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1

New method of posterior scallop augmentation for ischemic mitral regurgitation.  

PubMed

We report a new method of posterior middle scallop (P2) augmentation for ischemic mitral regurgitation to achieve deep coaptation. First, P2 was divided straight at the center and partially detached from the annulus in a reverse T shape. A narrow pentagon-shaped section of pericardium was sutured to the divided P2 and annular defect. The tip of the pentagon was attached directly to the papillary muscle, thus creating a very large P2 scallop. A standard-sized ring was placed. We adopted this technique in 2 patients with advanced ischemic cardiomyopathy, and no mitral regurgitation was observed during a 1-year follow-up. PMID:25742844

Aoki, Masakazu; Ito, Toshiaki

2015-03-01

2

Quantitation of mitral regurgitation.  

PubMed

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

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

2011-01-01

3

Basic mechanisms of mitral regurgitation.  

PubMed

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

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

2014-09-01

4

Floppy mitral valve, mitral valve prolapse, and mitral valvular regurgitation  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a It is well recognized that the floppy mitral valve (FMV) complex is the central issue in the FMV, mitral valve prolapse (MVP),\\u000a and mitral valvular regurgitation (MVR) story. MVP associated with the FMV results from the systolic movement of portions\\u000a or segments of the FMV complex into the left atrium (LA). Prolapse of the FMV results in

Harisios Boudoulas; Charles F. Wooley

2001-01-01

5

Surgical timing for mitral valve regurgitation.  

PubMed

Advances in diagnostic and surgical techniques in the management of mitral regurgitation have resulted in improved survival rates and clinical outcomes. Echocardiography is a valuable noninvasive diagnostic tool in the determination of the timing of surgical correction of mitral regurgitation. Improved surgical techniques, the growing role of mitral valve repair, low operative mortality rates, and improved long-term survival rates are important considerations for earlier surgical intervention in symptomatic patients and in asymptomatic patients with echocardiographic criteria of left ventricular dilatation. Intraoperative transesophageal echocardiography is very useful in mitral valve repair and valve replacement with preservation of chordal structures. PMID:10978996

Ofili, E; Oduwole, A; Lapu-Bula, R; Lapa-Bula, R

2000-04-01

6

Rapid quantification of regurgitant flow through mitral valve models using the control volume method with segmented k-space magnetic resonance velocimetry  

Microsoft Academic Search

New approaches for the assessment of mitral regurgitation have focused on the quantification of the regurgitant flow volume, but they are accompanied by uncertainties. Recently, a control volume (CV) method applied via multi-slice and 3-directional magnetic resonance phase velocity mapping (MRPVM) showed potential for accurate quantification of the regurgitant volume. A limitation of conventional non-segmented MRPVM is its relatively long

H. Zhang; S. S. Halliburton; R. D. White; G. P. Chatzimavroudis

2002-01-01

7

The echocardiographic assessment of functional mitral regurgitation.  

PubMed

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

Ray, Simon

2010-12-01

8

Acute mitral regurgitation in Takotsubo cardiomyopathy.  

PubMed

Takotsubo cardiomyopathy (TTC) is a well-recognised entity that commonly manifests with chest pain, ST segment abnormalities and transient left ventricular apical ballooning without coronary artery obstructive disease. This syndrome usually portends a favourable outcome. In the rare haemodynamically unstable TTC patients, acute mitral regurgitation (MR) related to systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) is to be considered. Bedside echocardiography is key in recognition of this latter condition as vasodilators, inotropic agents or intra-aortic balloon counter-pulsation worsen the patient's clinical status. We discuss here a case of TTC where nitrate-induced subaortic obstruction and mitral regurgitation led to haemodynamic instability. PMID:24493864

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

2015-04-01

9

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation  

PubMed Central

Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. PMID:24383034

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

2013-01-01

10

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.  

PubMed

Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. PMID:24383034

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

2013-01-01

11

Dynamic mitral regurgitation: review of evidence base, assessment and implications for clinical management.  

PubMed

Both organic and functional mitral regurgitation are dynamic. Alterations in left ventricular and annular geometry, together with changing loading conditions on exertion, may lead to changes in the severity of mitral regurgitation. Exercise echocardiography is able to identify exercise-induced increases in the severity of mitral regurgitation and pulmonary artery systolic pressure which are responsible for symptoms in patients with mild or moderate dysfunction at rest. Prognostic parameters (exercise induced changes in effective orifice area, ejection fraction, and global longitudinal strain) may help risk-stratify patients with moderate or severe mitral regurgitation who are asymptomatic. This review examines the evidence base for dynamic mitral regurgitation, methods of assessment, clinical implications as well as possible therapies. PMID:25098202

Bhattacharyya, Sanjeev; Khattar, Rajdeep; Chahal, Nav; Senior, Roxy

2015-01-01

12

Mitral regurgitation in chronic heart failure: More questions than answers?  

Microsoft Academic Search

The presence, implications, and approach to mitral valvular disease in the setting of a cardiomyopathy has recently become\\u000a a focal issue for discussion. Although recent evidence suggests that mitral regurgitation confers a poor prognosis in heart\\u000a failure, the true prevalence of mitral regurgitation as well as its pathogenic contribution to prognosis in heart failure\\u000a remains uncertain. Whereas angiotensin-converting enzyme inhibitors

Mandeep R. Mehra; Mihai Gheorghiade; Robert O. Bonow

2004-01-01

13

Ischemic Mitral Regurgitation: A Quantitative Three-Dimensional Echocardiographic Analysis  

PubMed Central

Background A comprehensive three-dimensional echocardiography based approach is applied to preoperative mitral valve (MV) analysis in patients with ischemic mitral regurgitation (IMR). This method is used to characterize the heterogeneous nature of the pathologic anatomy associated with IMR. Methods Intraoperative real-time three-dimensional transesophageal echocardiograms of 18 patients with IMR (10 with anterior, 8 with inferior infarcts) and 17 patients with normal MV were analyzed. A customized image analysis protocol was used to assess global and regional determinants of annular size and shape, leaflet tethering and curvature, relative papillary muscle anatomy, and anatomic regurgitant orifice area. Results Both mitral annular area and MV tenting volume were increased in the IMR group as compared with patients with normal MV (mitral annular area = 1,065 ± 59 mm2 versus 779 ± 44 mm2, p = 0.001; and MV tenting volume = 3,413 ± 403 mm3 versus 1,696 ± 200 mm3, p = 0.001, respectively). Within the IMR group, patients with anterior infarct had larger annuli (1,168 ± 99 mm2) and greater tenting volumes (4,260 ± 779 mm3 versus 2,735 ± 245 mm3, p = 0.06) than the inferior infarct subgroup. Papillary-annular distance was increased in the IMR group relative to normal; these distances were largest in patients with anterior infarcts. Whereas patients with normal MV had very consistent anatomic determinants, annular shape and leaflet tenting distribution in the IMR group were exceedingly variable. Mean anatomic regurgitant orifice area was 25.8 ± 3.0 mm2, and the number of discrete regurgitant orifices varied from 1 to 4. Conclusions Application of custom analysis techniques to three-dimensional echocardiography images allows a quantitative and systematic analysis of the MV, and demonstrates the extreme variability in pathologic anatomy that occurs in patients with severe IMR. PMID:21172506

Vergnat, Mathieu; Jassar, Arminder S.; Jackson, Benjamin M.; Ryan, Liam P.; Eperjesi, Thomas J.; Pouch, Alison M.; Weiss, Stuart J.; Cheung, Albert T.; Acker, Michael A.; Gorman, Joseph H.; Gorman, Robert C.

2011-01-01

14

Surgical treatment of functional ischemic mitral regurgitation.  

PubMed

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

Jensen, Henrik

2015-03-01

15

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

PubMed

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

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

2011-02-01

16

Comparison of Early Surgery Versus Conventional Treatment in Asymptomatic Severe Mitral Regurgitation  

Microsoft Academic Search

Background—The optimal timing of surgical intervention in asymptomatic patients with severe mitral regurgitation is unclear. We therefore compared the long-term results of early surgery with a conventional treatment strategy. Methods and Results—From 1996 to 2005, 447 consecutive asymptomatic patients (253 men, age 5015 years) with severe degenerative mitral regurgitation and preserved left ventricular function were evaluated prospectively. The end point

Duk-Hyun Kang; Jeong Hoon Kim; Ji Hye Rim; Mi-Jeong Kim; Sung-Cheol Yun; Jong-Min Song; Hyun Song; Kee-Joon Choi; Jae-Kwan Song; Jae-Won Lee

2010-01-01

17

Tricuspid regurgitation after successful mitral valve surgery  

PubMed Central

The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified. PMID:22457188

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

2012-01-01

18

Intraoperative transesophageal echocardiography for surgical repair of mitral regurgitation.  

PubMed

Surgical repair of the mitral valve is being increasingly performed to treat severe mitral regurgitation. Transesophageal echocardiography is an essential tool for assessing valvular function and guiding surgical decision making during the perioperative period. A careful and systematic transesophageal echocardiographic examination is necessary to ensure that appropriate information is obtained and that the correct diagnoses are obtained before and after repair. The purpose of this article is to provide a practical guide for perioperative echocardiographers caring for patients undergoing surgical repair of mitral regurgitation. A guide to performing a systematic transesophageal echocardiographic examination of the mitral valve is provided, along with an approach to prerepair and postrepair assessment. Additionally, the anatomy and function of normal and regurgitant mitral valves are reviewed. PMID:24534653

Sidebotham, David Andrew; Allen, Sara Jane; Gerber, Ivor L; Fayers, Trevor

2014-04-01

19

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

PubMed Central

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

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

2015-01-01

20

THE EFFECT OF PURE MITRAL REGURGITATION ON MITRAL ANNULAR GEOMETRY AND 3-D SADDLE-SHAPE  

PubMed Central

Objectives Chronic ischemic mitral regurgitation (IMR) is associated with mitral annular dilatation in the septal-lateral dimension and flattening of the annular 3-D saddle-shape. To examine whether these perturbations are due to the ischemic insult, mitral regurgitation (MR), or both, we investigated the effects of pure MR (low pressure volume overload) on annular geometry and shape. Methods Eight radiopaque markers were sutured evenly around the mitral annulus in sheep randomized to control (CTRL, n=8) or experimental (HOLE, n=12) groups. In HOLE, a 3.5mm to 4.8mm hole was punched in the posterior leaflet to generate pure MR. 4-D marker coordinates were obtained radiographically 1 and 12 weeks postoperatively. Mitral annular area (MAA), annular septal-lateral (SL) and commissure-commissure (CC) dimensions, and annular height were calculated every 16.7ms. Results MR grade was 0.4±0.4 in CTRL and 3.0±0.8 in HOLE (p<0.001) at 12 weeks. End-diastolic LV volume index was greater in HOLE at both 1 and 12 weeks; end-systolic volume index was larger in HOLE at 12 weeks. MAA increased in HOLE predominantly in the CC dimension, with no difference in annular height between HOLE vs. CTRL at 1 or 12 weeks, respectively. Conclusions In contrast to annular SL dilatation and flattening of annular saddle-shape observed with chronic IMR, pure MR was associated with CC dimension annular dilatation and no change in annular shape. Thus, infarction is a more important determinant of SL dilatation and annular shape than is MR, which reinforces the need for disease-specific designs of annuloplasty rings. ULTRAMINI- ABSTRACT In a chronic pure mitral regurgitation (MR) ovine model, we examined changes in mitral annular dimensions and shape over 12 weeks to understand the contribution of MR to annular remodeling independent of the effects of myocardial infarction. Pure MR resulted in commissure-commissure annular dilatation and no change in annular saddle-shape. PMID:18805251

Nguyen, Tom C.; Itoh, Akinobu; Carlhäll, Carl J.; Bothe, Wolfgang; Timek, Tomasz A.; Ennis, Daniel B.; Oakes, Robert A.; Liang, David; Daughters, George T.; Ingels, Neil B.; Miller, D. Craig

2008-01-01

21

Criteria for Mitral Regurgitation Classification were inadequate for Dilated Cardiomyopathy  

PubMed Central

Background Mitral regurgitation (MR) is common in patients with dilated cardiomyopathy (DCM). It is unknown whether the criteria for MR classification are inadequate for patients with DCM. Objective We aimed to evaluate the agreement among the four most common echocardiographic methods for MR classification. Methods Ninety patients with DCM were included. Functional MR was classified using four echocardiographic methods: color flow jet area (JA), vena contracta (VC), effective regurgitant orifice area (ERO) and regurgitant volume (RV). MR was classified as mild, moderate or important according to the American Society of Echocardiography criteria and by dividing the values into terciles. The Kappa test was used to evaluate whether the methods agreed, and the Pearson correlation coefficient was used to evaluate the correlation between the absolute values of each method. Results MR classification according to each method was as follows: JA: 26 mild, 44 moderate, 20 important; VC: 12 mild, 72 moderate, 6 important; ERO: 70 mild, 15 moderate, 5 important; RV: 70 mild, 16 moderate, 4 important. The agreement was poor among methods (kappa = 0.11; p < 0.001). It was observed a strong correlation between the absolute values of each method, ranging from 0.70 to 0.95 (p < 0.01) and the agreement was higher when values were divided into terciles (kappa = 0.44; p < 0.01) Conclusion The use of conventional echocardiographic criteria for MR classification seems inadequate in patients with DCM. It is necessary to establish new cutoff values for MR classification in these patients. PMID:24100692

Mancuso, Frederico José Neves; Moisés, Valdir Ambrosio; Almeida, Dirceu Rodrigues; Oliveira, Wercules Antonio; Poyares, Dalva; Brito, Flavio Souza; de Paola, Angelo Amato Vincenzo; Carvalho, Antonio Carlos Camargo; Campos, Orlando

2013-01-01

22

Transesophageal echocardiographic Doppler study of the pulmonary venous flow pattern in severe mitral stenosis with variable degrees of mitral regurgitation.  

PubMed

The transesophageal echocardiographic data of 62 patients with severe, rheumatic mitral stenosis, which was either isolated or associated with different degrees of mitral regurgitation were reviewed to study and compare their pulmonary venous flow patterns. Peak systolic and peak diastolic flow velocities and their respective time intervals were measured, and the presence or absence of systolic flow reversal (SFR) was noted. The venous flow velocities and time integrals were all below normal and the ratio between the systolic and diastolic velocities were all blunted. Systolic flow reversal was observed in some patients with severe mitral stenosis with or without mitral regurgitation, and was highly correlated with the presence of atrial fibrillation. Among patients with mitral regurgitation and in atrial fibrillation, flow reversal timing was shorter in patients with significant mitral regurgitation than in patients with mild or no mitral regurgitation. PMID:9203494

Palileo, R A; Santos, R J

1997-06-01

23

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

PubMed Central

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

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

24

In-Vitro Mitral Valve Simulator Mimics Systolic Valvular Function of Chronic Ischemic Mitral Regurgitation Ovine Model  

PubMed Central

Background This study was undertaken to evaluate an in vitro mitral valve simulator's ability to mimic the systolic leaflet coaptation, regurgitation, and leaflet mechanics of a healthy and chronic ischemic mitral regurgitation (IMR) ovine model. Methods Mitral valve size and geometry of both healthy and chronic IMR ovine animals was used to recreate systolic mitral valve function in vitro. A2-P2 coaptation length, coaptation depth, tenting area, anterior leaflet strain, and mitral regurgitation were compared between the animal groups and valves simulated in the bench-top model. Results For the control conditions, no differences were observed between the healthy animals and simulator in coaptation length (p=.681), coaptation depth (p=.559), tenting area (p=.199), and anterior leaflet strain in the radial (p=.230) and circumferential (p=.364) directions. For the chronic IMR conditions, no differences were observed between the models in coaptation length (p=.596), coaptation depth (p=.621), tenting area (p=.879), and anterior leaflet strain in the radial (p=.151) and circumferential (p=.586) directions. Mitral regurgitation was similar between IMR models with an asymmetric jet originating from the tethered A3-P3 leaflets. Conclusion This study is the first to demonstrate the effectiveness of an in vitro simulator to emulate the systolic valvular function and mechanics of a healthy and chronic IMR ovine model. The in vitro IMR model provides the capability to recreate intermediary and exacerbated levels of annular and subvalvular distortion at which IMR repairs can be simulated. This system provides a realistic and controllable test platform for the development and evaluation of current and future IMR repairs. PMID:23374445

Siefert, Andrew W.; Rabbah, Jean Pierre; Koomalsingh, Kevin J.; Touchton, Steven A.; Saikrishnan, Neelakantan; McGarvey, Jeremy R.; Gorman, Robert C.; Gorman, Joseph H.; Yoganathan, Ajit P.

2013-01-01

25

Congenital mitral valve regurgitation in adult patients. A rare, often misdiagnosed but repairable, valve disease  

Microsoft Academic Search

Objective: Congenital mitral valve regurgitation (MVR) is a rare disease occurring in infancy or childhood. Although congenital MVR has been described in adults, no surgical series has been reported so far. We describe here a 6-year surgical experience of congenital MVR in adults at a single institution. Methods: We reviewed the data of 15 consecutive patients (8 men), aged more

Rachid Zegdi; Brahim Amahzoune; Mustapha Ladjali; Ghassan Sleilaty; Jérome Jouan; Christian Latrémouille; Alain Deloche; Jean-Noël Fabiani

2008-01-01

26

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

NASA Technical Reports Server (NTRS)

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

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

1998-01-01

27

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

PubMed

We report a case of cardiac sarcoidosis associated with mitral valve regurgitation. A 62-year-old woman with cardiac sarcoidosis was admitted for the treatment of an intractable mitral regurgitation. She had been treated for cardiac sarcoidosis with prednisolone, and she had undergone pacemaker implantation because of advanced complete A-V block 5 years before. However, her hemodynamics deteriorated, and echocardiography revealed severe functional mitral regurgitation, thinning of the ventricular septum, and left ventricular dysfunction. The patient underwent mitral valve replacement with a mechanical prosthetic valve, and her postoperative course was uneventful. She is currently well without exacerbation of heart failure at 2 years after operation. Functional mitral regurgitation is a relatively common complication in patients with cardiac sarcoidosis. Mitral valve replacement should be considered in patients with medically intractable mitral valve dysfunction due to cardiac sarcoidosis. PMID:25743560

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

2015-03-01

28

Percutaneous Treatment of Mitral Regurgitation: Current Status and Future Directions  

PubMed Central

The burgeoning field of catheter-based, percutaneous valve intervention takes an interdisciplinary approach to mitral valve regurgitation with the goal of maximizing clinical outcomes and minimizing procedure-associated morbidity. This exciting field continues to push the boundaries of technological innovation as it expands the armamentarium available to treat valvular disease. Around the world teams are working to create a catheter-based approach that is practical and durable. Several technologies are in various stages of development and clinical application. PMID:22443644

Soni, Lori K.; Argenziano, Michael

2015-01-01

29

Acute massive mitral regurgitation from prosthetic valve dysfunction.  

PubMed Central

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

Cooper, D K; Sturridge, M F

1976-01-01

30

[One-staged operation for mitral regurgitation and annuloaortic ectasia without aortic regurgitation with Marfan syndrome; report of a case].  

PubMed

A 32-year-old man with Marfan syndrome was admitted to our hospital for detail examination of congestive heart failure. Doppler echocardiography showed severe mitral regurgitation due to prolapse of posterior mitral leaflet. Annuloaortic ectasia without aortic regurgitation was also detected by aortography. Considering the future operative need for aortic root and ascending aorta, we performed mitral valve replacement with a mechanical valve and preventive concomitant aortic root replacement with a composite valve graft. His postoperative course was uneventful. Optimal surgical treatment of mitral regurgitation and annuloaortic ectasia in Marfan syndrome is controversial because the underlying connective tissue defect theoretically might compromise repair durability. Several surgical options for mitral regurgitation and annuloaortic ectasia in Marfan syndrome are discussed. PMID:15151037

Kumano, H; Fumimoto, K; Hige, K; Aoyama, T; Nishioka, T; Shibata, T

2004-05-01

31

CoreValve prosthesis causes anterior mitral leaflet perforation resulting in severe mitral regurgitation.  

PubMed

Percutaneous transcatheter aortic valve replacement (TAVR) has become an alternative to surgical therapy for patients with severe aortic stenosis and high operative risk, but it is associated with specific complications. We report the case of a 72-year-old man who underwent the procedure without complications; however, 45 days after the procedure, he was admitted to the hospital with symptoms of heart failure secondary to severe mitral regurgitation. Necropsy findings showed prosthesis malposition and perforation of the anterior mitral leaflet caused by the contact of the stent of the CoreValve prosthesis (Medtronic, Minneapolis, MN). We discuss TAVR complications, specifically regarding low positioning of the prosthetic valve. PMID:24999172

Cozzarin, Alberto; Cianciulli, Tomás F; Guidoin, Robert; Zhang, Ze; Lax, Jorge A; Saccheri, María C; García Escudero, Alejandro; Estrada, Jorge E

2014-09-01

32

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

PubMed Central

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

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

2014-01-01

33

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

PubMed Central

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

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

34

Management-Oriented Classification of Mitral Valve Regurgitation  

PubMed Central

Mitral regurgitation (MR) has previously been classified into rheumatic, primary, and secondary MR according to the underlying disease process. Carpentier's/Duran functional classifications are apt in describing the mechanism(s) of MR. Modern management of MR, however, depends primarily on the severity of MR, status of the left ventricular function, and the presence or absence of symptoms, hence the need for a management-oriented classification of MR. In this paper we describe a classification of MR into 4 phases according to LV function: phase I = MR with normal left ventricle, phase II = MR with normal ejection fraction (EF) and indirect signs of LV dysfunction such as pulmonary hypertension and/or recent onset atrial fibrillation, phase III = EF ? 30%–< 50% and/or mild to moderate LV dilatation (ESID 40–54?mm), and phase IV = EF < 30% and/or severe LV dilatation (ESDID ? 55?mm). Each phase is further subdivided into three stages: stage “A” with an effective regurgitant orifice (ERO) < 20?mm, stage “B” with an ERO = 20–39?mm, and stage “C” with an ERO ? 40?mm. Evidence-based indications and outcome of intervention for MR will also be discussed. PMID:22347660

El Oakley, Reida; Shah, Aijaz

2011-01-01

35

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

E-print Network

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 ...

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

2004-01-01

36

Mitral regurgitation and axial flow left ventricular assist device: a computer simulation study.  

PubMed

Good right ventricular function is one of the major determinants of long-term outcomes in patients with implanted left ventricular assist devices (LVADs). In the present study, a computer model was developed to assess the impact of mitral regurgitation on right ventricular workload at different levels of LVAD support. Left ventricular assist device was simulated by a model of HeartMate II. The computer model has shown that the regurgitant volume of the mitral valve falls significantly only after the systolic pressure in the left ventricle decreases, which occurs at higher LVAD revolutions per minute (RPM) when there is no ejection through the aortic valve. However, at low LVAD RPM, the pressures in the left atrium and the pulmonary artery decrease significantly, despite a small decrease in regurgitant volume. According to the computer model, LVAD support decreases mitral regurgitation. Furthermore, regurgitant volume has a smaller impact on the right ventricular afterload when compared with a heart without LVAD support. PMID:23820280

Jelenc, Matija; Jelenc, Blaž; Vrtovec, Bojan; Kneževi?, Ivan

2013-01-01

37

Early improvement in congestive heart failure after correction of secondary mitral regurgitation in end-stage cardiomyopathy  

Microsoft Academic Search

Mitral regurgitation frequently complicates dilated cardiomyopathy, aggravates volume overload of the left ventricle, and contributes to symptoms of congestive heart failure. This study was performed to assess the impact of mitral valve reconstruction in nine consecutive patients with severe mitral regurgitation resulting from end-stage dilated cardiomyopathy. Clinical and echocardiographic follow-up were obtained 17 ± 5 and 16 ± 6 weeks

David S. Bach; Steven F. Bolling

1995-01-01

38

Management of organic mitral regurgitation: guideline recommendations and controversies.  

PubMed

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

Gurzun, Maria-Magdalena; Popescu, Andreea C; Ginghina, Carmen; Popescu, Bogdan A

2015-03-01

39

Percutaneous approaches to valve repair for mitral regurgitation.  

PubMed

Percutaneous therapy has emerged as an option for treatment of mitral regurgitation for selected, predominantly high-risk patients. Most of the percutaneous approaches are modifications of existing surgical approaches. Catheter-based devices mimic these surgical approaches with less procedural risk, due to their less-invasive nature. Percutaneous annuloplasty can be achieved indirectly via the coronary sinus or directly from retrograde left ventricular access. Catheter-based leaflet repair with the MitraClip (Abbott Laboratories, Abbott Park, Illinois) is accomplished with an implantable clip to mimic the surgical edge-to-edge leaflet repair technique. A large experience with MitraClip has been reported, and several other percutaneous approaches have been successfully used in smaller numbers of patients to demonstrate proof of concept, whereas others have failed and are no longer under development. There is increasing experience in both trials and practice to begin to define the clinical utility of percutaneous leaflet repair, and annuloplasty approaches are undergoing significant development. Transcatheter mitral valve replacement is still in early development. PMID:24583296

Feldman, Ted; Young, Amelia

2014-05-27

40

Management of Organic Mitral Regurgitation: Guideline Recommendations and Controversies  

PubMed Central

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

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

2015-01-01

41

Real?Time 3?Dimensional Dynamics of Functional Mitral Regurgitation: A Prospective Quantitative and Mechanistic Study  

PubMed Central

Background Three?dimensional transthoracic echocardiography (3D?TTE) with dedicated software permits quantification of mitral annulus dynamics and papillary muscle motion throughout the cardiac cycle. Methods and Results Mitral apparatus 3D?TTE was acquired in controls (n=42), patients with left ventricle dysfunction and functional mitral regurgitation (LVD?FMR; n=43) or without FMR (LVD?noMR, n=35). Annulus in both normal and LVD?noMR subjects displayed saddle shape accentuation in early?systole (ratio of height to intercommissural diameter, 10.6±3.7 to 13.5±4.0 in normal and 9.1±4.3 to 12.6±3.6 in LVD?noMR; P<0.001 for diastole to early?systole motion, P=NS between those groups). In contrast, saddle shape was unchanged from diastole in FMR patients (10.0±6.4 to 8.0±5.2; P=NS, P<0.05 compared to both other groups). Papillary tips moved symmetrically towards to the midanterior annulus in control and LVD?noMR subjects, maintaining constant ratio of the distances between both tips to midannulus (PtAR) throughout systole. In LVD?FMR patients midsystolic posterior papillary tip to anterior annulus distance was increased, resulting in higher PtAR (P=0.05 compared to both other groups). Mechanisms of early? and midsystolic FMR differed between different etiologies of LV dysfunction. In patients with anterior MI and global dysfunction annular function and dilatation were the dominant parameters, while papillary muscle motion was the predominant determinant of FMR in patients with inferior MI. Conclusions Inadequate early?systolic annular contraction and saddle?shape accentuation in patients with impaired LV contribute to early–mitral incompetency. Asymmetric papillary tip movement towards the midanterior annulus is a major determinant of mid? and late?systolic functional mitral regurgitation. PMID:23727698

Topilsky, Yan; Vaturi, Ori; Watanabe, Nozomi; Bichara, Valentina; Nkomo, Vuyisile T.; Michelena, Hector; Le Tourneau, Thierry; Mankad, Sunil V.; Park, Soon; Capps, Mary Ann; Suri, Rakesh; Pislaru, Sorin V.; Maalouf, Joseph; Yoshida, Kiyoshi; Enriquez?Sarano, Maurice

2013-01-01

42

The Effects of Mitral Regurgitation Alone are Sufficient for Leaflet Remodeling  

PubMed Central

Background Although chronic mitral regurgitation (MR) results in adverse left ventricular remodeling, its effect on the mitral valve leaflets per se is unknown. In a chronic ovine model, we tested whether isolated MR alone was sufficient to remodel the anterior mitral leaflet (AML). Methods Twenty-nine sheep were randomized to either control (CTRL, n=11) or experimental (HOLE, n=18) groups. In HOLE, a 2.8–4.8mm diameter hole was punched in the middle scallop of the posterior mitral leaflet to create “pure” MR. At 12 weeks, the AML was analyzed immunohistochemically to assess markers of collagen and elastin synthesis as well as matrix metalloproteinases and proteoglycans. A semi-quantitative grading scale for characteristics such as intensity and delineation of stain between layers was used to quantify differences between HOLE and CTRL specimens across the heterogeneous leaflet structure. Results At 12 weeks, MR grade was greater in HOLE vs. CTRL (3.0±0.8 vs. 0.4±0.4, p<0.001). In HOLE AML, saffron-staining collagen (Movat) decreased, consistent with an increase in matrix metalloproteases. Type III collagen expression was increased in the mid-leaflet and free edge and expression of prolyl-4-hydroxylase (indicating collagen synthesis) was increased in the spongiosa layer. The proteoglycan decorin, also involved in collagen fibrillogenesis, was increased compared to CTRL (all p?0.05). Conclusions In HOLE AML, the increased expression of proteins related to collagen synthesis and matrix degradation suggests active matrix turnover. These are the first observations showing that regurgitation alone can stimulate mitral leaflet remodeling. Such leaflet remodeling needs to be considered in reparative surgical techniques. PMID:18824762

Stephens, Elizabeth H.; Nguyen, Tom C.; Itoh, Akinobu; Ingels, Neil B.; Miller, D. Craig; Grande-Allen, K. Jane

2015-01-01

43

Surgical management of right coronary artery-coronary sinus fistula causing severe mitral and tricuspid regurgitation.  

PubMed

Coronary arteriovenous (AV) fistula is a rare congenital anomaly, mostly diagnosed incidentally during routine coronary angiography. We report a symptomatic patient with right coronary artery to coronary sinus (RCA-CS) fistula, complicated by aneurysmal dilatation and thrombosis of the CS, causing severe mitral regurgitation (MR) and tricuspid regurgitation (TR). PMID:19815568

El Watidy, Ahmed M; Ismail, Huda H; Calafiore, Antonio M

2010-01-01

44

Noncompaction cardiomyopathy: A new mechanism for mitral regurgitation with distinct clinical, echocardiographic features and pathological correlations  

PubMed Central

Noncompaction cardiomyopathy (NCCM) is a primary, genetic cardiomyopathy with variable clinical manifestations that include mitral regurgitation (MR). Methods This study comprised patients diagnosed with NCCM and MR in two cardiac centers (King Abdul-Aziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia and Sudan Heart Institute, Khartoum, Sudan), and seen in the period between 2002 and 2013. The study describes follow up, clinical, echocardiographic, and histopathological findings. Results Nineteen cases (85% females) were identified. Ten percent of the cases had relapses and remissions of heart failure. Echocardiographic features included leaflet retraction in all patients, characteristic malcoaptation, and a zigzag deformity of anterior leaflet in 57% of patients. Ruptured chordae were found in 15% of the patients. One patient had pathological examination of the mitral valve which showed myxomatous degeneration, and sclerotic and calcific changes. Conclusion We describe and discuss a new mechanism for MR caused by NCCM with identifiable clinical and echocardiographic features, and pathological correlations.

Ali, Sulafa K.M.; Abu-Sulaiman, Riyadh; Agouba, Rihab Beshir

2014-01-01

45

Indications for intervention in asymptomatic children with chronic mitral regurgitation.  

PubMed

Based on outcome data, surgery is recommended for asymptomatic adults with chronic mitral regurgitation (MR) and systolic dysfunction, marked left ventricular (LV) dilation, pulmonary hypertension, atrial fibrillation, or high likelihood of successful repair; but indications for children are poorly defined. We sought to determine predictors of postoperative LV dysfunction in asymptomatic children with chronic MR. The surgical database was searched for all children who underwent mitral valve surgery for chronic MR (2000-2012). Exclusion criteria were preoperative symptoms, acute MR, cardiomyopathy, or other defects affecting LV size. Preoperative and latest follow-up clinical and echocardiographic data were obtained. LV dysfunction was defined as ejection fraction (EF) ?55% or shortening fraction (SF) ?28%. Associations between preoperative factors and late LV dysfunction were determined using univariate Poisson regression. For the 25 children who met criteria, preoperative median LV end systolic Z score (LVESZ) was 5.3, EF was 65%, and SF was 34%. At follow-up (median 3.9 years), nine patients (36%) had LV dysfunction. Lower preoperative SF (OR 0.6, p < 0.001) and higher LVESZ (OR 1.7, p < 0.01) were associated with late LV dysfunction. LVESZ ? 5 combined with SF ? 33% had a sensitivity of 89%, specificity of 88%, and negative predictive value of 93% for late LV dysfunction. Only 1/14 patients with preoperative SF > 33% had late LV dysfunction. For asymptomatic children with chronic MR, surgery should be considered before LVESZ exceeds five and SF falls below 33%. Patients with SF > 33% may be followed with serial echocardiographic measurements. PMID:25304243

Johnson, Joyce T; Eckhauser, Aaron W; Pinto, Nelangi M; Weng, Hsin-Yi; Minich, L LuAnn; Tani, Lloyd Y

2015-02-01

46

Criteria for determining the need for surgical treatment of tricuspid regurgitation during mitral valve replacement  

PubMed Central

Background Tricuspid regurgitation (TR) is common in patients with mitral valve disease; however, there are no straightforward, rapidly determinably criteria available for deciding whether TR repair should be performed during mitral valve replacement. The aim of our retrospective study was to identify a simple and fast criterion for determining whether TR repair should be performed in patients undergoing mitral valve replacement. Methods We reviewed the records of patients who underwent mitral valve replacement with or without (control) TR repair (DeVega or Kay procedure) from January 2005 to December 2008. Preoperative and 2-year postoperative echocardiographic measurements included right ventricular and atrial diameter, interventricular septum size, TR severity, ejection fraction, and pulmonary artery pressure. Results A total of 89 patients were included (control, n = 50; DeVega, n = 27; Kay, n = 12). Demographic and clinical characteristics were similar between groups. Cardiac variables were similar between the DeVega and Kay groups. Right atrium and ventricular diameter and ejection fraction were significantly decreased postoperatively both in the control and operation (DeVega + Kay) group (P < 0.05). Pulmonary artery pressure was significantly decreased postoperatively in-operation groups (P < 0.05). Our findings indicate that surgical intervention for TR should be considered during mitral valve replacement if any of the following preoperative criteria are met: right atrial transverse diameter > 57 mm; right ventricular end-diastolic diameter > 55 mm; pulmonary artery pressure > 58 mmHg. Conclusions Our findings suggest echocardiography may be used as a rapid and simple means of determining which patients require TR repair during mitral valve replacement. PMID:22443513

2012-01-01

47

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

PubMed Central

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

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

2011-01-01

48

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

PubMed

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

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

2011-09-01

49

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

NASA Technical Reports Server (NTRS)

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.

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

50

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

SciTech Connect

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.

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

2008-07-15

51

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

PubMed Central

Secondary or functional mitral regurgitation (FMR) represents an increasing feature of mitral valve disease characterized by abnormal function of anatomically normal leaflets in the context of the impaired function of remodelled left ventricles. The anatomic and pathophysiological basis of FMR are briefly analyzed; in addition, the role of exercise echocardiography for the assessment of FMR is discussed in view of its relevance to clinical practice. PMID:20003417

2009-01-01

52

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

NASA Astrophysics Data System (ADS)

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

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

2001-10-01

53

Severe mitral regurgitation caused by perivalvular abnormal communication of the mitral valve due to blunt chest trauma.  

PubMed

Perivalvular leaks are usually caused by suture interruption in prosthetic valves or infective endocarditis. Traumatic mitral annular dehiscence is a very uncommon event. We present a rare case of severe mitral regurgitation secondary to perivalvular abnormal communication in a 35-year-old man with a history of blunt chest trauma. He presented with symptoms of cough and chest tightness for 3 months. Preoperative two-dimensional and real time three-dimensional transesophageal echocardiography clearly showed the position and size of the perivalvular abnormal communication and the incident damage of the left ventricular wall. The patient finally underwent successful surgical repair. PMID:23186363

Wu, Wei-Hua; Xie, Xiao-Yi; Ma, Lan; Lu, Jing

2013-03-01

54

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

PubMed Central

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

2009-01-01

55

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

PubMed Central

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

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

2012-01-01

56

[Intraoperative evaluation for residual mitral valve regurgitation; usefulness of the retrograde cardioprotective beating test].  

PubMed

Intraoperative evaluation is important for successful mitral valve plasty (MVP). We performed a saline injection test and a retrograde cardioprotective beating test (RC-beating test) for intraoperative evaluation. The concept of the RC- beating test is evaluation of residual mitral valve regurgitation( MR) under cardiac beating. A 66-year-old man with severe MR underwent MVP. The P3 chorda was ruptured and we performed quadrangular resection. The saline injection test showed trivial regurgitation. We then performed the RC-beating test and it revealed severe leakage from the posterior commissure(PC). Since the PC had a sclerotic change, another quadrangular resection was performed. Moreover,as the anterior leaflet( A3) was slightly elongated, the region was resected in an obtuse-angled triangle shape and repaired by suturing the edges. The final RC-beating test showed no residual leakage. The RC-beating test is useful for detecting residual mitral valve leakage. PMID:25201364

Yanase, Yohsuke; Sato, Hiroshi; Yamada, Hiroyuki; Watanabe, Toshitaka; Uehara, Mayuko; Tachibana, Kazutoshi; Miyaki, Yasuko; Takagi, Nobuyuki; Higami, Tetsuya

2014-09-01

57

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

PubMed

Exercise transthoracic echocardiography (ExE) was recently proposed to evaluate tolerance and help risk stratification of mitral regurgitation (MR). Few data are available on the feasibility of Doppler echocardiographic recordings at exercise in daily practice in both secondary and primary MR. Comprehensive resting and ExE were performed in 72 unselected patients (age 59 ± 15 years, 62 % men), with no or minimal symptoms, with at least moderate (mean effective regurgitant orifice area (ERO) = 36 ± 14 mm(2)) primary or secondary MR in two French university hospitals. At rest, quantification of ERO was more challenging in semi-supine position than in classic left lateral decubitus position (55/72; 76 % vs 66/72; 92 %; p = 0.012), particularly in mitral valve (MV) prolapse (35/47; 74 %). During exercise, ERO was only obtained in 30/55 (55 %) patients and was more difficult to assess in MV prolapse than in rheumatic or ischemic MR (respectively in 43, 67 and 88 %, p = 0.046). At peak exercise, ERO was more frequently obtained in symptomatic than asymptomatic patients (77 vs 37 %, p = 0.046) because peak heart rate was lower (113 ± 20 vs 133 ± 23 bpm, p = 0.026). Systolic pulmonary artery pressure (SPAP) was obtained in 69 patients (96 %) at rest and in 60 patients (83 %) at peak exercise (Pex). LV contractile reserve (CR), monitored in all patients (100 %), was found in 51/72 patients (71 %). In daily ExE, monitoring of the CR and SPAP appeared less challenging than MR quantification by the PISA method. Monitoring of ERO was more feasible in ischemic MR than in MV prolapse. PMID:25326411

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

2015-02-01

58

The extent of papillary muscle approximation affects mortality and durability of mitral valve repair for ischemic mitral regurgitation  

PubMed Central

Background Since reduction annuloplasty alone for ischemic mitral regurgitation (MR) cannot prevent late recurrence of MR or improve survival for those with left ventricular (LV) dysfunction, and the surgical approach to this etiology is still controversial, we conducted a study to assess the efficacy of the additional papillary muscle approximation (PMA) procedure for ischemic MR by comparing the different subtypes of PMA. Methods We studied 45 patients who underwent mitral annuloplasty and papillary muscle approximation (PMA) for ischemic MR between 2003 and 2012. Papillary muscles were approximated entirely (cPMA: complete PMA, n?=?32) through an LV incision or partially from the tips to mid-parts (iPMA: incomplete PMA, n?=?13) through the mitral and aortic valves. Twenty-three patients with cPMA also underwent LV plasty (LVP). We assessed the outcomes after PMA by comparing cPMA and iPMA. Results The baseline MR grade, NYHA class, LV end-diastolic diameter, and LV ejection fraction (LVEF) were 2.8?±?1.0, 3.2?±?0.6, 67?±?6 mm, and 30?±?10%, respectively. There were no significant differences in these parameters among those with iPMA, cPMA/LVP-, and cPMA/LVP+, though iPMA patients had better LVEF than others. Three patients died before discharge and 12 died during the follow-up. Recurrence of grade 2+ and 3+ MR occurred in 8 and 2 patients, respectively. Reoperation for recurrent MR was performed only for the 2 patients with recurrence of grade 3+ MR. The cPMA was associated with lower mortality (log-rank P?=?0.020) and a lower rate of recurrence of MR ?2+ (log-rank P?=?0.005) than iPMA. In contrast, there were no significant differences in the mortality (log-rank P?=?0.45) and rate of recurrence (log-rank P?=?0.98) between those with cPMA/LVP- and cPMA/LVP+. The 4-year survival rate and rate of freedom from recurrence of MR ?2+ were 83% and 85% for those with cPMA, repectively. In contrast, the rates were 48% and 48% for those with iPMA, respectively. Conclusions Complete PMA could be associated with lower postoperative mortality and higher durability of mitral valve repair for ischemic MR. PMID:24893928

2014-01-01

59

Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence.  

PubMed

Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis. PMID:24508019

Ramakrishna, Harish; Kohl, Benjamin A; Jassar, Arminder S; Augoustides, John G T

2014-04-01

60

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)

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.

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

61

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

PubMed Central

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

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

2014-01-01

62

Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction  

Microsoft Academic Search

Background\\/objectiveThe role of factors that increase left atrial pressure or cause acute left atrial dilatation is frequently emphasised in the pathogenesis of atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). This study was designed to test the hypothesis that functional mitral regurgitation (FMR) occurring after AMI may promote AF by producing left atrial volume overload.SettingIntensive care unit of

Fadel Bahouth; Diab Mutlak; Moran Furman; Anees Musallam; Haim Hammerman; Jonathan Lessick; Saleem Dabbah; Shimon Reisner; Yoram Agmon; Doron Aronson

2010-01-01

63

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

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

64

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

PubMed Central

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

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

65

Mitral ValveReplacement WithandWithout Chordal Preservation inPatients With Chronic Mitral Regurgitation Mechanisms forDifferences inPostoperative Ejection Performance  

Microsoft Academic Search

Background. Standard mitral valve replacement (MVR)inpatients withchronic mitral regurgitation consistently results ina decrease inpostoperative left ventricular (LV)ejection performance. Thisfall in ejection performance hasbeenattributed, atleast inpart, tounfavorable loading conditions imposed by theelimination ofthelow-impedance pathway forLV emptying intotheleftatrium. Incontrast to standard MVR inwhichthechordae tendineae aresevered, however, MVR withchordal preservation (MVR-CP)doesnotusually decrease LV ejection performance despite similar removalofthelow- impedance pathway. Thepurposeofthepresent study was

John D. Rozich; Blase A. Carabello; Bruce W. Usher; John M. Kratz; Adelle E. Bell; R. Zile

2010-01-01

66

The change in mitral regurgitation severity after trans-catheter aortic valve implantation  

PubMed Central

Background Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation (TAVI). Methods MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. Results The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 (85.3%) to 43 (63.2%) (p < 0.001). Vena contracta width was decreased from 0.47 ± 0.28 to 0.25 ± 0.21, (p = 0.043). About 59.4% (19/32) of those who had moderate to severe MR and 85.7% (12/14) of those with severe MR experienced a significant improvement in MR after the procedure (p < 0.001). Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 ± 1.9 in those who improved vs. 25.0 ± 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356. Conclusions TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study. PMID:25544817

Almasood, Ali; Al Ahmari, Saeed; El-shurafa, Haytham; Alotaibi, Mohammed; al kasab, saad; AlAbdallah, Moheeb; Al-moghairi, abdulrahman; Al khushail, Abdullah; Al-Amri, Husain

2014-01-01

67

Correlation between Mitral Regurgitation and Myocardial Mechanical Dyssynchrony and QRS Duration in Patients with Cardiomyopathy  

PubMed Central

Abstract Background: Several competing geometric and hemodynamic factors are suggested as contributing mechanisms for functional mitral regurgitation (MR) in heart failure patients. We aimed to study the relationships between the severity of MR and the QRS duration and dyssynchrony markers in patients with ischemic or dilated cardiomyopathy. Methods: We prospectively evaluated 251 heart failure patients with indications for echocardiographic evaluation of possible cardiac resynchronization therapy. All the patients were subjected to transthoracic echocardiography and tissue Doppler imaging to evaluate the left ventricular (LV) synchronicity. The patients were divided into two groups according to the severity of MR: ? mild MR and ? moderate MR. The effects of different dyssynchrony indices were adjusted for global and regional left ventricular remodeling parameters. Results: From the 251 patients (74.5% male, mean age = 53.38 ± 16.68 years), 130 had ? mild MR and 121 had ? moderate MR. There were no differences between the groups regarding the mean age, frequency of sex, and etiology of cardiomyopathy. The LV systolic and diastolic dimensions were greater in the patients with ? moderate MR (all p values < 0.001). Among the different echocardiographic factors, the QRS duration (150.75 ± 34.66 vs. 126.77 ± 29.044 ms; p value = 0.050) and interventricular mechanical delay (41.60 ± 29.50 vs. 35.00 ms ± 22.01; p value = 0.045) were significantly longer in the patients with ? mild MR in the univariate analysis. After adjusting the effect of these parameters on the severity of MR for the regional and global LV remodeling parameters, no significant impact of the QRS duration and dyssynchrony indices was observed. Conclusion: Our results showed that the degree of functional MR was not associated with the QRS duration and inter- and intraventricular dyssynchrony in our patients with cardiomyopathy. No association was found between the severity of MR and the ischemic or dilated etiology for cardiomyopathy.

Sardari, Akram; Ashraf, Haleh; Khorsand, Mani; Zoroufian, Arezou; Sahebjam, Mohammad; Jalali, Arash; Sadeghian, Hakimeh

2014-01-01

68

Chronic vagus nerve stimulation improves left ventricular function in a canine model of chronic mitral regurgitation.  

PubMed

BackgroundAutonomic dysfunction, characterized by sympathetic activation and vagal withdrawal, contributes to the progression of heart failure (HF). We hypothesized that chronic vagus nerve stimulation (VNS) could prevent left ventricular (LV) remodeling and dysfunction in a canine HF model induced by chronic mitral regurgitation (MR).Methods and resultsAfter the MR inducing procedure, 12 survived canines were randomly divided into the control (n¿=¿6) and the VNS (n¿=¿6) groups. At month 2, a VNS stimulator system was implanted in all canines. From month 3 to month 6, VNS therapy was applied in the VNS group but not in the control group. At month 6, compared with the control group, the canines in VNS group had significantly higher cardiac output (2.3¿±¿0.3 versus 2.9¿±¿0.4 L/min, P¿<¿0.05 , LV forward stroke volume (20.1¿±¿3.7 versus 24.8¿±¿3.9 ml, P¿<¿0.05), and end-systolic stiffness constant (2.2¿±¿0.3 versus 2.7¿±¿0.3, P¿<¿0.05). NT-proBNP and C-reactive protein were decreased significantly in the VNS group. However, no statistical difference was found in LV ejection fraction, LV end-diastolic dimension, LV end-diastolic volume, myocyte cross-sectional area, or collagen volume fraction between two groups.ConclusionsChronic VNS therapy may ameliorate MR-induced LV contractile dysfunction and improve the expression of biomarkers, but has less effect in improving LV chamber remodeling. PMID:25366939

Yu, Haiwen; Tang, Min; Yu, Jun; Zhou, Xiaohong; Zeng, Lepeng; Zhang, Shu

2014-11-01

69

Cardiac simulations of regurgitant jets in mitral valve, for different pathological cases, in steady and pulsatile flow  

Microsoft Academic Search

In order to assess the quantification of valvular heart insufficiency in adult echocardiography, we simulate flow dynamics in different models of mitral regurgitation (shapes and sizes) in steady and unsteady flow. The length, width and contraction coefficient of potential core, defined as the velocity zone where velocities are equal or superior to orifice velocity, obtained with physiologic and pressure flow

L. Sanchez; P. Fourgeau; D. Coisne; R. Perrault

1999-01-01

70

Real time three-dimensional transesophageal echocardiography guided coronary sinus cannulation during CARILLON mitral annuloplasty device therapy for a patient with chronic severe mitral regurgitation.  

PubMed

The coronary sinus (CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time. PMID:25231878

Mahmoud, Hani M; Al-Ghamdi, Mohammed A; Ghabashi, Abdullah E

2015-01-01

71

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

PubMed

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

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

2014-10-01

72

Mitral valve replacement after percutaneous transluminal mitral commissurotomy  

Microsoft Academic Search

Objectives: We reviewed our experience of mitral valve replacement (MVR) after percutaneous transluminal mitral commissurotomy (PTMC)\\u000a for mitral stenosis (MS). Methods: From December 1987 to December 2001, PTMC was conducted in 75 patients with symptomatic rheumatic MS. At mean follow-up of\\u000a 8.43.5 years, 11 patients (14.7%) underwent MVR for mitral restenosis (9 cases) and mitral regurgitation (MR) (2 cases).\\u000a The

Makoto Kamada; Kenji Ohsaka; Susumu Nagamine; Hidemitsu Kakihata

2004-01-01

73

Late results of valve replacement and factors influencing survival in patients with severe chronic mitral regurgitation.  

PubMed

Between July 1967 and September 1981 50 patients with isolated severe mitral regurgitation underwent mitral valve replacement. There were 29 males and 21 females (mean age 52 years). The aetiology of the valve lesion was rheumatic in 14 patients (mean age 42 years) and non-rheumatic in 36 patients (mean age 56 years). At the time of operation 36 patients (72%) were in class 3 or 4 of the New York Heart Association classification (mean duration of symptoms 20 months). Pre-operative ejection fraction was normal in only four patients (8%) and was below 0.50 in 27 patients (54%). There were two early deaths (4%) within one month of operation, and 17 late deaths (34%) during a follow-up period of four months to 10 years (mean 43 months). Actuarial analysis showed a 71% survival at five years and a 62% survival at 10 years after valve replacement. Of the 31 current survivors, 22 (71%) are in class 1 of the New York Heart Association classification, and all but two patients showed significant improvement in symptoms. Significant morbidity after operation occurred in 10 patients (20%) and was largely related to problems with anticoagulant control. Analysis of factors which may influence survival, showed that age greater than 55 years and parameters of left ventricular geometry, demonstrated by angiography, were the major determinants of survival. PMID:3866173

Thompson, R; Baird, J; Squire, B; Hilless, A; Leslie, P; Easthope, R

1985-11-13

74

Diagnostic Value of Vena Contracta Area in the Quantification of Mitral Regurgitation Severity by Color Doppler 3D Echocardiography  

PubMed Central

Background Accurate quantification of mitral regurgitation (MR) is important for patient treatment and prognosis. Three-dimensional echocardiography allows for the direct measure of the regurgitant orifice area (ROA) by 3D-guided planimetry of the vena contracta area (VCA). We aimed to (1) establish 3D VCA ranges and cutoff values for MR grading, using the American Society of Echocardiography–recommended 2D integrative method as a reference, and (2) compare 2D and 3D methods of ROA to establish a common calibration for MR grading. Methods and Results Eighty-three patients with at least mild MR underwent 2D and 3D echocardiography. Direct planimetry of VCA was performed by 3D echocardiography. Two-dimensional quantification of MR included 2D ROA by proximal isovelocity surface area (PISA) method, vena contracta width, and ratio of jet area to left atrial area. There were significant differences in 3D VCA among patients with different MR grades. As assessed by receiver operating characteristic analysis, 3D VCA at a best cutoff value of 0.41 cm2 yielded 97% of sensitivity and 82% of specificity to differentiate moderate from severe MR. There was significant difference between 2D ROA and 3D VCA in patients with functional MR, resulting in an underestimation of ROA by 2D PISA method by 27% as compared with 3D VCA. Multivariable regression analysis showed functional MR as etiology was the only predictor of underestimation of ROA by the 2D PISA method. Conclusions Three-dimensional VCA provides a single, directly visualized, and reliable measurement of ROA, which classifies MR severity comparable to current clinical practice using the American Society of Echocardiography–recommended 2D integrative method. The 3D VCA method improves accuracy of MR grading compared with the 2D PISA method by eliminating geometric and flow assumptions, allowing for uniform clinical grading cutoffs and ranges that apply regardless of etiology and orifice shape. PMID:21730026

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

2011-01-01

75

Usefulness of three-dimensional transesophageal echocardiography in retrieval of a dislodged vascular plug used to close paraprosthetic mitral regurgitation.  

PubMed

In this report, we describe a case of periprocedural dislodgement of an Amplatzer Vascular Plug II device during percutaneous closure of severe paraprosthetic mitral regurgitation. The free plug in the left atrium was successfully retrieved percutaneously using a snare inserted through a sheath under live/real time three-dimensional transesophageal echocardiographic guidance. This proved crucial not only in guiding device deployment but also in detecting and helping management of complications. PMID:25565183

Ahmed, Mustafa I; Elguindy, Mostafa; Bowen, Luis; Alli, Oluseun O; Guvenc, Tolga; Nanda, Navin C

2015-01-01

76

Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra  

ClinicalTrials.gov

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

2014-08-08

77

New insights in the pathophysiology of mitral and aortic regurgitation in pediatric age: role of angiotensin-converting enzyme inhibitor therapy.  

PubMed

This review has been focused on the new insights in the pathophysiology of mitral and aortic regurgitation and on the role of ACE-inhibitor therapy in children with chronic volume overload due to left-sided valvular lesions. Recent clinical studies show that these drugs have favorable effects when administered orally in chronic mitral and aortic regurgitation. Interestingly, the beneficial effects of ACE-inhibition regard the basic anatomic, hemodynamic and adaptive pathologic conditions related to volume overload, namely, the regurgitant orifice area and volume and ventricular remodeling. The heart is a plastic structure, constantly being altered in size, shape and composition in response to chronic volume overload. Thus, modulation of cardiac plasticity by ACE-inhibition raises the possibility of using new therapeutic strategies specifically designed to prevent and/or antagonize the mechanical disadvantages secondary to volume overload-induced cardiac remodeling. The beneficial effects of ACE-inhibition have also been observed in growing children with asymptomatic valvular regurgitation; thus, it appears that the unloading therapy has the potential of influencing the natural history of both mitral and aortic regurgitation and possibly delays surgical valve repair or replacement. These data justify early inhibition of the renin-angiotensin system in children with left ventricular volume overload due to mitral and aortic regurgitation. PMID:11256536

Pisacane, C; Pacileo, G; Santoro, G; Sarubbi, B; Iacono, C; Russo, M G; Calabrò, R

2001-02-01

78

Three-dimensional remodeling of mitral valve in patients with significant regurgitation secondary to rheumatic versus prolapse etiology.  

PubMed

The present study aimed to investigate geometric remodeling of the mitral valve (MV) and to identify the geometric determinants of mitral regurgitation (MR) severity in patients with significant MR secondary to a rheumatic or prolapse etiology. We studied 90 consecutive patients in normal sinus rhythm, including 70 patients showing significant MR (52 with prolapsed/flail and 18 with rheumatic MV) and 20 controls with normal MV without MR. A full volume image was acquired using transesophageal echocardiography, and geometric analysis of the MV leaflet was performed with dedicated software. Areas of the MV annulus and the anterior and posterior leaflets were larger in the rheumatic and prolapsed MV than in the normal controls. No difference was found between the rheumatic and prolapsed MR in those parameters, except that the posterior leaflet area was smaller in rheumatic MR than in prolapsed MR. The leaflet to annulus area ratio was lower and the anterior to posterior leaflet area ratio was higher in the rheumatic MR group than in the prolapsed MR group. A large anteroposterior annulus diameter and small posterior leaflet tenting angle were independently associated with the effective regurgitant orifice area in rheumatic MV, although the leaflet to annulus area ratio was independently associated with the effective regurgitant orifice area in the prolapsed MV. In conclusion, similarities and differences in geometric MV remodeling exist between rheumatic and prolapsed MR. The knowledge of those quantitative differences could open the way to precise planning of surgery tailored to the underlying pathologic entity. PMID:23499274

Song, Jong-Min; Jung, Yoo-Jin; Jung, Yeon-Ju; Ji, Hyo-Won; Kim, Dae-Hee; Kang, Duk-Hyun; Song, Jae-Kwan

2013-06-01

79

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

PubMed

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

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

2015-04-15

80

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

PubMed

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

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

81

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

PubMed Central

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

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

1994-01-01

82

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

PubMed

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

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

2015-04-15

83

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

PubMed

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

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

2014-02-01

84

Preoperative Predictors of Late Postoperative Outcome among Patients with NonischemicMitral Regurgitation with ‘High Risk’ Descripto rs and Comparison with Unoperated Patients  

Microsoft Academic Search

Among patients with chronic nonischemic mitral regurgitation (MR), high short-term mortality risk can be identified by left (LV) and\\/or right ventricular (RV) ejection fraction (EF) criteria (LVEF ?45% and\\/or RVEF ?30%). Mitral valve replacement or repair (MVR) significantly improves outcome in this subgroup, but predictors of late postoperative survival are not known, and the benefit of MVR has not been

Detlef Wencker; Jeffrey S. Borer; Clare Hochreiter; Richard B. Devereux; Mary J. Roman; Paul Kligfield; Phyllis Supino; Karl Krieger; O. Wayne Isom

2000-01-01

85

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

PubMed Central

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

Yurdakul, Selen; Y?ldirimtürk, Özlem

2014-01-01

86

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

PubMed Central

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

Kossaify, Antoine; Akiki, Vanessa

2014-01-01

87

Elimination of Ischemic Mitral Regurgitation Does Not Alter Long-Term Left Ventricular Remodeling in the Ovine Model  

PubMed Central

Background The efficacy of annuloplasty for ischemic mitral regurgitation (IMR) has been difficult to establish. Using an established ovine model of IMR, we tested the ability of ring annuloplasty to durably relieve IMR and reverse or limit progression of left ventricular (LV) remodeling during a clinically relevant follow-up period. Methods A posterolateral infarction known to result in chronic IMR was initiated in 33 sheep. Echocardiography was used to assess LV end diastolic and systolic volumes and IMR (0 to 4 scale) before and 8 weeks after infarction. Eight weeks after infarction, 20 surviving animals with ?2+ IMR were randomized (1:1) to no treatment or undersized, semi-rigid, complete ring annuloplasty placement. LV remodeling and IMR were assessed at 4 and 6 months after infarction. Results All animals had similarly sized LV volumes at baseline (end systolic, 27.8 ± 4.6 mL; end diastolic, 53.5 ± 6.4 mL). The 20 randomized animals survived to complete the study. The degree of IMR before randomization was similar in treatment (2.6 ± 0.4) and control (2.8 ± 0.3) groups. At the 6-month follow-up, the degree of IMR was significantly less in the annuloplasty group (0.3 ± 0.1 vs 3.4 ± 0.6); however, LV volumes in the treatment group were not significantly different from the control group (end systolic, 82.1 ± 15.6 vs 81.1 ± 8.6 mL; end diastolic, 110.4 ± 22.1 vs 111.1 ± 16.5 mL). Conclusions In a clinically relevant ovine model of IMR, annuloplasty provides durable relief from IMR during an extended follow-up period but does not significantly influence LV remodeling. PMID:20732497

Matsuzaki, Kanji; Morita, Masato; Hamamoto, Hirotsugu; Noma, Mio; Robb, J. Daniel; Gillespie, Matthew J.; Gorman, Joseph H.; Gorman, Robert C.

2011-01-01

88

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)

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.

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

89

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

PubMed Central

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

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

2010-01-01

90

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

PubMed Central

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

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

2014-01-01

91

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

PubMed Central

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

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

92

Automated quantification of mitral valve regurgitation based on normalized centerline velocity distribution  

NASA Technical Reports Server (NTRS)

Previous echocardiographic techniques for quantifying valvular regurgitation are limited by factors including uncertainties for orifice location and a hemispheric convergence assumption that often results in over- and underestimation of flow rate and regurgitant orifice area. Using computational fluid dynamics simulations, these factors were eliminated, allowing a more accurate assessment of regurgitation. A model was developed to allow automated quantification of regurgitant orifice diameter based on the centerline velocity data available from color M-mode echocardiography. The model, validated using in vitro unsteady flow data, demonstrated improved accuracy for orifice diameter (y=0.95x + 0.38, r=0.96) and volume (y=1.18x - 4.72, r=0.93).

Deserranno, D.; Greenberg, N. L.; Thomas, J. D.; Garcia, M. J.

2001-01-01

93

Frequency of Ischemic Mitral Regurgitation after First-Time Acute Myocardial Infarction and its Relation to Infarct Location and In-Hospital Mortality  

PubMed Central

Abstract Background: Ischemic mitral regurgitation (IMR) is a common complication after acute myocardial infarction (AMI). We aimed to investigate the frequency of IMR following first-time AMI and its association with infarct location, in-hospital mortality, and complications. Methods: From September 2011 to November 2012, all patients with a diagnosis of first-time acute ST-elevation MI were enrolled in the study. Patients with previous MI and heart failure, organic mitral valve disorders, and previous mitral surgery were excluded from the study. The patients' baseline characteristic, echocardiographic parameters, and complications were recorded. The frequency of IMR after AMI and its relation to infarct location and in-hospital mortality were evaluated. Results: Altogether, 250 patients (180 male) at a mean age of 60.21 ± 12.90 years were studied. IMR was detected in 114 (45%) patients. There was no association between the presence of MR and gender, systemic hypertension, smoking, diabetes mellitus, or body mass index; however, serum LDL-cholesterol and triglyceride levels were significantly higher in the patients with IMR . The most frequent territory of MI was anterior in the patients without MR, while the anterolateral territory was the most common one in the patients with IMR. The patients with IMR had more reduced left ventricular ejection fraction, more elevated left ventricular end-diastolic pressure, and higher pulmonary arterial pressure (p values < 0.001, < 0.001, and < 0.001, respectively). Stage III diastolic dysfunction was more frequent in the patients with IMR. All the deaths occurred in the IMR patients, who also had more complicated AMI. Conclusion: IMR following AMI is highly prevalent, and it complicates about half of the patients. Regarding its relation to the AMI complications, assessment of the MR severity is necessary to make an appropriate decision for treatment.

Fazlinezhad, Afsoon; Dorri, Mitra; Azari, Ali; Bigdelu, Leila

2014-01-01

94

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

SciTech Connect

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

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

1989-07-01

95

The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: A quantitative assessment integrating left ventricular function  

NASA Technical Reports Server (NTRS)

Although alteration in pulmonary venous flow has been reported to relate to mitral regurgitant severity, it is also known to vary with left ventricular (LV) systolic and diastolic dysfunction. There are few data relating pulmonary venous flow to quantitative indexes of mitral regurgitation (MR). The object of this study was to assess quantitatively the accuracy of pulmonary venous flow for predicting MR severity by using transesophageal echocardiographic measurement in patients with variable LV dysfunction. This study consisted of 73 patients undergoing heart surgery with mild to severe MR. Regurgitant orifice area (ROA), regurgitant stroke volume (RSV), and regurgitant fraction (RF) were obtained by quantitative transesophageal echocardiography and proximal isovelocity surface area. Both left and right upper pulmonary venous flow velocities were recorded and their patterns classified by the ratio of systolic to diastolic velocity: normal (>/=1), blunted (<1), and systolic reversal (<0). Twenty-three percent of patients had discordant patterns between the left and right veins. When the most abnormal patterns either in the left or right vein were used for analysis, the ratio of peak systolic to diastolic flow velocity was negatively correlated with ROA (r = -0.74, P <.001), RSV (r = -0.70, P <.001), and RF (r = -0.66, P <.001) calculated by the Doppler thermodilution method; values were r = -0.70, r = -0.67, and r = -0.57, respectively (all P <.001), for indexes calculated by the proximal isovelocity surface area method. The sensitivity, specificity, and predictive values of the reversed pulmonary venous flow pattern for detecting a large ROA (>0.3 cm(2)) were 69%, 98%, and 97%, respectively. The sensitivity, specificity, and predictive values of the normal pulmonary venous flow pattern for detecting a small ROA (<0.3 cm(2)) were 60%, 96%, and 94%, respectively. However, the blunted pattern had low sensitivity (22%), specificity (61%), and predictive values (30%) for detecting ROA of greater than 0.3 cm(2) with significant overlap with the reversed and normal patterns. Among patients with the blunted pattern, the correlation between the systolic to diastolic velocity ratio was worse in those with LV dysfunction (ejection fraction <50%, r = 0.23, P >.05) than in those with normal LV function (r = -0.57, P <.05). Stepwise linear regression analysis showed that the peak systolic to diastolic velocity ratio was independently correlated with RF (P <.001) and effective stroke volume (P <.01), with a multiple correlation coefficient of 0.71 (P <.001). In conclusion, reversed pulmonary venous flow in systole is a highly specific and reliable marker of moderately severe or severe MR with an ROA greater than 0.3 cm(2), whereas the normal pattern accurately predicts mild to moderate MR. Blunted pulmonary venous flow can be seen in all grades of MR with low predictive value for severity of MR, especially in the presence of LV dysfunction. The blunted pulmonary venous flow pattern must therefore be interpreted cautiously in clinical practice as a marker for severity of MR.

Pu, M.; Griffin, B. P.; Vandervoort, P. M.; Stewart, W. J.; Fan, X.; Cosgrove, D. M.; Thomas, J. D.

1999-01-01

96

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)

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.

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

97

THREE-DIMENSIONAL ULTRASOUND IMAGING MODEL OF MITRAL VALVE REGURGITATION: DESIGN AND EVALUATION  

PubMed Central

We describe the development of a cardiac flow model and imaging chamber to permit Doppler assessment of complex and dynamic flow events. The model development included the creation of a circulatory loop with variable compliance and resistance; the creation of a secondary regurgitant circuit; and incorporation of an ultrasound imaging chamber to allow two-dimensional (2D) and three-dimensional (3D) Doppler characterization of both simple and complex models of valvular regurgitation. In all, we assessed eight different pulsatile regurgitant volumes through each of four rigid orifices differing in size and shape: 0.15 cm2 circle, 0.4 cm2 circle, 0.35 cm2 slot and 0.4 cm2 arc. The achieved mean (and range) hemodynamic measures were: peak trans-orifice pressure gradient 117 mm Hg (40 to 245 mm Hg), trans-orifice peak Doppler velocity 560 cm/s (307 to 793 cm/s), Doppler time-velocity integral 237 cm (111 to 362 cm), regurgitant volume 43 mL (11 to 84 mL) and orifice area 0.32 cm2 (0.15 to 0.4 cm2). The model was designed to optimize Doppler signal quality while reflecting anatomic structural relationships and flow events. The 2D color Doppler, 3D color Doppler and continuous wave Doppler quality was excellent whether the data were acquired from the imaging window parallel or perpendicular to the long-axis of flow. This model can be easily adapted to mimic other intracardiac flow pathology or assess future Doppler applications. PMID:18255217

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

2012-01-01

98

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

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

99

Predictors of left ventricular remodeling after surgical repair or replacement for pure severe mitral regurgitation caused by leaflet prolapse.  

PubMed

We sought to determine whether preoperative baseline echocardiographic analysis and the type of surgical procedure are predictive of the magnitude and timing of postoperative left ventricular (LV) remodeling in patients undergoing valve surgery for pure severe mitral regurgitation (MR) secondary to leaflet prolapse. Seventy-two consecutive patients without coronary artery disease undergoing valve repair (MVr; n = 42) or replacement (MVR; n = 30) underwent preoperative, early (1 to 2 days) and late postoperative (4.5 ± 2.5 and 18 ± 8.0 months) echocardiography. Patients were categorized according to their baseline LV ejection fraction (EF) (Group 1: EF ?60%, Group 2: EF = 50% to 59%, Group 3: EF <50%). Preservation of the subvalvular apparatus was achieved in most patients undergoing MV replacement (87%). Over a median follow-up period of 450 days, LVEF changed as follows: Group 1: 63% ± 2% to 60% ± 3% (p <0.0001); Group 2: 55% ± 3% to 52% ± 6% (p <0.0001); Group 3: 43% ± 4% to 42% ± 5% (p <0.01). Two-thirds of the observed changes in LV diameters and volumes occurred in the first 6 months. Preoperative LVEF was the best predictor of postoperative LVEF ?60% (odds ratio 1.50, 95% confidence interval, 1.25 to 1.97; p <0.0001). No significant difference was found in LV remodeling parameters between patients undergoing MVr and MVR. In conclusion, patients with pure severe MR due to valve prolapse LVEF remained normal after surgery only in patients with baseline LVEF ?60%. MVR with subvalvular preservation was associated with similar postoperative remodeling as MVr. PMID:23683949

Sénéchal, Mario; MacHaalany, Jimmy; Bertrand, Olivier F; O'Connor, Kim; Parenteau, Julie; Dubois-Sénéchal, Isaïe-Nicolas; Costerousse, Olivier; Dubois, Michelle; Voisine, Pierre

2013-08-15

100

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

PubMed

Significant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients. PMID:24681140

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

2014-06-24

101

Techniques and results of direct-access minimally invasive mitral valve surgery: A paradigm for the future  

Microsoft Academic Search

Objectives: Our objective was to determine whether direct-access minimally invasive mitral valve surgery can improve recovery and cost while maintaining the efficacy of conventional surgery. Methods: Minimally invasive mitral valve operations were performed on 106 patients, 58% male, average age 58.1 years, with good ventricular function. Ninety underwent repair of a regurgitant, myxomatous valve, and 16 underwent mitral valvuloplasty for

Lishan Aklog; David H. Adams; Gregory S. Couper; Reuben Gobezie; Samuel Sears; Lawrence H. Cohn

1998-01-01

102

Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement: Effects on left ventricular volume and function  

Microsoft Academic Search

Objective: The merits of retaining the subvalvular apparatus during mitral valve replacement for chronic mitral regurgitation have been demonstrated in numerous retrospective clinical investigations but not in a randomized study. In this report we analyzed the early and late effects of complete versus partial chordal preservation on left ventricular mechanics. Methods: Forty-seven patients undergoing isolated surgical correction of mitral insufficiency

Kwok L. Yun; Colleen F. Sintek; D. Craig Miller; Thomas A. Pfeffer; Gary S. Kochamba; Siavosh Khonsari; Michael R. Zile

2002-01-01

103

Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement: Effects on left ventricular volume and function  

Microsoft Academic Search

Objective: The merits of retaining the subvalvular apparatus during mitral valve replacement for chronic mitral regurgitation have been demonstrated in numerous retrospective clinical investigations but not in a randomized study. In this report we analyzed the early and late effects of complete versus partial chordal preservation on left ventricular mechanics. Methods: Forty-seven patients undergoing isolated surgical correction of mitral insuf-

Kwok L. Yun; Colleen F. Sintek; D. Craig; Thomas A. Pfeffer; Gary S. Kochamba; Siavosh Khonsari; Michael R. Zile

104

Robotic mitral valve surgery: A United States multicenter trial  

Microsoft Academic Search

Objective: In a prospective phase II Food and Drug Administration trial, robotic mitral valve repairs were performed in 112 patients at 10 centers by using the da Vinci surgical system. The safety of performing valve repairs with computerized telemanipulation was studied. Methods: After institutional review board approval, informed consent was obtained. Patients had moderate to severe mitral regurgitation. Operative technique

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

2005-01-01

105

Mitral valve regurgitation  

MedlinePLUS

... be done to look at the heart valve structure and function: CT scan of the chest Echocardiogram (an ultrasound examination of the heart) - transthoracic or transesophageal Magnetic resonance imaging (MRI) Cardiac catheterization may be done if ...

106

Unusual vanishing interstitial lymphatic "pearls" in a patient presenting with extensive interstitial and mediastinal MDCT features of acute cardiogenic failure related to bradycardia and mitral regurgitation.  

PubMed

Thoracic multidetector computed tomography-MDCT-was simultaneously performed during emergency abdominal CT in a patient presenting with abdominal pain and acute cardiogenic edema related to sick sinus syndrome and mitral prolapse with regurgitation. A constellation of severe but completely reversible interstitial and mediastinal features was found comprising pleural effusions, diffuse alveolar ground glass, thickening of the bronchial walls and septal lines, hazy infiltration of the mediastinal fat, and enlarged lymphatic nodes. Multiple atypical hypodense nodular "pearls" were also found. These oval shape or fusiform pearls were distributed along the thickened septal lines and disappeared completely after treatment. The hypothesis of transient lymphatic ectasia or lakes is proposed for these never previously described abnormalities. PMID:24845053

Coulier, Bruno; El Khoury, Elie; Deprez, Fabrice C; Ghaye, Benoît; Van den Broeck, Stephane; Tourmous, Hussein

2014-12-01

107

Echocardiographic evidence of posteromedial hypokinesis of the left ventricle in relation to mitral regurgitation in cardiac sarcoidosis.  

PubMed

We describe herein the case of a 49-year-old female patient with pulmonary sarcoidosis (stage II) with cardiac manifestation. This consisted of systolic dysfunction without dilatation of the left ventricle and severe mitral insufficiency, possibly due to thinning of the posteromedial left ventricular free wall, based on our echocardiographic observations. PMID:17143715

Katsouras, Christos S; Leontaridou, Christina; Achenbach, Kirstin; Maglaras, George; Vassiliou, Miltiadis P; Kolettis, Theophilos; Goudevenos, John A; Michalis, Lampros K; Constantopoulos, Stavros H

2006-11-01

108

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

Microsoft Academic Search

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

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

2001-01-01

109

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

PubMed Central

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

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

2012-01-01

110

Haemolysis and acute renal failure after mitral valve repair.  

PubMed

We present a case of severe haemolysis and acute renal failure 5 weeks following mitral valve repair of mitral valve prolapse. Intravascular haemolysis in this patient was caused by fragmentation of a mitral regurgitant jet due to residual prolapse and partial dehiscence of the mitral valve repair ring. Urgent redo mitral valve repair was successful in resolving the mitral regurgitation and haemolysis, but renal function parameters could not be restored to normal values. PMID:23705562

Viaene, Els; Schroeyers, Pascal; Dujardin, Karl

2013-04-01

111

Variability between methods of calculating mitral valve area: Simultaneous Doppler echocardiographic and cardiac catheterization studies conducted before and after percutaneous mitral valvuloplasty  

Microsoft Academic Search

The purpose of this study was to assess the variability of measuring the mitral valve area (MVA) by the cardiac catheterization (Gorlin) method and two Doppler echocardiographic methods, the pressure half-time and continuity equation methods. The determinants of MVA were measured simultaneously before and after percutaneous mitral balloon valvuloplasty (PBMV). Thirty-three patients with severe mitral stenosis underwent simultaneous measurements of

Kyle W. Klarich; Charanjit S. Rihal; Rick A. Nishimura

1996-01-01

112

Mitral Valve Repair  

MedlinePLUS

... heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, ...

113

Transcatheter mitral direct annuloplasty: state of the art.  

PubMed

Transcatheter mitral interventions are emerging as a novel therapy for patients with severe symptomatic mitral regurgitation who are deemed to be high risk or inoperable. Surgical treatment of mitral regurgitation includes a wide spectrum of therapies, ranging from leaflet and annular repair, to mitral valve replacement. Annuloplasty plays a fundamental role in open heart mitral valve repair, since it is associated with longer durability and higher degree of mitral regurgitation reduction. Direct annuloplasty is the interventional methodology most closely reproducing open heart annular repair. We describe the challenges and opportunities of the most promising technologies currently under development which will become available in clinical practice in the next future. PMID:24831761

Maisano, F; Kuck, K H

2014-06-01

114

Quantitation of left ventricular regurgitant fraction by first pass radionuclide angiocardiography  

SciTech Connect

A new technique for quantitating left ventricular regurgitant fraction from first pass radionuclide angiocardiographic studies is described. The technique involves measurement of the total number of counts ejected from the right and left ventricles (CR and CL, respectively). In the absence of any valve insufficiency and equal counting efficiency from each ventricle, CR/CL . 1. In the presence of mitral or aortic insufficiency, or both, the regurgitant fraction can be calculated as (CL -- CR)/CL, if no right ventricular regurgitation is present. In this report the theoretical derivation of the method and practical aspects of measuring CL and CR are presented. The technique was tried in a small group of 5 normal volunteers, 7 patients studied with cardiac catheterization without regurgitation and 22 patients with mitral or aortic insufficiency, or both. Excellent correlation was found with cardiac catheterization data in the latter group (r . 0.86, n . 22). This method appears to be a simple and accurate technique for measuring left ventricular regurgitant fraction due to mitral or aortic valve disease, or both.

Janowitz, W.R.; Fester, A.

1982-01-01

115

Mitral Regurgitation (Beyond the Basics)  

MedlinePLUS

... Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736. ...

116

Modelling chorded prosthetic mitral valves using the immersed boundary method.  

PubMed

The Immersed Boundary (IB) Method is an efficient method of modelling fluid structure interactions. However, it has two main limitations: ease of use and ability to model static loading. In this paper, the method is developed, so that it can efficiently and easily model any multileaflet elastic structure. The structure may include chordae, which attach to the leaflets and continue through the leaflet surfaces. In addition, an external surface pressure may be applied to the leaflets, thus enabling the deformations that arise under steady loads to be solved. This method is validated for a model of the native mitral valve under systolic loading and for a prosthetic aortic valve under static loading. It is then applied to a new chorded prosthetic mitral valve, housed in a cylindrical tube, subject to a physiological periodic fluid flow. Results are compared with those obtained by using the commercial package ANSYS as well as with experimental measurements. Qualitative agreements are obtained. There are some discrepancies due to the current IB method being unable to model bending and shear behaviour. In particular, the fibre structures of the new prosthetic valve model developed using the IB method may be prone to crimping. Further development of the IB method is necessary to include bending effects. This will improve the accuracy of both the dynamic and static analysis. PMID:17271109

Watton, P N; Luo, X Y; Singleton, R; Wang, X; Bernacca, G M; Molloy, P; Wheatley, D J

2004-01-01

117

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

PubMed Central

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

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

2012-01-01

118

Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement  

PubMed Central

Background Mitral valve repair for posterior mitral leaflet (PML) prolapse has been considered to be a standard treatment because of its high success rate and high level of patient satisfaction. The aim of this study was to evaluate the clinical results of two different techniques of PML prolapse, quadrangular resection (QR) and chordal replacement (CR). Materials and Methods The subjects consisted of 56 patients who had undergone mitral valve repair for PML prolapse between November 1997 and December 2010. The patients were divided into two groups according to surgical technique. Among them, 31 patients underwent QR (group QR) and 25 patients had CR (group CR). We reviewed the medical records of the patients retrospectively to compare the clinical outcomes of both groups. Results After mitral valve repair, the degree of mitral regurgitation (MR) in both groups decreased to the to a mild degree or less and the amount of remnant MR was slightly higher in the CR group but it was not statistically different. Three patients received mitral valve-related reoperation (2 in the QR group and 1 in the CR group). Freedom from mitral valve-related reoperation at 7 years was 93% for the QR group and 96% for the CR group and was not significantly different between the two groups. Conclusion Both QR and CR showed excellent long-term results and were considered equally effective methods for PML prolapse. PMID:23614098

Park, Kwon-Jae; Yi, Jung Hoon; Park, Jong Yoon

2013-01-01

119

Mitral annular calcification predicts immediate results of percutaneous transvenous mitral commissurotomy  

PubMed Central

Background Many previous studies have evaluated the impact of mitral valve (MV) deformity scores on the percutaneous transvenous mitral commissurotomy (PTMC) outcome in patients with mitral stenosis; however, the relationship between mitral annulus calcification (MAC) and the PTMC result has not yet been established. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC. Methods Of all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7%male, mean ± SD age = 42.8 ± 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area > = 1.5 cm2 with > = 25% increase and without final mitral regurgitation grade > 2) was compared between two groups of patients with MAC (n = 17) and those without MAC (n = 70). Results The optimal result was obtained in 55 (63.2%) patients, whereas the result was suboptimal in 32 (36.8%) patients due to insufficient MV area increase in 31(96.9%) subjects and post-procedure mitral regurgitation grade > 2 in 1(3.1%). The rate of optimal PTMC results was less in patients with MAC in comparison to those without MAC (29.4% vs.71.4%). After adjustments for possible confounders such as age and leaflets morphological subcomponents (thickening, mobility, calcification, and subvalvular thickening), MAC remained a significant negative predictor of a suboptimal PTMC result (odds ratio = 0.154; 95%CI = 0.038-0.626, p value = 0.009) together with leaflet thickening (odds ratio = 0.214; 95%CI = 0.060-0.770, p value = 0.018). Conclusions MAC appeared to independently influence the immediate result of PTMC; therefore, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC. PMID:22035075

2011-01-01

120

Recurrent stuck mitral valve: eosinophilia an unusual pathology.  

PubMed

Eosinophilia is a very unusual and rare cause of thrombosis of prosthetic mitral valve. We report a 10-year-old male child of recurrent stuck prosthetic mitral valve. The child underwent mitral valve replacement for severe mitral regurgitation secondary to Rheumatic heart disease. He had recurrent prosthetic mitral valve thrombosis, despite desired INR levels. There was associated eosinophilia. The child was treated on the lines of tropical eosinophilia with oral prednisolone and diethylcarbamazine, the eosinophil count dropped significantly with no subsequent episode of stuck mitral valve. We discuss the management of recurrent stuck mitral valve and also eosinophilia as a causative factor for the same. PMID:25586257

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

2015-03-01

121

Percutaneous complete repair of failed mitral valve prosthesis: simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - single-centre experience.  

PubMed

Aims: Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis. Methods and results: From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class ?2 was achieved in all patients (19±3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation. Conclusions: Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm). PMID:24800978

Kliger, Chad; Angulo, Rocio; Maranan, Leandro; Kumar, Robert; Jelnin, Vladimir; Kronzon, Itzhak; Fontana, Gregory P; Plestis, Konstadinos; Patel, Nirav; Perk, Gila; Ruiz, Carlos E

2014-05-01

122

Mitral Valve Area During Exercise After Restrictive Mitral Valve Annuloplasty  

PubMed Central

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

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

123

Mitral valve prolapse.  

PubMed

Mitral valve prolapse (MVP) now is a commonly recognized syndrome with an apparent prevalence of approximately 4-6%. It appears to occur more frequently in females and occasionally it is familial. In most instances, the syndrome is idiopathic, although it occurs in association with many other conditions, particularly Marfan's syndrome, rheumatic heart disease, coronary heart disease, congestive cardiomyopathy, ostium secundum atrial septal defect, Ehlers-Danlos syndrome or abnormalities of the thoracic cage. The majority of patients with the syndrome have minimal, if any, symptoms and have a benign course. When symptoms do occur, more frequently they are palpitations, chest pain, dyspnea on exertion or fatigue. Neuropsychiatric symptoms or even transient ischemic episodes may occur rarely. Very rarely, complications such as severe mitral regurgitation, arrhythmias or infective endocarditis may occur. Characteristically, patients have a midsystolic click, occasionally followed by a systolic murmur. The timing of the click and the onset of the murmur usually is variable, depending on the ventricular volume. The electrocardiogram frequently shows ST-T wave changes. The diagnosis usually can be confirmed by echocardiography or left ventricular angiography. Most patients with MVP require no treatment other than reassurance. If a systolic murmur is present, prophylaxis against infective endocarditis during dental work probably is useful. Patients with palpitations or chest pain usually respond well to treatment with propranolol. Patients with progressive severe mitral regurgitation require mitral valve replacement. PMID:6993166

Schlant, R C; Felner, J M; Miklozek, C L; Lutz, J F; Hurst, J W

1980-07-01

124

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

PubMed Central

We present a case of transient left ventricular outflow tract obstruction after mitral valve replacement with a high-profile bioprosthesis; only the posterior native mitral valve leaflet was preserved. A 76-year-old woman was admitted to our institution with pulmonary edema. Two weeks earlier, she had undergone mitral valve replacement at our hospital due to severe mitral stenosis and 2+ mitral regurgitation complicated by cardiac failure and atrial fibrillation. The patient was taking digoxin, furosemide, and warfarin at the time of readmission. Echocardiography showed a narrowed left ventricular outflow tract. Doppler echocardiography revealed a peak 64-mmHg gradient between the septum and the strut of the bioprosthesis. The patient was successfully treated medically. This case indicates that the risk of left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement is not always eliminated by removal of the anterior mitral valve leaflet when the posterior mitral leaflet is preserved. PMID:17041708

Guler, Niyazi; Ozkara, Cenap; Akyol, Aytac

2006-01-01

125

Pre-operative systolic anterior motion of the mitral valve in a patient undergoing mitral valve repair  

PubMed Central

A patient with myxomatous mitral valve prolapse underwent mitral mitral valve repair due to severe symptomatic mitral regurgitation. Preoperative echocardiography demonstrated systolic anterior motion of the mitral valve. This finding disappeared once spontaneous chordal rupture occurred, resulting in a flail posterior mitral leaflet. As the patient was considered at high risk of developing post-repair SAM, he was operated on using surgical techniques aimed at lowering the risk of this complication. Despite this, post-repair SAM did develop and could only be eliminated by a surgical edge-to-edge (Alfieri) repair. PMID:24062939

Eyal, Allon; Raanani, Ehud; Shapira, Yaron

2013-01-01

126

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

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

127

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

PubMed

Current artificial heart valves either have limited lifespan or require the recipient to be on permanent anticoagulation therapy. In this paper, effort is made to assess a newly developed bileaflet valve prosthesis made of synthetic flexible leaflet materials, whose geometry and material properties are based on those of the native mitral valve, with a view to providing superior options for mitral valve replacement. Computational analysis is employed to evaluate the geometric and material design of the valve, by investigation of its mechanical behaviour and unsteady flow characteristics. The immersed boundary (IB) method is used for the dynamic modelling of the large deformation of the valve leaflets and the fluid-structure interactions. The IB simulation is first validated for the aortic prosthesis subjected to a hydrostatic loading. The predicted displacement fields by IB are compared with those obtained using ANSYS, as well as with experimental measurements. Good quantitative agreement is obtained. Moreover, known failure regions of aortic prostheses are identified. The dynamic behaviour of the valve designs is then simulated under four physiological pulsatile flows. Experimental pressure gradients for opening and closure of the valves are in good agreement with IB predictions for all flow rates for both aortic and mitral designs. Importantly, the simulations predicted improved physiological haemodynamics for the novel mitral design. Limitation of the current IB model is also discussed. We conclude that the IB model can be developed to be an extremely effective dynamic simulation tool to aid prosthesis design. PMID:16584739

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

2007-01-01

128

Management of tricuspid regurgitation.  

PubMed

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

De Bonis, Michele; Taramasso, Maurizio; Lapenna, Elisabetta; Alfieri, Ottavio

2014-01-01

129

Management of tricuspid regurgitation  

PubMed Central

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

Taramasso, Maurizio; Lapenna, Elisabetta; Alfieri, Ottavio

2014-01-01

130

Percutaneous reduction of mitral valve regurgitation using the MitraClip system – immediate and 90-day follow-up of 3 cases  

PubMed Central

Treatment of hemodynamically significant valvular heart diseases has been the domain of cardiac surgery for decades. However, a promising novel method is the MitraClip system, involving percutaneous connection of insufficient valve leaflets with special cobalt-chrome clips. Our study presents clinical characteristics, course of treatment with the MitraClip system, and immediate and 90-day clinical and echocardiographic follow-up of the first 3 patients treated in our institution. Subsequently, based on data from the literature and our own experience, the current position around the world, and the target group of patients who are most likely to benefit from treatment using the MitraClip system, are discussed. PMID:24570704

Kustrzycka-Kratochwil, Dorota; Telichowski, Artur; Witkowski, Tomasz; Banasiak, Waldemar; Jankowska, Ewa A.; Ponikowski, Piotr; Reczuch, Krzysztof

2013-01-01

131

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

PubMed Central

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

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

2012-01-01

132

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

PubMed

Transcatheter aortic valve implantation, as well as interventional mitral valve repair, offer reasonable therapeutic options for high-risk surgical patients. We report a rare case of early post-interventional aortic valve prosthesis migration to the left ventricular outflow tract, with paravalvular leakage and causing severe mitral valve regurgitation. Initial successful interventional mitral valve repair using a clipped edge-to-edge technique revealed, in a subsequent procedure, the recurrence of mitral valve regurgitation leading to progressive heart failure and necessitating subsequent surgical aortic and mitral valve replacement. PMID:23864579

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

2013-11-01

133

Quantitative Evaluation of Annuloplasty on Mitral Valve Chordae Tendineae Forces to Supplement Surgical Planning Model Development  

PubMed Central

Purpose Computational models of the heart’s mitral valve (MV) exhibit potential for preoperative surgical planning in ischemic mitral regurgitation (IMR). However challenges exist in defining boundary conditions to accurately model the function and response of the chordae tendineae to both IMR and surgical annuloplasty repair. Towards this goal, a ground-truth data set was generated by quantifying the isolated effects of IMR and mitral annuloplasty on leaflet coaptation, regurgitation, and tethering forces of the anterior strut and posterior intermediary chordae tendineae. Methods MVs were excised from ovine hearts (N=15) and mounted in a pulsatile heart simulator which has been demonstrated to mimic the systolic MV geometry and coaptation of healthy and chronic IMR sheep. Strut and intermediary chordae from both MV leaflets (N=4) were instrumented with force transducers. Tested conditions included a healthy control, IMR, oversized annuloplasty, true-sized annuloplasty, and undersized mitral annuloplasty. A2-P2 leaflet coaptation length, regurgitation, and chordal tethering were quantified and statistically compared across experimental conditions. Results IMR was successfully simulated with significant increases in MR, tethering forces for each of the chordae, and decrease in leaflet coaptation (p<.05). Compared to the IMR condition, increasing levels of downsized annuloplasty significantly reduced regurgitation, increased coaptation, reduced posteromedial papillary muscle strut chordal forces, and reduced intermediary chordal forces from the anterolateral papillary muscle (p<.05). Conclusions These results provide for the first time a novel comprehensive data set for refining the ability of computational MV models to simulate IMR and varying sizes of complete rigid ring annuloplasty. PMID:24634699

Siefert, Andrew W.; Rabbah, Jean-Pierre M.; Pierce, Eric L.; Kunzelman, Karyn S.; Yoganathan, Ajit P.

2014-01-01

134

Coronary Revascularization Alone or with Mitral Valve Repair  

PubMed Central

We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr). A total of 83 patients had a reduced left ventricular ejection fraction and moderate mitral regurgitation: 28 patients underwent CABG+MVr, and 55 underwent CABG alone. Changes in mitral regurgitation, functional class, and left ventricular ejection fraction were compared in both groups. The mean follow-up was 5.1 ± 3.6 years (range, 0.1–15.1 yr). Reduction of 2 mitral-regurgitation grades was found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P < 0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively (P = 0.1), as well as improvements in left ventricular ejection fraction and functional class. One- and 5-year survival rates were similar in the CABG+MVr and CABG-only groups: 96% ± 3% versus 96% ± 4%, and 87% ± 5% versus 81% ± 8%, respectively (P = NS). Propensity analysis showed similar results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and 47% at late follow-up, respectively. In patients with moderate ischemic mitral regurgitation, either surgical approach led to an improvement in functional class. Early and intermediate-term mortality rates were low with either CABG or CABG+MVr. However, an increased rate of late recurrent mitral regurgitation in the CABG+MVr group was observed. PMID:19876417

Goland, Sorel; Czer, Lawrence S.C.; Siegel, Robert J.; DeRobertis, Michele A.; Mirocha, James; Zivari, Kaveh; Kass, Robert M.; Raissi, Sharo; Fontana, Gregory; Cheng, Wen; Trento, Alfredo

2009-01-01

135

Assessment of mitral Björk-Shiley prosthetic dysfunction using digitised M mode echocardiography.  

PubMed Central

Digitised M mode echocardiograms were analysed in 22 patients with possible Björk-Shiley mitral prosthetic dysfunction. Patients with paraprosthetic mitral regurgitation had a significantly greater shortening fraction, an increased peak rate of dimension change during systole, and an increased peak velocity of circumferential fibre shortening than those with poor left ventricular function. Patients with a clotted prosthesis had lower values for shortening fraction and peak rate of dimension change during systole than patients with paraprosthetic regurgitation. In this latter group, the peak rate of dimension change during diastole and peak lengthening rate were greater than in either those patients with poor left ventricular function or those with a clotted prosthesis. In addition, the peak lengthening rate was greater in those with a clotted prosthesis than in those with poor left ventricular function. Thus M mode echocardiography is a useful method of assessing mitral prosthetic dysfunction and allows patients with paraprosthetic regurgitation to be distinguished from those with either poor left ventricular function or a clotted prosthesis. PMID:6691866

Dawkins, K D; Cotter, L; Gibson, D G

1984-01-01

136

Requirement for accurate measurement of regurgitant stroke volume by the combined continuous-wave Doppler and color Doppler flow convergence method.  

PubMed

The examination conditions necessary for accurate measurement of regurgitant volume by the proximal flow convergence method applying a simple hemispheric equation remain uncertain. This study investigated the requirement for measuring regurgitant stroke volume from the combined continuous-wave and color Doppler proximal flow convergence approach. Twenty-five pulsatile flow rates were produced by driving five regurgitant stroke volumes ranging from 30 to 70 ml/beat through planar orifices with cross-sectional areas ranging from 0.10 to 1.0 cm2. Four different shaped orifices (circular, rectangular with a major/minor axis ratio 2:1, slitlike with a major/minor axis ratio of 8:1, and square) having identical orifice areas (0.5 cm2) were examined. Regurgitant volume (RV) was estimated from the combined continuous-wave and color Doppler approach according to the previously described equation RV = 2 pi x (r max)2 x AV x (TVI/Vmax), where r max is maximal radial distance, AV is aliasing velocity, TVI is time velocity integral of regurgitant jet, and Vmax is peak velocity of regurgitant jet. Plotting the difference between actual and calculated RV versus radial distance of the proximal convergence shell for each flow rate from circular to rectangular orifices yielded curves conforming to a curvilinear function that crossed the point of zero difference at 1.0 cm. However, in the slitilke orifice, a more remote distance (1.6 cm) is required for the best agreement. Actual regurgitant stroke volume can be estimated well by the combined continuous-wave Doppler and proximal flow convergence method applying a simple hemispheric equation if an aliasing velocity is used that results in a radial distance of at least 1.0 cm. PMID:9006286

Nozaki, S; Shandas, R; DeMaria, A N

1997-01-01

137

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

PubMed Central

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

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

138

Successful management of multiple infected sub-mitral aneurysms of left ventricle  

PubMed Central

Sub-mitral aneurysms are rarely reported clinical entity. Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one. A 17-year-old boy with sub-mitral aneurysm presented with severe mitral regurgitation, which was diagnosed by echocardiography and successfully managed surgically. The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics. PMID:24701086

Nair, Vinitha Viswambharan; Kalra, Rajat; Narang, Rajiv; Airan, Balram

2014-01-01

139

Mechanics of the mitral valve  

PubMed Central

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

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

2013-01-01

140

Mitral valve disease: a cardiologic-surgical interaction.  

PubMed

The respective roles of cardiologist and cardiac surgeon in the operative management of any specific case of mitral valve disease are variable. The range from the prevalent complete predominance of the surgeon through meaningful interaction between the two, concerning the timing and type of surgery, to predominance of the cardiologist when the surgeon accepts a role of technician. There are a number of scenarios in mitral valve surgery in which a reduced risk of postoperative hospital mortality and morbidity, by performing the simplest and shortest procedure, have to be balanced against enhanced peri-operative problems when other aspects are addressed that improve, sometimes markedly, the long-term prognosis. It is argued that a mildly stenotic aortic valve should often be replaced at the time of mitral valve surgery; that despite technical difficulties and a variable long-term postoperative course, surgeons should continue to repair rather than replace the mitral valves of young patients with severe mitral regurgitation despite the invariable presence of active rheumatic carditis; and that excess leaflet tissue and lax chordae in cases of degenerative mitral regurgitation are casually related to multifocal and potentially fatal ventricular ectopy. The crucial but neglected role of an organically abnormal tricuspid anulus in allowing dilatation and hence tricuspid regurgitation in patients with rheumatic mitral valve disease is considered in some detail. Such dilatation may occur late after mitral valve surgery for rheumatic disease, has generally and incorrectly been regarded as "functional" tricuspid regurgitation, contributes importantly to the postoperative "restriction-dilatation syndrome" and can be effectively prevented, or when once established then surgically managed, by a modified De Vega anuloplasty. Finally it is believed that, unlike mitral balloon valvuloplasty in selected instances, successful tricuspid balloon valvuloplasty can never be accomplished without causing significant tricuspid regurgitation and the procedure should be abandoned. PMID:8950247

Barlow, J B

1996-10-01

141

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

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

2013-01-01

142

Percutaneous balloon mitral commissurotomy during pregnancy.  

PubMed Central

OBJECTIVE: To evaluate the effectiveness and safety of percutaneous balloon mitral commissurotomy for the treatment of pregnant women with severe mitral stenosis over a period of six years. DESIGN: Analysis of clinical, haemodynamic, and echocardiographic data before and immediately after the procedure, the pregnancy outcome, and the fate of newborn babies. SETTING: Academic cardiovascular centre in Monastir, Tunisia. PATIENTS: 44 pregnant patients who underwent percutaneous transvenous dilatation of the mitral valve between January 1990 and February 1996. Grade 2 mitral regurgitation was present in two patients and densely calcific valves in three (7%). RESULTS: Commissurotomy was successfully achieved in all cases. The total mean (SD) duration of teh procedure was 72 (18) minutes and that of fluoroscopy 16 (7) minutes. Left atrial pressure decreased from 28 (10) to 14 (7) mm Hg, mitral pressure gradient fell from 22 (8) to 5 (3) mm Hg. Cardiac output increased from 4.8 (1.1) to 6.3 (1.2) l/min and Gorlin mitral valve area from 0.96 (0.21) to 2.4 (0.4) cm2 (all P < < 0.001). Cross sectional echocardiographic mitral valve area increased from 1.07 (0.21) to 2.32 (0.36) cm2. There were no maternal or fetal deaths. Complications included a grade 4 mitral regurgitation in one patient that required early valve replacement. All patients delivered at full term, 42 vaginally and two (5%) by caesarean section; 41 babies were normal and three whose mothers had the procedure near term were relatively hypotrophic. At a mean follow up of 28 (12) months (range 2 to 26) all children had normal growth. CONCLUSIONS: During pregnancy, balloon mitral commissurotomy is the treatment of choice of severe pliable mitral stenosis in patients who are refractory to medical treatment. PMID:9227303

Ben Farhat, M.; Gamra, H.; Betbout, F.; Maatouk, F.; Jarrar, M.; Addad, F.; Tiss, M.; Hammami, S.; Chahbani, I.; Thaalbi, R.

1997-01-01

143

[Diagnostic value of mitral and septal echocardiographic changes in aortic valve insufficiency].  

PubMed

116 patients with aortic regurgitation of different severity with and without associated valvular lesions were studied with echocardiography. In all cases the diagnosis was proven by cardiac catheterisation. Typical fluttering of the anterior mitral valve leaflet and the interventricular septum were oftener observed with increasing degree of severity of aortic regurgitation. An associated fluttering of the posterior mitral valve leaflet is described. This is seen with increasing severity of the valvular lesion and in more than 90% of patients with severe aortic regurgitation as it is observed with the anterior mitral leaflet. An isolated fluttering of the interventricular septum was observed in two cases and is also regarded as a specific finding in aortic regurgitation. There was a significant higher pulse pressure in patients with fluttering of the anterior mitral leaflet and/or the interventricular septum than in those cases without fluttering. Fluttering of mitral leaflets in aortic regurgitation was seen even in patients with additional mitral stenosis with and without calcification and after commissurotomy. A premature mitral valve closure was noted in one of 93 cases, an incomplete diastolic aortic valve closure in 29 of 78 cases. The diastolic diameter of the aortic root was mildly increased in 17 patients with pure aortic regurgitation. In 8 patients, mostly with severe aortic regurgitation, the E-F-Slope of the anterior mitral leaflet ranged between 120 and 160 mm/sec. The presented findings do not allow a conclusion regarding the severity of aortic regurgitation. However, they do allow the echocardiographic diagnosis of aortic regurgitation with a high degree of accuracy, in particular in cases of fluttering. PMID:960975

Daniel, W; Walpurger, G; Lichtlen, P

1976-07-01

144

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty  

PubMed Central

Objective Leaflet prolapse resulting from acute chordal rupture is one presentation of fibroelastic deficiency that is associated with minimal leaflet changes in the prolapsing segment. Minimizing resection and preserving leaflet tissue may be an optimal surgical strategy. We examined the importance of the leaflet preservation concept by comparing resective and nonresective surgical procedures in practice today. Methods Eight porcine mitral valves were evaluated in an in vitro heart simulator before surgical manipulation. Mitral regurgitation was created in these valves by transecting the posterior marginal chordae resulting in severe P2 prolapse. After confirmation of mitral regurgiation via regurgitant flow measurement (mL/beat), regurgitation was corrected by three repairs: neochordoplasty with polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Flagstaff, Ariz), triangular resection, and quadrangular resection with annular compression. Post-repair valve hemodynamics were quantified under pulsatile conditions of 120 mm Hg peak transmitral pressure and 5 L/min cardiac output at 70 beats/min. Furthermore, hemodynamic, geometric, and echocardiographic indices were measured. Results Transecting the marginal chordae resulted in severe P2 prolapse and significant mitral regurgiation (19.3 ± 4.3 mL/beat). Regurgitant volume was significantly reduced after any of the three surgical approaches (quadrangular, 4.38 ± 1.6 mL/beat; triangular, 2.56 ± 1.0 mL/beat; neochordal, 2.86 ± 1.24 mL/beat). In comparison with the baseline normal valves, leaflet coaptation length and posterior leaflet mobility were significantly reduced in the quadrangular resection group, whereas they were partially restored in the triangular resection and fully preserved in the neochordoplasty group. Conclusions Although the three repair procedures are hemodynamically comparable, valve function and leaflet kinematics were significantly better after a nonresection or limited resective correction of leaflet prolapse in this experimental model of acute chordal rupture with otherwise normal leaflet geometry. PMID:19619772

Padala, Muralidhar; Powell, Scott N.; Croft, Laura R.; Thourani, Vinod H.; Yoganathan, Ajit P.; Adams, David H.

2015-01-01

145

Intraoperative echocardiographic detection of regurgitant jets after valve replacement  

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

146

Review of mitral valve insufficiency: repair or replacement  

PubMed Central

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

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

2014-01-01

147

[Percutaneous approaches for mitral valve interventions--a real alternative technique for standard cardiac surgery?].  

PubMed

Standard therapy of advanced mitral valve regurgitation currently consists of mitral valve reconstruction through heart surgery including heart-lung machine employment. Typically, a ring is implanted and a leaflet reduced, if necessary, to approximate the posterior and anterior mitral valve leaflets to each other. Because of high comorbidity among this patient population, new and less burdening catheter-based techniques have been developed. Clinical etiology of mitral valve regurgitation is divided into two categories: "structural" versus "functional". The MONARC system of the Edwards Lifesciences company consists of three components--distal stent, bridge with bioabsorbing coating, proximal stent--and is implanted into the coronary sinus. The underlying principle is an indirect annuloplasty of the mitral valve annulus resulting from resorption of the bridge coating and leading to a reduction and indirect tightening of the mitral valve annulus. The EVOLUTION I (EV I) study in patients suffering from functional mitral regurgitation to a degree between 2+ and 4+ revealed--12 months after the MONARC implantation--a mitral valve regurgitation reduction from 2.48 to 1.78. The EV I study found interaction of the foreshortening bridge with the coronary arteries in some patients. This problem is most widely excluded by previous computed tomographic or angiographic examinations in the ongoing follow-up study EV II. Direct annuloplasty is made possible in case of functional mitral regurgitation by using the Mitralign Percutaneous Annuloplasty System (MPAS) of the Mitralign company. In doing so, an improved coadaptation of the mitral valve leaflet is achieved by inserting three sutures into the posterior mitral valve annulus and subsequent plicating.The MitraClip of the Evalve company uses the principle of the edge-to-edge technique. In doing so, the posterior and anterior leaflets are joined by implanting a clip, resulting in a reduction of mitral regurgitation with two diastolic orifices. In contrast to strukthe other two procedures, the MitraClip can be used for both functional and structural mitral valve regurgitation. The EVEREST I study and the EVEREST II study, as far as it has already been published, show that this procedure is secure and its results are very positive. The previous results of all three procedures show that catheter-based techniques for treating high-risk patients suffering from mitral valve regurgitation arrive at positive results in part, so that possibly a real alternative to conventional heart surgery will be available in the future. PMID:19784562

Frerker, Christian; Schäfer, Ulrich; Schewel, Dimitry; Krüger, Matthias; Malisius, Rainer; Schneider, Carsten; Geidel, Stephan; Bergmann, Martin; Kuck, Karl-Heinz

2009-09-01

148

Intermittent tethering of second-order chords after mitral valve repair for bileaflet prolapse.  

PubMed

Mitral valve regurgitation which occurs immediately after repair can be due to anatomic (failure of repair) or functional (systolic anterior motion) reasons. We report a case where a patient with bileaflet prolapse showed, after surgical correction of the disease, moderate to severe regurgitation after cardiopulmonary bypass was stopped. The regurgitation was due to second-order tethering and was successfully treated with second-order chordal cutting. PMID:24296225

Iacò, Angela L; Ahmed, Ahmed A; Al Zaharani, Gormallah; Al Amri, Hussein; Di Mauro, Michele; Calafiore, Antonio M

2013-12-01

149

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

PubMed

As the technique of open heart surgery has improved, CMC has been abandoned in favor of OMC and MVR. We evaluated and compared the results of CMC, OMC and MVR. METHOD. Between 1965 and 1978, 141 patients with mitral stenosis (MS) underwent CMC, and late follow-up obtained in 117 (83%) of them (CMC group). Between 1980 and 1989, 72 patients and 37 patients underwent OMC (OMC group) and MVR (MVR group), respectively. Cumulative follow-up periods were 1982, 632 and 200 patient-years in the CMC, OMC and MVR groups, respectively. RESULTS. (1) Survival rate; In the CMC group there were 2 operative deaths due to severe mitral regurgitation (MR). There were 17 late deaths, due to reoperations in 4 patients, cerebral infarction in 4 patients, congestive heart failure in 3 patients, myocardial infarction in 2 patients and unknown causes in 4 patients. The survival rate was 95%, 91% and 86% at 5, 10 and 15 years, respectively, in the CMC group. In the OMC and MVR groups there was no death. (2) The event free rate was 89%, 79% and 58% at 5, 10 and 15 years, respectively, in the CMC group, 97% and 97% at 5 and 10 years in the OMC group, and 95% and 90% at 4 and 5 years in the MVR group. (3) Reoperations; In the CMC group of 40 patients (34%) required reoperations in an average of 10.4 years after the initial operation, due to re-MS in 22 patients, MR in 10 patients and MRS in the 8 patients. Reoperative findings consisted of clefts in the mitral leaflets in 7 patients. There were pulmonary hypertension in 15 patients and tricuspid regurgitation in 22 patients. Fourteen patients underwent tricuspid anuloplasty and one patient underwent a tricuspid valve replacement. In the OMC group one patient required a reoperation due to MR; in the MVR group one patient required a reoperation due to a thrombosed valve. CONCLUSION. In the CMC group the survival rate and the event free rate were lower, and the rate of reoperation was higher than in the other two groups. PMID:8409599

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

1993-09-01

150

Minimally Invasive Approach for Redo Mitral Valve Replacement: No Aortic Cross-Clamping and No Cardioplegia  

PubMed Central

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.

Kim, Hong Rae; Kim, Gwan Sic; Yoo, Jae Suk; Lee, Jae Won

2015-01-01

151

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

PubMed Central

The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role. PMID:24349984

Sgouropoulou, Sophia

2013-01-01

152

Accuracy of a Mitral Valve Segmentation Method Using J-Splines for Real-Time 3D Echocardiography Data  

PubMed Central

Patient-specific models of the heart’s mitral valve (MV) exhibit potential for surgical planning. While advances in 3D echocardiography (3DE) have provided adequate resolution to extract MV leaflet geometry, no study has quantitatively assessed the accuracy of their modeled leaflets versus a ground-truth standard for temporal frames beyond systolic closure or for differing valvular dysfunctions. The accuracy of a 3DE-based segmentation methodology based on J-splines was assessed for porcine MVs with known 4D leaflet coordinates within a pulsatile simulator during closure, peak closure, and opening for a control, prolapsed, and billowing MV model. For all time points, the mean distance error between the segmented models and ground-truth data were 0.40±0.32 mm, 0.52±0.51 mm, and 0.74±0.69 mm for the control, flail, and billowing models. For all models and temporal frames, 95% of the distance errors were below 1.64 mm. When applied to a patient data set, segmentation was able to confirm a regurgitant orifice and post-operative improvements in coaptation. This study provides an experimental platform for assessing the accuracy of an MV segmentation methodology at phases beyond systolic closure and for differing MV dysfunctions. Results demonstrate the accuracy of a MV segmentation methodology for the development of future surgical planning tools. PMID:23460042

Siefert, Andrew W.; Icenogle, David A.; Rabbah, Jean-Pierre; Saikrishnan, Neelakantan; Rossignac, Jarek; Lerakis, Stamatios; Yoganathan, Ajit P.

2013-01-01

153

[Diagnosis of the failure and thrombosis of a mitral valve prosthesis based on indirect study methods].  

PubMed

The possibilities of phono- and polycardiography in the diagnosis of failure and thrombosis of a mitral valve prosthesis are demonstrated. It is established that the most characteristic phonocardiographic signs of paravalvular failure in patients with this pathological condition are a systolic murmur, a reduced second sound-sound of mitral valve prosthesis opening interval and ejection period (according to the findings of polycardiography) and prolongation of the Q-first sound interval. In typical cases, thrombosis of a mitral valve prosthesis is attended by a diastolic murmur, a reduced second sound-sound interval of prosthesis opening, and prolongation of the Q-first sound interval. PMID:7218646

Lartseva, F A; Cherenkova, N D

1981-02-01

154

Comparative value of transthoracic and transoesophageal echocardiography before balloon dilatation of the mitral valve  

Microsoft Academic Search

Objective—To assess the relative merits of transthoracic and transoesophageal echocardiography before balloon dilatation of the mitral valve.Design—Transthoracic and transoesophageal echocardiograms were prospectively performed in 35 patients being considered for balloon dilatation of the mitral valve. Echocardiograms were analysed for image quality, the assessment of valve morphology, the detection of left atrial thrombus, and the assessment of mitral regurgitation and other

Martyn R Thomas; Mark J Monaghan; David W Smyth; Jennie M Metcalfe; David E Jewitt

1992-01-01

155

Computational study of the dynamics of a bileaflet mechanical heart valve in the mitral position.  

PubMed

A computational study of the flow-structure interaction of a bileaflet mechanical heart valve in the mitral position is presented. Flow in a simple model of the left ventricle is simulated using an immersed boundary method, and the dynamics of the valve leaflets are solved in a fully-coupled manner with the flow. Simulations are conducted for two distinct valve orientations and multiple valve hinge locations, and the performance of the valve is compared in terms of metrics associated with leaflet motion, mitral regurgitation, and mechanical energy losses through the valve. Results indicate that a bileaflet mechanical heart valve with a more centrally located hinge, and implanted in the anatomical orientation provides the best overall performance. The fluid and leaflet dynamics, as well as the clinical implications underlying these findings are discussed. PMID:24777886

Choi, Young Joon; Vedula, Vijay; Mittal, Rajat

2014-08-01

156

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

PubMed

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

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

2015-04-01

157

In-Vivo Mitral Annuloplasty Ring Transducer: Implications for Implantation and Annular Downsizing  

PubMed Central

Mitral annuloplasty has been a keystone to the success of mitral valve repair in functional mitral regurgitation. Understanding the complex interplay between annular-ring stresses and left ventricular function has significant implications for patient-ring selection, repair failure, and patient safety. A step towards assessing these challenges is developing a transducer that can be implanted in the exact method as commercially available rings and can quantify multidirectional ring loading. An annuloplasty ring transducer was developed to measure stresses at eight locations on both the in-plane and out-of-plane surfaces of an annuloplasty ring’s titanium core. The transducer was implanted in an ovine subject using 10 sutures at near symmetric locations. At implantation, the ring was observed to undersize the mitral annulus. The flaccid annulus exerted both compressive (?) and tensile stresses (+) on the ring ranging from ?3.17 to 5.34 MPa. At baseline hemodynamics, stresses cyclically changed and peaked near midsystole. Mean changes in cyclic stress from ventricular diastole to mid-systole ranged from ?0.61 to 0.46 MPa (in-plane direction) and from ?0.49 to 1.13 MPa (out-of-plane direction). Results demonstrate the variability in ring stresses that can be introduced during implantation and the cyclic contraction of the mitral annulus. Ring stresses at implantation were approximately 4 magnitudes larger than the cyclic changes in stress throughout the cardiac cycle. These methods will be extended to ring transducers of differing size and geometry. Upon additional investigation, these data will contribute to improved knowledge of annulus-ring stresses, LV function, and the safer development of mitral repair techniques. PMID:23948375

Siefert, Andrew W.; Touchton, Steven A.; McGarvey, Jeremy R.; Takebayashi, Satoshi; Rabbah, Jean Pierre M.; Jimenez, Jorge H.; Saikrishnan, Neelakantan; Gorman, Robert C.; Gorman, Joseph H.; Yoganathan, Ajit P.

2013-01-01

158

Mitral annular hinge motion contribution to changes in mitral septal-lateral dimension and annular area  

PubMed Central

Objective The mitral annulus is a dynamic, saddle-shaped structure consisting of fibrous and muscular regions. Normal physiologic mechanisms of annular motion are incompletely understood, and more complete characterization is needed to provide rational basis for annuloplasty ring design and to enhance clinical outcomes. Methods Seventeen sheep had radiopaque markers implanted; 16 around the annulus and 2 on middle anterior and posterior leaflet edges. Four-dimensional marker coordinates were acquired with biplanar videofluoroscopy at 60 Hz. Hinge angle was quantified between fibrous and muscular annular planes, with 0° defined at end diastole, to characterize its contribution to alterations in mitral septal–lateral dimension and 2-dimensional total annular area throughout the cardiac cycle. Results During isovolumic contraction (pre-ejection), hinge angle abruptly increased, reaching maximum (steepest saddle shape, change 18° ± 13°) at peak left ventricular pressure. During ejection, hinge angle did not change; it then decreased during early filling (change 2° ± 2°). Septal–lateral dimension and total area paralleled hinge angle dynamics and leaflet distance (anterior to posterior marker). Pre-ejection septal–lateral reduction was 13% ± 7% (3.3 ± 1.5 mm) from 9% muscular dimension fall and 18° ± 13° hinge angle increase. Conclusions Pre-ejection increase in hinge angle contributes substantially to septal–lateral and total area reduction, facilitating leaflet coaptation. Semirigid annuloplasty rings or partial bands may preserve hinge motion, but possible recurrent annular dilatation could result in recurrent mitral regurgitation. Long-term clinical studies are required to determine who might benefit most from preserving intrinsic hinge motion without compromising repair durability. PMID:19747697

Itoh, Akinobu; Ennis, Daniel B.; Bothe, Wolfgang; Swanson, Julia C.; Krishnamurthy, Gaurav; Nguyen, Tom C.; Ingels, Neil B.; Miller, D. Craig

2010-01-01

159

Problem: Heart Valve Regurgitation  

MedlinePLUS

... the same amount of blood. Regurgitation occurs when: Blood flows back through the valve as the leaflets are ... flow in two directions during the contraction. Some blood flows from the ventricle through the aortic valve – as ...

160

A novel and practical cardiovascular magnetic resonance method to quantify mitral annular excursion and recoil applied to hypertrophic cardiomyopathy  

PubMed Central

Background We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. Methods We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED. Results Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P?mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject. Conclusions Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers. PMID:24886666

2014-01-01

161

Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus  

PubMed Central

Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome. PMID:25401131

Hekmat, Manouchehr; Ghorbani, Mohsen; Ghaderi, Hamid; Majidi, Masoud; Beheshti, Mahmood

2014-01-01

162

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

PubMed

Congenital mitral valve abnormalities are rare and cause mitral stenosis, regurgitation, or a combination of the two. Three-dimensional echocardiography has provided new insight into the structure and function of both normal and abnormal mitral valves. Three-dimensional imaging permits accurate anatomic diagnosis and enhances two-dimensional echocardiographic data. Moreover, it enables echocardiographers to communicate effectively with cardiothoracic surgeons when displaying, analyzing, and describing pathology. The purpose of this report is to review congenital mitral valve disease, focusing on the benefits of three-dimensional echocardiography in its evaluation. PMID:24360740

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

2014-02-01

163

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

PubMed Central

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

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

2010-01-01

164

Mitral valve prolapse  

MedlinePLUS

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

165

Coronary air embolism during mitral valvuloplasty.  

PubMed

A 30-year-old male with a history of rheumatic mitral valve disease presented with progressive exertional dyspnoea. Echocardiography revealed a mitral valve area of 1 cm2, a mitral valve score of 6/16, and absence of mitral regurgitation. Percutaneous mitral valvuloplasty was performed using the multitrack technique. Unexpectedly, one balloon suddenly ruptured during a second inflation. The patient experienced severe chest pain and shock. The electrocardiogram showed ST-segment elevation in leads II, III, and aFV. Prompt resuscitation was performed and right coronary angiography showed a bubble of air trapped at the crux of the right coronary artery, with loss of myocardial blush.The operator injected 100 mcg of nitroglycerin inside the right coronary, followed by intracoronary infusion of normal saline. Ultimately, right coronary angiography revealed that the air was successfully cleared off the artery, with TIMI grade 3 flow and, return of myocardial blush. Eventually, chest pain disappeared, with a favourable haemodynamic condition. PMID:22032066

Rifaie, Osama; Nammas, Wail

2011-10-01

166

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

NASA Astrophysics Data System (ADS)

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

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

2012-06-01

167

Mitral paravalvular leak: caution in percutaneous occluder device deployment.  

PubMed

A frail 70-year-old woman presented with symptomatic mitral paravalvular leak 2 months after undergoing a double valve replacement for mixed mitral and aortic valve disease. There was no evidence of prosthetic valve endocarditis. Percutaneous closure of the paravalvular leak was attempted as an alternative to a high-risk surgical procedure. This therapy was successful in reducing the regurgitation but resulted in severe intravascular hemolysis and acute renal failure requiring hemodialysis.The development of new hemolysis and acute renal failure directed our attention to the Amplatzer device as a possible etiology for these complications. The assumption that her kidney injury was recent and likely reversible compelled us to think of the surgical method as a definitive option. A re-operative surgery was performed, which included retrieval of the occluder devices, pericardial patch repair, and re-replacement using a new biological prosthesis. The patient's urine output gradually improved, and the patient was dismissed with normal renal function.We present this case as an unusual complication of percutaneous device closure. It also highlights the reversible nature of acute renal failure due to intravascular hemolysis and demonstrates the importance of early surgical intervention for this condition. PMID:23439352

Altarabsheh, Salah Eldien; Deo, Salil V; Rihal, Charanjit S; Park, Soon J

2013-02-01

168

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

PubMed Central

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

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

2013-01-01

169

Computational analysis of the effect of valvular regurgitation on ventricular mechanics using a 3D electromechanics model.  

PubMed

Using a three-dimensional electromechanical model of the canine ventricles with dyssynchronous heart failure, we investigated the relationship between severity of valve regurgitation and ventricular mechanical responses. The results demonstrated that end-systolic tension in the septum and left ventricular free wall was significantly lower under the condition of mitral regurgitation (MR) than under aortic regurgitation (AR). Stroke work in AR was higher than that in MR. On the other hand, the difference in stroke volume between the two conditions was not significant, indicating that AR may cause worse pumping efficiency than MR in terms of consumed energy and performed work. PMID:25644379

Lim, Ki Moo; Hong, Seung-Bae; Lee, Byong Kwon; Shim, Eun Bo; Trayanova, Natalia

2015-03-01

170

Mitral Valve Prolapse  

MedlinePLUS

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

171

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

PubMed

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE) helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function. PMID:24732619

Joshi, Shreedhar S; Thimmarayappa, Ashwini; Nagaraja, P S; Jagadeesh, A M; Furtado, Arul; Bhat, Seetharam

2014-01-01

172

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

PubMed

Between January, 2009 and December, 2013, 84 patients were identified who underwent isolated mitral valve surgery in Jamaica at The University Hospital of the West Indies and The Bustamante Hospital for Children. The most common pathology requiring surgery was rheumatic heart disease, accounting for 84% of the procedures performed. The majority of patients had regurgitation of the mitral valve (67%), stenosis of the mitral valve (22%), and mixed mitral valve disease (11%). The most common procedure performed was replacement of the mitral valve (69%), followed by mitral valve repair (29%). Among the patients, one underwent closed mitral commissurotomy. The choice of procedure differed between age groups. In the paediatric population (<18 years of age), the majority of patients underwent repair of the mitral valve (89%). In the adult population (18 years and above), the majority of patients underwent mitral valve replacement (93%). Overall, of all the patients undergoing replacement of the mitral valve, 89% received a mechanical valve prosthesis, whereas 11% received a bioprosthetic valve prosthesis. Of the group of patients who underwent mitral valve repair for rheumatic heart disease, 19% required re-operation. The average time between initial surgery and re-operation was 1.2 years. Rheumatic fever and rheumatic heart disease remain significant public health challenges in Jamaica and other developing countries. Focus must remain on primary and secondary prevention strategies in order to limit the burden of rheumatic valvulopathies. Attention should also be directed towards improving access to surgical treatment for young adults. PMID:25647387

Little, Sherard G

2014-12-01

173

Takotsubo's syndrome after mitral valve repair and rescue with extracorporeal membrane oxygenation.  

PubMed

We report a case of Takotsubo's syndrome in a 37-year-old woman after mitral valve repair for severe mitral regurgitation triggered by a severe protamine reaction that was likely associated with immune-mediated coronary hypersensitivity (Kounis' syndrome) and made worse by resuscitation with high doses of catecholamines. The patient recovered fully after a 4-day course of extracorporeal membrane oxygenation therapy (ECMO). PMID:24792263

Li, Stephanie; Koerner, Michael M; El-Banayosy, Aly; Soleimani, Behzad; Pae, Walter E; Leuenberger, Urs A

2014-05-01

174

Overlapping annuloplasty of the mitral valve in children.  

PubMed

Harmonious reduction of the posterior annulus of the mitral valve can be a useful adjunct to obtain complete valve competence in case of annular dilatation. We present a technique with the use of two resorbable sutures that overlap over the middle third of the posterior annulus that was used in 10 children with good short-term results. Resorption of the sutures should permit subsequent normal growth of the mitral valve. If the primary cause of valvular regurgitation was corrected, it can be expected that the repair will remain stable after resorption of the sutures. PMID:15111215

Prêtre, René; Kadner, Alexander; Dave, Hitendu; Bettex, Dominique; Turina, Marko I

2004-05-01

175

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

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

176

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

Microsoft Academic Search

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

Yongguang Cheng; Hui Zhang

2010-01-01

177

[Comparison of long-term outcome of closed mitral commissurotomy (CMC) versus open mitral commissurotomy (OMC) and mitral valve replacement (MVR)].  

PubMed

To predict the late result of percutaneous mitral balloon valvotomy (PMV), we studied long term outcome of CMC which is similar to PMV in terms of closed heart technic, comparing with those of OMC and MVR. 226 patients with mitral stenosis were studied. 117 patients had CMC, 72 had OMC and 37 had MVR. The cumulative follow up period in these groups were 1892 patient year, 632 patient year and 200 patient year respectively. Postoperative actual survival rate at 5, 10, 15 years in CMC patients were 95 +/- 2%, 91 +/- 3%, 86 +/- 3% respectively. No operative or late death was seen in OMC or MVR patients. Postoperative event free rate at 10 years in OMC or MVR patients (97 +/- 2%, 90 +/- 6%, respectively) were higher than that in CMC patients (79 +/- 4%). Thromboembolism developed in 7 (6%) CMC patients, and 4 of these patients died from cerebral embolism. No patient in OMC or MVR group had thromboembolism. Reoperation was done for mitral restenosis or regurgitation in 40 CMC patients. 15 (38%) of these patients were associated with pulmonary hypertension, and 22 (55%) patients had secondary tricuspid regurgitation. On the other hand, only 1 OMC patient and 1 MVR patient had reoperation due to restenosis or thrombosed artificial valve. These results suggest that PMV should be indicated for restricted cases of mitral stenosis. PMID:1470106

Imoto, K; Kondo, J; Kajiwara, K; Hoshino, K; Hirano, K; Suzuki, S; Matsumoto, A

1992-09-01

178

Does preoperative left heart failure affect outcome and quality of life after mitral valve surgery?  

Microsoft Academic Search

Summary Objective: In patients scheduled for mitral valve surgery, preoperative left heart failure may reflect the degree of mitral valve disease. We assessed the incidence of left heart failure in patients who underwent mitral valve surgery and analysed the impact on mid-term outcome and quality of life in these patients. Methods: The data of 204 consecutive patients who underwent mitral

T. R. Wyss; F. F. Immer; O. F. Donati; T. P. Carrel

179

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)

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.

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

180

Mitral valve surgery - open  

MedlinePLUS

... remove your mitral valve and sew a new one into place. There are two types of mitral valves: Mechanical -- made of man-made (synthetic) materials, such as titanium. These valves last the longest. You will need ...

181

If I Had - Tricuspid Regurgitation  

MedlinePLUS Videos and Cool Tools

... tricuspid insufficiency. That is not necessarily a chronic process but the kind of thing that could be evaluated pretty readily. What is the management of tricuspid regurgitation? Dr. Bonow: The management of ...

182

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

PubMed Central

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

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

2014-01-01

183

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

PubMed Central

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

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

2011-01-01

184

Transfemoral and transseptal valve-in-valve implantation into a failing mitral xenograft with a balloon-expandable biological valve.  

PubMed

Valve-in-valve implantation for degenerated surgical bioprosthetic valves is becoming an increasingly accepted approach in selected high-risk patients. In the past, valve-in-valve implantations have been mainly performed in aortic position and only rarely in mitral position. We describe the case of an 81-year-old female patient with severe mitral regurgitation of a degenerated Carpentier-Edwards biological prosthesis treated by transfemoral and transseptal implantation of a SAPIEN-XT valve. PMID:23176928

Schaefer, Ulrich; Frerker, Christian; Schewel, Dimitry; Thielsen, Thomas; Meincke, Felix; Kreidel, Felix; Kuck, Karl-Heinz

2012-12-01

185

Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk  

Microsoft Academic Search

Objective: Conventional or minimally invasive surgical mitral valve repair (MVR) is the gold-standard treatment for severe mitral regurgitation (MR) of any etiology. Given its good safety profile, trans-catheter MVR with the MitraClip™ device is used increasingly for high-risk or inoperable patients. We report our experience with failed MitraClip™ therapy and its impact on subsequent surgical strategies, such as the feasibility

Lenard Conradi; Hendrik Treede; Olaf Franzen; Moritz Seiffert; Stephan Baldus; Johannes Schirmer; Thomas Meinertz; Hermann Reichenspurner

186

[Determination of the transvalvular gradient using continuous wave Doppler in patients with mitral stenosis. Correlation with the hemodynamic method].  

PubMed

In order to assess the reliability of Doppler echocardiography in the determination of mean mitral gradient 38 consecutive patients (pts) affected by rheumatic mitral valve stenosis (MS) were analyzed by continuous wave Doppler echocardiography (CWD). Cardiac catheterization (CATH) was performed within 24 hours from echocardiographic examination. The mean diastolic mitral gradient (MG) at CATH was calculated by planimetry from simultaneously recorded left ventricular and pulmonary artery wedge pressure. The maximal velocity profile through the mitral valve was used to calculate pressure gradient by CWD. A mean mitral gradient was calculated for each patient by the planimetered velocity profile throughout diastole. MG determined by CATH ranged from 6 to 31 mmHg (mean 15.2 +/- 6.0); MG determined by CWD ranged from 4 to 18 mmHg (mean 10 +/- 3.7). The correlation between CWD and CATH by linear regression analysis was: y = 0.53 X + 1.8; r = 0.85; p less than 0.001. Mean % error of CWD in the assessment of MG was 34.7%. In conclusion this study indicates that CWD seems systematically underestimate MG with respect to CATH. The identification of CWD flow tracings "optimal" for analysis could not represent the maximal velocity of transmitral jet, which is a complex three dimensional entity. In addition non-simultaneous determinations of gradient and day-to-day variations in cardiac output may account for discrepancies between CWD and CATH measurements. PMID:3653587

Moro, E; Nicolosi, G L; Burelli, C; Rellini, G L; Grenci, G; Zanuttini, D

1987-04-01

187

Schistosome Feeding and Regurgitation  

PubMed Central

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

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

2014-01-01

188

Schistosome feeding and regurgitation.  

PubMed

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

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

2014-08-01

189

Assessment of Mitral Annulus Velocity by Doppler Tissue Imaging in the Evaluation of Left Ventricular Diastolic Function  

Microsoft Academic Search

Objectives. This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function.Background. Mitral inflow velocity recorded by Doppler echocardiography has been widely used to evaluate left ventricular diastolic function but is affected by other factors. The mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function.Methods. Mitral annulus

Dae-Won Sohn; In-Ho Chai; Dong-Jun Lee; Hee-Chan Kim; Hyo-Soo Kim; Byung-Hee Oh; Myoung-Mook Lee; Young-Bae Park; Yun-Shik Choi; Jung-Don Seo; Young-Woo Lee

1997-01-01

190

Calcific embolization with infective endocarditis involving the posterior mitral leaflet in a patient with underlying hypertrophic obstructive cardiomyopathy.  

PubMed

We report a case of infective endocarditis (IE) involving the posterior mitral leaflet (PML) with calcific embolization in a patient with hypertrophic obstructive cardiomyopathy (HOCM). Amongst HOCM patients with IE, the anterior mitral leaflet and basal septal myocardium are almost always involved due to the endocardial damage caused by recurrent outflow obstruction and valvular regurgitation. The management of our patient was complicated by moderate mitral stenosis, repeated calcific embolic strokes, dynamic left ventricular outflow track obstruction, and respiratory failure due to flash pulmonary edema. To our knowledge, this is the first reported case of PML involvement in HOCM presenting in this manner. PMID:25030330

Lather, Navneet; Niziolek, Kyle; Toth, Peter; Harris, David M

2015-02-01

191

Regurgitative food transfer among wild wolves  

USGS Publications Warehouse

Few studies of monogamous canids have addressed regurgitation in the context of extended parental care and alloparental care within family groups. We studied food transfer by regurgitation in a pack of wolves on Ellesmere Island, North West Territories, Canada during six summers from 1988 through 1996. All adult wolves, including yearlings and a post-reproductive female, regurgitated food. Although individuals regurgitated up to five times per bout, the overall ratio of regurgitations per bout was 1.5. Pups were more likely to receive regurgitations (81%) than the breeding female (14%) or auxiliaries (6%). The breeding male regurgitated mostly to the breeding female and pups, and the breeding female regurgitated primarily to pups. The relative effort of the breeding female was correlated with litter size ( de Kendall = 0.93, P = 0.01).

Mech, L.D.; Wolf, P.C.; Packard, J.M.

1999-01-01

192

Systematic review of robotic minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

193

Transcatheter aortic valve implantation in a patient with mechanical mitral prosthesis: a lesson learned from an intraventricular clash.  

PubMed

We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. A condition of cardiogenic shock quickly developed. A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards-Sapien valve implantation through the Corevalve. This case strongly demonstrates how much a careful evaluation of the features of the mitral prosthesis and patient anatomy is crucial to select which specific transcatheter bioprosthesis would better perform. PMID:23592397

Testa, Luca; Gelpi, Guido; Bedogni, Francesco

2013-10-01

194

Transcatheter valve-in-valve implantation for degenerated mitral valve bioprosthesis under 3D echocardiographic guidance.  

PubMed

Transcatheter mitral valve-in-valve replacement is increasingly being performed as operator and center experience in transcatheter valve replacement technology and techniques have accrued. Complications, such as valve embolization and paravalvular regurgitation, still occur and relate to valve deployment. The use of novel imaging techniques, such as 3D echocardiography, allows for better differentiation of cardiac structures and appropriate positioning of the transcatheter valve using well-visualized anatomical landmarks. Here the authors describe in images and video the use of 3D echocardiography for deployment of a mitral valve-in-valve. PMID:25134981

Lerakis, Stamatios; Hayek, Salim S; Thourani, Vinod; Babaliaros, Vasilis

2014-09-01

195

Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation.  

PubMed

We report two cases of delayed migration of the Sapien XT device after a successful mitral valve-in-valve (VIV) implantation. The procedure was performed through a transapical approach. Echocardiography was used to choose the size of the Sapien XT device. Although the immediate results were satisfactory both the cases presented with severe regurgitation (1 week and 3 months). Investigations revealed atrial migration of the Sapien device in both the cases, which was confirmed at the time of reoperation. We discuss possible mechanisms, which could have resulted in the delayed migration and highlight the difference between VIV procedures in mitral position versus other positions. PMID:23784983

Bapat, Vinayak Vinnie Nilkanth; Khaliel, Feras; Ihleberg, Leo

2014-01-01

196

Transcatheter valve used in a bailout technique during complicated open mitral valve surgery  

PubMed Central

Here, we describe the case of a 62-year old woman who required aortic and mitral valve replacement plus coronary artery bypass grafting. Transoesophageal echocardiogram revealed stenosis of the aortic valve (Ao valve area, 0.9 cm2; PG, 45 mmHg; MG, 25 mmHg) and a diseased calcified mitral valve with stenosis and regurgitation (mitral valve area, 1.1 cm2; MG, 10 mmHg; RV, 25 ml; ERO, 12 mm2). The mitral annulus calcifications were very deep into the left atrium and the left ventricle muscle, around the full annulus circumference. We decided to avoid complete deep mitral annulus decalcification. The left atrium was surgically exposed, and we deployed a 26-mm Edwards SAPIEN XT endovalve through the left atriotomy. To prevent paravalvular leakage, we then used a pericardial patch to close the gap between the endovalve and the calcified mitral annulus. The postoperative echocardiogram showed perfect anchoring of the endovalve in the mitral annulus without any paravalvular leakage. PMID:23814136

Astarci, Parla; Glineur, David; De Kerchove, Laurent; El Khoury, Gebrine

2013-01-01

197

Transoesophageal Doppler echocardiographic measurement of cardiac output by the mitral annulus method  

PubMed Central

Objective—To compare cardiac output measured by the transoesophageal Doppler and thermodilution techniques. Design—Prospective direct comparison of paired measurements by both techniques in each patient. Setting—Intensive care unit in a cardiovascular centre. Patients—65 patients after open heart surgery (mean (SD) age 53 (12) years). Interventions—Cardiac output was measured simultaneously by the transoesophageal Doppler and thermodilution techniques. Cardiac output was measured again after a mechanical intervention or volume loading. Results—The limits of agreement were ?2·53 to +0·83 1·min?1 for cardiac output measured by the Doppler and thermodilution techniques. This suggests that the Doppler method alone would not be suitable for clinical use. The second measurement of cardiac output by thermodilution was compared with cardiac output estimated from the first and second Doppler measurements and the first thermodilution measurement. The limits of agreement (?0·55 to +0·51 1·min?1) were good enough for clinical use. Conclusions—After cardiac output had been measured simultaneously by both the Doppler and thermodilution techniques, subsequent transoesophageal Doppler alone gave a clinically useful measurement of cardiac output. PMID:1467040

Shimamoto, Hiroyuki; Kito, Hiroyuki; Kawazoe, Kohei; Fujita, Tsuyoshi; Shimamoto, Yoriko

1992-01-01

198

Total preservation of chordae tendinae in mitral valve replacement (MVR).  

PubMed

Chordal papillary integrity is crucial for a good left ventricular performance following mitral valve surgery. From June 1991-July 1993 (2 years), 200 mitral surgeries were performed by the authors out of which MVR were done by preserving all chordae tendineae in 36 patients (18%), ages 11-64 years (mean 36 +/- 13.2 SD), female to male ratio 3:1, New York Heart Association (NYHA) functional class III-IV. Preoperative workup revealed pure mitral stenosis (MS) in 12 patients (33%), mitral regurgitation (MR) in 16 (44%), MS + MR in 7 (19%), MS + aortic regurgitation (AR) in 4 (11%), MR + secundum atrial septal defect (ASD) in 2 (6%), MR + primum ASD in 1, MR + coronary artery disease (CAD) in 1 (3%) and moderate to severe pulmonary hypertension in all. Twenty-two patients (61%) had MVR only, 4 (11%) had MVR + aortic valve replacement (AVR), 10 (29%) had MVR + tricuspid annuloplasty (TVA), MVR + secundum ASD closure in 2 (6%), MVR+primum ASD closure in 1 (3%) and MVR + coronary artery bypass grafting (CABG) in 1 (3%). Bioprosthesis used were: St. Vincents 17 (47%) and Carpentier Edwards 2 (6%). Mechanical valves used were: St. Jude's 1 (3%), Bjork-Shiley 2 (6%), St. Vincents 5 (14%), CarboMedics 9 (25%). Success of the procedure were accomplished in all (100%) and was judged by extubation period of 6-18 hours, decreased pulmonary artery pressure, good prosthetic function and adequate ventricular performance by subsequent echocardiographic assessments. There were no early (< 30 days) mortality. All patients showed NYHA functional class I-II except in one with Marfan syndrome.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7775549

Binafsihi, W; Kirlan, S; Abdulgani, H B

1994-12-01

199

Scintigraphic diagnosis of tricuspid regurgitation  

SciTech Connect

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%.

Tu'meh, S.S. (Harvard Medical School, Boston, MA); Tracy, D.A.; Wynne, J.; Konstam, M.A.; Kozlowski, J.F.; Neumann, A.L.; Holman, B.L.

1982-11-01

200

Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound  

Microsoft Academic Search

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

L Hatle; A Brubakk; A Tromsdal; B Angelsen

1978-01-01

201

Mitral Valve Prolapse.  

ERIC Educational Resources Information Center

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)

Bergy, Gordon G.

1980-01-01

202

Mitral Valve Prolapse  

MedlinePLUS

... and ventricle, separated by the tricuspid (tri-CUSS-pid) valve. With each heartbeat, the atria contract and ... heart pumps blood and how your heart's electrical system works. Mitral Valve Prolapse In MVP, when the ...

203

Mitral Valve Repair Surgery  

MedlinePLUS

... the slide which demonstrates what he has just told you, in terms of placing these sutures, in this ... right before we began the mitral valve work, you were told that we excised the left atrial appendage. Why ...

204

Port-access mitral valve replacement in dogs  

Microsoft Academic Search

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

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

1996-01-01

205

Regurgitation and Gastroesophageal Reflux Disease in Six to Nine Months Old Indonesian Infants  

PubMed Central

Purpose Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months. Methods Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months. Results According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (>3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the "weight for age z-score" trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution. Conclusion Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed. PMID:24511520

Hegar, Badriul; Satari, Debora Hindra I.; Sjarif, Damayanti R.

2013-01-01

206

[Effectiveness of Mitral Natural Folding Plasty for Minimally Invasive Cardiac Surgery Mitral Valve Plasty( MICS MVP)].  

PubMed

We performed 45 cases of Natural folding plasty without leaflet resection for degenerative mitral regurgitation (MR) between September 2005 and July 2014. Twenty cases of 45 were operated by right small intercostal approach (MICS). There was no operative mortality. No patient had greater than mild MR intraoperative transesophageal echocardiography. The median follow-up was 847 (19~1,747) days. One case needed a second pump run performed without complication. One patient had a reoperation performed for recurrent MR 20 months later. Natural folding plasty for degenerative MR with favorable long term out come in our results. This technique is simple and reproducible for most surgeons. Furthermore, with its simplicity and reversibility, we considered it to be suitable for MICS approach. PMID:25595157

Kondo, Shunichi; Tsuboi, Eitoshi; Rokkaku, Kyu; Irie, Yoshihito; Yokoyama, Hitoshi

2015-01-01

207

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

PubMed Central

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

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

208

Efficacy and Safety of Beating Heart Mitral Valve Replacement  

PubMed Central

Background: The interest in beating heart surgery is growing since better results can be obtained with this procedure compared to conventional myocardial protection techniques using cardioplegic solutions. This led us to consider mitral valve replacement with beating heart. Objectives: This study aimed to determine the safety and efficacy of beating heart mitral valve replacement without cross clamp. Methods: This prospective study was conducted on the patients with isolated mitral valve disease requiring mitral valve replacement according to ACC / AHA guidelines. In this study, 15 patients underwent mitral valve replacement using beating heart technique (Group A) and 15 ones underwent mitral valve replacement using arrested heart technique (Group B). The patients were randomized using block randomization. The data were analyzed using the SPSS statistical software. Results: Preoperative parameters were comparable in the two groups. Most of the patients in both study groups were in NYHA class III or IV. Postoperatively, however, most of the patients in the two groups were either in NYHA class I or II. No mortality occurred in the beating heart group, while one mortality occurred in the arrested heart group. The results showed a significant difference between the two groups regarding the mean bypass time, mean operating time, mean ICU stay, and mean length of hospital stay. Conclusions: Beating heart mitral valve replacement is equally safe as the arrested heart technique. Thus, it is recommended as an appropriate alternative to the arrested heart technique for mitral valve replacement. PMID:24936483

Wani, Mohd Lateef; Ahangar, Abdul Gani; Singh, Shyam; Irshad, Ifat; ul-Hassan, Nayeem; Wani, Shadab Nabi; Ahmad Ganie, Farooq; Bhat, Mohd Akbar

2014-01-01

209

Experimental transapical endoscopic ventricular visualization and mitral repair.  

PubMed

Background?An increasing number of experimental beating heart animal studies describe simple transapical mitral valve repairs based on the direct endoscopic visualization of the left ventricle. The aim of our human cadaveric study was to develop a method for more complex transapical endoscopic procedures by on-pump heart operations. Materials and Methods?After preparation of 20 human fresh cadavers, a standard left anterolateral minithoracotomy was performed in the fifth intercostal space and the pericardium was entered. A rigid 0 degree endoscope and the instruments were introduced through a silicon apical port. To restore the natural form of the left heart, CO2 was insufflated. To test the mitral valve competence, the left ventricle was pressure-injected with saline after each step. After transecting the chords of the A2 segment of the anterior mitral leaflet before the experimental mitral valve repair, the tendinous chord was replaced using an especially designed clip chord. The second part of the experiment consisted of a segmental excision of the P2 segment of the posterior mitral leaflet followed by a standard valvuloplasty and suture annuloplasty. Results?With the help of the described transapical endoscopic mitral valve repair technique, we gained direct visual information of the coaptation line of the mitral leaflets as well as the anatomy and function of the subvalvular apparatus. Using intracardiac imaging, we could perform successful transapical complex mitral repair in each case. Conclusion?The minimally invasive transapical endoscopic method has the potential to offer advantages for on-pump mitral valve repair procedures even in complex mitral valve repair cases. PMID:25207488

Ruttkay, Tamas; Czesla, Markus; Nagy, Henrietta; Götte, Julia; Baksa, Gabor; Patonay, Lajos; Doll, Nicolas; Galajda, Zoltan

2015-04-01

210

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy  

PubMed Central

The MitraClip percutaneous mitral valve repair system, developed as an option for percutaneous mitral repair, was clinically introduced in 2007. From 2010 through 2012, 6 of our patients underwent mitral valve surgery after MitraClip failure. Their mean age was 75 ± 7.7 years (range, 62–87 yr). Three had undergone cardiac surgery previously. In 5 of the 6 patients, mitral regurgitation recurred after initially successful MitraClip deployment and was the indication for surgery. The mean interval between MitraClip implantation and surgery was 106 ± 86 days (range, 0–238 d). Mitral valve repair was feasible in 3 patients; the others underwent valve replacement. All the patients underwent additional cardiac procedures, because the MitraClip worsened existing conditions. Echocardiograms revealed sufficient valvular repairs. Two patients died during hospitalization, one of cerebral infarction and the other of bowel ischemia. Mitral valve repair after failed MitraClip therapy can be complex and a surgical challenge. Careful consideration should be given to appropriate patient selection for MitraClip therapy, because the MitraClip can cause existing pathologic valvular conditions to deteriorate substantially. The interval between MitraClip failure and corrective surgery should be as short as possible. The primary indication is an issue of ongoing discussion. PMID:25593525

Zierer, Andreas; Khalil, Mahmud; Ay, Mahmut; Beiras-Fernandez, Andres; Moritz, Anton; Stock, Ulrich Alfred

2014-01-01

211

Emerging Trends in Heart Valve Engineering: Part III. Novel Technologies for Mitral Valve Repair and Replacement.  

PubMed

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

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

2015-04-01

212

Neisseria sicca endocarditis requiring mitral valve replacement in a previously healthy adolescent.  

PubMed

Infective endocarditis due to Neisseria sicca, a normal inhabitant of the upper respiratory tract, is rarely reported but associated with embolic phenomena and large vegetations often requiring surgical intervention. We report a previously healthy 12-year-old girl who presented with prolonged fever and altered mental status. The patient developed rapidly progressive respiratory insufficiency and cardiovascular instability, and echocardiography demonstrated a large vegetation on the mitral valve. She developed worsening mitral regurgitation with resultant pulmonary hemorrhage and underwent mitral valve replacement. Her blood culture was positive for N. sicca. This infection should be considered in patients with prolonged high fever and multiorgan dysfunction. Despite a typically severe course, reported mortality is low. PMID:21975499

Aronson, Paul L; Nelson, Kyle A; Mercer-Rosa, Laura; Donoghue, Aaron

2011-10-01

213

[Left ventricular outflow tract obstruction after mitral valve plasty; report of a case].  

PubMed

A 65-year-old female was admitted to our hospital with mitral regurgitation (MR). Transthoracic echocardiography showed severe mitral valve prolapse and subaortic septal hypertrophy with no pressure gradient. Mitral valve plasty consisted of artificial chorda implantation and ring annuloplasty was performed. During intensive care unit( ICU) stay after operation, systolic murmur and low cardiac output syndrome were noted and echocardiography revealed left ventricular outflow tract obstruction (LVOTO) without systolic anterior motion and MR. Cessation of catecholamine, volume administration, beta-blocker and negative inotropic drug like cibenzoline rapidly reduced LVOTO and the hemodynamic condition was improved. Even in a case of subaortic septal hypertrophy with no pressure gradient, emergence of LVOTO should be considered when new systolic murmur and low cardiac output syndrome appeared. PMID:25201369

Takahashi, Ai; Uchida, Tetsuro; Kim, Cholsu; Maekawa, Yoshiyuki; Jimbu, Ryota; Mizumoto, Masahiro; Hirooka, Shuto; Yasumoto, Takumi; Yoshimura, Yukihiro; Sadahiro, Mitsuaki

2014-09-01

214

Atypical Early Aspergillus Endocarditis Post Prosthetic Mitral Valve Repair: A Case Report  

PubMed Central

A 64-year-old female operated 1 month previous for mitral valve repair presented with acute respiratory distress and dyspnea. Echocardiography showed large echogenic valvular mass measuring 2.3 × 1.3 cm with severe mitral regurgitation and dehiscence of the mitral ring posteriorly. The mass was attached subvalvularly to the ventricular septal-free wall and eroding through it, which required complete aggressive dissection of the infected tissues. Diagnosis was confirmed after resection of the valve by multiple negative blood cultures and positive valvular tissue for Aspergillus fumigatus endocarditis. She was treated with high dose of voriconazole for 3 months. Her postoperative period was complicated by acute-on-chronic renal failure. She responded very well to the management.

Abuzaid, Ahmed AbdulAziz; Zaki, Mahmood; Tarif, Habib

2015-01-01

215

Scintigraphic diagnosis of tricuspid regurgitation  

SciTech Connect

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 less than 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%.

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

1982-11-01

216

Ruptured giant mitral valve aneurysm: an unexpected finding in a diabetic patient with dyspnea and new-onset atrial fibrillation.  

PubMed

Mitral valve aneurysm (MVA) is a rare valve disease. The case is reported of pathologically proven MVA in a 61-year-old diabetic male with chronic alcoholic liver disease who presented with dyspnea and new-onset atrial fibrillation, without clinical elements of current or recent infection. Transthoracic echocardiography revealed a 'cystic' formation of the anterior mitral leaflet (AML) with mild mitral regurgitation (MR) and aortic regurgitation (AR) hitting the AML. Transesophageal echocardiography (TEE) showed clearly that the formation on the AML was a valve aneurysm, and depicted the site of aneurysm rupture with an additional jet of MR through the rupture. Following mitral valve replacement, pathology of the excised valve showed chronic bacterial endocarditis with calcified bacterial colonies, myxomatous changes with fibrinoid dissection of lamina fibrosa, and neovascularization of the leaflet. The mechanisms of MVA formation are discussed, together with its potential complications, diagnostic modalities and therapeutic strategies. The present case emphasizes that MVA is often a remnant of endocarditis, even when the latter is clinically silent and undiagnosed. The importance of chronic AR directed towards the AML as a predisposing condition for MVA formation is also underlined in this case. The superiority of TEE in providing a full exploration of the mitral valve morphology is verified. PMID:25803977

Trifunovic, Danijela; Vujisic-Tesic, Bosiljka; Bozic, Vesna; Petrovic, Milan; Ostojic, Miodrag

2014-07-01

217

Mitral valve surgery: wait and see vs. early operation.  

PubMed

Mitral valve repair represents the optimal surgical treatment for severe degenerative mitral regurgitation. According to the current guidelines, mitral repair is indicated in the presence of symptoms and/or signs of left ventricular (LV) dysfunction. In asymptomatic patients with preserved LV function, surgery should be considered in the presence of atrial fibrillation (AF) and/or pulmonary hypertension. In asymptomatic patients with preserved LV function, normal pulmonary artery pressure, and no episodes of AF, surgical timing is still an object of debate. The controversial issue is whether, in those circumstances, a 'wait and see (watchful waiting)' approach should be followed or an 'early repair' policy should be preferred. Indeed, a randomized trial comparing the two strategies has never been performed. In the absence of evidence-based arguments definitely supporting any particular course of action, advantages, drawbacks, and requirements for both strategies will be discussed in this review on the basis of the most significant observational studies which have focused on this issue. PMID:22933568

De Bonis, Michele; Bolling, Steven F

2013-01-01

218

Mitral Valve Prolapse  

MedlinePLUS

Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of the valve are "floppy" and ... to run in families. Most of the time, MVP doesn't cause any problems. Rarely, blood can ...

219

Mitral Valve Prolapse  

MedlinePLUS

... to limit participation in competitive sports. If your mitral valve prolapse causes chest pain or other symptoms, your doctor might prescribe medicines such as beta blockers to make your symptoms better. ... valve prolapse, infection (called bacterial endocarditis) can occur in the ...

220

Mitral valve repair versus replacement in simultaneous aortic and mitral valve surgery  

PubMed Central

BACKGROUND: Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated. METHODS: A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival. RESULTS: The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age >70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival. CONCLUSIONS: In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation. PMID:24294032

Urban, Marian; Pirk, Jan; Szarszoi, Ondrej; Skalsky, Ivo; Maly, Jiri; Netuka, Ivan

2013-01-01

221

[Influence of surgical intervention on the course of patients with rheumatic mitral valvular defects].  

PubMed

A retrospective study of 798 patients from Essen University Medical Hospital during the period 1960-1987 with operation performed due to valvular heart disease was undertaken. Among them were 324 suffering from mitral stenosis, 12 from mitral regurgitation, 462 from mixed mitral valvular diseases. The surgical treatment consisted of commissurotomy in 611 patients, and prosthetic valve replacement in 187 patients. Follow-up studies showed: Before and after operation, occurrence of embolism was 16.5 vs 8.7%; status of class of cardiac function (NYHA) from group with commissurotomy was 3.1 vs 2.0; NYHA classification in group of prosthetic replacement was 3.1 vs 1.9; 10 years survival rate after commissurotomy was 95.2%; after valve replacement it was 80.2%; early letality rate after operation (at or within 2 months after operation) depended on 1) the type of operation: commissurotomy 2.8%, valve replacement 10.2%; 2) the state of cardiac function: in class IV it was 12.9%, in class III 4.6%; 3) the number of operations: in only operation it was 4.8%, in reoperations 19.5%. Thus the following fact will lead to false judgement: though the area is the same, the regurgitant volume may vary with the brightness of coloration. Furthermore the left auricle will be enlarged consequently following the increase of regurgitant volume, also causing misinterpretation. It is of practical importance to consider some other factors in quantifying the regurgitant volume. PMID:2098579

Wang, L; Wehr, M; Hager, W

1990-01-01

222

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

PubMed

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

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

2015-03-01

223

Mitral Valve Prolapse (For Parents)  

MedlinePLUS

... a Heart Defect Atrial Septal Defect Heart and Circulatory System Congenital Heart Defects Arrhythmias Heart Murmurs Your Heart & Circulatory System Mitral Valve Prolapse Marfan Syndrome Ventricular Septal Defect ...

224

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

PubMed

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

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

2015-03-01

225

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

PubMed Central

A noninvasive method is described for measuring the pressure drop across the mitral valve in mitral stensois by Doppler ultrasound. A maximum frequency estimator was used to record maximum velocity in the Doppler signal from the mitral jet. Provided the angle between the ultrasound beam and the maximum velocity is close to zero the pressure drop can be calculated directly. Good correlation was found between Doppler measurements and simultaneous pressure recordings during heart catheterisation in 10 patients. No false negative or false positive diagnoses of mitral stenosis were made among 55 patients (35 patients with mitral stenosis and 20 patients with other valve lesions). The measurements were easy to perform in most patients and the method seems well suited both to diagnose and to follow patients with mitral stenosis. PMID:637964

Hatle, L; Brubakk, A; Tromsdal, A; Angelsen, B

1978-01-01

226

Mid-term results of mitral valve repair for complicated active bacterial endocarditis in high-risk patients.  

PubMed

Mitral valve repair in endocarditis achieves a competent valve and prevents septic embolization and acute left ventricular failure, in which operative mortality could be increased. Early and mid-term results were examined to establish whether emergency mitral valve repair offers an advantage in complicated active endocarditis. Ten patients with complicated active native valve endocarditis underwent mitral valve repair. The mean age was 45.8 +/- 18.5 years; two patients were female (20%). All patients had severe mitral regurgitation, which combined in one patient with mitral valve stenosis. New York Heart Association (NYHA) functional class was IV in all patients. The macroscopically infected tissue with vegetation in all patients was excised. Multiple techniques were required to achieve valve competence. There was one (10%) hospital death in a patient with persistent congestive heart failure, and a reoperation in another (10%) after 2 years. Mean follow-up was 32.1 +/- 12.7 months (range 1-45 months) and was complete. There were no late deaths, recurrent endocarditis, or thromboembolic events. Seven patients (77.7%) were in NYHA functional class I, and two (22.2%) were in class II. Mitral valve repair in complicated active bacterial endocarditis limited to leaflet tissues has a low operative mortality and valve-related morbidity, with promising mid-term survival in high-risk patients. PMID:15278391

Cebi, Niyazi; Bozkurt, Engin

2004-07-01

227

The edge-to-edge technique as a trick to rescue an imperfect mitral valve repair  

Microsoft Academic Search

Objective: The edge-to-edge (E-to-E) technique in mitral valve repair (MVR) is promising especially to correct mitral insufficiency (MI) caused by complex mitral valve lesions. We tested this technique to improve residual MI straight after conventional MVR. Methods: From September 1998 to January 2002, 108 consecutive patients underwent MVR with current techniques for pure MI. Intraoperative transesophageal echocardiography was performed before

Giuseppe Gatti; Gabriele Cardu; Rosanna Trane; Peppino Pugliese

2002-01-01

228

The edge-to-edge technique as a trick to rescue an imperfect mitral valve repair  

Microsoft Academic Search

Objective: The edge-to-edge (E-to-E) technique in mitral valve repair (MVR) is promising especially to correct mitral insufficiency (MI) caused by complex mitral valve lesions. We tested this technique to improve residual MI straight after conventional MVR. Methods: From September 1998 to January 2002, 108 consecutive patients underwent MVR with current techniques for pure MI. Intraoperative transeso- phageal echocardiography was performed

Giuseppe Gatti; Gabriele Cardu; Rosanna Trane; Peppino Pugliese

2010-01-01

229

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

PubMed

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

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

2014-09-01

230

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

preservation techniques have on long-term outcomes following mitral valve replacement. This study investigated the effect of sub-valvular apparatus preservation on long-term survival and quality of life following mitral valve replacement. Methods A...

Rao, Christopher; Hart, Jonathan; Chow, Andre; Siannis, Fotios; Tsalafouta, Polyxeni; Murtuza, Bari; Darzi, Ara; Wells, Frank C; Athanasiou, Thanos

2008-04-23

231

Myocardial deformation and rotational profiles in mitral valve prolapse.  

PubMed

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

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

2013-10-01

232

Combined mitral valve repair, LVOT myectomy and left atrial cryoablation therapy.  

PubMed

Asymmetric septal hypertrophy (ASH) is a common cause of left ventricular (LV) outflow tract obstruction. Mitral valve (MV) regurgitation is present in 30% of those patients as well as biatrial enlargement. Furthermore, paroxysmal or chronic atrial fibrillation (AF) occurs in up to 22%. Two male patients were admitted for shortness of breath and decreased physical ability. Hypertrophic obstructive cardiomyopathy (HOCM) with ASH, severe MV regurgitation and chronic AF were diagnosed in both patients; present for 8 years in patient 1 and 1 year in patient 2. Both received MV annuloplasty, transaortic septal resection using the modified Morrow et al.'s technique and left atrial cryoablation therapy via median sternotomy. Intraoperative measurement revealed no residual gradients and competent MV, furthermore, both patients were discharged in sinus rhythm. PMID:17670105

Opfermann, U T; Doll, N; Walther, T; Mohr, F W

2003-12-01

233

Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation.  

PubMed

The purpose of this study was to investigate the independent factors associated with the presence of left atrial (LA) spontaneous echo contrast (SEC) and thromboembolic events in patients with mitral stenosis (MS) in chronic atrial fibrillation (AF). Factors independently associated with LASEC, thrombi, and embolic events have been mainly investigated in patients with nonvalvular AF or inhomogeneous populations with rheumatic heart disease. Transesophageal and transthoracic echo studies were performed in 129 patients with MS in chronic AF. Previous embolic events were documented in 45 patients, 20 of them within 6 months, and 65 patients were receiving long-term anticoagulation. The intensity of LASEC and mitral regurgitation, the presence of thrombi and active LA appendage flow (peak velocities > or = 20 cm/s), and LA volume as well as other conventional echo-Doppler determinations were investigated in every patient. The prevalences of significant LASEC (degrees 3+ and 4+), thrombus, active LA appendage flow, and significant mitral regurgitation (>2+) were: 52% (67 patients), 29.5% (38 patients), 32% (41 patients), and 36% (47 patients), respectively. Multivariate analysis showed that decreasing mitral regurgitation severity, absence of active LA appendage flow, and mitral valve area were the independent correlates of LASEC (odds ratio [OR] 3.7, 5.4, and 0.17, respectively; all p <0.02). Active LA appendage flow and anticoagulant therapy were associated negatively, whereas the severity of LASEC was associated positively with the finding of LA thrombus (OR 9.6, 3.9, and 1.6, respectively; all p <0.05). The intensity of LASEC and previous anticoagulant therapy (OR 1.74 and 4.5, respectively; p <0.005) were the independent covariates of thrombi and/or recent embolic events. In conclusion, the severity of mitral regurgitation and lack of active LA appendage flow were, respectively, the strongest independent correlates of significant LASEC and thrombus in patients with MS in chronic AF. LASEC remains the cardiac factor most strongly associated with thrombus and/or recent embolic events in these patients. PMID:11009271

González-Torrecilla, E; García-Fernández, M A; Pérez-David, E; Bermejo, J; Moreno, M; Delcán, J L

2000-09-01

234

Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease  

PubMed Central

AIM: To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD). METHODS: Data from patients with GERD, who were diagnosed according to the Montreal definition, were collected between January 2009 and July 2010. The enrolled patients were assigned to a heartburn or a regurgitation group, and further assigned to an erosive esophagitis (EE) or a non-erosive reflux disease (NERD) subgroup, depending on the predominant symptoms and endoscopic findings, respectively. The general demographic data, the scores of the modified Chinese version of the GERDQ and the Short-form 36 (SF-36) questionnaire scores of these groups of patients were compared. RESULTS: About 108 patients were classified in the heartburn group and 124 in the regurgitation group. The basic characteristics of the two groups were similar, except for male predominance in the regurgitation group. Patients in the heartburn group had more sleep interruptions (22.3% daily vs 4.8% daily, P = 0.021), more eating or drinking problems (27.8% daily vs 9.7% daily, P = 0.008), more work interferences (11.2% daily vs none, P = 0.011), and lower SF-36 scores (57.68 vs 64.69, P = 0.042), than patients in the regurgitation group did. Individuals with NERD in the regurgitation group had more impaired daily activities than those with EE did. CONCLUSION: GERD patients with heartburn or regurgitation predominant had similar demographics, but those with heartburn predominant had more severely impaired daily activities and lower general health scores. The NERD cases had more severely impaired daily activity and lower scores than the EE ones did. PMID:25232262

Lee, Shou-Wu; Lien, Han-Chung; Lee, Teng-Yu; Yang, Sheng-Shun; Yeh, Hong-Jeh; Chang, Chi-Sen

2014-01-01

235

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

PubMed

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

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

2014-01-01

236

Value of Robotically Assisted Surgery for Mitral Valve Disease  

PubMed Central

Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotic surgery mitigate high technology costs. Design Clinical cohort study comparing costs of robotic vs. three contemporaneous conventional surgical approaches for degenerative mitral disease. Surgery was performed from 2006–2011, and comparisons were based on intent-to-treat, with propensity-matching used to reduce selection bias. Setting Large multi-specialty academic medical center. Participants 1,290 patients aged 57±11 years, 27% women, underwent mitral repair for regurgitation from posterior leaflet prolapse. Robotic surgery was used in 473, complete sternotomy in 227, partial sternotomy in 349, and anterolateral thoracotomy in 241. Three propensity-matched groups were formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiology, and echocardiographic measurements: robotic vs. sternotomy (n=198 pairs) vs. partial sternotomy (n=293 pairs) vs. thoracotomy (n=224 pairs). Interventions Mitral valve repair. Main Outcome Measures Cost of care, expressed as robotic capital investment, maintenance, and direct technical hospital cost, and benefit of care, based on differences in recovery time. Results Median cost of care for robotically assisted surgery exceeded the cost of alternative approaches by 27% (?5%, 68%), 32% (?6%, 70%), and 21% (?2%, 54%) (median [15th, 85th percentiles]) for complete sternotomy, partial sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: median 35 days for robotic surgery, 49 for complete sternotomy, 56 for partial sternotomy, and 42 for anterolateral thoracotomy. Resulting net differences in cost of robotic surgery vs. the three alternatives were 16% (?15%, 55%), 16% (?19%, 51%), and 15% (?7%, 49%), respectively. Beyond a volume threshold of 55–100 robotic cases per year, confidence limits for the cost of robotic surgery broadly overlapped those of conventional approaches. Conclusions In exchange for higher procedural costs, robotically assisted mitral valve surgery offers the clinical benefit of least invasive surgery, lowest postoperative cost, and fastest return to work. The value of robotically assisted surgery comparable to conventional approaches can only be realized in high-volume centers. PMID:24848944

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

2014-01-01

237

Mitral valvuloplasty: when the art of repair meets the biological science.  

PubMed

The majority of approaches currently described and practiced in mitral repair surgery result in the vertical immobilization of the posterior leaflet, with the anterior leaflet striving to produce an adequate coaptation. Despite the satisfactory hemodynamic outcome and disappearance of mitral regurgitation, this non-physiological situation results in a redistribution of forces within the mitral apparatus with an increased stress on the leaflets. Biological evidences are pointing at the ability of the valvular interstitial cells to actively respond to biomechanical changes, switching their phenotype and producing different patterns of extracellular matrix proteins. This biological event translates to changes in the anatomical and mechanical properties of the leaflets, leading to an increased stiffening and a susceptibility to develop calcification. These concepts find a clinical reflex in reports on the long-term thickening and calcification of the leaflets after mitral repair, and in the leaflets remodeling phenomena described in chronically dilated ventricles. The importance of respecting the physiological movement and dynamics of the leaflets when performing a valvuloplasty is underlined, and a potential pharmacological modulation of the aforementioned biological processes to ameliorate long-term results of the repair is hypothesized. PMID:25296452

Spadaccio, Cristiano; Gutermann, Herbert; Dion, Robert

2014-05-01

238

Mitral valve billow and prolapse: a brief review at 45 years  

PubMed Central

Summary Summary Barlow’s syndrome has become a regular, often-used and very often misused diagnosis. Its description followed extensive, prolonged and detailed clinical observation by JB Barlow and his co-workers. This major research effort was necessary because of the protean manifestations of the condition. The differentiation of Barlow’s syndrome from other conditions with similar and sometimes identical symptoms requires clear and unambiguous criteria. These criteria were identified by penetrative clinical research. Consequently, it became possible to diagnose Barlow’s syndrome with a high degree of specificity. Almost equally important were the gains made in understanding various conditions with similar symptoms but totally different management. An example of which, understanding some of the electrocardiographic patterns that emerge on effort in patients with ischaemic heart disease. Similarly, understanding mitral valve billow led to a greater knowledge of the entire pathophysiology of the mitral valve closure and important aspects of mitral regurgitation. Primary mitral valve billow, Barlow’s syndrome, resulted from clinical research of the highest quality and has had a major application in clinical medicine. PMID:19287811

Obel, IWP

2009-01-01

239

Regurgitative Food Transfer Among Wild Wolves  

NSDL National Science Digital Library

The Northern Prairie Wildlife Research Center (NPWRC) has made available several resources on wolves. This paper, on regurgitative food transfer, was written by L. David Mech and others and originally published in Canadian Journal of Zoology in 1995 [77:1192-1195]. The paper may be viewed online or downloaded as .zip files.

Mech, L. David.

2000-01-01

240

Aortic regurgitation: disease progression and management  

Microsoft Academic Search

Aortic regurgitation (AR) is a common valvular heart disease that unless appropriately managed is associated with morbidity and mortality. Left ventricular (LV) mechanics and aortic impedance are the main determinants of outcome in patients with AR and govern clinical management. Mild and moderate AR in individuals with normal LV dimensions are both generally benign. In the absence of symptoms and

Jonathan L Halperin; Seth H Goldbarg

2008-01-01

241

Mitral valve surgery - minimally invasive  

MedlinePLUS

... remove your mitral valve and sew a new one into place. There are two main types of new valves: Mechanical -- made of man-made materials, such as titanium and carbon. These valves last the longest. You ...

242

Living with Mitral Valve Prolapse  

MedlinePLUS

... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To ... Media Availability: Mitral valve repair following heart attack may offer ...

243

Prevalence of gastro-oesophageal reflux disease with upper gastrointestinal symptoms without heartburn and regurgitation  

PubMed Central

Background: Symptomatically ‘silent’ gastro-oesophageal reflux disease (GORD) may be underdiagnosed. Objective: To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care. Methods: Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom–acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist. Results: GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a ‘troublesome’ frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ. Conclusions: Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD. PMID:25360300

Wernersson, Börje; Ohlsson, Lis; Dent, John

2014-01-01

244

The papillary muscles as shock absorbers of the mitral valve complex. An experimental study  

Microsoft Academic Search

Objective: Although it is known that the papillary muscles ensure the continuity between the left ventricle (LV) and the mitral apparatus, their precise mechanism needs further study. We hypothesize that the papillary muscles function as shock absorbers to maintain a constant distance between their tips and the mitral annulus during the entire cardiac cycle. Materials and methods: Sonomicrometry crystals were

Thomas M. Joudinaud; Corrine L. Kegel; Erwan M. Flecher; Patricia A. Weber; Emmanuel Lansac; Ulrich Hvass; Carlos M. G. Duran

2007-01-01

245

Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy  

Microsoft Academic Search

Objective: This study reports initial results of partial left ventriculectomy performed with preservation of the mitral valve in the treatment of 27 patients with idiopathic dilated cardiomyopathy. Methods: Patients were in New York Heart Association class III or IV. Partial ventriculectomy was performed as an isolated procedure in four patients and associated with mitral annuloplasty in 23 patients. There were

Luiz Felipe P. Moreira; Noedir A. G. Stolf; Edimar A. Bocchi; Fernando Bacal; Maria C. P. Giorgi; José R. Parga; Adib D. Jatene

1998-01-01

246

Fibroblast growth factor 2 regulation of mitral valve interstitial cell repair in vitro  

Microsoft Academic Search

Objective: Because elongated mitral valve interstitial cells have features of myofibroblasts, it is likely that these cells are essential for the repair of injured valve leaflets. We characterized the cellular morphology and pattern of repair of these interstitial cells in wounds produced in vitro and tested the hypothesis that fibroblast growth factor 2 enhances interstitial cell repair. Methods: Mitral valve

Avrum I. Gotlieb; Alan Rosenthal; Pedram Kazemian

2002-01-01

247

Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study  

PubMed Central

Objective Mitral annular/leaflet calcification (MALC) is frequently observed in patients with degenerative aortic stenosis (AS). However, the impact of MALC on mitral valve function has not been established. We aimed to investigate whether MALC reduces mitral annular area and restricts leaflet opening, resulting in non-rheumatic mitral stenosis. Methods Real-time three-dimensional transoesophageal images of the mitral valve were acquired in 101 patients with degenerative AS and 26 control participants. The outer and inner borders of the mitral annular area (MAA) and the maximal leaflet opening angle were measured at early diastole. The mitral valve area (MVA) was calculated as the left ventricular stroke volume divided by the velocity time integral of the transmitral flow velocity. Results Although the outer MAA was significantly larger in patients with AS compared to control participants (8.2±1.3 vs 7.3±0.9?cm2, p<0.001), the inner MAA was significantly smaller (4.5±1.1 vs 5.9±0.9?cm2, p<0.001), resulting in an average decrease of 45% in the effective MAA. The maximal anterior and posterior leaflet opening angle was also significantly smaller in patients with AS (64±10 vs 72±8°, p<0.001, 71±12 vs 87±7°, p<0.001). Thus, MVA was significantly smaller in patients with AS (2.5±1.0 vs 3.8±0.8?cm2, p<0.001). Twenty-four (24%) patients with AS showed MVA <1.5?cm2. Multivariate regression analysis including parameters for mitral valve geometry revealed that a decrease in effective MAA and a reduced posterior leaflet opening angle were independent predictors for MVA. Conclusions Calcific extension to the mitral valve in patients with AS reduced effective MAA and the leaflet opening, resulting in a significant non-rheumatic mitral stenosis in one-fourth of the patients. PMID:25332828

Iwataki, Mai; Takeuchi, Masaaki; Otani, Kyoko; Kuwaki, Hiroshi; Yoshitani, Hidetoshi; Abe, Haruhiko; Lang, Roberto M; Levine, Robert A; Otsuji, Yutaka

2014-01-01

248

Effect of leaflet-to-chordae contact interaction on computational mitral valve evaluation  

PubMed Central

Background Computational simulation using numerical analysis methods can help to assess the complex biomechanical and functional characteristics of the mitral valve (MV) apparatus. It is important to correctly determine physical contact interaction between the MV apparatus components during computational MV evaluation. We hypothesize that leaflet-to-chordae contact interaction plays an important role in computational MV evaluation, specifically in quantitating the degree of leaflet coaptation directly related to the severity of mitral regurgitation (MR). In this study, we have performed dynamic finite element simulations of MV function with and without leaflet-to-chordae contact interaction, and determined the effect of leaflet-to-chordae contact interaction on the computational MV evaluation. Methods Computational virtual MV models were created using the MV geometric data in a patient with normal MV without MR and another with pathologic MV with MR obtained from 3D echocardiography. Computational MV simulation with full contact interaction was specified to incorporate entire physically available contact interactions between the leaflets and chordae tendineae. Computational MV simulation without leaflet-to-chordae contact interaction was specified by defining the anterior and posterior leaflets as the only contact inclusion. Results Without leaflet-to-chordae contact interaction, the computational MV simulations demonstrated physically unrealistic contact interactions between the leaflets and chordae. With leaflet-to-chordae contact interaction, the anterior marginal chordae retained the proper contact with the posterior leaflet during the entire systole. The size of the non-contact region in the simulation with leaflet-to-chordae contact interaction was much larger than for the simulation with only leaflet-to-leaflet contact. Conclusions We have successfully demonstrated the effect of leaflet-to-chordae contact interaction on determining leaflet coaptation in computational dynamic MV evaluation. We found that physically realistic contact interactions between the leaflets and chordae should be considered to accurately quantitate leaflet coaptation for MV simulation. Computational evaluation of MV function that allows precise quantitation of leaflet coaptation has great potential to better quantitate the severity of MR. PMID:24649999

2014-01-01

249

Mitral Annulus Segmentation from Three-Dimensional Ultrasound.  

PubMed

An accurate and reproducible segmentation of the mitral valve annulus from 3D ultrasound is useful to clinicians and researchers in applications such as pathology diagnosis and mitral valve modeling. Current segmentation methods, however, are based on 2D information, resulting in inaccuracies and a lack of spatial coherence. We present a segmentation algorithm which, given a single user-specified point near the center of the valve, uses max-flow and active contour methods to delineate the annulus geometry in 3D. Preliminary comparisons to manual segmentations and a sensitivity study show the algorithm is both accurate and robust. PMID:22011812

Schneider, Robert J; Perrin, Douglas P; Vasilyev, Nikolay V; Marx, Gerald R; Del Nido, Pedro J; Howe, Robert D

2009-01-01

250

[Intensity of tone and opening snap, and morphology of the bicuspid valve in patients with mitral valve disease].  

PubMed

The purpose of this study was to investigate the correlation between mitral valve morphology and amplitude of the first heart sound and the opening snap. The material consisted of 21 women and 19 men with mitral valve disease. They ranged in age from 24 to 56 years. 36 patients had pure or dominant mitral stenosis and 4 patients had combined mitral valve disease with dominant regurgitation. Phonocardiograms were recorded in all patients before mitral valve replacement. We analyzed the presence and the amplitude of opening snap and the amplitude of the first heart sound at the apex. The amplitude of the opening snap was expressed in mm and as a ratio to the maximal vibration of the second sound in the same cycle. The amplitude of the first sound was expressed in mm and as a ratio of the maximal vibration of the first sound to the maximal vibration of the first sound to the maximal vibration of the second sound in the same cycle. All amplitude measurements were made in 10 consecutive cardiac cycles and were then averaged. Then we studied all mitral valves removed in a uniform manner by one surgeon. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs (fig. 1). The mitral valve area and calcification area were estimated by planimetry of radiographs. Then we analyzed the localization of calcification and we calculated the ratio of calcification area to valve area. Valves were divided into three groups according to the degree of the fusion of subvalvular structures ("a funnel") (fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1942750

Mularek, T; Grajek, S; Jasi?ski, K; Dyszkiewicz, W; Ponizy?ski, A

1991-01-01

251

Robotic mitral valve surgery.  

PubMed

A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for placement of an atrial retractor, as well as needle, tissue, and suture retrieval. With the development of specialized retractors and a delivery/retrieval port, a truly endoscopic approach will be consistently reproducible. New navigation systems and image guided surgery portend an improving future for robotic cardiac surgery. Recently, we have combined robotically guided microwave catheters for ablation of atrial fibrillation with robotic mitral valve repairs (Fig. 8). Thus, we are beginning to achieve the ideal operation, with a native valve repair and a return to normal sinus rhythm. Robotic cardiac surgery is an evolutionary process, and even the greatest skeptics must concede that progress has been made toward endoscopic cardiac valve operations. Surgical scientists must continue to critically evaluate this technology in this new era of cardiac surgery. Despite enthusiasm, caution cannot be overemphasized. Surgeons must be careful because indices of operative safety, speed of recovery, level of discomfort, procedural cost, and long-term operative quality have yet to be defined. Traditional valve operations still enjoy long-term success with ever-decreasing morbidity and mortality, and remain our measure for comparison. Surgeons must remember that we are seeking the most durable operation with the least human trauma and quickest return to normalcy, all done at the lowest cost with the least risks. Although we have moved more asymptotically to these goals, surgeons alone must map the path for the final ascent. PMID:14712874

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

2003-12-01

252

Use of equilibrium (gated) radionuclide ventriculography to quantitate left ventricular output in patients with and without left-sided valvular regurgitation  

SciTech Connect

We examined the accuracy with which left ventricular output can be estimated by equilibrium radionuclide ventriculography. After red blood cells were labeled in vivo, we measured left ventricular end-diastolic and end-systolic count rates and the count rate in 5 ml of the patient's blood. After estimating the average ratio of counting efficiency for the left ventricle to counting efficiency for the blood sample (Elv/Es) in six patients, we calculated left ventricular output in 26 other patients as (left ventricular activity ejected per minute divided by activity per liter of blood) divided by the previously estimated Elv/Es. Radionuclide left ventricular output closely approximated Fick cardiac output (r . 0.94) in patients without mitral or aortic regurgitation and exceeded Fick cardiac output in all patients with valvular regurgitation. Regurgitant fraction, calculated as the difference between the radionuclide and Fick outputs divided by the radionuclide output, correlated with the severity of of regurgitation as assessed angiographically. The equilibrium radionuclide ventriculogram is an excellent means for noninvasive estimation of left ventricular output.

Konstam, M.A.; Wynne, J.; Holman, B.L.; Brown, E.J.; Neill, J.M.; Kozlowski, J.

1981-09-01

253

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

PubMed Central

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

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

2012-01-01

254

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

E-print Network

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 ...

Leeds, Daniel Demeny

2006-01-01

255

TexMi: Development of Tissue-Engineered Textile-Reinforced Mitral Valve Prosthesis  

PubMed Central

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

Moreira, Ricardo; Gesche, Valentine N.; Hurtado-Aguilar, Luis G.; Schmitz-Rode, Thomas; Frese, Julia

2014-01-01

256

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

PubMed

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

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

2014-09-01

257

Mitral valve surgery after previous CABG with functioning IMA grafts  

Microsoft Academic Search

Background. Mitral valve surgery after previous coronary artery bypass grafting presents a challenging problem for the cardiac surgeon. An injury to patent coronary artery bypass grafts, especially internal mammary artery grafts, during reoperation via a redo sternotomy, may be fatal. Therefore, a reliable alternative to the redo sternotomy is desirable to minimize potential injury to internal mammary artery grafts.Methods. Between

John G Byrne; Sary F Aranki; David H Adams; Robert J Rizzo; Gregory S Couper; Lawrence H Cohn

1999-01-01

258

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)

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.

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

259

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

NASA Technical Reports Server (NTRS)

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

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

2000-01-01

260

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

PubMed Central

Background Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions. Methods A cardiovascular and circulatory system (CVS) model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate "open on pressure, close on flow" law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle. Results Simulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV) loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends. Conclusions The resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves. PMID:21942971

2011-01-01

261

A novel high temporal resolution phase contrast MRI technique for measuring mitral valve flows  

NASA Astrophysics Data System (ADS)

Mitral valve flow imaging is inherently difficult due to valve plane motion and high blood flow velocities, which can range from 200 cm/s to 700 cm/s under regurgitant conditions. As such, insufficient temporal resolution has hampered imaging of mitral valve flows using magnetic resonance imaging (MRI). A novel phase contrast MRI technique, phase contrast using phase train imaging (PCPTI), has been developed to address the high temporal resolution needs for imaging mitral valve flows. The PCPTI sequence provides the highest temporal resolution to-date (6 ms) for measuring in-plane and through-plane flow patterns, with each velocity component acquired in a separate breathhold. Tested on healthy human volunteers, comparison to a conventional retrogated PC-FLASH cine sequence showed reasonable agreement. Results from a more rigorous validation using digital particle image velocimetry technique will be presented. The technique will be demonstrated in vitro using a physiological flow phantom and a St. Jude Medical Masters Series prosthetic valve.

Voorhees, Abram; Bohmann, Katja; McGorty, Kelly Anne; Wei, Timothy; Chen, Qun

2005-11-01

262

Electrophysiological analysis of mitral cells in the isolated turtle olfactory bulb.  

PubMed Central

1. An in vitro preparation of the turtle olfactory bulb has been developed. Electrophysiological properties of mitral cells in the isolated bulb have been analysed with intracellular recordings. 2. Mitral cells have been driven antidromically from the lateral olfactory tract, or activated directly by current injection. Intracellular injections of horseradish peroxidase (HRP) show that turtle mitral cells have long secondary dendrites that extend up to 1800 micrometer from the cell body and reach around half of the bulbar circumference. There are characteristically two primary dendrites, each supplying separate olfactory glomeruli. 3. Using intracellular current pulses, the whole-neurone resistance was found to range from 33 to 107 M omega. The whole-neurone charging transient had a slow time course. The membrane time constant was estimated to be 24-93 msec by the methods of Rall. The electrotonic length of the mitral cell equivalent cylinder was estimated by Rall's methods to be 0.9-1.9. 4. The spikes generated by turtle mitral cells were only partially blocked by tetrodotoxin (TTX) in the bathing medium. The TTX-resistant spikes were enhanced in the presence of tetraethylammonium (TEA), and blocked completely by cobalt. 5. The implications of the electrical properties for impulse generation in turtle mitral cells are discussed. The mitral cells have dendrodendritic synapses onto granule cells, and the TTX-resistant spikes may therefore play an important role in presynaptic transmitter release at these synapses. PMID:7310692

Mori, K; Nowycky, M C; Shepherd, G M

1981-01-01

263

Equilibrium radionuclide gated angiography in patients with tricuspid regurgitation  

SciTech Connect

Equilibrium gated radionuclide angiography was performed in 2 control groups (15 patients with no organic heart disease and 24 patients with organic heart disease but without right- or left-sided valvular regurgitation) and in 9 patients with clinical tricuspid regurgitation. The regurgitant index, or ratio of left to right ventricular stroke counts, was significantly lower in patients with tricuspid regurgitation than in either control group. Time-activity variation over the liver was used to compute a hepatic expansion fraction which was significantly higher in patients with tricuspid regurgitation than in either control group. Fourier analysis of time-activity variation in each pixel was used to generate amplitude and phase images. Only pixels with values for amplitude at least 7% of the maximum in the image were retained in the final display. All patients with tricuspid regurgitation had greater than 100 pixels over the liver automatically retained by the computer. These pixels were of phase comparable to that of the right atrium and approximately 180 degrees out of phase with the right ventricle. In contrast, no patient with no organic heart disease and only 1 of 24 patients with organic heart disease had any pixels retained by the computer. In conclusion, patients with tricuspid regurgitation were characterized on equilibrium gated angiography by an abnormally low regurgitant index (7 of 9 patients) reflecting increased right ventricular stroke volume, increased hepatic expansion fraction (7 of 9 patients), and increased amplitude of count variation over the liver in phase with the right atrium (9 of 9 patients).

Handler, B.; Pavel, D.G.; Pietras, R.; Swiryn, S.; Byrom, E.; Lam, W.; Rosen, K.M.

1983-01-15

264

Dynamic simulation of heart mitral valve with transversely isotropic material model  

E-print Network

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 ...

Weinberg, Eli, 1979-

2005-01-01

265

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

PubMed Central

Background Minimally invasive mitral valve surgery through a mini-thoracotomy approach was developed in the mid-1990s as an alternative to conventional sternotomy, but with reduced trauma and quicker recovery. However, technical demands and a paucity of comparative data have thus far limited the widespread adoption of minimally invasive mitral valve repair (MIMVR). Previous meta-analyses have grouped various surgical techniques and underlying valvular disease aetiologies together for comparison. The present study aimed to compare the clinical outcomes of MIMVR versus conventional mitral valve repair in patients with degenerative mitral valve disease. Methods A systematic review of the current literature was performed through nine electronic databases from January 1995 to July 2013 to identify all relevant studies with comparative data on MIMVR versus conventional mitral valve surgery. Measured endpoints included mortality, stroke, renal failure, wound infection, reoperation for bleeding, aortic dissection, myocardial infarction, atrial fibrillation, readmission within 30 days, cross clamp time, cardiopulmonary bypass time and durations of intensive care unit (ICU) stay and overall hospitalization. Echocardiographic outcomes were also assessed when possible. Results Seven relevant studies were identified according to the predefined study selection criteria, including one randomized controlled trial and six retrospective studies. Meta-analysis of clinical outcomes did not identify any statistically significant differences between MIMVR and conventional mitral valve repair. The duration of ICU stay was significantly shorter for patients who underwent MIMVR, but this did not translate to a shorter hospitalization period. Patients who underwent MIMVR required longer cross clamp time as well as cardiopulmonary bypass time. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes. Pain-related outcomes was assessed in one study and reported significantly less pain for patients who underwent MIMVR. However, this limited data was not suitable for meta-analysis. Conclusions The existing literature has limited data on comparative outcomes after MIMVR versus conventional mitral valve repair for patients with degenerative disease. From the available evidence, there are no significant differences between the two surgical techniques in regards to clinical outcomes. Patients who underwent MIMVR required longer cardiopulmonary bypass and cross clamp times, but the duration of stay in the ICU was significantly shorter than conventional mitral valve repair. PMID:24349970

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

2013-01-01

266

Self-expandable transcatheter aortic valve implantation for aortic stenosis after mitral valve surgery  

PubMed Central

OBJECTIVES Transcatheter aortic valve implantation has emerged as a valuable option to treat patients with symptomatic severe aortic stenosis, who are not being considered for surgery because of significant comorbidities. Concerns exist over treating patients who have previously undergone mitral valve surgery for possible interference between the percutaneous aortic valve and the mitral prosthesis or ring. METHODS At our centre, from May 2008 to December 2012, 172 patients (76 male) with severe symptomatic aortic stenosis were eligible for transcatheter aortic valve implant. Nine patients, affected by severe aortic stenosis, had previously undergone mitral valve surgery (4 mono-leaflet, 3 bileaflet, 1 bioprosthesis, 1 mitral ring); they were considered high-risk surgical candidates following joint evaluation by cardiac surgeons and cardiologist and had undergone TAVI. RESULTS Seven patients underwent standard femoral retrograde CoreValve® (Medtronic Inc., Minneapolis, USA) implantation, two patients underwent a direct aortic implantation through a mini-thoracotomy. All patients experienced immediate improvement of their haemodynamic status. No deformation of the nitinol tubing of the CoreValve, nor distortion or malfunction of the mechanical valve or mitral ring, occurred as assessed by echographical and fluoroscopic evaluation. No major postoperative complications occurred. In all patients , echocardiography indicated normal valve function during follow-up. CONCLUSIONS Our experience confirms the feasibility of CoreValve implantation in patients with mechanical mitral valves or mitral annuloplasty ring. PMID:23537849

Bruschi, Giuseppe; De Marco, Federico; Barosi, Alberto; Colombo, Paola; Botta, Luca; Nonini, Sandra; Martinelli, Luigi; Klugmann, Silvio

2013-01-01

267

Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based on Multiresolution Processing  

E-print Network

pre-operative and intra-operative examinations. In order to perform analysis on different phases different image resolution scales. The proposed method was evaluated against the classification results for various pathological conditions of the mitral valve.2,3 In mitral valve repair pre-operative procedures

Wong, Kenneth K.Y.

268

The use of a stentless porcine bioprosthesis to repair an ascending aortic aneurysm in combination with aortic valve regurgitation.  

PubMed Central

Over the years, many surgical methods have evolved for the treatment of ascending aortic aneurysm in combination with aortic valve regurgitation; however, precise guidelines for optimal surgical techniques for varying presentations have not been defined. We describe the use of a stentless porcine bioprosthesis (Medtronic Freestyle) in a patient with an ascending aortic aneurysm and aortic regurgitation. We used the complete root replacement method, and anastomosed a Dacron graft (Hemashield) between the bioprosthetic valve and the native aorta to replace the distal part of the aneurysm. Images PMID:10524742

Akpinar, B; Saniso?lu, I; Konuralp, C; Akay, H; Güden, M; Sönmez, B

1999-01-01

269

Computational Mitral Valve Evaluation and Potential Clinical Applications.  

PubMed

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

Chandran, Krishnan B; Kim, Hyunggun

2014-08-19

270

Left ventricular function in chronic aortic regurgitation  

SciTech Connect

Left ventricular performance was determined in 42 patients with moderate or severe aortic regurgitation during upright exercise by measuring left ventricular ejection fraction and volume with radionuclide ventriculography. Classification of the patients according to exercise tolerance showed that patients with normal exercise tolerance (greater than or equal to 7.0 minutes) had a significantly higher ejection fraction at rest (probability (p) . 0.02) and during exercise (p . 0.0002), higher cardiac index at exercise (p . 0.0008) and lower exercise end-systolic volume (p . 0.01) than did patients with limited exercise tolerance. Similar significant differences were noted in younger patients compared with older patients in ejection fraction at rest and exercise (both p . 0.001) and cardiac index at rest (p . 0.03) and exercise (p . 0.0005). The end-diastolic volume decreased during exercise in 60% of the patients. The patients with a decrease in volume were significantly younger and had better exercise tolerance and a larger end-diastolic volume at rest than did patients who showed an increase in volume. The mean corrected left ventricular end-diastolic radius/wall thickness ratio was significantly greater in patients with abnormal than in those with normal exercise reserve (mean +/- standard deviation 476 +/- 146 versus 377 +/- 92 mm Hg, p less than 0.05). Thus, in patients with chronic aortic regurgitation: 1) left ventricular systolic function during exercise was related to age, exercise tolerance and corrected left ventricular end-diastolic radius/wall thickness ratio, and 2) the end-diastolic volume decreased during exercise, especially in younger patients and patients with normal exercise tolerance or a large volume at rest.

Iskandrian, A.S.; Hakki, A.H.; Manno, B.; Amenta, A.; Kane, S.A.

1983-06-01

271

Clinical Significance of Markers of Collagen Metabolism in Rheumatic Mitral Valve Disease  

PubMed Central

Background Rheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. Methodology This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value <0.05 was considered statistically significant. Results Plasma PICP and PIIINP concentrations increased significantly (p<0.01) in MS and MR subjects compared to controls but decreased gradually over a one year period post mitral valve replacement (p<0.05). In MS, PICP level and MMP-1/TIMP-1 ratio strongly correlated with mitral valve area (r?=??0.40; r?=?0.49 respectively) and pulmonary artery systolic pressure (r?=?0.49; r?=??0.49 respectively); while in MR they correlated with left ventricular internal diastolic (r?=?0.68; r?=??0.48 respectively) and systolic diameters (r?=?0.65; r?=??0.55 respectively). Receiver operating characteristic curve analysis established PICP as a better marker (AUC?=?0.95; 95% CI?=?0.91?0.99; p<0.0001). A cut-off >459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. Conclusions Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis. PMID:24603967

Banerjee, Tanima; Mukherjee, Somaditya; Ghosh, Sudip; Biswas, Monodeep; Dutta, Santanu; Pattari, Sanjib; Chatterjee, Shelly; Bandyopadhyay, Arun

2014-01-01

272

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

NASA Astrophysics Data System (ADS)

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.

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

273

Nonobstructing Accessory Mitral Valve Tissue and Ventricular Septal Defect  

Microsoft Academic Search

A 4-month-old boy with ventricular septal defect was found to have accessory mitral valve tissue attached to the anterior leaflet of the mitral valve. Operation was successfully performed to excise the accessory mitral tissue in the left ventricular outflow tract and close the ventricular septal defect. Most previously reported cases with accessory mitral valve tissue were associated with left ventricular

Hiroshi Izumoto; Kazuaki Ishihara; Masaaki Ogawa; Yutaka Fujii; Kotaro Oyama; Kohei Kawazoe

1996-01-01

274

Prey regurgitation and stomach vacuity among groupers and snappers  

Microsoft Academic Search

Prey regurgitation during capture is a potential important confounding effect in fish dietary ecology studies as it may lead\\u000a to overestimation of stomach vacuity and underestimation of prey consumption. This study investigates patterns of prey regurgitation\\u000a and stomach vacuity among five grouper and three snapper species in shallow water off French Polynesia and tests the effectiveness\\u000a of piercing swim-bladders after

Matthias Vignon; Jan Dierking

2011-01-01

275

Erythrocyte survival in patients with porcine xenograft aortic and mitral valves.  

PubMed

Ten patients with porcine xenograft aortic and mitral valve prostheses were studied three to 36 months (mean 15 months) postoperatively for evidence of hemolysis. Studies included complete blood count, reticulocyte count, red cell indices, percentage of schistocytes on blood smears, bilirubin concentration, lactic dehydrogenase, serum iron, total iron binding capacity, haptoglobin, serum folate and vitamin B12 levels, Coombs' test, methemoglobin reduction test, autologous 51Cr erythrocyte survival, and urinary examination for iron and hemosiderin. All patients were hemodynamically stable. Nine patients had normal valve function and no evidence of hemolysis. One patient with paravalvular aortic regurgitation had mechanical hemolytic anemia with a negative Coombs' test. Porcine valve xenografts do not seem to be associated with hemolysis unless complicated by a paravalvular leak. PMID:7063904

Rao, K R; Patel, A R; Patel, R N; Kumaraiah, V; Towne, W D

1982-03-01

276

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

SciTech Connect

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.

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

2007-08-29

277

Pulmonary Regurgitation End-diastolic Gradient Is a Doppler Marker of Cardiac Status: Data from the Heart and Soul Study  

Microsoft Academic Search

Background: Echocardiograms routinely sample pulmonary regurgitation signals from which it is possible to measure end diastolic gradients; these correlate with pulmonary artery diastolic pressures. Methods: We performed echocardiograms in 741 ambulatory adults with coronary artery disease who were recruited for the Heart and Soul Study. We compared indicators of cardiac status among indi- viduals with normal (0-5.0 mm Hg) and

Bryan Ristow; Syed Ahmed; Lianyi Wang; Haiying Liu; Brad G. Angeja; Mary A. Whooley; Nelson B. Schiller

278

Mobile ventricular thrombus arising from the mitral annulus in patients with dense mitral annular calcification.  

PubMed

Mitral annular calcification (MAC) has been considered a risk factor for thrombo-embolic disease. Superimposed thrombus formation on MAC has not been well described as a possible underlying mechanism for this association. We report three patients with mobile left ventricular (LV) thrombus arising from the LV aspect of severe calcified mitral annulus in the setting of normal LV function, mitral valve function, and sinus rhythm. PMID:19919957

Sia, Ying T; Dulay, Daisy; Burwash, Ian G; Beauchesne, Luc M; Ascah, Kathryn; Chan, Kwan L

2010-03-01

279

Pushing with the pigtail: A novel approach to placing the MitraClip in a patient with a severely restricted posterior mitral leaflet.  

PubMed

The MitraClip is an US Food and Drug Administration-approved device for inoperable patients with severe degenerative mitral regurgitation (MR) and is under investigation for use in patients with severe functional MR. Simultaneously grasping both leaflets of the mitral valve can be technically challenging, however, in patients with a restricted posterior leaflet. We present one such case in which a pigtail catheter, placed retrograde into the left ventricle, was able to push the ventricular surface of the posterior leaflet into closer approximation with the anterior leaflet, and facilitate successful clip placement. We provide this report in hopes that it will provide a useful strategy for interventionalists faced with this challenging situation. © 2014 Wiley Periodicals, Inc. PMID:25115327

Jones, Brandon M; Tuzcu, E Murat; Kapadia, Samir R

2015-04-01

280

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

PubMed Central

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.

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

2015-01-01

281

[Plasty of left atrium in the isolated mitral valve prosthesis].  

PubMed

Possibilities of the procedures conduction of the left atrium (LA) plasty in a mitral valve prosthesis (MVP) were studied. There were examined 553 patients, in whom surgical treatment in the clinic was conducted. In all the patients MVP was conducted for isolated mitral valve failure and dilatation of LA. In 371 patients (the main group) MVP and LA plasty were conducted, in 182 (control group)--LA was not corrected. Morphometric indices of left cardiac cameras, survival, stability of the operation good results in late terms have witnessed high efficiency of MVP with LA reduction in comparison with such in a control group. Late results of MVP in conjunction with LA reduction exceed such in a control group, witnessing expediency of the proposed methods of surgical treatment application. PMID:25507014

2014-08-01

282

Circulating cytokine concentrations in dogs with different degrees of myxomatous mitral valve disease.  

PubMed

Cytokines have been associated with the progression of congestive heart failure (CHF) in humans and may be implicated in the pathophysiology of myxomatous mitral valve disease (MMVD) in dogs. The aim of this study was to determine the serum concentrations of cytokines in dogs with MMVD. The study included 16 Cairn terriers with no or minimal mitral regurgitation (MR), 41 Cavalier King Charles Spaniels (CKCS) with different degrees of MR and 11 dogs of different breeds with CHF due to MMVD. Granulocyte-macrophage colony-stimulating factor, interferon-?, interleukin (IL)-2, IL-6, IL-7, IL-8, IL-10, IL-15, IL-18, keratinocyte-derived chemokine, interferon-?-induced protein and monocyte chemoattractant protein-1 (MCP-1) were measured using a canine-specific multiplex immunoassay. CHF dogs had significantly higher MCP-1 concentrations than dogs with no or minimal MR. Among the CKCS, IL-2 and IL-7 decreased with increasing left atrial size and IL-7 also decreased with increasing MR. IL-8 decreased with increasing left ventricular end-systolic internal dimensions. MCP-1 was increased in CHF dogs compared to healthy control dogs and IL-2, IL-7 and IL-8 decreased with increasing indices of disease severity. The results suggest a role for these cytokines in canine MMVD and CHF. PMID:21696985

Zois, Nora E; Moesgaard, Sophia G; Kjelgaard-Hansen, Mads; Rasmussen, Caroline E; Falk, Torkel; Fossing, Christine; Häggström, Jens; Pedersen, Henrik D; Olsen, Lisbeth H

2012-04-01

283

Influence of Left Atrial and Ventricular Volumes on the Relation Between Mitral Valve Annulus and Coronary Sinus  

PubMed Central

The aim of this study was to evaluate the anatomic relation between the coronary sinus (CS), mitral annulus, and coronary arteries using 64-multislice computed tomography (MSCT) in patients presenting with a wide range of atrial volumes and left ventricular functions to determine the potential clinical use for percutaneous mitral annuloplasty (PMA). The MSCT data of 165 patients (age 63.65 ± 12.89 years, 67.3% men) were evaluated. The following variables were measured: CS length, CS ostium area, area of the section of CS when it becomes great cardiac vein, area between CS and atrioventricular groove assessed in volume-rendered 3-dimensional images, axial angle measured as the angle between CS and mitral annulus assessed in axial section, mitral valve annulus (MVA) area, left atrium volume, and left circumflex artery/marginal branch-CS relation referring to mitral annulus. The correlation was inversed between the reduction of the axial angle and all following variables: enlargement of both left ventricular end-systolic (r = ?0.429, p <0.001) and end-diastolic (r = ?0.428, p <0.001) volumes, left atrial volume (r = ?0.361, p <0.001), and MVA (r = ?0.324, p <0.001). Similarly, there was inverse correlation between the reduction of the area between CS and atrioventricular groove, and enlargement of both left ventricular end-systolic (r = ?0.376, p <0.001) and end-diastolic (r = ?0.291, p <0.001) volumes, left atrial volume (r = ?0.221, p = 0.001), and MVA (r = ?0.155, p = 0.019). Of note, circumflex artery was located between CS and MVA in 77% of the patients, but in patients with severe mitral regurgitation CS crossed circumflex/marginal branch artery more frequently (97% of cases). In conclusion, a close proximity of the CS to the mitral annulus but also to circumflex artery is more likely to occur with left atrial and ventricular enlargement. Thus, MSCT should be considered as part of the selection process of potential candidate to PMA to avoid external compression of circumflex artery/marginal branch by the device. PMID:18805117

Sorgente, Antonio; Truong, Quynh A.; Conca, Cristina; Singh, Jagmeet P.; Hoffmann, Udo; Faletra, Francesco F.; Klersy, Catherine; Bhatia, Rinky; Pedrazzini, Giovanni B.; Pasotti, Elena; Moccetti, Tiziano; Auricchio, Angelo

2009-01-01

284

[Pulsed Doppler echocardiographic observation of right and left ventricular inflow velocity patterns in various types of arrhythmia, with special reference to the mechanism of atrioventricular regurgitation].  

PubMed

To investigate the possibility for detection of atrio-ventricular (A-V) regurgitation in arrhythmias non-invasively, we recorded velocity patterns of blood flow at the inflow tract of the right (RVI) and left ventricles (LVI), and at the outflow tract of the left ventricle (LVO) by pulsed Doppler echocardiography in 32 patients with various types of arrhythmia. They were six cases with supraventricular premature contraction (SVPC), 13 with ventricular premature contraction (VPC), two with second degree A-V block, five with complete A-V block and six with artificial right ventricular pacemaker. The following results were obtained. In SVPC, peak velocity of the preceding early diastolic flow of RVI and LVI was related to the coupling interval. A crucial ectopic atrial contraction occurring at the early diastole augmented right or left ventricular filling by summation of the two kinds of ventricular filling. Peak velocity of the early diastolic flow at RVI and LVI was decreased after SVPC compared with that of normal sinus rhythm. A reverse flow was not observed in RVI or LVI velocity pattern in these cases. In VPC, peak velocity of the preceding early diastolic flow at RVI and LVI was related to the coupling interval. An effective early diastolic flow was not observed when coupling interval was short. A systolic A-V reverse flow was detected in six of eight cases of VPC with compensatory pause. In these six cases, M-mode and two-dimensional echograms showed patterns of tricuspid and/or mitral valve prolapse and systolic "bulging" of the left ventricular posterior wall. Peak velocity of the blood flow at LVO was decreased in VPCs with short coupling intervals, but it was increased markedly in the next beat after compensatory pause (post-extrasystolic potentiation). Velocity pattern of a blood flow at RVI and LVI showed two types of reverse flow patterns in all cases with complete A-V block or with artificial right ventricular pacemaker; a) systolic reverse flow in beats with P wave superimposed on QRS complex or ST segment, and b) diastolic reverse flow in beats with markedly prolonged P-R intervals. Diastolic tricuspid regurgitation was demonstrated by contrast echography at the level of the tricuspid valve orifice, and diastolic mitral regurgitation by left cineventriculography. The clinical implication of pulsed Doppler echocardiography to detect A-V regurgitation during systole and diastole was discussed in various types of arrhythmia. PMID:6205099

Oki, T; Asai, M; Takemura, H; Fukuda, N; Sakai, H; Ohshima, C; Tominaga, T; Taoka, M; Niki, T; Mori, H

1983-09-01

285

Effect of aortic valvular regurgitation upon the impedance cardiogram.  

PubMed Central

The first derivative thoracic impedance cardiogram, phonocardiogram, and electrocardiogram were recorded in three groups of 22 subjects each. In Group 1 (control), simultaneous impedance cardiogram, phonocardiogram, and aortic valve echocardiograms showed that the X point of the impedance cardiogram occurred synchronously with the aortic second heart sound and with echocardiographic aortic valve closure. In group 2 (clinical diagnosis of aortic regurgitation) the scalar magnitude of the impedance cardiogram O wave and the ratios of the impedance cardiogram wave form X/dz/dtmax and O/dz/dtmax were different from control. In addition, the early diastolic (X) and systolic portions (S) of the impedance cardiogram wave form of group 3 patients were planimetered and expressed as the ratio X/S, called the impedance cardiographic aortic regurgitant fraction (aortic RFI). The aortic RFI was increased by handgrip, a manoeuvre which acutely increases the magnitude of aortic regurgitation. The difference between Fick cardiac output and left ventricular angiographic output was used to calculate aortic valvular regurgitant fraction, which related closely to the impedance cardiogram. These data suggest that it is useful in the noninvasive assessment of aortic regurgitation. PMID:708536

Schieken, R M; Patel, M R; Falsetti, H L; Barnes, R W; Lauer, R M

1978-01-01

286

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

PubMed

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

Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

2015-06-01

287

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

PubMed Central

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.

Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

2015-01-01

288

How Is Mitral Valve Prolapse Treated?  

MedlinePLUS

... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To ... Media Availability: Mitral valve repair following heart attack may offer ...

289

How Is Mitral Valve Prolapse Diagnosed?  

MedlinePLUS

... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To ... Media Availability: Mitral valve repair following heart attack may offer ...

290

Computed tomography for planning and postoperative imaging of transvenous mitral annuloplasty: first experience in an animal model.  

PubMed

To investigate the use of computed tomography (CT) to measure the mitral valve annulus size before implantation of a percutaneous mitral valve annuloplasty device in an animal trial. Seven domestic pigs underwent CT before and after implantation of a Cardioband™ (a percutaneously implantable mitral valve annuloplasty device) with a second-generation 128-section dual-source CT machine. Implantation of the Cardioband™ was performed in a standard fashion according to a protocol. Animals were sacrificed afterwards and the hearts explanted. The Cardioband™ was found to be adequately implanted in all animals, with no anchor dehiscence and no damage of the circumflex artery (CX) or the coronary sinus (CS). The correct length of the band as chosen according to the length of the posterior mitral annulus measured in CT before implantation was confirmed in gross examination in all animals. The device did not result in a metal artifact-related degradation of image quality. The closest distance from the closest anchor to the CX was 2.1 ± 0.7 mm in diastole and 1.6 ± 0.5 mm systole. Mitral annulus distance to the CS was 6.4 ± 1.3 mm in diastole and 7.7 ± 1.1 mm in systole. CT visualization and measurement of the mitral valve annulus dimensions is feasible and can become the imaging method of choice for procedure planning of Cardioband™ implantations or other transcatheter mitral annuloplasty devices. PMID:25119889

Sündermann, Simon H; Gordic, Sonja; Manka, Robert; Cesarovic, Nikola; Falk, Volkmar; Maisano, Francesco; Alkadhi, Hatem

2015-01-01

291

Prosthetic mitral valve leaflet escape.  

PubMed

Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well. PMID:23837121

Kim, Darae; Hun, Sin Sang; Cho, In-Jeong; Shim, Chi-Young; Ha, Jong-Won; Chung, Namsik; Ju, Hyun Chul; Sohn, Jang Won; Hong, Geu-Ru

2013-06-01

292

Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure  

PubMed Central

Background Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results The mean follow-up duration was 4.9±3.1 years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of 4.4±2.5 years of echocardiographic follow-up (p<0.001). Conclusion Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures. PMID:22708080

Lim, Ju Yong; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun

2012-01-01

293

Study of collagen structure in canine myxomatous mitral valve disease   

E-print Network

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 ...

Hadian, Mojtaba

2009-01-01

294

Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: a speckle tracking echocardiography study.  

PubMed

Volume overload in chronic severe mitral regurgitation (MR) causes left atrial (LA) remodeling. Volume overload generally diminishes after mitral valve surgery and LA size and shape are expected to recover. The recovery of LA functions named as reverse remodeling is said to be related with prognosis and mortality. A few clinical and echocardiographic parameters have been reported to be associated with LA reverse remodeling. In this study, we investigated the relationship between LA peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography (2D STE) and LA reverse remodeling. 53 patients (24 females and 29 males, mean age: 45.7 ± 13.5 years) with severe MR and preserved left ventricular systolic function were included in the study. All patients had normal sinus rhythm. The etiology of MR was mitral valve prolapse (MVP) in 37 patients and rheumatic valvular disease in 16 patients. Mitral valve repair was performed in 30 patients while 23 underwent mitral valve replacement. Echocardiography was performed before the surgery and 6 months later. LA peak atrial longitudinal strain (PALS) was assessed with speckle tracking imaging. LA reverse remodeling was defined as a percent of decrease in LA volume index (LAVI). Left atrial volume index significantly decreased after surgery (58.2 ± 16.6 vs. 43.9 ± 17.2 ml/m2, p ? 0.001). Mean LAVI reduction was 22.5 ± 27.2%. There was no significant difference in LAVI reduction between mitral repair and replacement groups (22.1 ± 22.6 vs. 23.1 ± 32.8 %, p = 0.9). Although the decrease in LAVI was higher in MVP group than rheumatic group, it was not statistically significant (24.4 ± 26.8 vs. 18.2 ± 28.9%, p = 0.4). Correlates of LAVI reduction were preoperative LAVI (r 0.28, p = 0.039), PALS (r 0.36, p = 0.001) and age (r -0.36, p = 0.007). Furthermore, in multivariate linear regression analysis (entering models), preoperative LAVI, age and PALS were all significant predictors of LA reverse remodeling (p ? 0.001, p = 0.04, p = 0.001 respectively). Left atrial peak longitudinal strain measured by 2D STE, in conjunction with preoperative LAVI and age is a predictor of LA reverse remodeling in patients undergoing surgery for severe MR. We suggest that in this patient population, PALS may also be used as a preoperative prognostic marker. PMID:24781032

Candan, Ozkan; Ozdemir, Nihal; Aung, Soe Moe; Hatipoglu, Suzan; Karabay, Can Yucel; Guler, Ahmet; Gecmen, Cetin; Dogan, Cem; Omaygenc, Onur; Bakal, Ruken Bengi

2014-08-01

295

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

PubMed

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

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

2014-10-01

296

Clinical Presentation and Treatment Options for Mitral Valve Myxoma  

Microsoft Academic Search

Myxomas rarely are located on the mitral valve. We report the case of a 44-year-old man operated on successfully with mitral valve conservation, which is the 21st case of mitral valve myxoma reported in the western literature. Among the cases reported in the literature, the diagnosis was made at the time of autopsy in 6 cases, with premortem heart failure

Nabil Chakfé; Jean-Georges Kretz; Philippe Valentin; Bernard Geny; Hélène Petit; Sorin Popescu; Saleem Edah-Tally; Gilbert Massard

1997-01-01

297

Mitral Valve Prolapse in Persons with Down Syndrome.  

ERIC Educational Resources Information Center

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…

Pueschel, Siegfried M.; Werner, John Christian

1994-01-01

298

Evaluation of first-trimester tricuspid regurgitation for Down syndrome screening.  

PubMed

Screening for Down syndrome has become an integral part of prenatal care. In recent years, there has been significant interest in first-trimester screening methods. Increased nuchal translucency in the first trimester of pregnancy has been identified as a marker for chromosomal anomalies and congenital cardiac disease. In addition, research has identified a correlation between tricuspid regurgitation, diagnosed by pulsed-wave Doppler ultrasonography, in aneuploid fetuses between 11 and 13 + 6 weeks' gestation. This article provides a brief historical overview of screening for aneuploidy and examines the emerging trend and pitfalls of first-trimester screening. PMID:19011492

McGee, Deborah Cooper

2008-01-01

299

Viability of fresh mitral homograft valves  

PubMed Central

The present study was undertaken to measure and compare the viability of the mitral leaflet, chordae, and papillary muscle. The viability of the valves was assessed by autoradiography at regular intervals after sterilization and preservation in antibiotics and nutrient medium. The results showed different rates of decline in viability of the leaflet, muscle, and chordae of the mitral valves. Slightly more than 70% of the leaflet fibroblasts took up thymidine during the first 24 hours of storage. This is compared with 68% of papillary muscle fibroblasts and 40% of chordae fibroblasts. Viability of the chordae decreased rapidly and became pronounced at four weeks. One week is the maximum time for storage of mitral valves if it is desirable to preserve living cells in the chordae. PMID:4724496

Al-Janabi, Nawal; Ross, Donald N.

1973-01-01

300

Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome  

PubMed Central

Objective Analyse 2-year outcomes after MitraClip therapy and identify predictors of outcome. Methods Consecutive patients (n=74) undergoing MitraClip therapy were included in the MitraSWISS registry and followed prospectively. Results A reduction of mitral regurgitation (MR) to ? mild was achieved in 32 (43%) patients and to moderate in 31 (42%) patients; 16/63 (25%) patients with initially successful treatment developed recurrent moderate to severe or severe MR during the first year and only 1 patient did so during the second year. At 2?years, moderate or less MR was more frequently present in patients with a transmitral mean gradient <3?mm?Hg at baseline (73% vs 23%, p?

Toggweiler, Stefan; Zuber, Michel; Sürder, Daniel; Biaggi, Patric; Gstrein, Christine; Moccetti, Tiziano; Pasotti, Elena; Gaemperli, Oliver; Faletra, Francesco; Petrova-Slater, Iveta; Grünenfelder, Jürg; Jamshidi, Peiman; Corti, Roberto; Pedrazzini, Giovanni; Lüscher, Thomas F; Erne, Paul

2014-01-01

301

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

NASA Astrophysics Data System (ADS)

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

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

2012-03-01

302

Comparative endoscopic anatomic description of the mitral valvular complex: a cadaveric study.  

PubMed

Background?We compared the aortic, left atrial, and apical approaches to visualize the mitral valve with the goal to investigate the endoscopic anatomy and give exact step-by-step descriptions of these views. Materials and Methods?The mitral valvular complex of human cadaveric fresh hearts was investigated from three approaches using 0, 30, and 70 degrees rigid endoscopic optics. In 30 cases after the removal of the hearts, the endoscopes were introduced directly into the aortic root through an aortotomy, left atrium through a standard atriotomy, and apex of the heart through a transmural incision. In 10 cases, the in situ visualization was performed using standard surgical approaches, such as partial upper ministernotomy, right and left minithoracotomy. The investigation was performed first with the mitral valve open, then the left ventricle was filled with saline, and the valve was closed by clamping the aorta. Results?For the visualization of ventricular surfaces of the mitral leaflets and the subvalvular apparatus, the apical approach was most optimal. The aortic approach had limitations at the posterior leaflet. Using the atrial approach, we did not obtain any direct visual information about the subvalvular apparatus with the valve closed. The atrial surfaces of the leaflets were best visible using both the atrial and apical approaches with the mitral valve open. In the case of a closed valve, the apical approach did not allow for an investigation of the atrial surfaces. The aortic approach was useful to visualize the atrial surface of the posterior leaflet with an opened valve. Conclusion?In mitral valve repairs through the left atrium, an additional aortic or apical view could be useful to obtain functional information about the subvalvular apparatus by the sealing probe. PMID:24420678

Ruttkay, Tamas; Baksa, Gabor; Gotte, Julia; Glasz, Tibor; Patonay, Lajos; Galajda, Zoltan; Doll, Nicolas; Czesla, Markus

2015-04-01

303

IB, IBARM and mitral valves X. Y. Luo1, B.E.Griffith2,  

E-print Network

IB, IBARM and mitral valves X. Y. Luo1, B.E.Griffith2, M. Yin3, T. J. Wang3, P. N. Watton4 1) · based on real MV geometry, "similar" mechanical properties · with chordae ! #12;Immersed Boundary (IB) Methods-1 Old version: IB Uniform Eulerian grid, 1st order approximation, no bending, solved with FFT

Luo, Xiaoyu

304

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 unaffected in the longitudinal direction. MATERIALS AND METHODS Cell culture Cultured neurons of the olfactory bulb (OB) of Xenopus laevis were prepared as described previously by Bischofberger and Schild

305

Effects of Mitral Valve Replacement on Regional Left Ventricular Systolic Strain  

Microsoft Academic Search

Background. Mitral valve replacement (MVR) with chordal excision impairs left ventricular (LV) systolic function, but the responsible mechanisms remain incom- pletely characterized. Loss of normal annular-papillary continuity also adversely affects LV torsional deforma- tion, possibly due to changes in myocardial fiber contrac- tion pattern. Methods. Twenty-seven dogs underwent insertion of LV myocardial markers and a sham procedure (cardio- pulmonary bypass,

Marc R. Moon; Abe DeAnda; George T. Daughters; Neil B. Ingels; D. Craig Miller

2010-01-01

306

Survival and cause of death after mitral valve replacement in patients aged 80 years and over  

Microsoft Academic Search

Objective: Over the last decade there has been an increasing number of patients aged 80 years and over undergoing heart valve replacement. However, literature on the outcome of mitral valve replacement (MVR) in this age group is still limited. Methods: We conducted the present study by analysing data extracted from the UK Heart Valve Registry. From January 1986 to December

G. Asimakopoulos; M-B Edwards; J Brannan; K. M Taylor

1997-01-01

307

Mitral valve replacement in children: Evolution and outcomes of a 40-year experience  

Microsoft Academic Search

Background. The ideal prosthesis for mitral valve replacement (MVR) in children remains controversial. The study aim was to review of evolution and outcomes of our 40-year experience with MVR in children. Methods. Since 1963, 75 patients (mean age 9.2 years) have undergone a total of 103 MVR operations. The etiology for valve disease was congenital in 55% of patients, rheumatic

J. W. Brown; M. Ruzmetov; M. D. Rodefeld; M. W. Turrentine

2004-01-01

308

Characterization of Mitral Valve Anterior Leaflet Perfusion Patterns  

PubMed Central

Background and aim of the study Although previous histologic studies have demonstrated the presence of blood vessels in the anterior mitral leaflet (AML) and second-order chordae (SC), little is known of the pattern of leaflet perfusion. Henhe, the pattern and source of AML perfusion was investigated in an ovine model. Methods Fluorescein angiograms were obtained in 17 ovine hearts immediately after heparinization and cardioplegic arrest, using non-selective left coronary artery (LCA) and selective left anterior descending (LAD), proximal, mid- and distal left circumflex (LCx) perfusion. Serial photographs using a flash/filter system to optimize fluorescence were obtained through a left atriotomy. Results The proximal half of the AML was seen to be richly vascularized. A loop of vessels was consistently observed in the mitral annulus and AML; these vessels ran along the annulus, extended to the sites of SC insertion, and created anastomoses between these insertions. The SC contributed to the AML perfusion and the anastomotic loop. Selective perfusion of the LAD or proximal LCx artery (ligated before the first obtuse marginal artery) did not perfuse the AML (n = 6). Perfusion of the mid- and distal LCx (n = 7) consistently supplied the AML via SC insertion sites and annular branches. Conclusion The ovine AML is perfused by vessels that run through the SC and annulus simultaneously, and then create a communicating arcade in the leaflet. These vessels originate from the mid- and distal portions of the LCx. A loss of perfusion as a result of microvascular disease could have adverse implications. Derangements in the extensive vascular component of the mitral valve could be an important contributing factor to valve disease. PMID:20099688

Swanson, Julia C.; Davis, Lauren R.; Arata, Koji; Briones, Eleazar P.; Bothe, Wolfgang; Itoh, Akinobu; Ingels, Neil B.; Miller, D. Craig

2010-01-01

309

The mechanism of endocardial lead-induced tricuspid regurgitation  

PubMed Central

Using this case report we attempt to define the mechanism of endocardial lead-induced tricuspid regurgitation (TR) in particular the direct effect of endocardial pacing leads on the competence of the tricuspid valve. We recommend a high index of suspicion and an early diagnostic strategy in order to reduce long-term morbidity which is associated with this condition and the need for a potentially avoidable surgery. PMID:23576646

Khoshbin, Espeed; Abdelbar, Abdelrahman; Allen, Stuart; Hasan, Ragheb

2013-01-01

310

Mitral Valve Prolapse in Young Patients.  

ERIC Educational Resources Information Center

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…

McFaul, Richard C.

1987-01-01

311

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

NASA Technical Reports Server (NTRS)

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.

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

1998-01-01

312

Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery.  

PubMed

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:25774765

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

2015-04-01

313

Noninvasive estimation of both systolic and diastolic pulmonary artery pressure from Doppler analysis of tricuspid regurgitant velocity spectrum in patients with chronic heart failure  

Microsoft Academic Search

Background Noninvasive estimation of pulmonary artery systolic and diastolic pressures usually requires the investigation of both tricuspid and pulmonary regurgitant jets and an estimate of right atrial pressure. A new, noninvasive method to obtain pulmonary diastolic pressure (based on the hemodynamic demonstration that right ventricular systolic pressure and pulmonary artery diastolic pressure are equal at the time of pulmonary valve

Luca Lanzarini; Alessandra Fontana; Elena Lucca; Carlo Campana; Catherine Klersy

2002-01-01

314

Systolic anterior motion of mitral valve with calcified annulus in octogenarians.  

PubMed

Systolic anterior motion of the mitral leaflet causing left ventricular outflow tract obstruction is commonly seen in hypertrophic cardiomyopathy and also in patients with advanced mitral valve disease with excessive anterior leaflet tissue or a reduced aortic-mitral angle. We describe 2 octogenarians who presented with systolic mitral leaflet anterior motion in advanced mitral valve disease with severe mitral annular calcification and associated asymmetrical septal hypertrophy. PMID:24570531

Parissis, Haralabos; Hamid, Umar Imran; Jeganathan, Reubendra; Graham, Alastair

2013-08-01

315

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

PubMed Central

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

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

2013-01-01

316

Reduced Leaflet Stress in the Stentless Quadrileaflet Mitral Valve: A Finite Element Model  

PubMed Central

Background Failure of bioprosthetics is usually caused by calcification of the leaflets as a consequence of high tensile stresses. The stentless valve resembles native mitral valve anatomy, has a flexible leaflet attachment and a suspension at the papillary muscles, and preserves annuloventricular continuity. In this study, the effects of the stentless valve design on leaflet stress were investigated with a finite element model. Methods Finite element models of the stentless quadrileaflet mitral valve were created in the close and open configurations. The geometry of the stented trileaflet mitral valve was also analyzed for comparative purposes. Under the designated pressures, the regional stresses were evaluated, and the distributions of stresses were assessed. Results Regardless of whether the valve is in the open or close configuration, the maximum first principal stress was significantly lower in the stentless valve than in the stented valve. For the stentless valves, limited stress concentration was discretely distributed in the papillary flaps under both close and open conditions. In contrast, in the stented valve, increased stress concentration was evident at the central belly under the open condition and at the commissural attachment under close condition. In either configuration, the maximum second principal stress was markedly lower in the stentless valve than in the stented valve. Conclusions The stentless valve was associated with a significant reduction in leaflet stress and a more homogeneous stress distribution compared to the stented valve. These findings are consistent with recent reports of the clinical effectiveness of the stentless quadrileaflet mitral valve. PMID:23844060

Wang, Jian-Gang; Ren, Bi-Qiao

2013-01-01

317

Effect of the mitral valve on diastolic flow patterns  

NASA Astrophysics Data System (ADS)

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.

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

2014-12-01

318

Robotically assisted minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

319

Natural history of mitral valve prolapse  

Microsoft Academic Search

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

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

1995-01-01

320

Captopril-induced reduction of regurgitation fraction in aortic insufficiency  

SciTech Connect

Stimulated Renin-Angiotensin System (RAS) in aortic insufficiency (AI) leads to increased afterload and consequently to augmented aortic regurgitation (R). Therefore Captopril (C) mediated RAS-inhibition should diminish systemic vascular resistance and thus reduce R. In 9 patients (pts) with pure severe AI regurgitation fraction (RF) and left ventricular ejection fraction (LVEF) were determined before and 1 hr after i.v. injection of 25 mg C by gated radionuclide ventriculographie (RNV), using red blood cells labeled in vivo with 15 mCi Tc-99m. Enddiastolic and endsystolid frames were derived from the left ventricular volume curve. ROI's were selected over both ventricles. Ventricular boundaries were defined by a fourier phase image overlay. RF was calculated by the background corrected count rate ratio of left and right ventricular ROI. Arterial blood pressure (BP), heart rate (HR), plasma levels of angiotensin I, II (A1,A2), and the activity of angiotensin converting enzyme (ACE) were determined before and 1 hr after C-injection. Before C-medication mean RF was 54% (range 34% - 67%), after C mean RF decreased to 37% (17% - 59% range, rho<.05). Mean LVEF increased not significantly from 60% (range 51%-70%) to 66% (range 56% - 77%, rho>0.55). C did not significantly change HR or BP (HR: rho>0.9, BP: rho>0.6). A2 and ACE activity decreased to 40% and 50% of control values (rho<.01), respectively. A1 increased excessively. The authors conclude that the inhibition of ACE reduces significantly aortic regurgitation in patients with A1 and has thus a beneficial effect on left ventricular performance.

Kropp, J.; Reske, S.N.; Biersack, H.J.; Heck, I.; Mattern, H.; Winkler, C.

1984-01-01

321

Tricuspid Regurgitation: Clinical Importance and Its Optimal Surgical Timing  

PubMed Central

Tricuspid regurgitation (TR) has long been neglected based on the false belief that it is substantially rare in prevalence and is not so important in determining prognosis. Recent consecutive publications refuted this concept surrounding TR, and now we are contemplating this entity from different point of view. In this review, we mainly focus on isolated form of severe TR. In our daily clinical practice, however, patients with problems in more than one valve are more frequently encountered. Hence, we briefly touch on the results of severe TR surgery with or without left side valve operations here and there, as well. PMID:23560135

Lee, Seung-Pyo; Kim, Yong-Jin; Sohn, Dae-Won

2013-01-01

322

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

PubMed Central

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

Vandenplas, Y; De Greef, E

2014-01-01

323

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

PubMed

Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves. PMID:25849702

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

2015-01-01

324

Aortic regurgitation after transcatheter aortic valve implantation: mechanisms and implications  

PubMed Central

In recent years, transcatheter aortic valve implantation (TAVI) has become an established treatment option for selected high-risk patients with severe aortic stenosis (AS). Favorable results with regard to both hemodynamics and clinical outcome have been achieved with transcatheter valves. Aortic regurgitation (AR) remains a major concern after TAVI. Echocardiography is the imaging modality of choice to assess AR in these patients due to its wide accessibility and low cost. Mostly mild residual AR has been observed in up to 70% of patients. However, as even a mild degree of AR has been associated with a decreased survival up to two years after TAVI, accurate evaluation and classification of AR is important. AR in transcatheter valves can be divided into three types according to different pathophysiological mechanisms. Besides the well-known transvalvular and paravalvular forms of regurgitation, a third form termed supra-skirtal has recently been observed. A thorough understanding of AR in transcatheter valves may allow to improve device design and implantation techniques to overcome this complication. The aim of this review is to provide an overview of the three types of AR after TAVI focussing on the different pathophysiological mechanisms. PMID:24282741

Stähli, Barbara E.; Maier, Willibald; Corti, Roberto; Lüscher, Thomas F.; Jenni, Rolf

2013-01-01

325

Mitral stenosis and acute ST elevation myocardial infarction  

PubMed Central

We describe a patient who presented with acute (inferior wall) ST elevation myocardial infarction. Her echocardiogram showed severe mitral stenosis with ball valve thrombus in the left atrial body and thrombus in the left atrial appendage. Coronary angiogram revealed thromboembolic material in the right coronary artery. Mitral valve replacement was scheduled. PMID:25829656

Cardoz, Joseph; George, Raju

2015-01-01

326

Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography  

PubMed Central

This paper presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (3D TEE). Our approach uses physics-based modeling to solve for the stationary configuration of the closed valve structure from the patient-specific open valve structure, which is recovered using a user-in-the-loop, thin-tissue detector segmentation. The method utilizes a tensile shape finding approach based on energy minimization. This method is used to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using ten intraoperative 3D TEE sequences by comparing (a) the closed valve configuration predicted from the segmented open valve, with (b) the segmented closed valve, taken as ground truth. Experiments show promising results, with prediction errors on par with 3D TEE resolution and with good potential for applications in pre-operative planning. PMID:23497987

Burlina, Philippe; Sprouse, Chad; Mukherjee, Ryan; DeMenthon, Daniel; Abraham, Theodore

2013-01-01

327

Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling.  

PubMed

Comprehensive visual and quantitative analysis of in vivo human mitral valve morphology is central to the diagnosis and surgical treatment of mitral valve disease. Real-time 3D transesophageal echocardiography (3D TEE) is a practical, highly informative imaging modality for examining the mitral valve in a clinical setting. To facilitate visual and quantitative 3D TEE image analysis, we describe a fully automated method for segmenting the mitral leaflets in 3D TEE image data. The algorithm integrates complementary probabilistic segmentation and shape modeling techniques (multi-atlas joint label fusion and deformable modeling with continuous medial representation) to automatically generate 3D geometric models of the mitral leaflets from 3D TEE image data. These models are unique in that they establish a shape-based coordinate system on the valves of different subjects and represent the leaflets volumetrically, as structures with locally varying thickness. In this work, expert image analysis is the gold standard for evaluating automatic segmentation. Without any user interaction, we demonstrate that the automatic segmentation method accurately captures patient-specific leaflet geometry at both systole and diastole in 3D TEE data acquired from a mixed population of subjects with normal valve morphology and mitral valve disease. PMID:24184435

Pouch, A M; Wang, H; Takabe, M; Jackson, B M; Gorman, J H; Gorman, R C; Yushkevich, P A; Sehgal, C M

2014-01-01

328

Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling  

PubMed Central

Comprehensive visual and quantitative analysis of in vivo human mitral valve morphology is central to the diagnosis and surgical treatment of mitral valve disease. Real-time 3D transesophageal echocardiography (3D TEE) is a practical, highly informative imaging modality for examining the mitral valve in a clinical setting. To facilitate visual and quantitative 3D TEE image analysis, we describe a fully automated method for segmenting the mitral leaflets in 3D TEE image data. The algorithm integrates complementary probabilistic segmentation and shape modeling techniques (multi-atlas joint label fusion and deformable modeling with continuous medial representation) to automatically generate 3D geometric models of the mitral leaflets from 3D TEE image data. These models are unique in that they establish a shape-based coordinate system on the valves of different subjects and represent the leaflets volumetrically, as structures with locally varying thickness. In this work, expert image analysis is the gold standard for evaluating automatic segmentation. Without any user interaction, we demonstrate that the automatic segmentation method accurately captures patient-specific leaflet geometry at both systole and diastole in 3D TEE data acquired from a mixed population of subjects with normal valve morphology and mitral valve disease. PMID:24184435

Pouch, A.M.; Wang, H.; Takabe, M.; Jackson, B.M.; Gorman, J.H.; Gorman, R.C.; Yushkevich, P.A.; Sehgal, C.M.

2014-01-01

329

Three-dimensional echocardiography in congenital malformations of the mitral valve  

Microsoft Academic Search

Three-dimensional echocardiography has proved to be valuable in congenital heart disease by enhancing the evaluation of morphologic abnormalities and increasing the understanding of complex relationships. This study was undertaken to determine how 3-dimensional echocardiography could be best used to study some of the congenital malformations of the mitral valve such as mitral arcade, double orifice mitral valve, accessory mitral tissue,

Nilda Espinola-Zavaleta; Jesus Vargas-Barrón; Candace Keirns; Guillermo Rivera; Angel Romero-Cárdenas; Javier Roldán; Fause Attie

2002-01-01

330

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

PubMed Central

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

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

2015-01-01

331

Mitral Annulus Calcification is associated with valvular and cardiac structural abnormalities  

Microsoft Academic Search

INTRODUCTION: Mitral annulus calcification (MAC) is a common finding on echocardiographic examination. The goal of this study was to evaluate associations between MAC and cardiac abnormalities using a large echocardiographic database. METHODS: For this study we retrospectively reviewed 24,380 echocardiograms performed for clinical reasons between the years 1984 and 1998. RESULTS: MAC was reported in 1,494 (6.1%) subjects. Using multivariate

Mohammad-Reza Movahed; Yuji Saito; Mastaneh Ahmadi-Kashani; Ramin Ebrahimi

2007-01-01

332

The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease  

Microsoft Academic Search

Background. The surgical results of the Cox-Maze III procedure (CM-III) for atrial fibrillation (AF) associated with rheumatic mitral valve (MV) disease are not as good as the results from surgery for AF alone.Methods. To assess the efficacy and safety of the CM-III in AF associated with rheumatic MV disease, we retrospectively analyzed 75 patients who underwent the CM-III combined with

Ki-Bong Kim; Kwang Ree Cho; Dae-Won Sohn; Hyuk Ahn; Joon Ryang Rho

1999-01-01

333

Influence of concomitant CABG and urgent\\/emergent status on mitral valve replacement surgery  

Microsoft Academic Search

Background. Outcomes and resource utilization of patients undergoing mitral valve replacement (MVR) with or without concomitant coronary artery bypass grafting (CABG) were reviewed.Methods. Data for 1,844 patients undergoing isolated primary MVR at Emory University Hospitals between 1980 and 1997 were recorded prospectively in a computerized database.Results. The four groups included patients undergoing elective MVR with (n = 360) or without

Vinod H Thourani; William S Weintraub; Joseph M Craver; Ellis L Jones; John Parker Gott; W. Morris Brown; John D Puskas; Robert A Guyton

2000-01-01

334

Effects of mitral valve replacement on regional left ventricular systolic strain  

Microsoft Academic Search

Background. Mitral valve replacement (MVR) with chordal excision impairs left ventricular (LV) systolic function, but the responsible mechanisms remain incompletely characterized. Loss of normal annular-papillary continuity also adversely affects LV torsional deformation, possibly due to changes in myocardial fiber contraction pattern.Methods. Twenty-seven dogs underwent insertion of LV myocardial markers and a sham procedure (cardiopulmonary bypass, no MVR, n = 6),

Marc R Moon; Abe DeAnda; George T Daughters; Neil B Ingels; D. Craig Miller

1999-01-01

335

Permanent Pacemaker Lead Induced Severe Tricuspid Regurgitation in Patient Undergoing Multiple Valve Surgery  

PubMed Central

Severe and permanent tricuspid regurgitation induced by pacemaker leads is rarely reported in the literature. The mechanism of pacemaker-induced tricuspid regurgitation has been identified, but its management has not been well established. Furthermore, debate still exists regarding the proper surgical approach. We present the case of a patient with severe tricuspid regurgitation induced by a pacemaker lead, accompanied by triple valve disease. The patient underwent double valve replacement and tricuspid valve repair without removal of the pre-existing pacemaker lead. The operation was successful and the surgical procedure is discussed in detail.

Lee, Jung Hee; Kim, Tae Ho; Kim, Wook Sung

2015-01-01

336

A novel approach to calculation of mean mitral valve gradient by Doppler echocardiography.  

PubMed

The Doppler-derived mean mitral valve gradient (DeltaP(M)) based on the simplified Bernoulli equation requires computerized integration of the Doppler signal and evaluation by a technician with the use of special equipment. We have noted empirically that the DeltaP(M) can be derived by the equation DeltaP(M) = (P(P) - P(T)) / 3 + P(T). Peak (P(P)) and trough (P(T)) pressures are derived from the simplified Bernoulli equation (P = 4V(2)). This equation can be used by the experienced observer to calculate the mean mitral valve gradient without specialized equipment. The purpose of this study is to validate the above empirically derived equation in patients with mitral stenosis. We retrospectively reviewed 41 consecutive studies done at our institution from October 1, 1997, through September 30, 1998, in which mean mitral valve gradient was assessed. Each study was reviewed and the DeltaP(M), P(P), and P(T) were measured for 3 beats by using the software package on an HP Sonos 2500. DeltaP(M) was also calculated with our formula. A linear regression model was used to compare the results of the measured versus the calculated DeltaP(M). The following sub-categories were also evaluated: transthoracic studies (TTE), transesophageal studies (TEE), native valve gradients (NV), prosthetic valve gradients (PV), sinus rhythm (SR), and atrial fibrillation (AF). The results of the regression analysis of the entire population of mean versus calculated DeltaP(M) are n = 41, r = 0.99, P <.001, and standard error of the estimate (SEE) = 0.67. The regression results for the subgroups are as follows: TTE: n = 30, r = 0.99, P <.001, SEE = 0.51; TEE: n = 11, r = 0.99, P <.001, SEE = 59; NV: n = 26, r = 0.99, P <.001, SEE = 0.59; PV: n = 15, r = 0.98, P <.001, SEE = 0.84; SR: n = 23, r = 0.99, P <.001, SEE = 0.58; and AF: n = 18, r = 0.98, P <.001, SEE = 0.82. In conclusion, the simple formula that we have derived is an accurate method for calculation of mean mitral valve gradient, and it is accurate over multiple subgroups. Furthermore, the formula allows visual verification of mean mitral gradient without specialized software. PMID:11696836

Devlin, M; Jacobs, L E; Oliner, C M; Owen, A N; Ioli, A; Abbrescia, V D; Kotler, M N

2001-11-01

337

Signaling pathways in mitral valve degeneration.  

PubMed

Heart valves exhibit a highly-conserved stratified structure exquisitely designed to counter biomechanical forces delivered over a lifetime. Heart valve structure and competence is maintained by heart valve cells through a process of continuous turnover extracellular matrix (ECM). Degenerative (myxomatous) mitral valve disease (DMVD) is an important disease associated with aging in both dogs and humans. DMVD is increasingly regarded as a disease with identifiable signaling mechanisms that control key genes associated with regulation and dysregulation of ECM homeostasis. Initiating stimuli for these signaling pathways have not been fully elucidated but likely include both mechanical and chemical stimuli. Signaling pathways implicated in DMVD include serotonin, transforming growth factor ? (TGF?), and heart valve developmental pathways. High circulating serotonin (carcinoid syndrome) and serotoninergic drugs are known to cause valvulopathy that shares pathologic features with DMVD. Recent evidence supports a local serotonin signaling mechanism, possibly triggered by high tensile loading on heart valves. Serotonin initiates TGF? signaling, which in turn has been strongly implicated in canine DMVD. Recent evidence suggests that degenerative aortic and mitral valve disease may involve pathologic processes that mimic osteogenesis and chondrogenesis, respectively. These processes may be mediated by developmental pathways shared by heart valves, bone, and cartilage. These pathways include bone morphogenic protein (BMP) and Wnt signaling. Other signaling pathways implicated in heart valve disease include Notch, nitric oxide, and angiotensin II. Ultimately, increased understanding of signaling mechanisms could point to therapeutic strategies aimed at slowing or halting disease progression. PMID:22364692

Orton, E Christopher; Lacerda, Carla M R; MacLea, Holly B

2012-03-01

338

[Plasty of the left atrium in the isolated mitral valve prosthesis implantation].  

PubMed

Possibilities of the procedures conduction of the left atrium (LA) plasty in a mitral valve prosthesis (MVP) were studied. There were examined 553 patients, in whom surgical treatment in the clinic was conducted. In all the patients MVP was conducted for isolated mitral valve failure and dilatation of LA. In 371 patients (the main group) MVP and LA plasty were conducted, in 182 (control group)--LA was not corrected. Morphometric indices of left cardiac cameras, survival, stability of the operation good results in late terms have witnessed high efficiency of MVP with LA reduction in comparison with such in a control group. Late results of MVP in conjunction with LA reduction exceed such in a control group, witnessing expediency of the proposed methods of surgical treatment application. PMID:25417286

Popov, V V; Trembovetskaia, E M; Beshliaga, V M; Zakharova, V P; Pukas, E V

2014-08-01

339

Conservative surgical management of mitral insufficiency: an alternative approach.  

PubMed

Mitral valve insufficiency is frequently the result of elongated or ruptured chordae tendineae. Several techniques have been described for its correction. However, when there is a severe elongation or rupture of the chordae, the most widely accepted treatment option has been valve replacement. The best long-term outcomes observed in conservative surgeries led us to choose this procedure rather than the correction of mitral valve insufficiency. We described three techniques for correction of mitral prolapse due to elongated and/or ruptured chordae tendineae. In addition, we developed mold pre built bovine pericardial chords (Braile-Gregori prosthesis) for chordae replacement. Finally, since 1987, the rigid prosthetic semicircular ring (Gregori-Braile ring) has been consistently used in our centre for correction of the posterior dilation of mitral annulus preferably in its portion close to the posteromedial commissure. PMID:22996984

Gregori Junior, Francisco

2012-01-01

340

What Are the Signs and Symptoms of Mitral Valve Prolapse?  

MedlinePLUS

... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To ... Media Availability: Mitral valve repair following heart attack may offer ...

341

Dissection of the atrial wall after mitral valve replacement.  

PubMed Central

We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection. Images PMID:8680278

Lukács, L; Kassai, I; Lengyel, M

1996-01-01

342

Systematic review and meta-analysis of surgical ablation for atrial fibrillation during mitral valve surgery  

PubMed Central

Background Surgical ablation has emerged as an acceptable treatment modality for patients with atrial fibrillation (AF) undertaking concomitant cardiac surgery. However, the efficacy of surgical ablation in patient populations undergoing mitral valve surgery is not well established. The present meta-analysis aims to establish the current randomized evidence on clinical outcomes of surgical ablation versus no ablative treatment in patients with AF undergoing mitral valve surgery. Methods Electronic searches were performed using six databases from their inception to September 2013, identifying all relevant randomized controlled trials (RCTs) comparing surgical ablation versus no ablation in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. Results Nine relevant RCTs were identified for inclusion in the present analysis. The number of patients in sinus rhythm (SR) was significantly improved in the surgical ablation group compared to the non-ablation group at discharge. This effect on SR remained at all follow-up periods until >1 year. Results indicated that there was no significant difference between surgical ablation and no ablation in terms of 30-day mortality, all-cause mortality, pacemaker implantation, stroke, thromboembolism, cardiac tamponade, reoperation for bleeding and myocardial infarction. Conclusions Results from the present meta-analysis demonstrate that the addition of surgical ablation for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke and thromboembolism. Further research should be directed at correlating different surgical ablation subtypes to cardiac and cerebrovascular events at long-term follow-up. PMID:24516793

Phan, Kevin; Xie, Ashleigh; Tian, David H.; Shaikhrezai, Kasra

2014-01-01

343

Mitral Valve Prolapse and the Association with Cutaneous Mucin Infiltration  

PubMed Central

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

Farooq, Uzma; McLeod, Michael P.; Torchia, Daniele; Romanelli, Paolo

2013-01-01

344

Defect in mitochondrial functions in damaged human mitral valve  

Microsoft Academic Search

Mitochondrial diseases are a heterogeneous group of disorders in which a primary mitochondrial dysfunction is proven by morphological,\\u000a biochemical, and genetic examinations. The mitral valve has important function in the regulation of blood flow from one chamber\\u000a to another. Often, the mitral valve becomes abnormal with age, in Rheumatic fever or it is abnormal from birth (Congenital)\\u000a or it can

Santosh Shinde; Pawan Kumar; Kaushala Mishra; Neela Patil

2006-01-01

345

Three-dimensional echocardiography in congenital malformations of the mitral valve.  

PubMed

Three-dimensional echocardiography has proved to be valuable in congenital heart disease by enhancing the evaluation of morphologic abnormalities and increasing the understanding of complex relationships. This study was undertaken to determine how 3-dimensional echocardiography could be best used to study some of the congenital malformations of the mitral valve such as mitral arcade, double orifice mitral valve, accessory mitral tissue, cleft mitral valve, and unicuspid mitral valve. Five patients were studied. Three-dimensional echocardiography was found to be helpful in defining spatial location and extent of deformities. PMID:12019431

Espinola-Zavaleta, Nilda; Vargas-Barrón, Jesus; Keirns, Candace; Rivera, Guillermo; Romero-Cárdenas, Angel; Roldán, Javier; Attie, Fause

2002-05-01

346

[Thromboembolic accident after mitral valve replacement].  

PubMed

Between January 1981 and December 2000, we report 112 cases of mitral valvular replacement with bileaflet prothesis. Saint Jude prosthesis was implanted in 71% of cases. With a mean follow-up of 110 months we report a thromboembolic accident in 7 cases (6.2%). The linear rate of thromboembolic accident is 0.69% A/P. This complication was concerned 5 women and 5 men. The mean age is 54 years (43-65 years). An embolic accident without prosthesis thrombosis is noted in 6 cases. We report only one case of prosthesis occlusive thrombosis with urgent chirurgical intervention. Par rapport au RVM, l'ATE est survenue dans uns délai moyen de 129 months (86-168 months). Left atrium size, embolic antecedent, and bad anticoagulation are the predicted factors of thromboembolic accidents in our study. Patient age and sex, atrial fibrillation, type of bileaflet prosthesis don't influence the occurrence of thromboembolic accident. PMID:15382464

Drissa, Habiba; Ben Salah, Faten; Ben Romdhane, Seddika; Zaouali, Romdhane Mohsen

2004-03-01

347

How to start a minimal access mitral valve program  

PubMed Central

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

2013-01-01

348

[Mitral valve tissue characterization using acoustic microscopy].  

PubMed

Mitral valve hardness in the rough and clear zones was evaluated by measuring the propagation velocity (m/sec) of ultrasound through the valve, based on the hypothesis that harder tissues will have larger ultrasonic velocity values passing through the tissue. Mitral valve specimens were obtained from 16 normal subjects (age, 15-72 years) at autopsy. An acoustic microscope, operating at 450 MHz, was used to measure the ultrasonic velocity through the three layers of the valve: the atrialis; the spongiosa; and the fibrosa. Furthermore, the mean ultrasonic velocity through the three layers was measured. These measurements were conducted in the rough and clear zones of the valve. In the rough zone, the ultrasonic velocities were 1,634 +/- 71 in the atrialis, 1,574 +/- 37 in the spongiosa, and 1,726 +/- 97 m/sec in the fibrosa. In the clear zone, the ultrasonic velocities were 1,691 +/- 117 in the atrialis, 1,575 +/- 44 in the spongiosa, and 1,909 +/- 131 m/sec in the fibrosa. There were significant differences between velocities in the three layers in both the rough and clear zones. Furthermore, the mean ultrasonic velocity in the three layers in the clear zone (1,887 +/- 138 m/sec) was higher than that in the rough zone (1,642 +/- 53 m/sec; p < 0.001). These findings show that fibrosa, which is rich in collagen fibers, is harder than atrialis, which is rich in elastic fibers, and the spongiosa, which is poor in connective tissues, is the softest. The higher mean ultrasonic velocity in the clear zone than in the rough zone indicates that the clear zone is harder than the rough zone, although the clear zone is thinner than the rough zone. PMID:9666397

Masugata, H; Senda, S; Mizushige, K; Lu, X; Kinoshita, A; Sakamoto, H; Nozaki, S; Sakamoto, S; Matsuo, H

1998-01-01

349

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

E-print Network

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 ...

Liu, Mengmeng

2014-11-28

350

Radiofrequency Atrial Fibrillation Ablation Technique in Patients with Mitral Valve Surgery and Left Atrial Reduction Procedures  

PubMed Central

Abstract Background: About half of all patients who undergo mitral valve surgery suffer from atrial fibrillation (AF). Cox described the surgical cut-and-sew Maze procedure, which is an effective surgical method but has some complications. This study was designed to evaluate the efficacy of a substitution method of radiofrequency ablation (RFA) for patients undergoing mitral valve surgery with AF. Methods: We evaluated 50 patients, comprising 40 men and 10 women at a mean age of 61.8 ± 7.5 years, who underwent mitral valve surgery with RFA between March 2010 and August 2013. All the patients had permanent AF with an enlarged left atrium (LA). The first indication for surgery was underlying organic lesions. Mitral valve replacement or repair was performed in the patients as a single procedure or in combination with aortic valve replacement or coronary artery bypass grafting. Radiofrequency energy was used to create continuous endocardial lesions mimicking most incisions and sutures. We evaluated the pre- and postoperative LA size, duration of aortic cross-clamping, cardiopulmonary bypass time, intensive care unit stay, and total hospital stay. Results: The mean preoperative and postoperative LA sizes were 7.5 ± 1.4 cm and 4.3 ± 0.7 cm (p value = 0.0001), respectively. The mean cardiopulmonary bypass time and the aortic cross-clamping time were 134.3 ± 33.7 minand 109.0 ± 28.4 min, respectively. The average stay at the intensive care unit was 2.1 ± 1.2 days, and the total hospital stay was 8.3 ± 2.4 days. Rebleeding was the only complication, found in one patient. There was no early or late mortality. Eighty-two percent of the patients were discharged in normal sinus rhythm. Five other patients had normal sinus rhythm at 6months' follow-up, and the remaining 4 patients did not have a normal sinus rhythm after 6 months. Conclusion: Radiofrequency ablation, combined with LA reduction, is an effective option for the treatment of permanent AF concomitant with mitral valve surgery.

Nezafati, Pouya; Nezafati, Mohammad Hassan; Moshiri, Mohammad

2014-01-01

351

Management of Moderate Functional Tricuspid Valve Regurgitation at the Time of Pulmonary Valve Replacement: Is Concomitant Tricuspid Valve Repair Necessary?  

Microsoft Academic Search

Congenital heart defects with a component of pulmonary stenosis are often palliated in childhood by disrupting the pulmonary\\u000a valve. Patients often undergo subsequent pulmonary valve replacement (PVR) to protect the heart from the consequences of pulmonary\\u000a regurgitation. In the presence of associated moderate functional tricuspid valve (TV) regurgitation, it is unclear what factors\\u000a contribute to persistent TV regurgitation following PVR.

Brian Kogon; Manisha Patel; Traci Leong; Michael McConnell

2010-01-01

352

Journal of Biomechanics 40 (2007) 613626 Dynamic modelling of prosthetic chorded mitral valves using the  

E-print Network

and haemody- namic properties, however they have a limited lifespan due to tissue failure and calcification for the mitral position: these are designed for the aortic position and reversed for the mitral position, thus

Luo, Xiaoyu

2007-01-01

353

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

E-print Network

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 ...

Han, Richard I-Ming

2009-01-01

354

Discharge patterning in rat olfactory bulb mitral cells in vivo  

PubMed Central

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

Leng, Gareth; Hashimoto, Hirofumi; Tsuji, Chiharu; Sabatier, Nancy; Ludwig, Mike

2014-01-01

355

Aortic Valve Regurgitation that Resolved after a Ruptured Coronary Sinus Aneurysm Was Patched  

PubMed Central

Sinus of Valsalva aneurysms appear to be rare. They occur most frequently in the right sinus of Valsalva (52%) and the noncoronary sinus (33%). More of these aneurysms originate from the right coronary cusp than from the noncoronary cusp. Surgical intervention is usually recommended when symptoms become evident. We report the case of a 34-year-old woman who presented with a congenital, ruptured sinus of Valsalva aneurysm that originated from the noncoronary cusp. Moderate aortic regurgitation was associated with this lesion. Simple, direct patch closure of the ruptured aneurysm resolved the patient's left-to-right shunt and was associated with decreased aortic regurgitation to a degree that valve replacement was not necessary. Only trace residual aortic regurgitation was evident after 3 months, and the patient remained free of symptoms after 6 months. Our observations support the idea that substantial runoff blood flow in the immediate supra-annular region can be responsible for aortic regurgitation in the absence of a notable structural defect in the aortic valve, and that restoring physiologic flow in this region and equalizing aortic-cusp closure pressure can largely or completely resolve aortic insufficiency. Accordingly, valve replacement may not be necessary in all cases of ruptured sinus of Valsalva aneurysms with associated aortic valve regurgitation. PMID:24082388

Nascimbene, Angelo; Joggerst, Steven; Reddy, Kota J.; Cervera, Roberto D.; Ott, David A.; Wilson, James M.; Stainback, Raymond F.

2013-01-01

356

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

PubMed Central

A few cases of cardiac valve tophi have been reported in literature. In this case report, the echocardiographic characteristics of the hyperechoic mass in the posterior leaflet mitral valve, intact mitral valve ring, and the occurrence of severe tophaceous gout arthritis suggested the diagnosis of a gout tophus on the mitral valve. PMID:23230550

Rohani, Atooshe; Chamanian, Soheila; Hosseinzade, Peiman; Ramezani, Javad

2012-01-01

357

A case of mitral valve tophus in a patient with severe gout tophaceous arthritis.  

PubMed

A few cases of cardiac valve tophi have been reported in literature. In this case report, the echocardiographic characteristics of the hyperechoic mass in the posterior leaflet mitral valve, intact mitral valve ring, and the occurrence of severe tophaceous gout arthritis suggested the diagnosis of a gout tophus on the mitral valve. PMID:23230550

Rohani, Atooshe; Chamanian, Soheila; Hosseinzade, Peiman; Ramezani, Javad

2012-01-01

358

Non-bulimia: food regurgitation in a patient with self-diagnosed bulimia.  

PubMed

The increased prevalence of bulimia has received great publicity by the news media. Such publicity predisposes individuals to self-diagnosis. A 57-year-old man with a 10-year history of food regurgitation presented to an eating disorder clinic complaining of bulimia, which he had heard discussed on a television talk show. He proved not to have bulimia but a large pharyngoesophageal (Zenker's) diverticulum. The diagnosis of bulimia may be misattributed to various symptoms by patients. The differential diagnosis of chronic regurgitation and vomiting must be considered in such patients. PMID:3086293

Copeland, P M; Herzog, D B

1986-06-01

359

Entrapped central venous catheter after mitral valve replacement and its surgical retrieval.  

PubMed

Central venous pressure monitoring line insertion is routine prior to the conduct of cardiac surgery, and in rare instances, malposition can contribute to operative complications. We describe here how a central venous line lying in the right atrium became caught in a left atrial (LA) closure suture during a mitral valve replacement. The opening of the LA suture line is highly unsafe without cardiopulmonary bypass (CPB) because of the possibility of systemic air embolism, but by employing an ingenious method of suturing over and unravelling the continuous sutures closing the left atrium, it was possible to surgically retrieve it without the use of a CPB. PMID:22687430

Nair, Hema C; Banakal, Sanjay; Parachuri, V Rao; Shetty, Devi Prasad

2012-09-01

360

Thoracic CT  

MedlinePLUS

... parts. Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and ... lung Mitral regurgitation; acute Mitral regurgitation; chronic Mitral valve prolapse Pericarditis; bacterial Pericarditis; constrictive Pericarditis; post-MI ...

361

Bias and variability of diagnostic spectral parameters extracted from closing sounds produced by bioprosthetic valves implanted in the mitral position  

Microsoft Academic Search

A method is proposed to estimate the bias and variability of eight diagnostic spectral parameters extracted from mitral closing sounds produced by bioprosthetic heart valves. These spectral param- eters are: the frequency of the dominant (Fl) and second dominant (F2) spectral peaks, the highest frequency of the spectrum found at -3 dB (F-3), -10 dB (F-10) and -20 dB (F-20)

ROBERT GUARDO; HANI N. SABBAH; PAUL D. STEIN

1989-01-01

362

Long-term survival after mitral valve replacement in children aged <5 years: a multi-institutional study  

Microsoft Academic Search

Background—Short- and long-term outcomes after prosthetic mitral valve replacement (MVR) in children aged ,5 years are ill-defined and generally perceived as poor. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999) was reviewed. Methods and Results—MVR was performed 176 times on 139 patients. Median follow-up was 6.2 years (range 0 to 20 years, 96% complete). Age

Christopher A. Caldarone; Geetha Raghuveer; Christine B. Hills

2002-01-01

363

Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration  

NASA Technical Reports Server (NTRS)

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.

Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

2001-01-01

364

Validation of a decision-making strategy for systolic anterior motion following mitral valve repair.  

PubMed

Low cardiac output syndrome and hypotension are dreadful consequences of systolic anterior motion (SAM) after a mitral valve (MV) repair. The management of SAM in the operating room remains controversial. We validate a recently suggested two-step management method and classification of this complication. This was a teaching hospital-based observational study. We validated a novel two-step conservative management method, consisting in intravascular volume expansion and discontinuation of inotropic drugs (step 1), and increasing the afterload by ascending aorta manual compression while administering esmolol e.v. (step 2). We also validate a novel classification of SAM: easy-to-revert (responding to step 1), difficult-to-revert (responding to step 2), or persistent. Fifty patients had an easy-to-revert while 26 had a difficult-to-revert SAM; 4 patients had a persistent condition (promptly diagnosed through our decisional algorithm) and underwent an immediate second pump run to repeat the mitral repair surgery. We confirmed that SAM after a repair of a degenerative MV is common and validated a simple two-step conservative management method that allows to clearly identify those few patients who require immediate surgical revision. PMID:21636927

Landoni, Giovanni; Crescenzi, Giuseppe; Zangrillo, Alberto; Nicolotti, Davide; Bignami, Elena; Iaci, Giuseppe; Alfieri, Ottavio; Guarracino, Fabio

2011-01-01

365

Supravalvular aortic stenosis in adult with anomalies of aortic arch vessels and aortic regurgitation  

PubMed Central

The supravalvular aortic stenosis is a rare congenital heart defect being very uncommon in adults. We present a case of supravalvular aortic stenosis in adult associated with anomalies of the aortic arch vessels and aortic regurgitation, which was submitted to aortic valve replacement and arterioplasty of the ascending aorta with a good postoperative course. PMID:24598962

Valente, Acrisio Sales; Alencar, Polyanna; Santos, Alana Neiva; Lobo, Roberto Augusto de Mesquita; de Mesquita, Fernando Antônio; Guimarães, Aloyra Guedis

2013-01-01

366

New fatty acid amides from regurgitant of Lepidopteran (Noctuidae, Geometridae) caterpillars  

Microsoft Academic Search

Oral secretions of seven different species of caterpillars, feeding on natural and artificial diets have been analysed by liquid chromatography mass spectroscopy. The compounds present in the caterpillar regurgitates were identified as a structurally diverse group of conjugates of glutamine and glutamic acid linked via an amide bond to saturated and unsaturated C14-, C16- and C18 fatty acids. Proportions of

Georg Pohnert; Verena Jung; Erkki Haukioja; Kyösti Lempa; Wilhelm Boland

1999-01-01

367

Pathological anatomy of ventricular septal defect associated with aortic valve prolapse and regurgitation  

Microsoft Academic Search

Summary In an attempt to clarify the pathogenetic morphology of aortic regurgitation (AR) due to prolapse of the aortic valve (prolapsing AR) associated with ventricular septal defect (VSD), 201 specimens from Japanese autopsy series with isolated VSD were examined. Among these hearts, there were 128 cases (64%) of infundibular VSD (IVSD); 29 of them (14%) showed AR due to prolapsed

Masahiko Ando; Atsuyoshi Takao

1986-01-01

368

Severity of Intraoperative Tricuspid Regurgitation Predicts Poor Late Survival Following Cardiac Transplantation  

Microsoft Academic Search

BackgroundThis study evaluates the significance of tricuspid regurgitation (TR) on long-term survival as detected by intraoperative transesophageal echocardiography at the time of orthotopic heart transplantation. Although significant (2+ to 4+) TR after orthotopic heart transplantation is rare, its influence on long-term survival is unknown, warranting further investigation.

Curtis A. Anderson; Stanton K Shernan; Marzia Leacche; James D. Rawn; Subroto Paul; Tomislav Mihaljevic; John A. Jarcho; Lynne W. Stevenson; James Chen-Tson Fang; Eldrin F. Lewis; Gregory S. Couper; Gilbert H. Mudge; John G. Byrne

2004-01-01

369

Numerical simulation of patient-specific left ventricular model with both mitral and aortic valves by FSI approach.  

PubMed

Intraventricular flow is important in understanding left ventricular function; however, relevant numerical simulations are limited, especially when heart valve function is taken into account. In this study, intraventricular flow in a patient-specific left ventricle has been modelled in two-dimension (2D) with both mitral and aortic valves integrated. The arbitrary Lagrangian-Eulerian (ALE) approach was employed to handle the large mesh deformation induced by the beating ventricular wall and moving leaflets. Ventricular wall deformation was predefined based on MRI data, while leaflet dynamics were predicted numerically by fluid-structure interaction (FSI). Comparisons of simulation results with in vitro and in vivo measurements reported in the literature demonstrated that numerical method in combination with MRI was able to predict qualitatively the patient-specific intraventricular flow. To the best of our knowledge, we are the first to simulate patient-specific ventricular flow taking into account both mitral and aortic valves. PMID:24332277

Su, Boyang; Zhong, Liang; Wang, Xi-Kun; Zhang, Jun-Mei; Tan, Ru San; Allen, John Carson; Tan, Soon Keat; Kim, Sangho; Leo, Hwa Liang

2014-02-01

370

FSI simulation of asymmetric mitral valve dynamics during diastolic filling  

Microsoft Academic Search

In this article, we present a fluid–structure interaction algorithm accounting for the mutual interaction between two rigid bodies. The algorithm was used to perform a numerical simulation of mitral valve (MV) dynamics during diastolic filling. In numerical simulations of intraventricular flow and MV motion, the asymmetry of the leaflets is often neglected. In this study the MV was rendered as

S. K. Dahl; J. Vierendeels; J. Degroote; S. Annerel; L. R. Hellevik; B. Skallerud

2010-01-01

371

Fibrillin and Other Matrix Proteins in Mitral Valve Prolapse Syndrome  

Microsoft Academic Search

Background. Unlike myxomatous degeneration in Marfan syndrome, which has been reported to result from a mutation in the gene that codes for the extracel- lular structural protein fibrillin, no specific molecular abnormality has been documented to be the underlying cause of myxomatous degeneration in mitral valve pro- lapse syndrome (MVPS). The present study examined the distribution of fibrillin and other

Joseph F. Nasuti; Paul J. Zhang; Michael D. Feldman; Terri Pasha; Jasvir S. Khurana; Joseph H. Gorman III; Robert C. Gorman; Jagat Narula; Navneet Narula

372

Mitral Valve Surgery After Previous CABG With Functioning IMA Grafts  

Microsoft Academic Search

Background. Mitral valve surgery after previous coro- nary artery bypass grafting presents a challenging prob- lem for the cardiac surgeon. An injury to patent coronary artery bypass grafts, especially internal mammary artery grafts, during reoperation via a redo sternotomy, may be fatal. Therefore, a reliable alternative to the redo sternot- omy is desirable to minimize potential injury to internal mammary

John G. Byrne; Sary F. Aranki; David H. Adams; Robert J. Rizzo; Gregory S. Couper; Lawrence H. Cohn

373

Rat Olfactory Bulb Mitral Cells Receive Sparse Glomerular Inputs  

Microsoft Academic Search

SUMMARY Center-surround receptive fields are a fundamental unit of brain organization. It has been proposed that olfactory bulb mitral cells exhibit this functional circuitry, with excitation from one glomerulus and in- hibition from a broad field of glomeruli within reach of the lateral dendrites. We investigated this hypothesis using a combination of in vivo intrinsic imaging, single-unit recording, and a

Antoniu L. Fantana; Edward R. Soucy; Markus Meister

2008-01-01

374

Amounts of coronary arterial narrowing by atherosclerotic plaques in clinically isolated mitral valve stenosis: analysis of 76 necropsy patients older than 30 years.  

PubMed

Although several studies have described the status of the coronary arteries by angiography in patients with mitral stenosis (MS), few necropsy studies of the coronary arteries in these patients are available. The present report describes in detail the amounts of narrowing by atherosclerotic plaque of the 4 major epicardial coronary arteries in 76 necropsy patients, aged 31 to 79 years (mean 53) with clinically isolated MS (with or without associated mitral regurgitation but without aortic valve dysfunction). Of the 76 patients, greater than or equal to 1 major coronary artery was narrowed greater than 75% in cross-sectional area (XSA) in 38 (50%) and in 10 of the 38 patients greater than or equal to 1 major coronary artery was totally occluded or nearly so (greater than 95% XSA narrowing). A higher percent of the 29 men had significant (greater than 75% XSA) coronary narrowing than did the 47 women (62 vs 44%) and the men had more major coronary arteries significantly narrowed compared with the women (31 of 116 arteries [27%] vs 33 of 188 arteries [18%]). The 4 major coronary arteries in the 76 patients were divided into 5-mm segments and examined histologically: of the 3,124 segments (41 per patient), 620 segments (20%) were narrowed 0 to 25% in XSA, 1,826 (58%) were narrowed 26 to 50%, 470 (15%) were narrowed 51 to 75%, 188 (6%) were narrowed 76 to 95%, and 20 segments (1%) were narrowed 96 to 100% in XSA. The percent of segments narrowed greater than 75% in XSA was 9% in the men and 5% in the women.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3706163

Reis, R N; Roberts, W C

1986-05-01

375

Ethanol Infusion the Vein of Marshall Facilitates Mitral Isthmus Ablation  

PubMed Central

Background Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. Objective To test whether VOM ethanol infusion could help achieve MI block. Methods Perimitral conduction was studied in patients undergoing ablation of atrial fibrillation (AF). Group 1 included 50 patients with a previous AF ablation undergoing repeat ablation, 30 of which had had MI ablation. Spontaneous (8/50) or inducible PMF (21/50) was confirmed by activation mapping. Group 2 included 21 patients undergoing de novo VOM ethanol infusion. The VOM was cannulated with a quadripolar catheter for pacing and with an angioplasty balloon to deliver up to four 1mL infusions of 98% ethanol. Voltage maps were created before and after VOM ethanol. Bidirectional MI block was verified by differential pacing. RFA times required to achieve it were assessed. Results In Group 1, VOM ethanol infusion acutely terminated PMF in 5/29 patients. RFA needed to achieve bidirectional MI block was 2.2±1.6 min. Presence of PMF or previous MI ablation did not affect RFA times. In Group 2, RFA needed to achieve bidirectional MI block was 2.0±1.6 min (p=NS). Five patients had bidirectional MI block achieved solely by VOM ethanol without RFA. In both groups, ablation after VOM ethanol was required in the annular aspect of the MI. There were no acute complications. Conclusion VOM ethanol infusion is useful in the treatment of PMF and assists in reliably achieving bidirectional MI block. PMID:22406143

Báez-Escudero, José L.; Morales, Percy Francisco; Dave, Amish S.; Sasaridis, Christine M.; Kim, Young-Hoon; Okishige, Kaoru; Valderrábano, Miguel

2012-01-01

376

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

PubMed Central

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

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

2014-01-01

377

Renal Sympathetic Denervation Suppresses de novo Podocyte Injury and Albuminuria in Rats with Aortic Regurgitation  

PubMed Central

Background The presence of chronic kidney disease is a significant independent risk factor for poor prognosis in patients with chronic heart failure (CHF). However, the mechanisms and mediators underlying this interaction are poorly understood. In this study, we tested our hypothesis that chronic cardiac volume overload leads to de novo renal dysfunction by co-activating the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS) in the kidney. We also examined the therapeutic potential of renal denervation and RAS inhibition to suppress renal injury in CHF. Methods and Results Sprague-Dawley rats underwent aortic regurgitation (AR) and were treated for 6 months with either vehicle, olmesartan [an angiotensin II (AngII) receptor blocker], or hydralazine. At 6 months, albuminuria and glomerular podocyte injury were significantly increased in AR rats. These changes were associated with increased urinary angiotensinogen excretion, kidney AngII and norepinephrine (NE) levels, as well as enhanced angiotensinogen and angiotensin type 1a receptor gene expression, and oxidative stress in renal cortical tissues. AR rats with renal denervation had decreased albuminuria and glomerular podocyte injury, which were associated with reduced kidney NE, angiotensinogen, AngII and oxidative stress. Renal denervation combined with olmesartan prevented podocyte injury and albuminuria induced by AR. Conclusions In this chronic cardiac volume overload animal model, activation of the SNS augments kidney RAS and oxidative stress, which act as crucial cardio-renal mediators. Renal denervation and olmesartan prevent the onset and progression of renal injury, providing new insight into the treatment of cardio-renal syndrome. PMID:22328542

Rafiq, Kazi; Noma, Takahisa; Fujisawa, Yoshihide; Ishihara, Yasuhiro; Arai, Yoshie; Nabi, A.H.M. Nurun; Suzuki, Fumiaki; Nagai, Yukiko; Nakano, Daisuke; Hitomi, Hirofumi; Kitada, Kento; Urushihara, Maki; Kobori, Hiroyuki; Kohno, Masakazu; Nishiyama, Akira

2012-01-01

378

Isolated, persistent functional tricuspid valve regurgitation in a fetus with normal heart anatomy (and no extracardiac malformation). Case report.  

PubMed

Functional fetal tricuspid valve regurgitation was diagnosed by echocardiography at 27 weeks of gestation as an isolated anomaly with a maximum velocity of the regurgitation jet of 3 m/s. This was also observed at 30, 32 and 35 weeks of gestation and at term. Just after delivery pneumonia was diagnosed in the newborn baby based on clinical symptoms, chest X-ray and laboratory findings. To date persistent fetal tricuspid valve regurgitation has not been described in the literature on normal fetal heart anatomy. Various etiologies and possible pathomechanisms are discussed. PMID:12711872

Respondek-Liberska, M; Kraso?, A

2003-01-01

379

Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: Comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy  

Microsoft Academic Search

The purpose of this study was to determine the normal pattern and magnitude of mitral annular velocities in diastole by Doppler tissue imaging (DTI) and to assess whether this is altered in patients with left ventricular hypertrophy. Mitral annulus velocities were measured by DTI. Peak and time-velocity integral were measured from the DTI tracings and the timing of the velocities

Leonardo Rodriguez; Mario Garcia; Miguel Ares; Brian P. Griffin; Satoshi Nakatani; James D. Thomas

1996-01-01

380

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis  

PubMed Central

Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival. PMID:24903989

Ding, Chao; Jiang, Da-ming; Tao, Kai-yu; Duan, Qun-jun; Li, Jie; Kong, Min-jian; Shen, Zhong-hua; Dong, Ai-qiang

2014-01-01

381

Bileaflet versus posterior-leaflet-only preservation in mitral valve replacement.  

PubMed

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function. PMID:24808776

Ozdemir, Ahmet Coskun; Emrecan, Bilgin; Baltalarli, Ahmet

2014-04-01

382

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

PubMed

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. PMID:25319496

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

2014-12-01

383

Minimally invasive approach for redo mitral valve surgery  

PubMed Central

Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining “mitral valve” with the following terms: ‘minimally invasive’, ‘reoperation’, and ‘alternative approach’. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed “mini” thoracotomy or “port access”. The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these procedures has never been compared to open reoperations in a randomized trial, although published case series and comparisons to historical cohorts suggest that they are an effective and feasible alternative. Ongoing follow-up on current series will further define these procedures and provide valuable clinical outcome data. PMID:24251029

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

2013-01-01

384

Minimally invasive approach for redo mitral valve surgery.  

PubMed

Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these procedures has never been compared to open reoperations in a randomized trial, although published case series and comparisons to historical cohorts suggest that they are an effective and feasible alternative. Ongoing follow-up on current series will further define these procedures and provide valuable clinical outcome data. PMID:24251029

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

2013-11-01

385

Transjugular approach in valve-in-valve transcatheter mitral valve replacement: direct route to the valve.  

PubMed

With the recent emergence of transcatheter valve replacement, high-risk cases of structural valve deterioration after mitral bioprosthesis can be treated with valve-in-valve transcatheter mitral valve replacement (TMVR). The transapical approach has become the principal access for TMVR, but we report an alternative direct access for TMVR--transjugular transseptal route--in an 81-year-old woman with a degenerated mitral bioprosthesis. PMID:24882333

Kaneko, Tsuyoshi; Swain, JaBaris D; Loberman, Dan; Welt, Frederick G P; Davidson, Michael J; Eisenhauer, Andrew C

2014-06-01

386

Left ventricular pannus causing inflow obstruction late after mitral valve replacement for endocardial fibroelastosis  

Microsoft Academic Search

A case of mitral stenosis following mitral valve replacement in a patient with endocardial fibroelastosis is reported. A 14-year-old\\u000a boy presented with cardiac failure. He had been diagnosed as having endocardial fibroelastosis at the age of 7 months and\\u000a had undergone resection of endocardial fibrous tissue in the left ventricle at that time. Five years later his mitral valve\\u000a was

S. Dinarevic; A. Redington; M. Rigby; M. N. Sheppard

1996-01-01

387

Disc erosion in Models 103 and 104 of Beall mitral valve prostheses  

PubMed Central

Three cases of severe disc variance and erosion of the Teflon-disc Beall mitral valve prosthesis (Models 103 and 104) are reported. In two patients, the Beall mitral valves were excised and replaced with two Björk-Shiley mitral valves. The remaining patient did not survive, and at autopsy, the lens was found at the aortic bifurcation level. Because of this potentially lethal complication, careful follow-up of patients with Beall mitral valve prostheses (Models 103 and 104) is recommended. Images PMID:15216211

Gómez, Ricardo; Verduras, María José; Lopez-Quintana, Alfonso; Riera, Luis; Zerolo, Ignacio; Martinez-Bordiu, Cristóbal

1981-01-01

388

Anterior mitral leaflet reconstruction with pericardium in a 1.9 kg infant with endocarditis.  

PubMed

A premature twin of 1.9 kg had mitral valve endocarditis develop during neonatal intensive care. Vegetation involving the entire anterior mitral valve leaflet was identified. Reconstruction was achieved by near complete resection of the anterior mitral valve leaflet and retention of the peripheral margin of coaptation including primary and secondary chordae. The body of the anterior mitral valve leaflet was reconstructed using fresh autologous pericardium, a technique not previously reported in an infant of this size. Three and a half years later, the child is well and has required no further intervention. PMID:16731184

Healy, David G; Wood, Alfred E

2006-06-01

389

Robotic Tissue Tracking for Beating Heart Mitral Valve Surgery  

PubMed Central

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

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

2010-01-01

390

Effects of atrial arrhytmias on the regurgitation of a monoleaflet prosthetic heart valve.  

PubMed

Many patients who receive a prosthetic heart valve also have or acquire cardiac arrhythmias. However, most in vitro studies of prosthetic valves examine them under normal rhythms. In this study, a monoleaflet prosthetic heart valve was tested in vitro under conditions that simulated normal sinus rhythm, first degree atrioventricular heart block, and atrial fibrillation (fixed and variable ventricular rates). Atrial contraction was simulated by an active atrial chamber. The timing between the atrium and ventricle was adjusted to simulate various types of arrhythmias. The closing, leakage, and total regurgitant volumes and fractions increased for each type of atrial arrhythmia when compared to normal sinus rhythm. The peak regurgitant flow increased for first degree atrioventricular heart block and atrial fibrillation with a fixed ventricular rate compared to normal sinus rhythm. PMID:16048480

Zapanta, Conrad M

2005-08-01

391

Mitral Valve Disease in Marfan Syndrome and Related Disorders  

Microsoft Academic Search

Marfan syndrome (MFS) is a systemic disorder of the connective tissue with pleiotropic manifestations due to heterozygous\\u000a FBN1 mutations and consequent upregulation of TGF? signaling in affected tissues. Myxomatous thickening and elongation of the\\u000a mitral valve (MV) leaflets commonly occur in this condition. Investigation of murine models of this disease has led to improved\\u000a understanding of the mechanisms that underlie

Daniel P. Judge; Rosanne Rouf; Jennifer Habashi; Harry C. Dietz

392

State of the mitral valve in rabbits with hypokinesia  

NASA Technical Reports Server (NTRS)

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.

Strelkovska, V. Y.

1979-01-01

393

Severe Pulmonary Regurgitation Late After Total Repair of Tetralogy of Fallot: Surgical Considerations  

Microsoft Academic Search

Background After total repair of tetralogy of Fallot (TOF-R) with transannular patching (TAP), severe pulmonary regurgitation (PR) is reported to develop in up to 30% of patients at a follow-up of 20 years, and 10–15% or more need pulmonary valve replacement (PVR). In this study, time-related progression of PR and right ventricular (RV) dilatation, and functional recovery of the RV after

A. Borowski; A. Ghodsizad; J. Litmathe; W. Lawrenz; K. G. Schmidt; E. Gams

2004-01-01

394

Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot  

Microsoft Academic Search

Repaired tetralogy of Fallot (rTOF) has an excellent long-term prognosis; however, survival is somewhat less than normal. Of all the residual lesions and sequellae after rTOF, pulmonary regurgitation (PR) is the most important, correlating with right ventricular (RV) size, exercise intolerance and serious ventricular arrhythmias. Pulmonary valve replacement (PVR) has beneficial effects on RV size and function, provided it is

Periklis A. Davlouros; Ageliki A. Karatza; Michael A. Gatzoulis; Darryl F. Shore

2004-01-01

395

Pulmonary valve cusp augmentation for pulmonary regurgitation after repair of valvular pulmonary stenosis.  

PubMed

A 23-year-old female patient with a history of pulmonary valvectomy for pulmonary stenosis at 2 years of age underwent pulmonary valve repair, which consisted of remnant cusp extension using a fresh pericardium and commissural resuspension. An immediate postoperative computed tomographic scan showed full movement of the extended anterior cusp during systole, yet flail motion during diastole. However, follow-up magnetic resonance imaging at 10 months postoperatively revealed a small amount of pulmonary flow regurgitation (2.0%). PMID:25742858

Shin, Yu Rim; Park, Han Ki; Park, Young Hwan; Jung, Jo Won; Kim, Young Jin; Shin, Hong Ju

2015-03-01

396

Aortic valve tear with severe aortic regurgitation following blunt chest trauma  

PubMed Central

An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a 55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a mechanical prosthesis. PMID:21682925

2011-01-01

397

Ablation of peri-"mitral" flutter in a patient with congenitally corrected transposition of great vessels and situs inversus.  

PubMed

This case reports the successful ablation of a peri-"mitral" flutter in a patient with congenitally corrected transposition of the great vessels and situs inversus using an anterior mitral line. PMID:21535028

Palma, Eugen C; Raiszadeh, Farbod

2012-04-01

398

Bias and variability of diagnostic spectral parameters extracted from closing sounds produced by bioprosthetic valves implanted in the mitral position.  

PubMed

A method is proposed to estimate the bias and variability of eight diagnostic spectral parameters extracted from mitral closing sounds produced by bioprosthetic heart valves. These spectral parameters are: the frequency of the dominant (F1) and second dominant (F2) spectral peaks, the highest frequency of the spectrum found at -3 dB (F-3), -10 dB (F-10) and -20 dB (F-20) below the highest peak, the relative integrated area above -20 dB of the dominant peak (RIA20), the bandwidth at -3 dB of the dominant spectral peak (BW3), and the ratio of F1 divided by BW3 (Q1). The bias and variability of four spectral techniques were obtained by comparing parameters extracted from each technique with the parameters of a spectral "standard." This "standard" consisted of 19 normal mitral sound spectra computed analytically by evaluating the Z transform of a sum of decaying sinusoids on the unit circle. Truncation of the synthesized mitral signals and addition of random noise were used to simulate the physiological characteristics of the closing sounds. Results show that the fast Fourier transform method with rectangular window provides the best estimates of F1 and Q1, that the Steiglitz-McBride method with maximum entropy (pole-zero modeling with four poles and four zeros) can best evaluate F2, F-20, RIA20 and BW3, and that the all-pole modeling with covariance method (16 poles) is best suited to compute F-3. It was also shown that both the all-pole modeling and the Steiglitz-McBride methods can be used to estimate F-10. It is concluded that a single algorithm would not provide the best estimates of all spectral parameters. PMID:2759640

Cloutier, G; Durand, L G; Guardo, R; Sabbah, H N; Stein, P D

1989-08-01

399

Surgical treatment for aortic regurgitation caused by non-specific aortitis 1 Presented at the International Society for Cardiovascular Surgery Congress, London, England, September 1997 1  

Microsoft Academic Search

Aortic regurgitation caused by non-specific aortitis is relatively rare, and prosthetic valve detachment after aortic valve replacement has been reported to be one of the most serious complications. The authors investigated the surgical results in patients with aortic regurgitation caused by non-specific aortitis. Between 1978 and 1997, 90 patients with aortic regurgitation secondary to non-specific aortitis underwent surgery. There were

M Ando; Y Kosakai; Y Okita; R Matsukawa; S Takamoto

1999-01-01

400

Caseous Calcification of the Mitral Annulus: A Rare Cause of Intracardiac Mass  

PubMed Central

Caseous calcification of the mitral annulus is a rare form of periannular calcification with a mass-like appearance, that has to be in the differential of the cardiologist and radiologist. It classically looks like a round or semilunar hyperdense mass with an even denser peripheral rim, located in the posterior mitral annulus and having in general no clinical significance. PMID:23243545

Martinez-de-Alegria, Anxo; Rubio-Alvarez, Jose; Baleato-Gonzalez, Sandra

2012-01-01

401

Regional stiffening of the mitral valve anterior leaflet in the beating ovine heart  

Microsoft Academic Search

Left atrial muscle extends into the proximal third of the mitral valve (MV) anterior leaflet and transient tensing of this muscle has been proposed as a mechanism aiding valve closure. If such tensing occurs, regional stiffness in the proximal anterior mitral leaflet will be greater during isovolumic contraction (IVC) than isovolumic relaxation (IVR) and this regional stiffness difference will be

Gaurav Krishnamurthy; Akinobu Itoh; Julia C. Swanson; Wolfgang Bothe; Matts Karlsson; Ellen Kuhl; D. Craig Miller; Neil B. Ingels Jr.

2009-01-01

402

Near fatal puerperal thrombosis on Björk-Shiley mitral valve prosthesis.  

PubMed Central

A 22-year-old woman required emergency mitral valve replacement three weeks post partum because of thrombotic obstruction of her prosthetic mitral valve. Low dose subcutaneous heparin was administered from the 17th week of pregnancy. Though there was a successful fetal outcome, heparin did not prevent thrombosis on the prosthesis and its continuation into the puerperium proved nearly fatal. Images PMID:687495

McLeod, A A; Jennings, K P; Townsend, E R

1978-01-01

403

Orthodromic synaptic activation of rat olfactory bulb mitral cells in isolated slices  

Microsoft Academic Search

Axons of olfactory receptor neurons terminate in the glomerular layer of the olfactory bulb, where they synapse with the apical dendrites of mitral cells. Although the mitral cell and its excitation by the olfactory nerve have been the subject of numerous experimental investigations, in vitro studies of these neurons have primarily used nonmammalian preparations. We have recorded the responses of

William T. Nickell; M. T. Shipley; Michael M. Behbehani

1996-01-01

404

Predictors of Severe Tricuspid Regurgitation in Patients with Permanent Pacemaker or Automatic Implantable Cardioverter-Defibrillator Leads  

PubMed Central

Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more t