress, extracellular matrix remodeling and genomics. In particular, available evidence supports the role played by tissue remodeling processes in determining MVP onset and progression. Moreover, even if a consistent although controversial perturbation of haemostatic system and alterations of the oxidative stress equilibrium have been proposed to influence disease development, it is unknown whether these changes precede or follow MVP occurrence. Consequently, the complete knowledge of all the biochemical pathways involved are far from complete. In addition, changes in the regulation pattern of adrenergic and renin-angiotensin-aldosterone systems have been described in MVP syndrome, a condition characterized by the association of MVP with other peculiar neurological and general symptoms, but it is unknown whether these abnormalities are shared by "traditional" MVP. In conclusion, MVP is probably a multi-factorial process, and many aspects still need to be clarified. As surgery can only correct the damaged valve but not the underlying mechanisms, a more complete knowledge of the involved molecular pathways is necessary, as it may allow the discovery of targeted therapeutic strategies aimed at modifying or slackening MVP natural course in the early phases. PMID:21168228

  4. On the presence of affine fibril and fiber kinematics in the mitral valve anterior leaflet.

    PubMed

    Lee, Chung-Hao; Zhang, Will; Liao, Jun; Carruthers, Christopher A; Sacks, Jacob I; Sacks, Michael S

    2015-04-21

    In this study, we evaluated the hypothesis that the constituent fibers follow an affine deformation kinematic model for planar collagenous tissues. Results from two experimental datasets were utilized, taken at two scales (nanometer and micrometer), using mitral valve anterior leaflet (MVAL) tissues as the representative tissue. We simulated MVAL collagen fiber network as an ensemble of undulated fibers under a generalized two-dimensional deformation state, by representing the collagen fibrils based on a planar sinusoidally shaped geometric model. The proposed approach accounted for collagen fibril amplitude, crimp period, and rotation with applied macroscopic tissue-level deformation. When compared to the small angle x-ray scattering measurements, the model fit the data well, with an r(2) = 0.976. This important finding suggests that, at the homogenized tissue-level scale of ?1 mm, the collagen fiber network in the MVAL deforms according to an affine kinematics model. Moreover, with respect to understanding its function, affine kinematics suggests that the constituent fibers are largely noninteracting and deform in accordance with the bulk tissue. It also suggests that the collagen fibrils are tightly bounded and deform as a single fiber-level unit. This greatly simplifies the modeling efforts at the tissue and organ levels, because affine kinematics allows a straightforward connection between the macroscopic and local fiber strains. It also suggests that the collagen and elastin fiber networks act independently of each other, with the collagen and elastin forming long fiber networks that allow for free rotations. Such freedom of rotation can greatly facilitate the observed high degree of mechanical anisotropy in the MVAL and other heart valves, which is essential to heart valve function. These apparently novel findings support modeling efforts directed toward improving our fundamental understanding of tissue biomechanics in healthy and diseased conditions. PMID:25902446

  5. Autologous Transplantation of Bone Marrow Adult Stem Cells for the Treatment of Idiopathic Dilated Cardiomyopathy

    PubMed Central

    Westphal, Ricardo João; Bueno, Ronaldo Rocha Loures; Galvão, Paulo Bezerra de Araújo; Zanis Neto, José; Souza, Juliano Mendes; Guérios, Ênio Eduardo; Senegaglia, Alexandra Cristina; Brofman, Paulo Roberto; Pasquini, Ricardo; da Cunha, Claudio Leinig Pereira

    2014-01-01

    Background Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. Objective Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Methods We administered 4,54 x 108 ± 0,89 x 108 bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. Results During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. Conclusion Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation. PMID:25590932

  6. Elevated tricuspid regurgitant velocity as a marker for pulmonary hypertension in children with sickle cell disease: less prevalent and predictive than previously thought?

    PubMed

    Hebson, Camden; New, Tamara; Record, Elizabeth; Oster, Matthew; Ehrlich, Alexandra; Border, William; James-Herry, Angelica; Kanaan, Usama

    2015-03-01

    Although elevated tricuspid regurgitant velocity (TRV), an echocardiographic marker for pulmonary hypertension, has previously been tied to mortality in adult patients with sickle cell disease, recent data demonstrated that it correlates poorly with catheterization findings. We describe the largest echocardiographic evaluation of pediatric patients with sickle cell disease to date, specifically the results of a protocol whereby a TRV?250 cm/s prompted further evaluation. We investigated if elevated TRV would independently identify patients at risk for increased morbidity. A clinical echocardiographic database containing 630 patients with sickle cell disease was retrospectively reviewed; 120 patients (19%) met inclusion criteria and were compared 1:1 to randomly selected age-matched controls from the same database. By multivariate analysis, the elevated TRV cohort did not differ from controls in likelihood of acute chest episodes, hospitalization, or stroke. The study cohort's mean TRV in fact decreased to 242±33 cm/s at follow-up without a discernible and comprehensive intervention to explain the improvement. Three patients had catheterization-proven pulmonary hypertension. In conclusion, elevated TRV in children with sickle cell disease is less prevalent than previously thought and is not independently associated with increased short-term morbidity. PMID:24942020

  7. The Utility of 3D Left Atrial Volume and Mitral Flow Velocities as Guides for Acute Volume Resuscitation

    PubMed Central

    Santosa, Claudia M.; Rose, David D.; Fleming, Neal W.

    2015-01-01

    Left ventricular end-diastolic pressure (LVEDP) is the foundation of cardiac function assessment. Because of difficulties and risks associated with its direct measurement, correlates of LVEDP derived by pulmonary artery (PA) catheterization or transesophageal echocardiography (TEE) are commonly adopted. TEE has the advantage of being less invasive; however TEE-based estimation of LVEDP using correlates such as left ventricular end-diastolic volume (LVEDV) has technical difficulties that limit its clinical usefulness. Using intraoperative acute normovolemic hemodilution (ANH) as a controlled hemorrhagic model, we examined various mitral flow parameters and three-dimensional reconstructions of left atrial volume as surrogates of LVEDP. Our results demonstrate that peak E wave velocity and left atrial end-diastolic volume (LAEDV) correlated with known changes in intravascular volume associated with ANH. Although left atrial volumetric analysis was done offline in our study, recent advances in echocardiographic software may allow for continuous display and real-time calculation of LAEDV. Along with the ease and reproducibility of acquiring Doppler images of flow across the mitral valve, these two correlates of LVEDP may justify a more widespread use of TEE to optimize intraoperative fluid management. The clinical applicability of peak E wave velocity and LAEDV still needs to be validated during uncontrolled resuscitation. PMID:26236733

  8. Alpha-smooth muscle actin and serotonin receptors 2A and 2B in dogs with myxomatous mitral valve disease.

    PubMed

    Cremer, S E; Moesgaard, S G; Rasmussen, C E; Zois, N E; Falk, T; Reimann, M J; Cirera, S; Aupperle, H; Oyama, M A; Olsen, L H

    2015-06-01

    Canine Myxomatous mitral valve disease (MMVD) is an age-related disease. Serotonin (5-HT) is implicated in the pathogenesis as locally-produced or platelet-derived. Involvement of the 5-HT2A receptor (R) and 5-HT2BR in the induction of myxomatous-mediating valvular myofibroblasts (MF) has been suggested. In an age-matched population of dogs with non-clinical and clinical MMVD, the objectives were to investigate (1) gene expression of 5-HT2AR and 5-HT2BR, (2) protein expression and spatial relationship of 5-HT2AR, 5-HT2BR and MF in the mitral valve (MV) and the cardiac anterior papillary muscle (AP) and (3) serum 5-HT concentrations. Gene expression of 5-HT2BR was significantly higher in MV and AP among dogs with clinical MMVD. This was not found for 5-HT2BR protein expression, though association of 5-HT2BR with myxomatous pathology and co-localization of 5-HT2BR and MF in MV and AP support a functional relationship, perhaps perpetuation of clinical MMVD. 5-HT2AR-expression and serum 5-HT showed no differences between groups. PMID:25843893

  9. Traumatic disruption of the fibrous skeleton of the heart, with injury of the tricuspid and mitral valves, aortic annulus, and ventricular septum

    PubMed Central

    Kratz, John M.; Sade, Robert M.; Usher, Bruce W.; Gaddy, Joe E.

    1980-01-01

    In an automobile accident, a young man sustained blunt trauma to the chest that caused injury to the fibrous skeleton of the heart. The mitral and tricuspid valves and their annuli were lacerated, the aortic annulus was separated from the ventricular septum, and the ventricular septum was disrupted; however, with surgical management, the patient survived. PMID:15216256

  10. Calcium Signaling in Mitral Cell Dendrites of Olfactory Bulbs of Neonatal Rats and Mice during Olfactory Nerve Stimulation and Beta-Adrenoceptor Activation

    ERIC Educational Resources Information Center

    Yuan, Qi; Mutoh, Hiroki; Debarbieux, Franck; Knopfel, Thomas

    2004-01-01

    Synapses formed by the olfactory nerve (ON) provide the source of excitatory synaptic input onto mitral cells (MC) in the olfactory bulb. These synapses, which relay odor-specific inputs, are confined to the distally tufted single primary dendrites of MCs, the first stage of central olfactory processing. Beta-adrenergic modulation of electrical…

  11. Degenerative mitral valve disease: Survival of dogs attending primary-care practice in England.

    PubMed

    Mattin, M J; Boswood, A; Church, D B; McGreevy, P D; O'Neill, D G; Thomson, P C; Brodbelt, D C

    2015-12-01

    This study aimed to evaluate survival of dogs with degenerative mitral valve disease (DMVD). A retrospective cohort study of dogs with DMVD attending primary-care practices in England was undertaken. Cases of DMVD were identified within the electronic patient records (EPRs) of practices sharing data with VetCompass. Kaplan-Meier curves were used to explore survival and Cox regression models identified factors associated with hazard of death. The EPRs from 111,967 dogs, attending 93 veterinary practices between January 2010 and December 2011 identified 405 cases diagnosed with DMVD giving a prevalence of diagnosed DMVD of 0.36% (95% CI: 0.29-0.45%). A further 3557 dogs were classified as possible cases (heart murmurs consistent with DMVD). Overall, a total of 3962 dogs were classified as heart murmur cases (possible and diagnosed DMVD), giving a prevalence of 3.54% (95% CI: 3.26-3.84%). One hundred and sixteen (28.6%) of the diagnosed DMVD cases were incident, newly diagnosed with DMVD. The mean age at diagnosis was 9.52 years (95% CI: 8.98-10.14 years). Fifty-eight (50.0%) of the incident cases died during the study period. The median survival time (MST) for all-cause mortality was 25.4 months (95% CI: 20.4-34.4 months) after disease detection for DMVD cases. For possible cases, 121 (29.7%) from a random sample of 407 possible DMVD cases were incident cases (newly detected heart murmur consistent with DMVD during the study period). The mean age at which a heart murmur was first recorded in possible cases was 9.73 years (95% CI: 9.02-10.44 years). Forty-nine (40.5%) possible cases died during the study period. The MST for all-cause mortality was 33.8 months (95% CI: 23.7-43.1 months) after a heart murmur was initially detected. In the multivariable survival analysis for possible and diagnosed cases, Cavalier King Charles Spaniels (CKCSs) and other purebreds had higher hazards of death than crossbreds. Dogs weighing ?20.0kg and older dogs had an increased hazard of death compared with those <20.0kg and younger dogs, respectively. The study highlights poorer survival for all-cause mortality in CKCSs and larger dogs. The reported survival characteristics could aid veterinary surgeons' advice on the prognosis for dogs with DMVD and help the assessment of the impact of the condition at a population level. PMID:26058819

  12. A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography.

    PubMed

    Teshima, Hideki; Ikebuchi, Masahiko; Sano, Toshikazu; Kinugasa, Yusuke; Tai, Ryuta; Irie, Hiroyuki

    2015-12-01

    A 62-year-old female patient underwent mitral valve replacement with a 31/33-mm On-X valve for ischemic mitral valve regurgitation. Three months later, transthoracic echocardiography incidentally showed a blocked leaflet with 6 mmHg of mean pressure gradient and 2.4 cm(2) of mitral valve orifice area. Transesophageal echocardiography could not detect thrombus. Electrocardiographically gated multidetector-row computed tomography (MDCT) clearly demonstrated a blocked leaflet in the close position and thrombus (2 cm in length, 0.4 cm(2) in area) attached onto the atrial aspect of the leaflet. These findings observed by MDCT were confirmed at reoperation. MDCT was useful diagnostic method for visualizing prosthetic valve thrombosis. PMID:26105106

  13. Horseshoe thrombus in a patient with mechanical prosthetic mitral valve: A case report and review of literature.

    PubMed

    Mehra, Sanjay; Movahed, Assad; Espinoza, Carlos; Marcu, Constantin B

    2015-09-16

    Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications. PMID:26380832

  14. Horseshoe thrombus in a patient with mechanical prosthetic mitral valve: A case report and review of literature

    PubMed Central

    Mehra, Sanjay; Movahed, Assad; Espinoza, Carlos; Marcu, Constantin B

    2015-01-01

    Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications. PMID:26380832

  15. Video-assisted Port-Access mitral valve surgery: from debut to routine surgery. Will Trocar-Port-Access cardiac surgery ultimately lead to robotic cardiac surgery?

    PubMed

    Vanermen, H; Wellens, F; De Geest, R; Degrieck, I; Van Praet, F

    1999-07-01

    A right thoracotomy is a well-known alternative for midsternotomy to have access to the left atrium. The Port-Access (Heartport, Inc, Redwood City, CA) approach is an invaluable option to avoid cracking of ribs and cartilage. EndoCPB (Heartport, Inc) and Endo-Aortic Clamp (Heartport, Inc) allows installation of the extracorporeal circulation and cardiac arrest from the groin. Videoassistance and shafted instruments help the surgeon to perform the surgery through a 5 x 2-cm port and fulfill the main goals of minimally invasive cardiac surgery, comfort, cosmesis, and fast rehabilitation. From February 1997 to November 1998, 75 patients (40 men/35 women) had either Port-Access mitral valve repair (n = 41) or replacement (n = 33) for a variety of reasons: myxoid degeneration (n = 45), rheumatic disease (n = 21), chronic endocarditis (n = 4), annular dilatation (n = 2), and sclerotic disease (n = 2). One valve was replaced because of an ingrowing myxoma. There was one closure of a paravalvular leak. The mean age was 59.3 years of age (range, 32 to 83 years). Most patients had normal ejection fractions but different grades of mitral valve insufficiency and were in NYHA class II. One 71-year-old patient died after reoperation on postoperative day 1 for failed repair. Two patients had conversion to sternotomy and conventional ECC for repair of a dissected aorta. One patient died, one patient suffered a minor cerebrovascular deficit. Three patients had prolonged intensive care unit (ICU) stays for respiratory insufficiency, 5 patients underwent revision for bleeding. Mean ICU stay was 2.5 days; and mean hospital stay, 9 days (range, 4 to 36). A significant difference between the first 30 and last 38 patients in terms of length of stay in the ICU and the hospital was noticed. Two late mitral valve replacements for chronic endocarditis after repair occurred. One patient had medical therapy for endocarditis after mitral valve replacement. The debut of Port-Access mitral valve surgery may be nerve-racking; the routine is a smooth and sure surgery with maximum comfort, a very discrete scar, and a fast rehabilitation. There were no paravalvular leakages nor myocardial infarctions. Cerebrovascular accidents owing to thromboembolic phenomena, vascular lower limb or wound complications were not seen. Port-Access mitral valve surgery is a very important investment in the future of cardiac surgery. Some learning curve pitfalls were associated with the process of starting this revolutionary technique. PMID:10451253

  16. An evaluation of the use of new Doppler methods for detecting longitudinal function abnormalities in a pacing-induced heart failure model

    NASA Technical Reports Server (NTRS)

    Tabata, Tomotsugu; Cardon, Lisa A.; Armstrong, Guy P.; Fukamach, Kiyotaka; Takagaki, Masami; Ochiai, Yoshie; McCarthy, Patrick M.; Thomas, James D.

    2003-01-01

    BACKGROUND: Doppler tissue echocardiography and color M-mode Doppler flow propagation velocity have proven useful in evaluating cross-sections of patients with left ventricular (LV) dysfunction, but experience with serial changes is limited. Purpose and methods: We tested their use by evaluating the temporal changes of LV function in a pacing-induced congestive heart failure model. Rapid ventricular pacing was initiated and maintained in 20 dogs for 4 weeks. Echocardiography was performed at baseline and weekly during brief pacing cessation. RESULTS: With rapid pacing, LV volume significantly increased and ejection fraction (57%-28%), stroke volume (37-18 mL), and mitral annulus systolic velocity (16.1-6.6 cm/s) by Doppler tissue echocardiography significantly decreased, with ejection fraction and mitral annulus systolic velocity closely correlated (r = 0.706, P <.0001). In contrast to the mitral inflow velocities, mitral annulus early diastolic velocity decreased steadily (12.3-7.3 cm/s) resulting in a dramatic decrease in mitral annulus early/late (1.22-0.57) diastolic velocity with no tendency toward pseudonormalization. The color M-mode Doppler flow propagation velocity also showed significant steady decrease (57-24 cm/s) throughout the pacing period. Multiple regression analysis chose mitral annulus systolic velocity (r = 0.895, P <.0001) and propagation velocity (r = 0.782, P <.0001) for the most important factor predicting LV systolic and diastolic function, respectively. CONCLUSIONS: Doppler tissue echocardiography and color M-mode Doppler flow could evaluate the serial deterioration in LV dysfunction throughout the pacing period. These were more useful in quantifying progressive LV dysfunction than conventional ehocardiographic techniques, and were probably relatively independent of preload. These techniques could be suitable for longitudinal evaluation in addition to the cross-sectional study.

  17. The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet

    SciTech Connect

    Liao,J.; Yang, L.; Grashow, J.; Sacks, M.

    2007-01-01

    We have recently demonstrated that the mitral valve anterior leaflet (MVAL) exhibited minimal hysteresis, no strain rate sensitivity, stress relaxation but not creep (Grashow et al., 2006, Ann Biomed Eng., 34(2), pp. 315-325; Grashow et al., 2006, Ann Biomed. Eng., 34(10), pp. 1509-1518). However, the underlying structural basis for this unique quasi-elastic mechanical behavior is presently unknown. As collagen is the major structural component of the MVAL, we investigated the relation between collagen fibril kinematics (rotation and stretch) and tissue-level mechanical properties in the MVAL under biaxial loading using small angle X-ray scattering. A novel device was developed and utilized to perform simultaneous measurements of tissue level forces and strain under a planar biaxial loading state. Collagen fibril D-period strain ({epsilon}{sub D}) and the fibrillar angular distribution were measured under equibiaxial tension, creep, and stress relaxation to a peak tension of 90 N/m. Results indicated that, under equibiaxial tension, collagen fibril straining did not initiate until the end of the nonlinear region of the tissue-level stress-strain curve. At higher tissue tension levels, {epsilon}{sub D} increased linearly with increasing tension. Changes in the angular distribution of the collagen fibrils mainly occurred in the tissue toe region. Using {epsilon}{sub D}, the tangent modulus of collagen fibrils was estimated to be 95.5{+-}25.5 MPa, which was {approx}27 times higher than the tissue tensile tangent modulus of 3.58{+-}1.83 MPa. In creep tests performed at 90 N/m equibiaxial tension for 60 min, both tissue strain and D remained constant with no observable changes over the test length. In contrast, in stress relaxation tests performed for 90 min {epsilon}{sub D} was found to rapidly decrease in the first 10 min followed by a slower decay rate for the remainder of the test. Using a single exponential model, the time constant for the reduction in collagen fibril strain was 8.3 min, which was smaller than the tissue-level stress relaxation time constants of 22.0 and 16.9 min in the circumferential and radial directions, respectively. Moreover, there was no change in the fibril angular distribution under both creep and stress relaxation over the test period. Our results suggest that (1) the MVAL collagen fibrils do not exhibit intrinsic viscoelastic behavior, (2) tissue relaxation results from the removal of stress from the fibrils, possibly by a slipping mechanism modulated by noncollagenous components (e.g. proteoglycans), and (3) the lack of creep but the occurrence of stress relaxation suggests a 'load-locking' behavior under maintained loading conditions. These unique mechanical characteristics are likely necessary for normal valvular function.

  18. Wavelet packet-based insufficiency murmurs analysis method

    NASA Astrophysics Data System (ADS)

    Choi, Samjin; Jiang, Zhongwei

    2007-12-01

    In this paper, the aortic and mitral insufficiency murmurs analysis method using the wavelet packet technique is proposed for classifying the valvular heart defects. Considering the different frequency distributions between the normal sound and insufficiency murmurs in frequency domain, we used two properties such as the relative wavelet energy and the Shannon wavelet entropy which described the energy information and the entropy information at the selected frequency band, respectively. Then, the signal to murmur ratio (SMR) measures which could mean the ratio between the frequency bands for normal heart sounds and for aortic and mitral insufficiency murmurs allocated to 15.62-187.50 Hz and 187.50-703.12 Hz respectively, were employed as a classification manner to identify insufficiency murmurs. The proposed measures were validated by some case studies. The 194 heart sound signals with 48 normal and 146 abnormal sound cases acquired from 6 healthy volunteers and 30 patients were tested. The normal sound signals recorded by applying a self-produced wireless electric stethoscope system to subjects with no history of other heart complications were used. Insufficiency murmurs were grouped into two valvular heart defects such as aortic insufficiency and mitral insufficiency. These murmur subjects included no other coexistent valvular defects. As a result, the proposed insufficiency murmurs detection method showed relatively very high classification efficiency. Therefore, the proposed heart sound classification method based on the wavelet packet was validated for the classification of valvular heart defects, especially insufficiency murmurs.

  19. Mitral Cell ?1 and 5-HT2A Receptor Colocalization and cAMP Coregulation: A New Model of Norepinephrine-Induced Learning in the Olfactory Bulb

    PubMed Central

    Yuan, Qi; Harley, Carolyn W.; McLean, John H.

    2003-01-01

    In the present study we assess a new model for classical conditioning of odor preference learning in rat pups. In preference learning ?1-adrenoceptors activated by the locus coeruleus mediate the unconditioned stimulus, whereas olfactory nerve input mediates the conditioned stimulus, odor. Serotonin (5-HT) depletion prevents odor learning, with 5-HT2A/2C agonists correcting the deficit. Our new model proposes that the interaction of noradrenergic and serotonergic input with odor occurs in the mitral cells of the olfactory bulb through activation of cyclic adenosine monophosphate (cAMP). Here, using selective antibodies and immunofluorescence examined with confocal microscopy, we demonstrate that ?1-adrenoceptors and 5-HT2A receptors colocalize primarily on mitral cells. Using a cAMP assay and cAMP immunocytochemistry, we find that ?-adrenoceptor activation by isoproterenol, at learning-effective and higher doses, significantly increases bulbar cAMP, as does stroking. As predicted by our model, the cAMP increases are localized to mitral cells. 5-HT depletion of the olfactory bulb does not affect basal levels of cAMP but prevents isoproterenol-induced cAMP elevation. These results support the model. We suggest the mitral-cell cAMP cascade converges with a Ca2+ pathway activated by odor to recruit CREB phosphorylation and memory-associated changes in the olfactory bulb. The dose-related increase in cAMP with isoproterenol implies a critical cAMP window because the highest dose of isoproterenol does not produce learning. PMID:12551959

  20. Patterns of systolic stress distribution on mitral valve anterior leaflet chordal apparatus. A structural mechanical theoretical analysis.

    PubMed

    Nazari, S; Carli, F; Salvi, S; Banfi, C; Aluffi, A; Mourad, Z; Buniva, P; Rescigno, G

    2000-04-01

    Increasing diffusion and complexity of mitral valve repair procedures may prompt an interest in the evaluation of the patterns of stress distribution on the chords, which are, from the structural mechanical point of view, the weakest element of valve apparatus. This theoretical analysis concentrates in particular on the mitral valve anterior leaflet. As is known, the vast majority of the chordae are attached to the anterior leaflet within the coaptation area; during systole they are then necessarily parallel, aligned along the same plane as that of the leaflets' coaptation surface, to which they are attached; moreover the thickness of the chordae increases significantly from the marginal chordae to the more central ones. In normal conditions during systole the progressively wider coaptation surface causes the increasing stress to be supported by an increasing number of progressively thicker chords, which are substantially parallel and aligned on the coaptation surface plane in such a way that they can share the stress between them, according to their thickness; in other words chords form a multifilament functional unit which enrolls elements of increasing thickness in response to the mounting stress. The geometrical modifications of the valve apparatus architecture (annulus dilatation, leaflet retraction, chordal elongation or retraction) often associated with valve insufficiency due to chordal rupture, have the common result of causing, during systole, a radial disarrangement of the direction of most of the secondary chordae which are no longer parallel, aligned on the coaptation surface plane. Due to the negligible elastic module of the valve leaflet, in this new arrangement the various chordae cannot share the stress between themselves as they do in a normal physiological situation; on the contrary the thinner chordae nearer to the free margin are also loaded with the peak systolic stress, thus generating conditions favoring their rupture. It can, therefore, be hypothesized that the anatomopathological picture of valve insufficiency due to chordal rupture may be the final event of a series of geometrical modifications of valve apparatus architecture, the common consequence of which is to load thinner marginal chords with peak systolic stress from which they are normally spared, thus favoring their rupture. PMID:10901521

  1. On the in-vivo deformation of the mitral valve anterior leaflet: Effects of annular geometry and referential configuration

    PubMed Central

    Amini, Rouzbeh; Eckert, Chad E.; Koomalsingh, Kevin; McGarvey, Jeremy; Minakawa, Mashito; Gorman, Joseph H.; Gorman, Robert C.; Sacks, Michael S.

    2012-01-01

    Alteration of the native mitral valve (MV) shape has been hypothesized to have a profound effect on the local tissue stress distribution, and is potentially linked to limitations in repair durability. The present study was undertaken to elucidate the relation between MV annular shape and central mitral valve anterior leaflet (MVAL) strain history, using flat annuloplasty in an ovine model. In addition, we report for the first time the presence of residual in-vivo leaflet strains. In-vivo leaflet deformations were measured using sonocrystal transducers sutured to the MVAL (n=10), with the 3D positions acquired over the full cardiac cycle. In six animals a flat ring was sutured to the annulus and the transducer positions recorded, while in the remaining four the MV was excised from the exsanguinated heart and the stress-free transducer positions obtained. In the central region of the MVAL the peak stretch values, referenced to the minimum left ventricular pressure (LVP), were 1.10 ± 0.01 and 1.31 ± 0.03 (mean ± standard error) in the circumferential and radial directions, respectively. Following flat ring annuloplasty, the central MVAL contracted 28% circumferentially and elongated 16% radially at minimum LVP, and the circumferential direction was under a negative strain state during the entire cardiac cycle. After valve excision from the exsanguinated heart, the MVAL contracted significantly (18% and 30% in the circumferential and radial directions, respectively), indicating the presence of substantial in-vivo residual strains. While the physiological function of the residual strains (and their associated stresses) are at present unknown, accounting for their presence is clearly necessary for accurate computational simulations of MV function. Moreover, we demonstrated that changes in annular geometry dramatically alter valvular functional strains in-vivo. As levels of homeostatic strains are related to tissue remodeling and homeostasis, our results suggest that surgically-introduced alterations in MV shape could lead to the long term MV mechanobiological and microstructural alterations that could ultimately affect MV repair durability. PMID:22327292

  2. Morphological and Chemical Study of Pathological Deposits in Human Aortic and Mitral Valve Stenosis: A Biomineralogical Contribution

    PubMed Central

    Cottignoli, Valentina; Salvador, Loris; Valfré, Carlo

    2015-01-01

    Aim of this study was to investigate heart valve calcification process by different biomineralogical techniques to provide morphological and chemical features of the ectopic deposit extracted from patients with severe mitral and aortic valve stenosis, to better evaluate this pathological process. Polarized light microscopy and scanning electron microscopy analyses brought to light the presence of nodular and massive mineralization forms characterized by different levels of calcification, as well as the presence of submicrometric calcified globular cluster, micrometric cavities containing disorganized tissue structures, and submillimeter pockets formed by organic fibers very similar to amyloid formations. Electron microprobe analyses showed variable concentrations of Ca and P within each deposit and the highest content of Ca and P within calcified tricuspid aortic valves, while powder X-ray diffraction analyses indicated in the nanometer range the dimension of the pathological bioapatite crystals. These findings indicated the presence of highly heterogeneous deposits within heart valve tissues and suggested a progressive maturation process with continuous changes in the composition of the valvular tissue, similar to the multistep formation process of bone tissue. Moreover the micrometric cavities represent structural stages of the valve tissue that immediately precedes the formation of heavily mineralized deposits such as bone-like nodules. PMID:25685595

  3. Characterisation of the fatigue life, dynamic creep and modes of damage accumulation within mitral valve chordae tendineae.

    PubMed

    Gunning, Gillian M; Murphy, Bruce P

    2015-09-01

    Mitral valve prolapse is often caused by either elongated or ruptured chordae tendineae (CT). In many cases, rupture is spontaneous, meaning there is no underlying cause. We hypothesised that spontaneous rupture may be due to mechanical fatigue. To investigate this hypothesis, we tested porcine marginal CT: in uniaxial tension, and in fatigue at a range of peak stresses (n=12 at 15, 10 and 7.5MPa respectively, n=6 at 5MPa). The rupture surfaces of failed CT were observed histologically, under polarised light microscopy, and SEM. The cycles to failure for 15, 10, 7.5 and 5 MPa peak stresses were: (average±SD): 5077±4366, 49513±56414, 99927±108908, 197099±69103. A Weibull plot was constructed and from this, the number of cycles at 50% probability of failure was established in order to approximate the fatigue life, which was found to be 2.43MPa at 10 million cycles. The rate of creep increases exponentially with increasing peak stress. Under histological examination it was observed that CT which have been fatigued at low stress partially lose their organised collagen structure and can sustain micro-cracks that can be linked to increases in the creep rate. Furthermore our SEM images closely matched descriptions from the literature of spontaneous in vivo rupture. In conclusion, we believe that the mechanical test results we present strongly suggest that spontaneous chordal rupture and chordal elongation in vivo can be caused by mechanical fatigue. PMID:26087111

  4. A Spiral in the Heart: Mitral Valve Endocarditis with Unusual Vegetation Shape Potentially Affecting Effectiveness of Antibiotic Therapy

    PubMed Central

    Fibbi, Veronica; Ballo, Piercarlo; Abbondanti, Alessandro; Nannini, Marco; Fazi, Antonio

    2015-01-01

    We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These considerations suggest that vegetation shape might be considered of importance in patients with IE not only because of its classical association with embolization risk, but also because of its potential effect on the efficacy of antibiotic therapy. PMID:26583074

  5. Non-redundant odor coding by sister mitral cells revealed by light addressable glomeruli in the mouse

    PubMed Central

    Dhawale, Ashesh K.; Hagiwara, Akari; Bhalla, Upinder S.; Murthy, Venkatesh N.; Albeanu, Dinu F.

    2011-01-01

    Sensory inputs frequently converge on the brain in a spatially organized manner, often with overlapping inputs to multiple target neurons. Whether the responses of target neurons with common inputs become decorrelated depends on the contribution of local circuit interactions. We addressed this issue in the olfactory system using newly generated transgenic mice expressing channelrhodopsin-2 in all olfactory sensory neurons. By selectively stimulating individual glomeruli with light, we identified mitral/tufted (M/T) cells that receive common input (sister cells). Sister M/T cells had highly correlated responses to odors as measured by average spike rates, but their spike timing in relation to respiration was differentially altered. In contrast, non-sister M/T cells correlated poorly on both these measures. We suggest that sister M/T cells carry two different channels of information: average activity representing shared glomerular input, and phase-specific information that refines odor representations and is substantially independent for sister M/T cells. PMID:20953197

  6. The diagnostic value of transthoracic echocardiography for eosinophilic myocarditis: A single center experience from China.

    PubMed

    Xie, Mingxing; Cheng, Tsung O; Fei, Hongwen; Ren, Pingping; He, Yale; Wang, Xinfang; Lu, Qing; Han, Wei; Li, Ke; Li, Ling; Yang, Yali; Chen, Oudi

    2015-12-15

    The aim of this study is to explore the value of transthoracic echocardiography in the diagnosis of eosinophilic myocarditis. The echocardiographic characteristics of nine patients with eosinophilic myocarditis in our hospital between January 2004 and January 2012 were retrospectively reviewed. In our study, four of the nine patients were diagnosed to have small pericardial effusion. The obliteration of the apical cavity was observed in five of the nine patients. There were six patients with both mitral and tricuspid regurgitation, one patient with only mitral regurgitation, and one patient with only tricuspid regurgitation. Transthoracic echocardiography showed that the diameters of the left and right atria were both increased in eight of the nine patients. The diameter of the left ventricle was increased in five patients, and the right ventricular diameter was increased in four patients. The left ventricular ejection fraction was decreased in two of the nine patients. Five of the nine patients had pulmonary hypertension, and one patient had severe pulmonary hypertension. Transthoracic echocardiography is the primary method for the diagnosis of eosinophilic myocarditis and is also useful in follow-up of the disease. PMID:26301679

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

    PubMed

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

    2015-12-01

    Patients with congenital aortic valve stenosis (AVS) can remain asymptomatic but may develop progressive and often underestimated exercise intolerance. The risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated patients warrants earlier intervention. The timing for curative therapy for severe AVS is clear, but optimal timing for moderate stenosis (modAS) is unknown. AVS often coexists with aortic regurgitation, which adds a volume overload to an already pressure-overloaded LV, adding an additional challenge to the estimation of disease severity. We investigated the possible value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) upon treadmill exercise challenge in children with asymptomatic modAS versus moderate regurgitation (modAR). The aim was to determine optimal timing of peak biochemical response. Blood samples were obtained at rest, and then at 20, 40 and 60 min after peak exercise comparing modAS and modAR to healthy controls. Exercise performance was equivalent in all groups, with no difference for biomarker levels at rest. The increase in NT-proBNP was significant in modAR at 40 min (99.2 ± 48.6 ng/L; p = 0.04) and 60 min into recovery (100.0 ± 53.7 ng/L; p = 0.01), but not in modAS. The increase in hs-cTnT was significant only at 60 min into recovery for modAS and modAR. NT-proBNP and hs-cTnT following exercise challenge are possible discriminant biomarkers of modAR from modAS and controls at 60 min into recovery despite comparable exercise performance. This offers a promising avenue for future stratification of aortic valve disease and optimal timing of intervention. PMID:26123813

  8. Impella LD microaxial pump supporting combined mitral and coronary surgery in a patient with dilated cardiomyopathy. A short bridge to recovery?

    PubMed

    Szafron, Bart?omiej; Smoczy?ski, Rados?aw Hugon; Drobi?ski, Dominik; Pawlak, Agnieszka; Wojciechowski, Dariusz; Liszka, Irena Maria; Witkowska, Anna; Kalici?ski, Zygmunt; Gil, Robert; Suwalski, Piotr

    2015-03-01

    Cardiac surgeons have to face the problem of impaired left ventricle function in patients undergoing routine valve or coronary procedures. The intra-aortic balloon pump is not always effective in preventing cardiac failure. The idea of using a microaxial rotating pump as a short-term perioperative support seems to be a convenient solution. The case of a patient with dilated cardiomyopathy undergoing combined mitral and coronary surgery with elective use of the Impella LD pump is presented. Various options of applying the Impella device are discussed, especially as a bridge to transplant or bridge to recovery. PMID:26336480

  9. Impella LD microaxial pump supporting combined mitral and coronary surgery in a patient with dilated cardiomyopathy. A short bridge to recovery?

    PubMed Central

    Smoczy?ski, Rados?aw Hugon; Drobi?ski, Dominik; Pawlak, Agnieszka; Wojciechowski, Dariusz; Liszka, Irena Maria; Witkowska, Anna; Kalici?ski, Zygmunt; Gil, Robert; Suwalski, Piotr

    2015-01-01

    Cardiac surgeons have to face the problem of impaired left ventricle function in patients undergoing routine valve or coronary procedures. The intra-aortic balloon pump is not always effective in preventing cardiac failure. The idea of using a microaxial rotating pump as a short-term perioperative support seems to be a convenient solution. The case of a patient with dilated cardiomyopathy undergoing combined mitral and coronary surgery with elective use of the Impella LD pump is presented. Various options of applying the Impella device are discussed, especially as a bridge to transplant or bridge to recovery. PMID:26336480

  10. Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

    E-print Network

    Rao, Christopher; Hart, Jonathan; Chow, Andre; Siannis, Fotios; Tsalafouta, Polyxeni; Murtuza, Bari; Darzi, Ara; Wells, Frank C.; Athanasiou, Thanos

    2008-04-23

    :295-296. 49. Lewis EF, Johnson PA, Johnson W, Collins C, Griffin L, Stevenson LW: Preferences for quality of life or survival expressed by patients with heart failure. J Heart Lung Transplant 2001, 20:1016-1024. 50. Szende A, Williams A: Measuring self... with and without preserva- tion of the chordae tendineae. Surg Forum 1966, 17:178-179. 60. Rastelli GC, Tsakiris AG, Frye RL, Kirklin JW: Exercise tolerance and hemodynamic studies after replacement of canine mitral valve with and without preservation of chordae...

  11. Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.

    ClinicalTrials.gov

    2015-12-18

    Patients Waiting for Elective Isolated Coronary Artery Bypass Grafting (CABG); Patients Waiting for Aortic Valve Repair/Replacement for Moderate Aortic Stenosis or Severe Regurgitation; Patients Waiting for Mitral Valve Repair/Replacement for Moderate Stenosis or Severe Regurgitation; Patients Waiting for Combined CABG/Valve Procedures.

  12. Transthoracic two-dimensional xPlane and three-dimensional echocardiographic analysis of the site of mitral valve prolapse.

    PubMed

    McGhie, Jackie S; de Groot-de Laat, Lotte; Ren, Ben; Vletter, Wim; Frowijn, René; Oei, Frans; Geleijnse, Marcel L

    2015-12-01

    This study sought to assess the value of two-dimensional (2D) transthoracic echocardiography (TTE), 2D xPlane imaging and three-dimensional (3D) TTE for the definition of the site and the extent of mitral valve (MV) prolapse. Fifty patients underwent transthoracic 2D, 2D xPlane and 3D echocardiography. With 2D xPlane a segmental analysis of the MV was performed, by making a lateral sweep across the MV coaptation line as seen in the parasternal short-axis view. Inter-observer agreement for specific scallop prolapse was for 2D xPlane excellent (97 %, kappa = 0.94) and for 3D TTE moderate (85 %, kappa = 0.67). The respective sensitivities of standard 2D TTE, 2D xPlane, and 3D TTE for the identification of the precise posterior scallop prolapse were for P1 92, 85, and 92 %, for P2 96, 96, and 82 %, and for P3 86, 81, and 71 %. In total, 5 (8 %) prolapsing MV scallops were missed by 2D TTE, 7 (12 %) by 2D xPlane, and 12 (20 %) by 3D TTE. The sensitivity of 3D TTE was significantly lower than standard 2D imaging (80 % versus 93 %, P < 0.05). The extent of P2 prolapse was under or overestimated in 5 patients with 2D xPlane and in 9 patients with 3D TTE. 2D xPlane imaging is an accurate, easy to use (compared to 3D TTE) and easy to interpret (compared to 2D and 3D TTE) imaging modality to study the site and the extent of MV prolapse. PMID:26276508

  13. [beta]1-Adrenoceptor or [alpha]1-Adrenoceptor Activation Initiates Early Odor Preference Learning in Rat Pups: Support for the Mitral Cell/cAMP Model of Odor Preference Learning

    ERIC Educational Resources Information Center

    Harley, Carolyn W.; Darby-King, Andrea; McCann, Jennifer; McLean, John H.

    2006-01-01

    We proposed that mitral cell [beta]1-adrenoceptor activation mediates rat pup odor preference learning. Here we evaluate [beta]1-, [beta]2-, [alpha]1-, and [alpha]2-adrenoceptor agonists in such learning. The [beta]1-adrenoceptor agonist, dobutamine, and the [alpha]1-adrenoceptor agonist, phenylephrine, induced learning, and both exhibited an…

  14. Fatal Histoplasma capsulatum mitral endocarditis in a French patient treated for rheumatoid arthritis.

    PubMed

    Letranchant, Lorraine; Debourgogne, Anne; Doco-Lecompte, Thanh; Contet-Audonneau, Nelly; May, Thierry; Machouart, Marie

    2012-03-01

    Histoplasmosis is an infectious disease caused by the inhalation of Histoplasma capsulatum spores, a fungus encountered in many diverse areas around the world. Although this infection is often asymptomatic, it may become dramatic in immunocompromised patients. In November 2005, an endocarditis due to Histoplasma capsulatum was diagnosed in a French woman treated for rheumatoid arthritis and who had traveled to South America 2 years earlier. We confirmed the biological diagnosis by mycological, serological, and histological methods. In spite of receiving the appropriate treatment, the patient died 3 months later of cardiac insufficiency. We report here this additional case of Histoplasma endocarditis, by hoping to help rapid and accurate diagnosis of such infections in their early stages of development, in non-endemic areas. PMID:22042634

  15. Valve repair in rheumatic heart disease in pediatric age group.

    PubMed

    Reddy, Pramod K; Dharmapuram, Anil K; Swain, Sunil K; Ramdoss, Nagarajan; Raghavan, Sreekanth S; Murthy, Kona S

    2008-04-01

    Valve repair in children is technically demanding but more desirable than valve replacement. From April 2004 to September 2005, 1 boy and 8 girls with rheumatic heart disease, aged 2-13 years (median, 9 years), underwent valve repair for isolated mitral regurgitation in 5, combined mitral and aortic regurgitation in 2, mitral stenosis in 1, and mitral regurgitation associated with atrial septal defect in 1. Chordal shortening in 7, annular plication in 6, commissurotomy in 1, reconstruction of commissural leaflets in 7 were performed for mitral valve disease. Plication and reattachment of the aortic cusps was carried out in 2 patients. Annuloplasty rings were not used. All patients survived the operation, 8 had trivial or mild residual mitral regurgitation, and 1 had trivial aortic regurgitation. Mean left atrial pressure decreased from 14 to 7 mm Hg postoperatively. During follow-up of 3-18 months, all children were asymptomatic and enjoyed normal activity. None required reoperation. In addition to chordal shortening and annular plication, reconstruction of the commissural leaflets is considered the most important aspect of valve repair. It can be achieved without annuloplasty rings, giving good early and midterm results. PMID:18381871

  16. Noninvasive assessment of mitral inertness: clinical results with numerical model validation

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    Inertial forces (Mdv/dt) are a significant component of transmitral flow, but cannot be measured with Doppler echo. We validated a method of estimating Mdv/dt. Ten patients had a dual sensor transmitral (TM) catheter placed during cardiac surgery. Doppler and 2D echo was performed while acquiring LA and LV pressures. Mdv/dt was determined from the Bernoulli equation using Doppler velocities and TM gradients. Results were compared with numerical modeling. TM gradients (range: 1.04-14.24 mmHg) consisted of 74.0 +/- 11.0% inertial forcers (range: 0.6-12.9 mmHg). Multivariate analysis predicted Mdv/dt = -4.171(S/D (RATIO)) + 0.063(LAvolume-max) + 5. Using this equation, a strong relationship was obtained for the clinical dataset (y=0.98x - 0.045, r=0.90) and the results of numerical modeling (y=0.96x - 0.16, r=0.84). TM gradients are mainly inertial and, as validated by modeling, can be estimated with echocardiography.

  17. Mechanisms of cardiac hypertrophy in canine volume overload

    NASA Technical Reports Server (NTRS)

    Matsuo, T.; Carabello, B. A.; Nagatomo, Y.; Koide, M.; Hamawaki, M.; Zile, M. R.; McDermott, P. J.

    1998-01-01

    This study tested whether the modest hypertrophy that develops in dogs in response to mitral regurgitation is due to a relatively small change in the rate of protein synthesis or, alternatively, is due to a decreased rate of protein degradation. After 3 mo of severe experimental mitral regurgitation, the left ventricular (LV) mass-to-body weight ratio increased by 23% compared with baseline values. This increase in LV mass occurred with a small, but not statistically significant, increase in the fractional rate of myosin heavy chain (MHC) synthesis (Ks), as measured using continuous infusion with [3H]leucine in dogs at 2 wk, 4 wk, and 3 mo after creation of severe mitral regurgitation. Translational efficiency was unaffected by mitral regurgitation as measured by the distribution of MHC mRNA in polysome gradients. Furthermore, there was no detectable increase in translational capacity as measured by either total RNA content or the rate of ribosome formation. These data indicate that translational mechanisms that accelerate the rate of cardiac protein synthesis are not responsive to the stimulus of mitral regurgitation. Most of the growth after mitral regurgitation was accounted for by a decrease in the fractional rate of protein degradation, calculated by subtracting fractional rates of protein accumulation at each time point from the corresponding Ks values. We conclude that 1) volume overload produced by severe mitral regurgitation does not trigger substantial increases in the rate of protein synthesis and 2) the modest increase in LV mass results primarily from a decrease in the rate of protein degradation.

  18. Large Patent Ductus Arteriosus in a 44-Year-Old Woman Leading to Calcium Deposition in the Left Atrium and Mitral and Aortic Valves

    PubMed Central

    Roberts, Carey Camille

    2015-01-01

    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously. PMID:26175644

  19. Clinical Application of 3-Dimensional Echocardiography in the USA.

    PubMed

    Shiota, Takahiro

    2015-10-23

    Three-dimensional (3D) echocardiography is one of the most promising methods for the diagnosis of cardiac disease. Left and right ventricular size and function are currently evaluated with 2D echocardiography. However, for unpredictable asymmetry of the chamber geometry, conventional 2D echocardiography cannot be used to accurately determine absolute chamber volumes and ejection fraction. As for valvular heart diseases, the 3D echo approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the valves and their dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical procedures such as edge-to-edge mitral valve repair. Color Doppler 3D echo has also been valuable to identify the location of the regurgitant orifice, and the severity and character of the valvular regurgitation. In addition, 3D echo is invaluable in the diagnosis and management of congenital heart disease and in certain other situations, such as evaluation of the aortic annulus for transcatheter aortic valve implantation or replacement. It is now clear that 3D echocardiography, especially with the continued development of real-time 3D transesophageal echo technology, will enhance the diagnosis and management of patients with heart diseases. (Circ J 2015; 79: 2287-2298). PMID:26459394

  20. Mitral Valve Prolapse

    MedlinePLUS

    ... may not close tightly. These flaps normally help seal or open the valve. Much of the time, ... and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the ...

  1. Mitral Valve Replacement

    MedlinePLUS

    ... amount of blood forward. This is called volume overload. The heart can compensate for this overload for many months or years, provided that the ... if any, restrictions on your activity. (For more information about your recovery, refer to What to Expect ...

  2. Mitral Valve Prolapse

    MedlinePLUS

    ... back through the valve also may have a heart murmur . A heart murmur is the sound caused by the leaking blood. ... For Parents MORE ON THIS TOPIC The Heart Heart Murmurs Atrial Septal Defect Quiz: Heart & Circulatory System Getting ...

  3. Mitral valve surgery - open

    MedlinePLUS

    ... the rest of your life. Biological, made of human or animal tissue. These valves last 10 to 12 years. ... occur, but this is rare. Valves made from human or animal tissue fail over time, but have a lower ...

  4. Alternative method for cardioplegia delivery during totally endoscopic robotic intracardiac surgery.

    PubMed

    Watanabe, Go; Ishikawa, Norihiko

    2014-09-01

    The optimal technique for antegrade cardioplegia delivery during totally endoscopic robotic surgery is still evolving. Cardioplegia delivery with endovascular balloon clamping of the aorta is commonly used but this method has several disadvantages and may lead to serious complications. We describe a novel cardioplegia delivery procedure for totally endoscopic intracardiac surgeries such as atrial septal defect closure and mitral valve repair. The method uses a transthoracic aortic clamp and an antegrade cardioplegia cannula without the need for thoracotomy. The technique is safe and reliable, permits simple cardioplegic arrest, and prevents complications related to endovascular balloon clamping during robot-assisted intracardiac surgery. PMID:25193212

  5. Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial

    PubMed Central

    Breithardt, Günter; Baumgartner, Helmut; Berkowitz, Scott D.; Hellkamp, Anne S.; Piccini, Jonathan P.; Stevens, Susanna R.; Lokhnygina, Yuliya; Patel, Manesh R.; Halperin, Jonathan L.; Singer, Daniel E.; Hankey, Graeme J.; Hacke, Werner; Becker, Richard C.; Nessel, Christopher C.; Mahaffey, Kenneth W.; Fox, Keith A. A.; Califf, Robert M.

    2014-01-01

    Aims We investigated clinical characteristics and outcomes of patients with significant valvular disease (SVD) in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial. Methods and results ROCKET AF excluded patients with mitral stenosis or artificial valve prostheses. We used Cox regression to adjust comparisons for potential confounders. Among 14 171 patients, 2003 (14.1%) had SVD; they were older and had more comorbidities than patients without SVD. The rate of stroke or systemic embolism with rivaroxaban vs. warfarin was consistent among patients with SVD [2.01 vs. 2.43%; hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.55–1.27] and without SVD (1.96 vs. 2.22%; HR 0.89, 95% CI 0.75–1.07; interaction P = 0.76). However, rates of major and non-major clinically relevant bleeding with rivaroxaban vs. warfarin were higher in patients with SVD (19.8% rivaroxaban vs. 16.8% warfarin; HR 1.25, 95% CI 1.05–1.49) vs. those without (14.2% rivaroxaban vs. 14.1% warfarin; HR 1.01, 95% CI 0.94–1.10; interaction P = 0.034), even when controlling for risk factors and potential confounders. In intracranial haemorrhage, there was no interaction between patients with and without SVD where the overall rate was lower among those randomized to rivaroxaban. Conclusions Many patients with ‘non-valvular atrial fibrillation’ have significant valve lesions. Their risk of stroke is similar to that of patients without SVD after controlling for stroke risk factors. Efficacy of rivaroxaban vs. warfarin was similar in patients with and without SVD; however, the observed risk of bleeding was higher with rivaroxaban in patients with SVD but was the same among those without SVD. Atrial fibrillation patients with and without SVD experience the same stroke-preventive benefit of oral anticoagulants. PMID:25148838

  6. Massive hemothorax due to subclavian vein tear during internal jugular vein cannulation in a 15-year-old boy scheduled for mitral valve replacement

    PubMed Central

    Mishra, Sandeep Kumar; Paulose, Deepak; Kundra, Pankaj; Parida, Satyen

    2015-01-01

    We present an unusual case of life-threatening hemothorax in a 15-year-old boy following subclavian vein tear during internal jugular vein (IJV) cannulation prior to initiation of surgery (mitral valve replacement). Successful IJV cannulation was done in the third attempt. However, we missed the subclavian tear which occurred during the first two initial attempts as there was no clinical evidence suggestive of it at that point of time. This undiagnosed hemothorax led to hemodynamic decompensation requiring high volume and inotropic support to wean the patient off cardiopulmonary bypass. This unusually high requirement of fluid and inotropes required the surgeon to look for noncardiac causes for the hemodynamic disturbance and he noticed a bulge in the right pleura, which on exploration had approximately 1.5 L of collected blood. It was then retrospectively analyzed that the cause of this hemothorax could have been the undue lateral orientation of the needle during IJV cannulation and the advancement of the dilator to its entire length could have injured the subclavian vein. Here, we also would like to discuss the safety precautions to be taken during the cannulation, like the needle orientation and the length to which the dilator must be advanced for safe central venous cannulation. PMID:26712992

  7. Different Profiles of Main and Accessory Olfactory Bulb Mitral/Tufted Cell Projections Revealed in Mice Using an Anterograde Tracer and a Whole-Mount, Flattened Cortex Preparation

    PubMed Central

    Kang, Ningdong; Baum, Michael J.

    2011-01-01

    A whole-mount, flattened cortex preparation was developed to compare profiles of axonal projections from main olfactory bulb (MOB) and accessory olfactory bulb (AOB) mitral and tufted (M/T) cells. After injections of the anterograde tracer, Phaseolus vulgaris leucoagglutinin, mapping of labeled axons using a Neurolucida system showed that M/T cells in the AOB sent axons primarily to the medial and posterior lateral cortical amygdala, with minimal branching into the piriform cortex. By contrast, M/T cells in the MOB displayed a network of collaterals that branched off the primary axon at several levels of the lateral olfactory tract (LOT). Collaterals emerging from the LOT into the anterior piriform cortex were often observed crossing into the posterior piriform cortex. M/T cells in the dorsal MOB extended fewer collaterals from the primary axon in the rostral LOT than did M/T cells from the anterior or ventral MOB. MOB M/T cells that projected to the medial amygdala did not do so exclusively, also sending collaterals to the anterior cortical amygdala as well as to olfactory cortical regions. This arrangement may be related to the ability of social experience to modify the response of mice to volatile pheromones detected by the main olfactory system. PMID:21177285

  8. Noninvasive radioisotopic technique for detection of platelet deposition on bovine pericardial mitral-valve prosthesis and in vitro quantification of visceral microembolism in dogs

    SciTech Connect

    Dewanjee, M.K.; Trastek, V.F.; Tago, M.; Torianni, M.; Kaye, M.P.

    1983-01-01

    Platelet deposition on bovine pericardial-tissue mitral-valve prostheses in dogs was observed noninvasively by use of /sup 111/In-labeled platelets and quantified after sacrifice at one, 14 and 30 days postimplantation (300-400 microCi of labeled platelets having been injected 24 hrs previously). Thrombosis on the sewing ring and pericardial leaflets at one and 14 days and on the leaflets at 30 days was delineated in scintiphotos. In vitro quantification (% injected dose) indicated that the sewing ring and perivalvular tissue retained 0.75% of labeled platelets at one day postimplantation, 0.084% at 14 days, and 0.0042% at 30 days. Platelet survival was reduced to 38 hrs at 21 days postimplantation but returned toward the normal (50 hrs) with endothelial covering of the sewing ring. Microemboli in lung and kidney, as measured by tissue/blood radioactivity ratio, decreased significantly at 30 days. /sup 111/In-labeled platelets thus provide a sensitive marker for noninvasive imaging and in vitro quantification of platelet deposition on valvular prostheses and microemboli trapped in viscera.

  9. Afterhyperpolarization (AHP) regulates the frequency and timing of action potentials in the mitral cells of the olfactory bulb: role of olfactory experience.

    PubMed

    Duménieu, Maël; Fourcaud-Trocmé, Nicolas; Garcia, Samuel; Kuczewski, Nicola

    2015-05-01

    Afterhyperpolarization (AHP) is a principal feedback mechanism in the control of the frequency and patterning of neuronal firing. In principal projection neurons of the olfactory bulb, the mitral cells (MCs), the AHP is produced by three separate components: classical potassium-mediated hyperpolarization, and the excitatory and inhibitory components, which are generated by the recurrent dendrodendritic synaptic transmission. Precise spike timing is involved in olfactory coding and learning, as well as in the appearance of population oscillatory activity. However, the contribution of the AHP and its components to these processes remains unknown. In this study, we demonstrate that the AHP is developed with the MC firing frequency and is dominated by the potassium component. We also show that recurrent synaptic transmission significantly modifies MC AHP and that the strength of the hyperpolarization produced by the AHP in the few milliseconds preceding the action potential (AP) emission determines MC firing frequency and AP timing. Moreover, we show that the AHP area is larger in younger animals, possibly owing to increased Ca(2+) influx during MC firing. Finally, we show that olfactory experience selectively reduces the early component of the MC AHP (under 25 msec), thus producing a modification of the AP timing limited to the higher firing frequency. On the basis of these results, we propose that the AHP, and its susceptibility to be selectively modulated by the recurrent synaptic transmission and olfactory experience, participate in odor coding and learning by modifying the frequency and pattern of MC firing. PMID:26019289

  10. Assessment of cardiac function and rheumatic heart disease in children with adenotonsillar hypertrophy.

    PubMed Central

    Odemis, Ender; Catal, Ferhat; Karadag, Ahmet; Kurtaran, Hanifi; Ark, Nebil; Mete, Emin

    2006-01-01

    Our aim was to evaluate whether adenotonsillar hypertrophy (ATH) is associated with rheumatic heart disease (RHD) in children. Fifty-three patients with ATH and 50 healthy children as a control group were enrolled in the study. Medical history and clinical findings were investigated, and echocardiographies were done by researchers who were unaware of the diagnosis. The two groups were compared. Valvular findings suggesting RHD were encountered in four patients (7.5%) in the ATH group and in two children (4%) in the control group. This difference was not statistically significant (p = 0.098); however, we found physiological mitral regurgitation to be significantly more frequent in the ATH group than in the control group (p = 0.023). ATH did not increase the risk of valvulitis related to RHD regardless of adenoid size and frequency of the infection. To preclude the misdiagnosis of mitral regurgitation that results from RHD, diagnostic criteria for pathological mitral regurgitation should be carefully applied. PMID:17225844

  11. Teacher Candidate Disposition: Moral Judgement or Regurgitation?

    ERIC Educational Resources Information Center

    Johnson, Lisa E.

    2008-01-01

    Developing teacher candidates who are able to make moral judgements to equitably resolve classroom dilemmas, conduct student assessment and allocate resources is critical for today's diverse classrooms and should be part of fostering professional disposition. However, one challenge of incorporating dispositions in teacher education and a valid…

  12. Dynamic obstruction induced by systolic anterior motion of the mitral valve in a volume-depleted left ventricle: an unexpected cause of acute heart failure in a patient with chronic obstructive pulmonary disease

    PubMed Central

    Kim, Suji; Kim, So Jeong; Kim, Jina; Yoon, Phillhoon; Park, Jeongwoong

    2015-01-01

    Systolic anterior motion (SAM) of the mitral valve (MV) and left ventricular outflow tract (LVOT) dynamic obstruction (DO) typically occur in hypertrophic cardiomyopathy; however, they can appear in an apparently normal heart in association with changes in cardiac loading conditions and/or hyperdynamic left ventricular (LV) performance. Meanwhile, chronic obstructive pulmonary disease (COPD) can impair LV filling by elevating pulmonary vascular resistance. The authors report a case of transient acute heart failure caused by LVOT DO resulting from SAM of the MV in a severely volume-depleted LV in a patient with acute COPD exacerbation.

  13. Short-term follow-up of exercise training program and beta-blocker treatment on quality of life in dogs with naturally acquired chronic mitral valve disease

    PubMed Central

    Marcondes-Santos, M.; Mansur, A.P.; Fragata, F.S.; Strunz, C.M.C.

    2015-01-01

    This study aimed to evaluate the effects of carvedilol treatment and a regimen of supervised aerobic exercise training on quality of life and other clinical, echocardiographic, and biochemical variables in a group of client-owned dogs with chronic mitral valve disease (CMVD). Ten healthy dogs (control) and 36 CMVD dogs were studied, with the latter group divided into 3 subgroups. In addition to conventional treatment (benazepril, 0.3-0.5 mg/kg once a day, and digoxin, 0.0055 mg/kg twice daily), 13 dogs received exercise training (subgroup I; 10.3±2.1 years), 10 dogs received carvedilol (0.3 mg/kg twice daily) and exercise training (subgroup II; 10.8±1.7 years), and 13 dogs received only carvedilol (subgroup III; 10.9±2.1 years). All drugs were administered orally. Clinical, laboratory, and Doppler echocardiographic variables were evaluated at baseline and after 3 and 6 months. Exercise training was conducted from months 3-6. The mean speed rate during training increased for both subgroups I and II (ANOVA, P>0.001), indicating improvement in physical conditioning at the end of the exercise period. Quality of life and functional class was improved for all subgroups at the end of the study. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level increased in subgroup I from baseline to 3 months, but remained stable after training introduction (from 3 to 6 months). For subgroups II and III, NT-proBNP levels remained stable during the entire study. No difference was observed for the other variables between the three evaluation periods. The combination of carvedilol or exercise training with conventional treatment in CMVD dogs led to improvements in quality of life and functional class. Therefore, light walking in CMVD dogs must be encouraged. PMID:26445331

  14. Short-term follow-up of exercise training program and beta-blocker treatment on quality of life in dogs with naturally acquired chronic mitral valve disease.

    PubMed

    Marcondes-Santos, M; Mansur, A P; Fragata, F S; Strunz, C M C

    2015-10-01

    This study aimed to evaluate the effects of carvedilol treatment and a regimen of supervised aerobic exercise training on quality of life and other clinical, echocardiographic, and biochemical variables in a group of client-owned dogs with chronic mitral valve disease (CMVD). Ten healthy dogs (control) and 36 CMVD dogs were studied, with the latter group divided into 3 subgroups. In addition to conventional treatment (benazepril, 0.3-0.5 mg/kg once a day, and digoxin, 0.0055 mg/kg twice daily), 13 dogs received exercise training (subgroup I; 10.3±2.1 years), 10 dogs received carvedilol (0.3 mg/kg twice daily) and exercise training (subgroup II; 10.8±1.7 years), and 13 dogs received only carvedilol (subgroup III; 10.9±2.1 years). All drugs were administered orally. Clinical, laboratory, and Doppler echocardiographic variables were evaluated at baseline and after 3 and 6 months. Exercise training was conducted from months 3-6. The mean speed rate during training increased for both subgroups I and II (ANOVA, P>0.001), indicating improvement in physical conditioning at the end of the exercise period. Quality of life and functional class was improved for all subgroups at the end of the study. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level increased in subgroup I from baseline to 3 months, but remained stable after training introduction (from 3 to 6 months). For subgroups II and III, NT-proBNP levels remained stable during the entire study. No difference was observed for the other variables between the three evaluation periods. The combination of carvedilol or exercise training with conventional treatment in CMVD dogs led to improvements in quality of life and functional class. Therefore, light walking in CMVD dogs must be encouraged. PMID:26445331

  15. Central-Approach Surgical Repair of Coarctation of the Aorta with a Back-up Left Ventricular Assist Device for an Infant Presenting with Severe Left Ventricular Dysfunction

    PubMed Central

    Kim, Tae Hoon; Shin, Yu Rim; Kim, Young Sam; Kim, Do Jung; Kim, Hyohyun; Shin, Hong Ju; Htut, Aung Thein; Park, Han Ki

    2015-01-01

    A two-month-old infant presented with coarctation of the aorta, severe left ventricular dysfunction, and moderate to severe mitral regurgitation. Through median sternotomy, the aortic arch was repaired under cardiopulmonary bypass and regional cerebral perfusion. The patient was postoperatively supported with a left ventricular assist device for five days. Left ventricular function gradually improved, eventually recovering with the concomitant regression of mitral regurgitation. Prompt surgical repair of coarctation of the aorta is indicated for patients with severe left ventricular dysfunction. A central approach for surgical repair with a back-up left ventricular assist device is a safe and effective treatment strategy for these patients. PMID:26665108

  16. Triple cardiac rupture.

    PubMed

    Vazquez, Alejandro; Osa, Ana; Vicente, Rosario; Montero, Jose A

    2014-09-01

    Left ventricular free wall rupture and acute ischaemic mitral regurgitation are nowadays rare, but still potentially lethal mechanical complications after acute myocardial infarction. We report a case of a sequential left ventricular free wall rupture, anterolateral papillary muscle disruption, secondary severe mitral regurgitation and subsequent posteromedial papillary muscle head rupture in a single patient during the same ischaemic episode after myocardial infarction, and their related successful surgical procedures and management until discharge. Prompt bedside diagnosis and emergent consecutive surgical procedures, as well as temporary left ventricular assistance, were crucial in the survival of this patient. PMID:24876216

  17. Left ventricular pseudoaneurysm after valve replacement.

    PubMed

    Lee, Jun Ho; Jeon, Seok Chol; Jang, Hyo-Jun; Chung, Won-Sang; Kim, Young Hak; Kim, Hyuck

    2015-02-01

    We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy. PMID:25705601

  18. Identification of Sandhoff disease in a Thai family: clinical and biochemical characterization.

    PubMed

    Sakpichaisakul, Kullasate; Taeranawich, Pairat; Nitiapinyasakul, Achara; Sirisopikun, Todsaporn

    2010-09-01

    Sandhoff disease is a GM2 gangliosidosis that is rare in Thailand. The authors report a Thai family with two children known to have infantile form of Sandhoff disease. The index case exhibited mitral valve prolapse with mitral regurgitation as an early sign, which is a rare presentation in Sandhoff disease. Thereafter the patient had developmental regression, startle reaction, and cherry red spots. The diagnosis was confirmed by biochemical analysis. PMID:20873083

  19. Pharmacodynamic and Efficacy Profile of TGN 255, a Novel Direct Thrombin Inhibitor, in Canine Cardiopulmonary Bypass and Simulated Mitral Valve Repair

    PubMed Central

    Nelson, David A.; Nelson, Katherine T.; Miller, Matthew W.; Dupe, Robert; Chahwala, Suresh B.; Kennedy, Anthony; Chander, Chaman; Fossum, Theresa W.

    2008-01-01

    Abstract: Heparin-induced thrombocytopenia can be a life-threatening sequel to conventional use of unfractionated heparin in cardiopulmonary bypass (CPB). This study evaluated the pharmacokinetic/pharmacodynamic (PK/PD) and efficacy profile of a novel direct thrombin inhibitor, TGN 255, during cardiac surgery in dogs. Point-of-care coagulation monitoring was also compared against the plasma concentrations of TRI 50c, the active metabolite of TGN 255. The study was conducted in three phases using 10 animals: phase 1 was a dose-ranging study in conscious animals (n = 6), phase 2 was a similar but terminal dose-ranging study in dogs undergoing CPB (n = 6), and phase 3 was with animals undergoing simulated mitral valve repair (terminal) using optimal TGN 255 dose regimens derived from phases I and II (n = 4). During the study, PD markers and drug plasma levels were determined. In addition, determinations of hematologic markers and blood loss were undertaken. Phase 1 studies showed that a high-dose regimen of a 5-mg/kg bolus and infusion of 20 mg/kg/h elevated PD markers in conscious animals, at which time there were no measured effects on platelet or red blood cell counts, and the mean plasma concentration of TRI 50C was 20.6 fg/mL. In the phase 2 CPB dose-ranging study, this dosing regimen significantly elevated all the PD markers and produced hemorrhagic and paradoxical thrombogenic effects. In the phase 3 surgical study, a lower TGN 255 dose regimen of a 2.5-mg/kg bolus plus 10 mg/kg/h produced anticoagulation, elevated PD markers, and produced minimal post-operative blood loss in the animals. Plasma levels of TRI 50C trended well with the conventional point-of-care coagulation monitoring. TGN 255 provided effective anticoagulation in a canine CPB procedure, enabling successful completion with minimal blood loss. These findings support further evaluation of TGN 255 as an anticoagulant for CPB. PMID:18705547

  20. Echocardiographic assessment of cardiac disease

    NASA Technical Reports Server (NTRS)

    Popp, R. L.

    1976-01-01

    The physical principles and current applications of echocardiography in assessment of heart diseases are reviewed. Technical considerations and unresolved points relative to the use of echocardiography in various disease states are stressed. The discussion covers normal mitral valve motion, mitral stenosis, aortic regurgitation, atrial masses, mitral valve prolapse, and idiopathic hypertrophic subaortic stenosis. Other topics concern tricuspic valve abnormalities, aortic valve disease, pulmonic valve, pericardial effusion, intraventricular septal motion, and left ventricular function. The application of echocardiography to congenital heart disease diagnosis is discussed along with promising ultrasonic imaging systems. The utility of echocardiography in quantitative evaluation of cardiac disease is demonstrated.

  1. A novel crosslinking method for improved tear resistance and biocompatibility of tissue based biomaterials.

    PubMed

    Tam, Hobey; Zhang, Will; Feaver, Kristen R; Parchment, Nathaniel; Sacks, Michael S; Vyavahare, Naren

    2015-10-01

    Over 300,000 heart valve replacements are performed annually to replace stenotic and regurgitant heart valves. Bioprosthetic heart valves (BHVs), derived from glutaraldehyde crosslinked (GLUT) porcine aortic valve leaflets or bovine pericardium are often used. However, valve failure can occur within 12-15 years due to calcification and/or progressive degeneration. In this study, we have developed a novel fabrication method that utilizes carbodiimide, neomycin trisulfate, and pentagalloyl glucose crosslinking chemistry (TRI) to better stabilize the extracellular matrix of porcine aortic valve leaflets. We demonstrate that TRI treated leaflets show similar biomechanics to GLUT crosslinked leaflets. TRI treated leaflets had better resistance to enzymatic degradation in vitro and demonstrated better tearing toughness after challenged with enzymatic degradation. When implanted subcutaneously in rats for up to 90 days, GLUT control leaflets calcified heavily while TRI treated leaflets resisted calcification, retained more ECM components, and showed better biocompatibility. PMID:26196535

  2. Abstract--Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma

    E-print Network

    Dupont, Pierre

    Abstract-- Replacing open-heart surgical procedures with beating-heart interventions substantially on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator. I. INTRODUCTION UE

  3. Hyperinsulinism in a child presenting with cardiac ischemia and bradycardia

    PubMed Central

    Al-Fayyadh, Majid; Bulbul, Ziad; Al Maneea, Waleed; Abbas, Bassam Bin

    2014-01-01

    A 5-year-old boy referred to our service with suspected sinus node dysfunction. In addition to the arrhythmia, he had moderate mitral valve regurgitation and depressed ventricular function during a hypoglycemic episode. Cardiac abnormalities resolved with glucose infusion. We believe that hypoglycemia was responsible for the cardiac manifestations and it should be considered in unexplained rhythm disturbances or ischemia. PMID:25544821

  4. Living with Mitral Valve Prolapse

    MedlinePLUS

    ... high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week Fruits, ... canola, peanut, safflower, and sesame oils Peanut butter Salmon and trout Tofu Sodium You should try to ...

  5. Mitral valve surgery - minimally invasive

    MedlinePLUS

    ... RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ... heart disease in adults. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ...

  6. Cumulant-based trapezoidal basis selection for heart sound classification.

    PubMed

    Safara, Fatemeh

    2015-11-01

    Past decades witnessed the expansion of linear signal processing methods in numerous biomedical applications. However, the nonlinear behavior of biomedical signals revived the interest in nonlinear signal processing methods such as higher-order statistics, in particular higher-order cumulants (HOC). In this paper, HOC are utilized toward heart sound classification. Heart sounds are presented by wavelet packet decomposition trees. Information measures are then defined based on HOC of wavelet packet coefficients, and three basis selection methods are proposed to prune the trees and preserve the most informative nodes for feature extraction. In addition, an approach is introduced to reduce the dimensionality of the search space from the whole wavelet packet tree to a trapezoidal sub-tree of it. This approach can be recommended for signals with a short frequency range. HOC features are extracted from the coefficients of selected nodes and fed into support vector machine classifier. Experimental data is a set of 59 heart sounds from different categories: normal heart sounds, mitral regurgitation, aortic stenosis, and aortic regurgitation. The promising results achieved indicate the capabilities of HOC of wavelet packet coefficients to capture nonlinear characteristics of the heart sounds to be used for basis selection. PMID:26403300

  7. Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy

    PubMed Central

    Rocha, Eduardo Arrais; Pereira, Francisca Tatiana Moreira; Abreu, José Sebastião; Lima, José Wellington O.; Monteiro, Marcelo de Paula M.; Rocha Neto, Almino Cavalcante; Quidute, Ana Rosa Pinto; Goés, Camilla Viana A.; Rodrigues Sobrinho, Carlos Roberto Martins; Scanavacca, Maurício Ibrahim

    2015-01-01

    Background Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre-implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6-12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options. PMID:26351981

  8. Incidence of new onset atrial fibrillation in patients with permanent pacemakers and the relation to the pacing mode

    PubMed Central

    Said, Sarmad; Alkhateeb, Haider; Cooper, Chad J.; Gosavi, Sucheta; Dwivedi, Alok; Paez, David; Abedin, Zainul

    2014-01-01

    Background Atrial fibrillation is a relatively common arrhythmia often seen in patients with permanent pacemakers. In this study we aimed to assess the incidence of atrial fibrillation in patients whose pacemakers were programmed to pace in the right ventricle (VVI) and compared it with patients whose pacemakers were programmed in non-VVI mode(i.e. AAI or DDD). Material/Methods Records of the patients with permanent pacemaker or implantable-cardioverter-defibrillator were evaluated and analyzed. These patients had regular periodic follow-up evaluation over the last 10 years. (January 1, 2002 to December 31, 2012). Patient demographic, pacemaker data, pacing mode, review and analysis of arrhythmia log for occurrence of new atrial fibrillation and echocardiographic findings for left atrial size, mitral regurgitation, were analyzed and recorded. Left atrial size was classified as mild, moderate or severe enlargement, depending on the left atrial dimension. Results Average age was 68 years. There was no gender predominance (51% male). Mean follow-up duration was 6 years and 3 months. Hispanic population represented the majority of the patients (65.4%). Majority of the devices (80.0%) were programmed as DDD pacing mode. Fifty-five patients (52.8%) did not develop atrial fibrillation. 85.7% of the patients paced in VVI-mode had atrial fibrillation while atrial fibrillation occurred in 37.4% among patients paced in non-VVI-mode. This difference was statistically significant (P<0.0001). Conclusions Right ventricular pacing in a VVI mode was associated with higher incidence of atrial fibrillation, mitral regurgitation and left atrial enlargement. Non-VVI based pacing demonstrated lower incidence of new onset atrial fibrillation. PMID:24535068

  9. Using the Scientific Method to Improve Mentoring

    ERIC Educational Resources Information Center

    McGuire, Saundra Yancy

    2007-01-01

    Many students who enter colleges and universities seem to be focused on memorizing and regurgitating information rather than on developing critical thinking and problem solving skills. Mentoring is crucial to help these students transition from the current approach to one that will be successful in college. Successful mentoring requires a…

  10. Flow measurement by cardiovascular magnetic resonance: a multi-centre multi-vendor study of background phase offset errors that can compromise the accuracy of derived regurgitant or shunt flow measurements

    PubMed Central

    2010-01-01

    Aims Cardiovascular magnetic resonance (CMR) allows non-invasive phase contrast measurements of flow through planes transecting large vessels. However, some clinically valuable applications are highly sensitive to errors caused by small offsets of measured velocities if these are not adequately corrected, for example by the use of static tissue or static phantom correction of the offset error. We studied the severity of uncorrected velocity offset errors across sites and CMR systems. Methods and Results In a multi-centre, multi-vendor study, breath-hold through-plane retrospectively ECG-gated phase contrast acquisitions, as are used clinically for aortic and pulmonary flow measurement, were applied to static gelatin phantoms in twelve 1.5 T CMR systems, using a velocity encoding range of 150 cm/s. No post-processing corrections of offsets were implemented. The greatest uncorrected velocity offset, taken as an average over a 'great vessel' region (30 mm diameter) located up to 70 mm in-plane distance from the magnet isocenter, ranged from 0.4 cm/s to 4.9 cm/s. It averaged 2.7 cm/s over all the planes and systems. By theoretical calculation, a velocity offset error of 0.6 cm/s (representing just 0.4% of a 150 cm/s velocity encoding range) is barely acceptable, potentially causing about 5% miscalculation of cardiac output and up to 10% error in shunt measurement. Conclusion In the absence of hardware or software upgrades able to reduce phase offset errors, all the systems tested appeared to require post-acquisition correction to achieve consistently reliable breath-hold measurements of flow. The effectiveness of offset correction software will still need testing with respect to clinical flow acquisitions. PMID:20074359

  11. [When should transesophageal echography be ordered?].

    PubMed

    Lesbre, J P

    1994-10-15

    The exceptional quality of cardiac imaging, access to otherwise inaccessible anatomic areas and optimal alignment on anatomic structures make transoesophageal echography an exceptional high performance imaging technique. But when should it be ordered? Suspected aortic dissection is a major indication for transoesophageal echography. Diagnosis can be confirmed with sensitivity and specificity of 95 to 99%. The performance of the transoesophageal route is also better than that of the transthoracic route in case of suspected infectious endocarditis and should be ordered when the transthoracic image is insufficient, a perivalvular abscess is suspected, fever persists, infection on a prosthesis is suspected, blood cultures are negative or heart failure compromises cardiac performance. It should be remembered however, that a normal transoesophageal echography cannot eliminate the diagnosis of infectious endocarditis. The method is however extremely useful for close follow-up of endocarditis. Thrombo-embolic events with neurological or peripheral expression are also frequent indications for transoesophageal echography. Three direct causes can be detected: thrombus in the left atrium, contrast in the left atrium corresponding to micro-platelet aggregation due to prolonged stasis and intra-aortic debris. Septal anomalies may indicate an indirect cause. Aortic or mitral valvulopathies are another area of importance because transoesophageal echography results are well correlated with haemodynamic performance. Patients with a poorly tolerated mitral regurgitation with or without criteria of gravity could benefit from transoesophageal echography. Valve prostheses, especially mitral prosthesis, are also important indications. Per-operative examinations are particularly important for evaluating valve replacement quality after cardiac circulation has been reestablished. In addition, the high quality of transoesophageal images is particularly useful in investigating congenital cardiopathies and in certain intensive care patients. PMID:7824453

  12. Inclusion cylinder method for aortic valve replacement utilising the Ross operation in adults with predominant aortic stenosis – 99% freedom from re-operation on the aortic valve at 15 years

    PubMed Central

    Skillington, Peter D.; Mokhles, M. Mostafa; Wilson, William; Grigg, Leeanne; Larobina, Marco; O'Keefe, Michael; Takkenberg, Johanna

    2013-01-01

    Background: To report our experience with the Ross operation in patients with predominant aortic stenosis (AS) using an inclusion cylinder (IC) method. Methods: Out of 324 adults undergoing a Ross operation, 204 patients of mean age of 41.3 years (limits 16–62) underwent this procedure for either AS or mixed AS and regurgitation (AS/AR) between October, 1992 and February, 2012, implanting the PA with an IC method. Clinical follow up and serial echo data for this group is 97% complete with late mortality follow up 99% complete. Results: There has been zero (0%) early mortality, and late survival at 15 years is 98% (96%, 100%). Only one re-operation on the aortic valve for progressive aortic regurgitation (AR) has been required with freedom from re-operation on the aortic valve at 15 years being 99% (96%, 100%). The freedom from all re-operations on the aortic and pulmonary valves at 15 years is 97% (94%, 100%). Echo analysis at the most recent study shows that 98% have nil, trivial or mild AR. Aortic root size has remained stable, shown by long-term (15 year) echo follow up. Conclusions: In an experience spanning 19 years, the Ross operation used for predominant AS using the IC method described, results in 99% freedom from re-operation on the aortic valve at 15 years, better than any other tissue or mechanical valve. For adults under 65 years without significant co-morbidities who present with predominant AS, the pulmonary autograft inserted with this technique gives excellent results. PMID:24749112

  13. Evaluation of the pulse-contour method of determining stroke volume in man.

    NASA Technical Reports Server (NTRS)

    Alderman, E. L.; Branzi, A.; Sanders, W.; Brown, B. W.; Harrison, D. C.

    1972-01-01

    The pulse-contour method for determining stroke volume has been employed as a continuous rapid method of monitoring the cardiovascular status of patients. Twenty-one patients with ischemic heart disease and 21 patients with mitral valve disease were subjected to a variety of hemodynamic interventions. The pulse-contour estimations, using three different formulas derived by Warner, Kouchoukos, and Herd, were compared with indicator-dilution outputs. A comparison of the results of the two methods for determining stroke volume yielded correlation coefficients ranging from 0.59 to 0.84. The better performing Warner formula yielded a coefficient of variation of about 20%. The type of hemodynamic interventions employed did not significantly affect the results using the pulse-contour method. Although the correlation of the pulse-contour and indicator-dilution stroke volumes is high, the coefficient of variation is such that small changes in stroke volume cannot be accurately assessed by the pulse-contour method. However, the simplicity and rapidity of this method compared to determination of cardiac output by Fick or indicator-dilution methods makes it a potentially useful adjunct for monitoring critically ill patients.

  14. [Benfluorex and valvular heart disease].

    PubMed

    Tribouilloy, Christophe; Jeu, Antoine; Maréchaux, Sylvestre; Jobic, Yannick; Rusinaru, Dan; Andréjak, Michel

    2011-11-01

    Benfluorex is responsible of restrictive organic valvular regurgitations via one of its metabolites, the norfenfluramine. It has been withdrawn from the european market in June 2010. In France, about five millions of people have been exposed to benfluorex since its market launch in 1976. At the time of its market withdrawn, over 300,000 patients in France were taking the drug. Aortic and mitral valves are the most frequent involved. The prevalence of this type of valve damage is not yet known with accuracy. Severe regurgitations appear to be rare (less than one case per thousand exposed patients-year). PMID:21981882

  15. Congenital submitral aneurysm and sinus of valsalva aneurysm.

    PubMed

    Chockalingam, Anand; Gnanavelu, G; Alagesan, R; Subramaniam, T

    2004-05-01

    Submitral aneurysm (SMA) is congenital outpouching of the left ventricular (LV) wall invariably occurring adjacent to the posterior leaflet of mitral valve. SMA is typically diagnosed in young adults who present with severe mitral regurgitation, heart failure, systemic embolism, and sudden cardiac death. African blacks account for the majority of the reported SMA cases. Our report of the very rare combination of SMA with aortic sinus aneurysm lends support to the congenital origin of this pathology occurring due to developmental deficiency in the fusion of myocardium and cardiac fibro skeleton. Complete diagnosis was made by transthoracic echocardiography. PMID:15104545

  16. The Origin of Echocardiography

    PubMed Central

    Singh, Siddharth; Goyal, Abha

    2007-01-01

    The original description of M-mode echocardiography in 1953, by Inge Edler (1911–2001) and his physicist friend Hellmuth Hertz, marked the beginning of a new diagnostic noninvasive technique. Edler used this technique primarily for the preoperative study of mitral stenosis and diagnosis of mitral regurgitation. His work was carried forward by cardiologists all over the world, who developed Doppler, 2-dimensional, contrast, and transesophageal echocardiography. These are now standard in cardiologic examinations. Edler also influenced neurologists and obstetricians at Lund University (Sweden) to use ultrasound in their fields. For his landmark discovery, Edler is recognized as the “Father of Echocardiography.” PMID:18172524

  17. [Papillary Muscle Rupture after Repair of Ischemic Left Ventricular Free Wall Rupture; Report of a Case].

    PubMed

    Kurumisawa, Soki; Kaminishi, Yuichirou; Akutsu, Hirohiko; Takazawa, Ippei; Aizawa, Kei; Misawa, Yoshio

    2015-11-01

    A 67-year-old man experienced acute inferior myocardial infarction. Echocardiography and computed tomography showed massive pericardial effusion. He underwent emergency operation for ischemic ventricular free wall rupture. During the operation, an oozing type rupture was found on the inferior wall and the bleeding was completely controlled by applying fibrin glue sheets. On the 5th day after the operation, ventricular tachycardia appeared with hemodynamic deterioration. Echocardiography showed a ruptured posteromedial papillary muscle with massive mitral regurgitation. Intra-aortic balloon pumping was introduced and emergency repair operation was performed. The mitral valve was replaced with a bioprosthetic valve. The postoperative course was uneventful. PMID:26555919

  18. MitraClip—data analysis of contemporary literature

    PubMed Central

    Schofer, Niklas; Lubos, Edith; Schirmer, Johannes; Conradi, Lenard; Treede, Hendrik; Reichenspurner, Hermann; Blankenberg, Stefan; Schäfer, Ulrich

    2015-01-01

    Treatment of mitral regurgitation (MR) with the MitraClip (MC), a percutaneous, transseptal edge-to-edge reconstruction of the mitral valve, has become an interesting treatment option in most patients not eligible for surgery. Lately a variety of studies have been published analyzing the treatment of MR with the MC in degenerative as well as functional MR. The results for both entities of MR show negligible intraprocedural mortality, low periprocedural complications rates and a beneficiary outcome in terms of reduction in MR as well as an improvement in functional capacity and quality of life. Here we summarize the latest results focusing on safety and efficacy of MC treatment. PMID:26543596

  19. Effect of pulmonary circulation on vector impedance cardiogram.

    PubMed

    Pedhnekar, S A; Jindal, G D; Nerurkar, S N; Dharani, J B; Deshpande, A K; Parulkar, G B

    1990-10-01

    Vector impedance cardiograms in horizontal lead configuration [VICG(H)] were recorded in 34 normal subjects, 18 patients with mitral stenosis, 9 patients with mitral regurgitation, 14 patients with aortic regurgitation and 13 patients with non- cyanotic septal disorders. Data in normal subjects revealed that most of the phase reversal points in VICG(H) waveform did not coincide with those of conventional impedance cardiogram. The shape of VICG(H) waveform and values of VICG indices were observed to be markedly affected in patients having significant alteration in the pulmonary circulation and the changes observed were specific of the type of the disorder. The results of the study suggested that right side of the heart had dominant contribution in generation of VICG(H) waveform. PMID:2132247

  20. Surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a patient with porcelain aorta.

    PubMed

    Hashimoto, Makoto; Fukui, Toshihiro; Takanashi, Shuichiro

    2015-08-01

    We report a rare case of surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a 90-year old female with severe aortic calcification. The patient underwent aortic balloon valvuloplasty for symptomatic aortic stenosis, resulting in severe aortic regurgitation because of injury to the right coronary cusp of the aortic valve and severe mitral regurgitation because of rupture of the chordae tendineae. She became haemodynamically unstable and required treatment with mechanical ventilation and assisted circulation. Urgent surgical treatment was planned. The patient's porcelain aorta increased the difficulty of surgery, but the procedure was carefully planned, and aortic valve replacement and mitral valve repair were performed successfully without major complications. The patient had a satisfactory postoperative course and was transferred to another hospital for rehabilitation on the 8th postoperative day. PMID:25187531

  1. New dysmorphic features in Rubinstein-Taybi syndrome.

    PubMed Central

    Kanjilal, D; Basir, M A; Verma, R S; Rajegowda, B K; Lala, R; Nagaraj, A

    1992-01-01

    We report a new case of Rubinstein-Taybi syndrome with a hypoplastic right kidney, persistent pulmonary hypertension, and mitral valve regurgitation. Other pertinent features included broad thumbs, broad big toes, syndactyly of the third and fourth fingers bilaterally, beaked nose, broad columella of the nose, patent ductus arteriosus, and motor and mental retardation. The testes were descended. The 3 month old patient had delayed motor and mental development corresponding to a 1 month old infant. Images PMID:1404300

  2. Case report: Symptoms of advanced heart failure--a case for radiofrequency catheter ablation?

    PubMed

    Bulava, Alan; Heinc, Petr; Hutyra, Martin; Kaminek, Milan; Krivankova, Malvina; Richter, Marek; Lukl, Jan

    2006-08-01

    A sixty-year-old man with previous history of coronary artery disease was admitted due to progressive worsening of dyspnoea at exertion (NYHA III functional class) and no angina. Coronary angiography confirmed occlusion of the right coronary artery which was naturally bypassed by homocollaterals with TIMI 3 flow to the peripheral branches. The lesion was not technically suitable for percutaneous angioplasty. The left coronary artery was without stenosis. On echocardiography, both the left ventricle and the left atrium were dilated and hemodynamically significant mitral regurgitation was present. Surface ECG showed a left bundle branch block with repeated runs of monomorphic ventricular ectopic beats (PVC). Radiofrequency catheter ablation of the focus in the posteroseptal region of the left ventricle underneath the mitral valve was performed using electroanatomical mapping system. After the procedure, mitral regurgitation decreased and reverse remodeling of the left ventricle and the left atrium occurred with concomitant significant clinical improvement of the patient. The authors discuss several treatment strategies: mitral valve repair surgery combined with revascularization, implantation of a biventricular ICD system or elimination of the focus of monomorphic VT runs by radiofrequency catheter ablation as a possible causal approach in the treatment of PVC-induced cardiomyopathy. PMID:17061158

  3. Neisseria elongata subsp elongata infective endocarditis following endurance exercise.

    PubMed

    Jenkins, Joanne May; Fife, Amanda; Baghai, Max; Dworakowski, Rafal

    2015-01-01

    A 31-year-old Argentinian woman presented with a 3-week history of fever, night sweats, myalgia and lethargy following a work trip to Uganda where she ran a marathon. Malarial screens were negative but C reactive protein, erythrocyte sedimentation rate and neutrophil count were raised and she was anaemic. A new pansystolic murmur was heard over the mitral valve and the transthoracic echocardiogram showed a large vegetation (>1?cm) with at least moderate mitral regurgitation. Blood cultures grew Neisseria elongata, subsp elongata treated initially with ceftriaxone then oral ciprofloxacin to complete 4?weeks of treatment. CT scan revealed a wedge-shaped area of low attenuation in the spleen in keeping with a splenic infarct. Seven days postadmission, the patient underwent a successful mitral valve repair. Recovery was complicated by a likely embolic infarct in the right frontal lobe, but the patient was discharged 12?days postoperative with no neurological sequelae. PMID:26655669

  4. Easy method for measurement of opening angle of Björk-Shiley valve with two computers. Proof of floating phenomenon of Björk-Shiley valve.

    PubMed

    Akanuma, T; Matsuzawa, H; Eguchi, S

    1981-09-01

    A new method for measuring the opening angle of Björk-Shiley valve (B-S valve) was reported in 1977. However, this method is complicated enough to permit quick calculation of the opening angle in multiple frames of one cinefilm. We devised a new method with using two computers (NAC Cardias GP 2000, TEXAS TI-59) for calculating the opening angle of the B-S valve. We measured the opening angle of 7 cases (they were all implanted B-S valves, 5 were mitral and 2 were aortic). Results are the following: (1) The maximum opening angle ranged from 54 degrees to 65 degrees and the mean value was 58.1 degrees. (2) We showed the floating phenomenon of B-S valve with our method. (3) We showed the accuracy of our method by measuring 10 times the same photograph of B-S valve. (4) We showed that our method is very accurate by comparing the values calculated by our method with those calculated directly from the valve which was removed from a patient. (5) It takes less than 30 minutes to calculate the opening angle of 60 frames (we took 60 frames of cine-film per minutes. PMID:7300016

  5. Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

    PubMed

    Sabzi, Feridoun

    2015-01-01

    Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function. PMID:26157465

  6. Newton's method

    SciTech Connect

    More, J. J.; Sorensen, D. C.

    1982-02-01

    Newton's method plays a central role in the development of numerical techniques for optimization. In fact, most of the current practical methods for optimization can be viewed as variations on Newton's method. It is therefore important to understand Newton's method as an algorithm in its own right and as a key introduction to the most recent ideas in this area. One of the aims of this expository paper is to present and analyze two main approaches to Newton's method for unconstrained minimization: the line search approach and the trust region approach. The other aim is to present some of the recent developments in the optimization field which are related to Newton's method. In particular, we explore several variations on Newton's method which are appropriate for large scale problems, and we also show how quasi-Newton methods can be derived quite naturally from Newton's method.

  7. Patient-specific finite element based analysis of ventricular myofiber stress after Coapsys: Importance of residual stress.

    PubMed Central

    Carrick, Richard; Ge, Liang; Lee, Lik Chuan; Zhang, Zhihong; Mishra, Rakesh; Axel, Leon; Guccione, Julius M.; Grossi, Eugene A.; Ratcliffe, Mark B.

    2012-01-01

    Background We sought to determine regional myofiber stress after Coapsys device (Myocor, Inc., Maple Grove, Minnesota) implantation using a finite element (FE) model of the left ventricle (LV). Chronic ischemic mitral regurgitation (CIMR) is due to LV remodeling after postero-lateral myocardial infarction. The Coapsys device consists of a single trans-LV chord placed below the mitral valve such that when tensioned it alters LV shape and decreases CIMR. Methods FE models of the LV were based on magnetic resonance images (MRI) obtained before (PRE-OP) and after (POST-OP) CABG + Coapsys in a single patient. To determine the effect of Coapsys and LV pre-stress, virtual Coapsys (VIRTUAL-COAPSYS) was performed on the PRE-OP model. Diastolic and systolic material parameters in the PRE-OP, POST-OP and VIRTUAL-COAPSYS were adjusted so that model LV volume agreed with MRI data. CIMR was abolished in the post-op models. In each case, myofiber stress and pump function were calculated. Results Both POST-OP and VIRTUAL-COAPSYS shifted end-systolic (ES) and end diastolic (ED) pressure volume relationships (PVR) to the left. As a consequence and because CIMR was reduced after Coapsys, pump function was unchanged. Coapsys decreased myofiber stress at ED and ES in both the remote and infarct regions of the myocardium. However, knowledge of Coapsys and LV pre-stress was necessary for accurate calculation of LV myofiber stress especially in the remote zone. Conclusions Coapsys decreases myofiber stress at ED and ES. The improvement in myofiber stress may contribute to the long term effect of Coapsys on LV remodeling. PMID:22560323

  8. Evaluation of Acquired Valvular Heart Disease by the Pediatrician: When to Follow, When to Refer for Intervention? Part I.

    PubMed

    Saxena, Anita

    2015-11-01

    Lesions of the heart valves are the commonest acquired cardiac abnormalities seen in pediatric age group. In India, the underlying cause for most valvular diseases is chronic rheumatic heart disease (RHD). The aim of evaluation of patients with valvular heart disease is not only to make a diagnosis, but also to decide the management plan. The pediatrician or physician is usually the first health care provider to whom such patients (or their parents) report. It is therefore imperative that the general physician and pediatricians are well versed with valvular heart diseases. Valvular abnormalities produce characteristic murmurs and a bedside diagnosis is possible in majority. However, further investigations such as X ray of the chest and an ECG are useful tools to refine the diagnosis. Echocardiography is now widely available to most of the patients in India and is very useful for assessing the severity of valve lesion and to identify the underlying etiology. Serial echocardiography is instrumental in deciding the timing of intervention. Mitral valve is most commonly affected followed by aortic; in some patients both valves may be affected. The valve may not close properly, resulting in regurgitation of blood flow in reverse direction or does not open fully (stenosis). In mitral regurgitation (MR), the blood flows in the reverse direction. MR can occur secondary to several causes, but in India, the commonest cause is RHD. Patient may remain asymptpmatic for a long period of time. Symptoms include fatigue, palpitations and later exertional breathlessness. MR typically produces a pansystolic murmur at apex, which may radiate to left axilla. Surgical intervention is reserved for all symptomatic patients with severe MR. Valve repair is preferred over prosthetic valve replacement. Mitral stenosis (MS) is almost always due to RHD. Severe MS results in pulmonary hypertension, right ventricular failure and tricuspid regurgitation. Patients are often symptomatic with dyspnea. Hemoptysis may occur. A typical rumbling mid diastolic murmur is the hallmark of MS. Balloon mitral valvotomy, performed in the catheterization lab, is recommended for severe MS. PMID:26141545

  9. Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

    PubMed Central

    Marcinkiewicz, Anna; Ko?mider, Anna; Walczak, Andrzej; Zwoli?ski, Rados?aw; Jaszewski, Ryszard

    2015-01-01

    Introduction Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. Case study 1 The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs’ surface was found. A biological aortic prosthesis was reimplanted without complications. Case study 2 The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored. Conclusions Precise and modern diagnostic methods facilitated selection of the treatment method. However, the intraoperative view also seems to be crucial in individualizing the surgical approach. PMID:26702274

  10. Vortex methods

    SciTech Connect

    Chorin, A.J. |

    1993-06-01

    Vortex methods originated from the observation that in incompressible inviscid flow vorticity (or, more accurately, circulation) is a conserved quantity, as can be readily deduced from the absence of tangential stresses. Thus, if the vorticity is known at time t=0, one can find the flow at a later time by simply following the vorticity. In this narrow context, a vortex method is a numerical method that follows vorticity. The author restricts himself in these lectures to a special class of numerical vortex methods, those that are based on a Lagrangian transport of vorticity in hydrodynamics by smoothed particles (blobs) and those whose analysis contributes to the understanding of blob methods. Blob methods started in the 1930`s.

  11. Case method.

    PubMed Central

    Carson, R A

    1986-01-01

    Teaching medical ethics by the case method may be enriched by adding to the principles-and-rules approach to practical reasoning modes of inquiry and interpretation that engage the moral imagination. PMID:3959040

  12. Electrodeionization method

    DOEpatents

    Lin, YuPo J.; Hestekin, Jamie; Arora, Michelle; St. Martin, Edward J.

    2004-09-28

    An electrodeionization method for continuously producing and or separating and/or concentrating ionizable organics present in dilute concentrations in an ionic solution while controlling the pH to within one to one-half pH unit method for continuously producing and or separating and/or concentrating ionizable organics present in dilute concentrations in an ionic solution while controlling the pH to within one to one-half pH unit.

  13. Digital angiography in the pediatric patient with congenital heart disease: comparison with standard methods

    SciTech Connect

    Levin, A.R.; Goldberg, H.L.; Borer, J.S.; Rothenberg, L.N.; Nolan, F.A.; Engle, M.A.; Cohen, B.; Skelly, N.T.; Carter, J.

    1983-08-01

    Digital subtraction angiography (DSA) permits high-resolution cardiac imaging with relatively low doses of contrast medium and reduced radiation exposure. These are potential advantages in children with congenital heart disease. Computer-based DSA (30 frames/sec) and conventional cutfilm angiography (6 frames/sec) or cineangiography (60 frames/sec) were compared in 42 patients, ages 2 months to 18 years (mean 7.8 years) and weighing 3.4 to 78.5 kg (mean 28.2 kg). There were 29 diagnoses that included valvular regurgitant lesions, obstructive lesions, various shunt abnormalities, and a group of miscellaneous anomalies. For injections made at a site distant from the lesion and on the right side of the circulation, the mean dose of contrast medium was 60% to 100% of the conventional dose given during standard angiography. With injections made close to the lesion and on the left side of the circulation, the mean dose of contrast medium was 27.5% to 42% of the conventional dose. Radiation exposure for each technique was markedly reduced in all age groups. A total of 92 digital subtraction angiograms were performed. Five studies were suboptimal because too little contrast medium was injected; in the remaining 87 injections, DSA and conventional studies resulted in identical diagnoses in 81 instances (p less than .001 vs chance). The remaining six injections made during DSA failed to confirm diagnoses made angiographically by standard cutfilm angiography or cineangiography. We conclude that DSA usually provides diagnostic information equivalent to that available from cutfilm angiography and cineangiography, but DSA requires considerably lower doses of contrast medium and less radiation exposure than standard conventional methods.

  14. Successful cardiac resynchronization therapy in a 3-year-old girl with isolated left ventricular non-compaction and narrow QRS complex: a case report.

    PubMed

    Saito, Kazuyoshi; Ibuki, Keijirou; Yoshimura, Naoki; Hirono, Keiichi; Watanabe, Sayaka; Watanabe, Kazuhiro; Uese, Keiichiro; Yasukouchi, Satoshi; Ichida, Fukiko; Miyawaki, Toshio

    2009-11-01

    Cardiac resynchronization therapy (CRT) is a new method of treatment for refractory heart failure. However, for children, its indication, efficacy, and long-term prognosis remain unclear. This study describes the use of CRT for a 3-year-old girl with intractable heart failure caused by isolated left ventricular non-compaction (LVNC) with narrow QRS complex. Echocardiography showed diffuse hypokinetic left ventricular (LV) wall motion (ejection fraction =29.3%) with dyssynchrony between the apex, posterior and lateral walls, where numerous prominent trabeculations existed, and severe mitral regurgitation. Biventricular resynchronization using epicardial pacing leads was performed under general anesthesia. Pacing sites for optimal synchronization in the ventricular walls where chosen using tissue Doppler imaging, and AV delay was adjusted to achieve maximal systolic blood pressure and maximal cardiac output. Over a follow-up period of 2 years, she exhibited significant and sustained improvement in LV function and clinical symptoms. BNP levels decreased from 1,960 to 82 pg/ml. QRS duration (103 ms) on ECG did not change after CRT. We conclude that pediatric CRT provides a highly useful adjunct for the treatment of heart failure, even in patients with a narrow QRS duration, and might improve the prognosis of patients with LVNC. PMID:19352045

  15. Ensemble Methods

    NASA Astrophysics Data System (ADS)

    Re, Matteo; Valentini, Giorgio

    2012-03-01

    Ensemble methods are statistical and computational learning procedures reminiscent of the human social learning behavior of seeking several opinions before making any crucial decision. The idea of combining the opinions of different "experts" to obtain an overall “ensemble” decision is rooted in our culture at least from the classical age of ancient Greece, and it has been formalized during the Enlightenment with the Condorcet Jury Theorem[45]), which proved that the judgment of a committee is superior to those of individuals, provided the individuals have reasonable competence. Ensembles are sets of learning machines that combine in some way their decisions, or their learning algorithms, or different views of data, or other specific characteristics to obtain more reliable and more accurate predictions in supervised and unsupervised learning problems [48,116]. A simple example is represented by the majority vote ensemble, by which the decisions of different learning machines are combined, and the class that receives the majority of “votes” (i.e., the class predicted by the majority of the learning machines) is the class predicted by the overall ensemble [158]. In the literature, a plethora of terms other than ensembles has been used, such as fusion, combination, aggregation, and committee, to indicate sets of learning machines that work together to solve a machine learning problem [19,40,56,66,99,108,123], but in this chapter we maintain the term ensemble in its widest meaning, in order to include the whole range of combination methods. Nowadays, ensemble methods represent one of the main current research lines in machine learning [48,116], and the interest of the research community on ensemble methods is witnessed by conferences and workshops specifically devoted to ensembles, first of all the multiple classifier systems (MCS) conference organized by Roli, Kittler, Windeatt, and other researchers of this area [14,62,85,149,173]. Several theories have been proposed to explain the characteristics and the successful application of ensembles to different application domains. For instance, Allwein, Schapire, and Singer interpreted the improved generalization capabilities of ensembles of learning machines in the framework of large margin classifiers [4,177], Kleinberg in the context of stochastic discrimination theory [112], and Breiman and Friedman in the light of the bias-variance analysis borrowed from classical statistics [21,70]. Empirical studies showed that both in classification and regression problems, ensembles improve on single learning machines, and moreover large experimental studies compared the effectiveness of different ensemble methods on benchmark data sets [10,11,49,188]. The interest in this research area is motivated also by the availability of very fast computers and networks of workstations at a relatively low cost that allow the implementation and the experimentation of complex ensemble methods using off-the-shelf computer platforms. However, as explained in Section 26.2 there are deeper reasons to use ensembles of learning machines, motivated by the intrinsic characteristics of the ensemble methods. The main aim of this chapter is to introduce ensemble methods and to provide an overview and a bibliography of the main areas of research, without pretending to be exhaustive or to explain the detailed characteristics of each ensemble method. The paper is organized as follows. In the next section, the main theoretical and practical reasons for combining multiple learners are introduced. Section 26.3 depicts the main taxonomies on ensemble methods proposed in the literature. In Section 26.4 and 26.5, we present an overview of the main supervised ensemble methods reported in the literature, adopting a simple taxonomy, originally proposed in Ref. [201]. Applications of ensemble methods are only marginally considered, but a specific section on some relevant applications of ensemble methods in astronomy and astrophysics has been added (Section 26.6). The conclusion (Section 26.7) ends this pap

  16. [Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature].

    PubMed

    Tasrini, J; Scheffer, J; Vaislic, C; Giraud, C; Glock, Y; Cérène, A; Puel, P

    1984-10-01

    The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase. PMID:6439146

  17. Characterization methods

    SciTech Connect

    Glass, J.T.

    1993-01-01

    Methods discussed in this compilation of notes and diagrams are Raman spectroscopy, scanning electron microscopy, transmission electron microscopy, and other surface analysis techniques (auger electron spectroscopy, x-ray photoelectron spectroscopy, electron energy loss spectroscopy, and scanning tunnelling microscopy). A comparative evaluation of different techniques is performed. In-vacuo and in-situ analyses are described.

  18. Gelcasting methods

    DOEpatents

    Walls, Claudia A. (Oak Ridge, TN); Kirby, Glen H. (Knoxville, TN); Janney, Mark A. (Knoxville, TN); Omatete, Ogbemi O. (Knoxville, TN); Nunn, Stephen D. (Knoxville, TN); McMillan, April D. (Knoxville, TN)

    2000-01-01

    A method of gelcasting includes the steps of providing a solution of at least hydroxymethylacrylamide (HMAM) and water. At least one inorganic powder is added to the mixture. At least one initiator system is provided to polymerize the HMAM. The initiator polymerizes the HMAM and water, to form a firm hydrogel that contains the inorganic powder. One or more comonomers can be polymerized with the HMAM monomer, to alter the final properties of the gelcast material. Additionally, one or more additives can be included in the polymerization mixture, to alter the properties of the gelcast material.

  19. The ‘Inextricabilis Syndrome’: a case with no solution

    PubMed Central

    Khachatryan, Tigran; Beigel, Roy; Arsanjani, Reza

    2014-01-01

    Summary We describe a case of a 58-year-old man with cardiogenic shock who underwent triple vessel coronary artery bypass and a left ventricular assist device (LVAD) implantation. His course was complicated by stroke, worsening mitral regurgitation, aortic regurgitation, and multiple cardiac thrombi while on the device. We provide the details of the patient's hospital course, management, and echocardiographic findings. We also discuss the utility of echocardiography before LVAD insertion and its role for continued monitoring after insertion. Learning points Ventricular assist devices (VADs) are used as bridge to decision, transplant, recovery, or destination therapy in patients with advanced heart failure and cardiogenic shock.VADs improve survival and the quality of life but have significant associated complications.Echocardiography plays an essential role before VAD insertion and for postoperative cardiac monitoring. Information provided by echocardiography is used in device selection, consideration for corrective surgical interventions, and device explantation.

  20. Connective Tissue Disorders and Cardiovascular Complications: The indomitable role of Transforming Growth Factor-beta signaling

    PubMed Central

    Wheeler, Jason B.; Ikonomidis, John S.; Jones, Jeffrey A.

    2015-01-01

    Marfan Syndrome (MFS) and Loeys-Dietz Syndrome (LDS) represent heritable connective tissue disorders that cosegregate with a similar pattern of cardiovascular defects (thoracic aortic aneurysm, mitral valve prolapse/regurgitation, and aortic dilatation with regurgitation). This pattern of cardiovascular defects appears to be expressed along a spectrum of severity in many heritable connective tissue disorders and raises suspicion of a relationship between the normal development of connective tissues and the cardiovascular system. Given the evidence of increased transforming growth factor-beta (TGF-?) signaling in MFS and LDS, this signaling pathway may represent the common link in this relationship. To further explore this hypothetical link, this chapter will review the TGF-? signaling pathway, heritable connective tissue syndromes related to TGF-? receptor (TGFBR) mutations, and discuss the pathogenic contribution of TGF-? to these syndromes with a primary focus on the cardiovascular system. PMID:24443024