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1

Percutaneous approaches to mitral regurgitation  

Microsoft Academic Search

Opinion statement  Percutaneous therapy for mitral repair has emerged over the past several years as an investigational option for treating mitral\\u000a regurgitation (MR). A variety of novel methods to treat MR using a percutaneous route have been developed. Most of these approaches\\u000a are modifications of surgical techniques, some established and some obscure. The basic surgical approaches to mitral repair\\u000a are annuloplasty

Faisal Alqoofi; Ted Feldman

2009-01-01

2

Echocardiographic assessment of ischemic mitral regurgitation.  

PubMed

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

Dudzinski, David M; Hung, Judy

2014-01-01

3

Surgical treatment of asymptomatic and mildly symptomatic mitral regurgitation  

Microsoft Academic Search

Objective: The purpose of this study was to review the risk-benefit ratio of mitral valve repair in patients with severe mitral regurgitation and no or mild symptoms.Methods: From January 1989 to December 1994, 584 patients were operated on for mitral regurgitation. Of these, 175 patients were in New York Heart Association class I or II with grade 3 to 4

Miguel Sousa Uva; Gilles Dreyfus; Giuseppe Rescigno; Nadji al Aile; Roberto Mascagni; Mauro La Marra; Fréderic Pouillart; Shirish Pargaonkar; Evelyne Palsky; Radwan Raffoul; Marcio Scorsin; Giorgio Noera; Arrigo Lessana

1996-01-01

4

Mitral Valve Regurgitation  

MedlinePLUS

... Accessed Dec. 9, 2014. Rehfeldt KH, et al. Robot-assisted mitral valve repair. Journal of Cardiothoracic and Vascular Anesthesia. 2011;25:721. Suri RM, et al. Minimally invasive heart surgery: How and why in 2012. Current Cardiology Reports. ...

5

Calculation of mitral regurgitant orifice area with use of a simplified proximal convergence method: Initial clinical application  

Microsoft Academic Search

To validate a previously proposed simplified proximal flow convergence method for calculating mitral regurgitant orifice area (ROA), a prospective study was conducted in ambulatory patients and in patients undergoing open heart surgery. Assuming a pressure difference between the left ventricle and left atrium of approximately 100 mm Hg (jet velocity [vp] 500 cm\\/s) and setting the color aliasing velocity (va)

Min Pu; David L. Prior; Xiaoxue Fan; Craig R. Asher; Connie Vasquez; Brian P. Griffin; James D. Thomas

2001-01-01

6

Percutaneous mitral valve repair for mitral regurgitation.  

PubMed

Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/- 0.5 to 0.8 +/- 0.4 (P < 0.0001) and LV ejection fraction increased from 33 +/- 13% to 45 +/- 11% (P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/- 4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive-off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved. Animal studies show excellent healing, with incorporation of the device into the leaflets at 6-10 weeks with persistent coaptation. Another percutaneous approach has been to utilize the proximity of the coronary sinus (CS) to the mitral annulus (MA). Placement of a self-compressing device in the CS along the region of the posterior MA has, in canine models, reduced MR and addresses the issues of MA dilation and its contribution to MR. Ongoing studies are underway for both techniques. PMID:12664822

Block, Peter C

2003-02-01

7

Subvalvular techniques to optimize surgical repair of ischemic mitral regurgitation  

PubMed Central

Purpose of review Surgical treatment of ischemic mitral regurgitation with reduction annuloplasty is the current standard of practice, yet recurrence rates approaching 30% limit the benefits of repair in this subset of patients. In an effort to improve outcomes, attention has turned to understanding the contribution of leaflet tethering in this disease process. Subvalvular techniques to alleviate leaflet restriction have recently been incorporated into methods of repair. Recent findings Parameters of left ventricular remodeling have been quantified as risk factors for recurrence of mitral regurgitation following reduction annuloplasty. Papillary muscle relocation restores the physiologic configuration of the subvalvular apparatus, and results in significantly reduced rates of recurrent mitral regurgitation and adverse cardiac events over time. Secondary chordal cutting or reimplantation results in significantly increased leaflet mobility, decreased severity of recurrent mitral regurgitation, and improved reverse remodeling without adverse effect on left ventricular function. Summary A superior repair with decreased recurrence of mitral regurgitation and enhanced reversal of left ventricular remodeling is possible when subvalvular techniques are combined with traditional ring annuloplasty. Further understanding of preoperative parameters that predict disease recurrence and inclusion of concomitant subvalvular techniques in this subset of patients will be the next major advance in this field. PMID:24378635

Wagner, Cynthia E.; Kron, Irving L.

2014-01-01

8

The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size  

Microsoft Academic Search

Objectives. The purpose of this study was to quantify and characterize the regurgitant flow pattern and regurgitant orifice area in patients undergoing therapy for severe heart failure using contemporary echocardiographic techniques.Background. Mitral regurgitation may be dynamic in patients with heart failure and ultimately correlate with outcome in a group of patients.Methods. Fourteen patients with severe heart failure felt to require

Luis B. Rosario; Lynne W. Stevenson; Scott D. Solomon; Richard T. Lee; Sharon C. Reimold

1998-01-01

9

Treatment and management of mitral regurgitation  

Microsoft Academic Search

Mitral regurgitation (MR) is the most-common valvular heart disease in the western world. From an etiologic point of view, MR can be either organic (mainly degenerative in western countries) or functional (secondary to left ventricular remodeling in the context of ischemic or idiopathic dilated cardiomyopathy). Degenerative and functional MR are completely different disease entities that pose specific decision-making problems and

Francesco Maisano; Giovanni La Canna; Ottavio Alfieri; Michele De Bonis

2011-01-01

10

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

2014-02-01

11

Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy  

Microsoft Academic Search

Background. The aim of this study was to assess the occurrence of reverse left ventricular (LV) remodeling after effective mitral valve repair in advanced dilated cardiomyopathy and its impact on clinical outcome and repair durability. Methods. Of 111 patients undergoing mitral valve repair in ischemic or idiopathic dilated cardiomyopathy, 79 patients with no or trivial residual mitral regurgitation (MR) at

Michele De Bonis; Elisabetta Lapenna; Alessandro Verzini; Giovanni La Canna; Antonio Grimaldi; Lucia Torracca; Francesco Maisano; Ottavio Alfieri

12

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

13

Surgical management of mitral regurgitation associated with marfan’s syndrome  

Microsoft Academic Search

Background. The surgical treatment of mitral regurgitation associated with Marfan’s syndrome remains controversial because of the underlying degenerative process.Methods. From October 1986 to June 1996, 33 patients with Marfan’s syndrome underwent a mitral valve procedure. The mean age was 30 years (range, 2 to 55 years). Mitral regurgitation was caused by annulus dilatation in 2 patients, leaflet prolapse in 30

Jean-François G Fuzellier; Sylvain M Chauvaud; Paul Fornes; Alain J Berrebi; Paul S Lajos; Patrick Bruneval; Alain F Carpentier

1998-01-01

14

Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy  

PubMed Central

Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfunction of one or more components of the mitral valve apparatus occurs in 39–74% and affects almost all heart failure patients. Survival is decreased in subjects with more than mild mitral regurgitation irrespective of the aetiology of heart failure. The goal of treating functional mitral regurgitation is to slow or reverse ventricular remodelling, improve symptoms and functional class, decrease the frequency of hospitalization for congestive heart failure, slow progression to advanced heart failure (time to transplant) and improve survival. This article reviews the role of mitral valve surgery in patients with heart failure and dilated cardiomyopathy. PMID:24146526

Al-Amri, Hussein S.; Al-Moghairi, Abdulrahman M.; El Oakley, Rieda M.

2011-01-01

15

The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique  

Microsoft Academic Search

Objectives: Mitral-valve repair in Barlow's disease is challenging; conventional techniques are difficult to perform, and there is a high risk of a postoperative suboptimal result. Double-orifice repair has been applied in a standardized approach to treat patients with severe mitral regurgitation and bileaflet prolapse due to Barlow's disease. Methods: Since 1993, 82 patients with severe mitral regurgitation due to Barlow's

Francesco Maisano; Jan J. Schreuder; Michele Oppizzi; Brenno Fiorani; Carlo Fino; Ottavio Alfieri

2000-01-01

16

Lobar pulmonary edema due to mitral regurgitation: diagnosis by echocardiography.  

PubMed

One etiology of unilateral lobar pulmonary edema is mitral regurgitation. Echocardiography is able to demonstrate the retrograde flow of blood into the pulmonary veins and allows timely diagnosis and treatment planning. Correction of mitral regurgitation is followed by resolution of the radiographic abnormality. PMID:9690502

Dexter, E U; Snider, J M; Gordon, E E; Richenbacher, W E

1997-01-01

17

Mitral cerclage annuloplasty, a novel transcatheter treatment for secondary mitral valve regurgitation: Initial results in swine  

PubMed Central

Structured Abstract Objectives We developed and tested a novel transcatheter circumferential annuloplasty technique to reduce mitral regurgitation in porcine ischemic cardiomyopathy. Background Catheter-based annuloplasty for secondary mitral regurgitation exploits the proximity of the coronary sinus to the mitral annulus, but is limited by anatomic variants and coronary artery entrapment. Methods The procedure, “cerclage annuloplasty,” is guided by MRI roadmaps fused with live X-ray. A coronary sinus guidewire traverses a short segment of basal septal myocardium to reenter the right heart where it is exchanged for a suture. Tension is applied interactively during imaging and secured with a locking device. Results We found two feasible suture pathways from the great cardiac vein across the interventricular septum to create cerclage. Right-ventricular septal reentry required shorter fluoroscopy times than right atrial reentry, which entailed a longer intramyocardial traversal but did not cross the tricuspid valve. Graded tension progressively reduced septal-lateral annular diameter but not end-systolic elastance or regional myocardial function. A simple arch-like device protected entrapped coronary arteries from compression even during supra-therapeutic tension. Cerclage reduced mitral regurgitation fraction (from 22.8 ± 12.7% to 7.2 ± 4.4%, p=0.04) by slice-tracking velocity-encoded MRI. Flexible cerclage reduced annular size but preserved annular motion. Cerclage also displaced the posterior annulus towards the papillary muscles. Cerclage introduced reciprocal constraint to the left ventricular outflow tract and mitral annulus that enhanced leaflet coaptation. A sample of human coronary venograms and CT angiograms suggested that most have suitable venous anatomy for cerclage. Conclusions Transcatheter mitral cerclage annuloplasty acutely reduces mitral regurgitation in porcine ischemic cardiomyopathy. Entrapped coronary arteries can be protected. MRI provided insight into the mechanism of cerclage action. PMID:19660696

Kim, June-Hong; Kocaturk, Ozgur; Ozturk, Cengizhan; Faranesh, Anthony Z.; Sonmez, Merdim; Sampath, Smita; Saikus, Christina E.; Kim, Ann H.; Raman, Venkatesh K.; Derbyshire, J. Andrew; Schenke, William H.; Wright, Victor J.; Berry, Colin; McVeigh, Elliot R.; Lederman, Robert J.

2009-01-01

18

Magnetic resonance assessment of aortic and mitral regurgitation.  

PubMed Central

Magnetic resonance imaging provides an accurate method for the measurement of left and right ventricular volume. The ratio of left ventricular stroke volume to right ventricular stroke volume was calculated from contiguous transverse magnetic resonance images and was used to measure the severity of regurgitation in 18 patients with aortic regurgitation and 10 with mitral regurgitation. Cardiac anatomy was well demonstrated, allowing an assessment of relative chamber volumes and associated abnormalities, although valve abnormality was not well seen. There was a weak correlation between magnetic resonance measurements of left ventricular end diastolic volume and stroke volume ratio. The stroke volume ratio differed significantly in four groups with increasing angiographic severity of regurgitation, and all but the group with trivial regurgitation differed significantly from normal. There was good correlation between magnetic resonance and radionuclide measurements of left ventricular ejection fraction and stroke volume ratio, although the stroke volume ratio was consistently overestimated by radionuclide ventriculography. Correlation was less good for the right ventricular ejection fraction, which was underestimated by radionuclide ventriculography. It is concluded that magnetic resonance imaging provides valuable information in patients with valvar regurgitation, and serves as a suitable standard by which to judge conventional techniques. Images Fig 1 Fig 2 Fig 3 PMID:3790381

Underwood, S R; Klipstein, R H; Firmin, D N; Fox, K M; Poole-Wilson, P A; Rees, R S; Longmore, D B

1986-01-01

19

Effect of mitral valve replacement on left ventricular function in mitral regurgitation  

Microsoft Academic Search

To evaluate the effect of mitral valve replacement on left ventricular function in mitral regurgitation, we measured (1) the end-systolic stress\\/volume ratio, which is practically independent of changes in loading conditions, and (2) the left ventricular contractile reserves upon isometric exercise, both before and one year after mitral valve replacement in 11 patients with mitral regurgitation. The end-systolic stress\\/volume ratio

H V Huikuri

1983-01-01

20

Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance.  

PubMed

Cardiovascular magnetic resonance (CMR) is increasingly used to assess patients with mitral regurgitation. Its advantages include quantitative determination of ventricular volumes and function and the mitral regurgitant fraction, and in ischemic mitral regurgitation, regional myocardial function and viability. In addition to these, identification of leaflet prolapse or restriction is necessary when valve repair is contemplated. We describe a systematic approach to the evaluation of mitral regurgitation using CMR which we have used in 149 patients with varying etiologies and severity of regurgitation over a 15 month period. Following standard ventricular cine acquisitions, including 2, 3 and 4 chamber long axis views and a short axis stack for biventricular function, we image movements of all parts of the mitral leaflets using a contiguous stack of oblique long axis cines aligned orthogonal to the central part of the line of coaptation. The 8-10 slices in the stack, orientated approximately parallel to a 3-chamber view, are acquired sequentially from the superior (antero-lateral) mitral commissure to the inferior (postero-medial) commissure, visualising each apposing pair of anterior and posterior leaflet scallops in turn (A1-P1, A2-P2 and A3-P3). We use balanced steady state free precession imaging at 1.5 Tesla, slice thickness 5 mm, with no inter-slice gaps. Where the para-commissural coaptation lines curve relative to the central region, two further oblique cines are acquired orthogonal to the line of coaptation adjacent to each commissure. To quantify mitral regurgitation, we use phase contrast velocity mapping to measure aortic outflow, subtracting this from the left ventricular stroke volume to calculate the mitral regurgitant volume which, when divided by the left ventricular stroke volume, gives the mitral regurgitant fraction. In patients with ischemic mitral regurgitation, we further assess regional left ventricular function and, with late gadolinium enhancement, myocardial viability. Comprehensive assessment of mitral regurgitation using CMR is feasible and enables determination of mitral regurgitation severity, associated leaflet prolapse or restriction, ventricular function and viability in a single examination and is now routinely performed at our centre. The mitral valve stack of images is particularly useful and easy to acquire. PMID:19102740

Chan, K M John; Wage, Ricardo; Symmonds, Karen; Rahman-Haley, Shelley; Mohiaddin, Raad H; Firmin, David N; Pepper, John R; Pennell, Dudley J; Kilner, Philip J

2008-01-01

21

Pulmonary oedema associated with mitral regurgitation: prevalence of predominant right upper lobe involvement in children  

Microsoft Academic Search

Objective. To evaluate the hypothesis that pulmonary venous congestion and oedema manifested predominantly in the right upper lobe in\\u000a children with mitral regurgitation occur more frequently than previously thought. Materials and methods. Three radiologists retrospectively and independently reviewed the plain chest radiographs of 54 children (26 girls, 28 boys,\\u000a age range 2 days–18 years, median 9.5 years) with mitral regurgitation

François Gudinchet; Paola Rodoni; Abdulhakim Sarraj; Maurice Payot; Pierre Schnyder

1998-01-01

22

Percutaneous treatment of mitral regurgitation with MitraClip device  

PubMed Central

The percutaneous edge-to-edge repair of mitral regurgitation with a MitraClip device has been recently approved in Europe. The results of the randomized EVEREST II study showed a favourable safety profile of the technique. However, the efficacy in terms of regurgitation reduction in a population with predominantly degenerative mitral disease was inferior as compared to the results of conventional open heart surgery. Nevertheless, up to 50% of symptomatic heart failure patients with severe mainly functional mitral regurgitation are not treated surgically because of very high procedural risk. The registry data suggest that the minimally invasive and generally well-tolerated MitraClip procedure reduces symptoms and need for recurrent hospitalization and improves left ventricular function in inoperable subjects. The ongoing randomized clinical trials with clinical endpoints will further define the current role of percutaneous edge-to-edge repair in heart failure patients with mitral regurgitation. PMID:24570757

Witkowski, Adam

2013-01-01

23

Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation  

Microsoft Academic Search

Background. We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR. Methods. We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3 ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed. Results. Actuarial

Daniel R. Wong; Arvind K. Agnihotri; Judy W. Hung; Gus J. Vlahakes; Cary W. Akins; Alan D. Hilgenberg; Joren C. Madsen; Thomas E. MacGillivray; Michael H. Picard; David F. Torchiana

2010-01-01

24

Assessment of mitral regurgitation by magnetic resonance imaging.  

PubMed

To evaluate the potential of magnetic resonance imaging (MRI) in detection and quantification of mitral regurgitation, 26 pts. with echocardiographically or angiographically documented mitral regurgitation were examined using a 0.5 Tesla superconducting magnet. In each patient a multislice-multiphase study in a sagittal-coronal double angulated projection (four-chamber view equivalent) was performed to assess left and right ventricular volumes, ejection fraction and regurgitant fraction. Additionally a blood flow sensitive cine-study (fast field echo: FFE) was done to visualize direction and area of regurgitant jet. MRI data were compared with quantitative and quantitative assessment of mitral regurgitation by angiography, 2D echocardiography, Doppler sonography and color flow mapping. Using the FFE mode MRI was able to detect the regurgitant jet as a typical signal loss within the left atrium in all patients. The ratio of regurgitant jet area/left atrium area as determined by MRI showed a correlation with a comparable ratio from color Doppler sonography of R = 0.87 (p less than 0.001). There was also good agreement in semiquantitative grading of mitral regurgitation between MRI and angiography (R = 0.77, p less than 0.001). The determination of left and right ventricular stroke volume allowed the calculation of the regurgitant fraction, which showed a correlation with invasively determined regurgitation fraction of R = 0.84 (p less than 0.001). These data provide additional information that MRI may be useful as a noninvasive technique to detect and quantify mitral regurgitation. PMID:2630843

Glogar, D; Globits, S; Neuhold, A; Mayr, H

1989-01-01

25

Functional mitral regurgitation: therapeutic strategies for a ventricular disease.  

PubMed

Functional mitral regurgitation is a highly prevalent condition among patients with ischemic and dilated cardiomyopathies. Arising from remodeling of both the mitral valve annulus and the left ventricle, it is associated with high mortality and morbidity. In selected patients, cardiac resynchronization therapy helps to reduce functional mitral regurgitation, but surgical intervention remains the mainstay of therapy when medical therapy for left ventricular dysfunction has been inadequate. It is, however, associated with significant perioperative risks and does not alter long-term mortality. Percutaneous devices, and more recently the Mitraclip in particular, represent a promising alternative that can improve symptoms and ventricular remodeling with significantly lower periprocedural risk. PMID:24440574

Punnoose, Lynn; Burkhoff, Daniel; Cunningham, Lian; Horn, Evelyn M

2014-04-01

26

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

27

[Time changes of mitral regurgitant jets: a 4th dimension for Doppler evaluation of the severity of mitral regurgitation].  

PubMed

The quantitation of mitral regurgitation is based on measurement of the maximal jet area by colour flow mapping. Discrepancies have been reported with the possibility of significant temporal variations of jet size. The aim of this study was to determine whether evaluation could be improved by taking these variations into consideration. Three dimensional Doppler colour flow mapping by combining measurements of length, height and width of the jet in two orthogonal planes, in order to obtain a global index of regurgitation, was undertaken in 40 patients with angiographically documented mitral regurgitation classified in three degrees, mild, moderate and severe. Two-dimensional Doppler with colour M-mode was performed in each patient analysing early, mild and late systole. In the absence of significant temporal variation, assessment was based on measurement of maximal jet area alone (maximum global regurgitation index). When there were significant temporal variations, the index was calculated during each phase of systole and the values averaged to obtain a mean global regurgitation index. Temporal variations were observed in 14 of the 40 patients (35%), mainly in mild and moderate regurgitation. Significant differences were noted in the values of maximal (p < 0.01 to 0.001) and mean global regurgitation indices (p < 0.001 to 0.0001) between each degree of severity. A paired study demonstrated significant differences between the two indices in mild (p < 0.01) and moderate regurgitation (p < 0.05). Assessment of the severity of mitral regurgitation was satisfactory in 65% of cases using the maximal global regurgitation index with 14 overestimations, all in cases of mild and moderate regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7802533

Veyrat, C; el Yafi, W; Yatibinghi, N; Sainte-Beuve, D; Gourtchiglouian, C; Magand, N; Kalmanson, D

1994-02-01

28

Feasibility and Efficacy of Mitral Valve Repair for Degenerative Mitral Regurgitation in the Elderly.  

PubMed

Purpose: The number of elderly patients who require surgical treatment for mitral regurgitation (MR) is increasing. However, the feasibility and efficacy of mitral valve repair in elderly patients are unclear.Methods: We retrospectively reviewed 55 patients, aged ?75 years, who underwent mitral valve repair for degenerative MR between 1991 and 2011. All patients were followed up for 4.7 ± 3.4 years.Results: The patients aged ?75 years were more symptomatic and had a higher incidence of persistent atrial fibrillation and pulmonary hypertension than those aged <75 years. Thirty-day and in-hospital mortality was 1.8% and 7.3%, respectively, and the 5-year survival rate was 81.6% ± 5.8%. The leading cause of late death was stroke, which primarily occurred in patients with postoperative atrial fibrillation. Except for a single failure of repair due to technical reasons, there was no recurrence of severe MR or reoperation on the mitral valve. In the late follow-up period, the mean left ventricular diastolic diameter significantly decreased and the mean left ventricular ejection fraction was approximately 60%. Most patients had mild symptoms at follow-up.Conclusion: Mitral valve repair can provide satisfactory early as well as long-term outcomes and can preserve left ventricular function even in the elderly. PMID:24429695

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

2014-01-15

29

Severe mitral regurgitation unmasked after bilateral lung transplantation  

PubMed Central

Abstract A 33-year-old female patient with advanced idiopathic pulmonary artery hypertension underwent bilateral lung transplantation. The postsurgical course was complicated by prolonged mechanical ventilation and acute hypoxemia with recurrent episodes of pulmonary edema. An echocardiogram revealed improved right-sided pressures along with a dilated left atrium, a structurally normal mitral valve, and a new posterior-oriented severe mitral regurgitation. The patient’s condition improved after treatment with arterial vasodilators and diuretics, and she has remained in World Health Organization functional class I after almost 36 months of follow-up. We hypothesize that cardiac ventricle remodeling and a geometric change in mitral valve apparatus after transplantation led to the hemodynamic changes and recurrent pulmonary edema seen in our patient. Our case is, to our knowledge, the second report of severe valvular regurgitation in a structurally normal mitral valve apparatus in the postoperative period and the first of a patient to be treated without valve replacement. PMID:24618554

Force, Seth D.; Pelaez, Andres

2013-01-01

30

Percutaneous and off-pump treatments for functional mitral regurgitation  

Microsoft Academic Search

A new era in the treatment of functional mitral regurgitation is emerging with new devices that can be placed percutaneously\\u000a or minimally invasively without cardiopulmonary bypass. These devices are categorized into three groups: annuloplasty, edge-to-edge\\u000a repair, and ventricular reshaping. Percutaneous annuloplasty devices, implanted via the coronary sinus, mimic surgical annuloplasty\\u000a by reducing the mitral annular anterior-posterior (or septal-lateral) dimension. Several

Kiyotaka Fukamachi

2008-01-01

31

Pulsed Doppler echocardiographic indices for assessing mitral regurgitation.  

PubMed Central

Pulsed Doppler indices were devised in order to grade the severity of mitral regurgitation on a quantitative basis. Indices were obtained by mapping the regurgitant jet by recording abnormal systolic Doppler signals detected on a "yes/no" basis using a 3 MHz pulsed Doppler velocimeter associated with a cross sectional real time ultrasonic scanner. Combined information from two echographic planes was used to take into account the geometrical three dimensional configuration of the jet. The following dimensions of the jet were measured: (a) the length and the height in the long axis view of the left atrium (long axis regurgitant index (LARI), 0.5 X length X height); (b) the width at the annulus in the short axis view (short axis regurgitant index (SARI); (c) the total regurgitant index (TRI) calculated as the product of LARI multiplied by SARI. Sixteen normal subjects and 94 patients including 46 cases of mitral regurgitation confirmed by angiography (32 of whom proceeded to surgery) were investigated. The diagnostic sensitivity was 91% and the specificity 94%. The jet was detected in 76% of cases. Indices were correlated with independently performed angiographic grading on a three point scale. The best linear correlation was obtained for the TRI; mean values were significantly increased for each grade of severity. Correlations with invasive procedures showed an 87% success rate for the Doppler prediction of the involved regurgitant leaflet(s) and of the anatomical site of the lesion at the annulus. In addition, an abnormal diastolic signal was found in five of the eight patients with ruptured chordae and also a decreased percentage of systolic shortening of the annulus diameter in patients with mitral regurgitation compared with those without. Images PMID:6691864

Veyrat, C; Ameur, A; Bas, S; Lessana, A; Abitbol, G; Kalmanson, D

1984-01-01

32

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

33

Mechanism of Decrease in Mitral Regurgitation After Cardiac Resynchronization Therapy  

PubMed Central

Background Cardiac resynchronization therapy (CRT) has been shown to reduce functional mitral regurgitation (MR). It has been proposed that the mechanism of MR reduction relates to geometric change or, alternatively, changes in left ventricular (LV) contractile function. Normal mitral valve (MV) function relies on a balance between tethering and closing forces on the MV leaflets. Functional MR results from a derangement of this force–balance relationship, and CRT may be an important modulator of MV function by its ability to enhance the force–balance relationship on the MV. We hypothesized that CRT improves the comprehensive force balance acting on the valve, including favorable changes in both geometry and LV contractile function. Methods and Results We examined the effect of CRT on 34 patients with functional MR before and after CRT (209±81 days). MR regurgitant volume, closing forces on MV (derived from Doppler transmitral pressure gradients), including dP/dt and a factor (closing pressure ratio) expressing how long the peak closing gradient is maintained over systole (closing pressure ratio=velocity time integral/MR peak velocity×mitral regurgitation time), and dyssynchrony by tissue Doppler were measured. End-diastolic volume, end-systolic volume, mitral valve annular area (MAA) and contraction (percent change in MAA from end-diastole to midsystole), leaflet closing area (leaflet area during valve closure), and tenting volume (volume under leaflets to annular plane) were measured by 3D echocardiography. After CRT, end-diastolic volume (253±111 versus 221±110 mL, P<0.001) and end-systolic volume (206±97 versus 167±91 mL, P<0.001) decreased and ejection fraction (19±6 versus 27±9%, P<0.001) increased. MR regurgitant volume decreased from 35±17 to 23±14 mL (P<0.001), MAA from 11.6±3.5 to 10.5±3.1 cm2 (P<0.001), leaflet closing area from 15.4±5 to 13.7±3.8 cm2 (P<0.001), and tenting volume from 5.7±2.6 to 4.6±2.2 mL (P<0.001). Peak velocity (and therefore transmitral closing pressure) was more sustained throughout systole, as reflected by the increase in the closing pressure ratio (0.77±0.1 versus 0.84±0.1 before CRT versus after CRT, P=0.01); dP/dt also improved after CRT. There was no change in dyssynchrony or MAA contraction. Conclusions Reduction in MR after CRT is associated with favorable changes in MV geometry and closing forces on the MV. It does so by favorably affecting the force balance acting on the MV in 2 ways: reducing tethering through reversal of LV remodeling and increasing the systolic duration of peak transmitral closing pressures. PMID:19920042

Solis, Jorge; McCarty, David; Levine, Robert A.; Handschumacher, Mark D.; Fernandez-Friera, Leticia; Chen-Tournoux, Annabel; Mont, Luis; Vidal, Barbara; Singh, Jagmeet P.; Brugada, Josep; Picard, Michael H.; Sitges, Marta; Hung, Judy

2010-01-01

34

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

35

Long-Term Outcomes of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation Associated with Degenerative Mitral Regurgitation: Suture Annuloplasty Versus Ring Annuloplasty Using a Flexible Band.  

PubMed

Purpose: We investigated the long-term outcomes of suture/ring tricuspid valve annuloplasty for functional tricuspid regurgitation associated with degenerative mitral regurgitation.Methods: We retrospectively reviewed patients who underwent flexible ring tricuspid valve annuloplasty (n = 120) or suture tricuspid valve annuloplasty (n = 42) for functional tricuspid regurgitation concomitant with surgery for degenerative mitral regurgitation (mean follow-up duration, 5.3 ± 5.1 years).Results: The mean age of patients was 62.5 ± 13.1 years. Thirty-day mortality was zero in the suture group, and 0.8% in the ring group. Tricuspid regurgitation grade at discharge was lower in the ring group ( p = 0.002). No difference was observed between survival and freedom from major cardiac/cerebrovascular adverse events between the groups. However, freedom from ?moderate tricuspid regurgitation was higher in the ring group (Log-rank p = 0.003). From univariate analysis, the risk factors for ?moderate TR were suture annuloplasty and preoperative tricuspid regurgitation grade. No reoperation for recurrent tricuspid regurgitation occurred in either group because symptoms experienced by patients with recurrent tricuspid regurgitation were relatively insignificant.Conclusion: Concomitant tricuspid annuloplasty using flexible bands offered improved durability than suture annuloplasty for preventing postoperative tricuspid regurgitation progression. PMID:24583707

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

2014-02-28

36

[Quantification of mitral regurgitation by cine-MRI. Comparison with transesophageal echocardiography in 45 patients].  

PubMed

Cine-MRI demonstrates the presence of mitral regurgitation by a signal void. This study was undertaken to assess the value of this method for quantification of mitral regurgitation in a population not excluding either patients with mitral valve prostheses or those with atrial fibrillation. The subjects included had a mean age of 59 years and were referred for transoesophageal echocardiography, either for assessment of valvular heart disease (38 patients), or for detection of atrial thrombosis before external electrical cardioversion (7 patients). Eight patients had mitral valve prostheses and 19 were in atrial fibrillation. Cine-MRI was performed within 12 days of the transoesophageal echocardiography study with a 1.5 tesla magnet, using a sequence of gradient echo in 3 parallel planes in the 4 chamber view. The regurgitation was quantified by MRI from the extension of the signal void in the left atrium. The transoesophageal Doppler echocardiographic criteria were the width of the regurgitant jet at its origin, the intensity of the regurgitation signal recorded by continuous wave Doppler and the extension of the jet within the left atrium. The quantification by degrees 1 to 4 did not differ by more than 1 degree between the 2 techniques in 43 of the 45 patients. Out of 4 left atrial thrombus detected by transoesophageal echocardiography, only 1 was visible by MRI. The authors concluded that quantification of mitral regurgitation by cine-MRI provides similar results to those obtained by transoesophageal echocardiography and that the correlation remains valid in cases of atrial fibrillation. However, Doppler echocardiography provides further valuable information for the clinician. PMID:9539819

Ambrosi, P; Habib, G; Ferracci, A; Faugère, G; Luccioni, R; Bernard, P J

1997-11-01

37

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

38

Percutaneous and off-pump treatments for functional mitral regurgitation.  

PubMed

A new era in the treatment of functional mitral regurgitation is emerging with new devices that can be placed percutaneously or minimally invasively without cardiopulmonary bypass. These devices are categorized into three groups: annuloplasty, edge-to-edge repair, and ventricular reshaping. Percutaneous annuloplasty devices, implanted via the coronary sinus, mimic surgical annuloplasty by reducing the mitral annular anterior-posterior (or septal-lateral) dimension. Several devices, such as the PTMA, CARILLON, Monarch, and PS3 systems, are in clinical trials. Percutaneous edge-to-edge repair devices mimic the surgical Alfieri edge-to-edge repair technique, creating a double-orifice mitral valve; of these, MitraClip is in clinical trials. Ventricular reshaping devices treat both mitral annular dilatation and papillary muscle displacement (and thus leaflet tethering). The surgical Coapsys device is currently in clinical trials, and its percutaneous "interventional" version, iCoapsys, is being prepared for a clinical trial. Numerous issues need to be addressed before these devices can become standard therapies for functional mitral regurgitation. Device safety and efficacy must be demonstrated in carefully designed clinical trials with the goal of achieving outcomes equal to or better than those of surgical repair. PMID:18414987

Fukamachi, Kiyotaka

2008-01-01

39

Long-Term Outcomes after Mitral Valve Repair for Degenerative Mitral Regurgitation with Persistent Atrial Fibrillation.  

PubMed

Background?Atrial fibrillation (AF) adversely affects surgical outcomes of mitral valve surgery. However, the long-term impact of Maze procedure has not been clear yet. Patients and Methods?We retrospectively investigated 159 patients who underwent mitral valve repair for degenerative mitral regurgitation with persistent AF between 1991 and 2010. The mean age of patients was 63.1?±?10.5 years. After we started performing Maze procedure in 2002, 65 patients underwent concomitant Maze procedure. The median follow-up time was 7.5 years. Results?There was one operative death (0.63%). The overall survival rate was 91.0?±?2.6% at 5 years and 79.1?±?4.7% at 10 years. Survival was significantly better in patients who underwent Maze procedure than those who did not. The rate of freedom from AF in patients who underwent Maze procedure was 86.4?±?4.5% at 1?year and 81.1?±?5.6% at 5 years. The freedom rate from stroke was higher in patients who underwent Maze procedure than those who did not. Patients with postoperative AF had larger left ventricular systolic and diastolic diameters at follow-up and higher New York Heart Association functional class than patients without postoperative AF (1.4?±?0.5 vs. 1.1?±?0.3, p?

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

2014-07-15

40

The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical Outcome after Mitral Valve Repair for Degenerative Mitral Regurgitation.  

PubMed

Purpose: The aim of this study is to elucidate the impact of preoperative and postoperative pulmonary hypertension (PH) on long-term clinical outcomes after mitral valve repair for degenerative mitral regurgitation.Methods: A total of 654 patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2010 were retrospectively reviewed. Patients were divided into PH(+) group (137 patients) and PH(-) group (517 patients). Follow-up was complete in 99.0%. The median follow-up duration was 7.5 years.Results: Patients in PH(+) group were older, more symptomatic and had higher tricuspid regurgitation grade. Thirty-day mortality was not different between 2 groups (p = 0.975). Long-term survival rate was lower in PH(+) group; 10-year survival rate after the operation was 85.2% ± 4.0% in PH(+) group and 89.7% ± 1.8% in PH(-) group (Log-rank, p = 0.019). The incidence of late cardiac events were not different between groups, however, the recurrence of PH was more frequent in PH(+) group. The recurrence of PH had an adverse impact on survival rate, late cardiac events and symptoms. Univariate analysis showed age and preoperative tricuspid regurgitation grade were the predictors of PH recurrence.Conclusion: Early surgical indication should be advocated for degenerative mitral regurgitation before the progression of pulmonary hypertension and tricuspid regurgitation. PMID:24747547

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

2014-04-18

41

Effects of afterload reduction on vena contracta width in mitral regurgitation  

Microsoft Academic Search

Objectives. We used color Doppler flow mapping to determine whether vena contracta width (VCW) is a load-independent measure of the severity of mitral regurgitation.Background. VCW has been proposed to be a relatively load-independent measure of mitral regurgitation severity in flow models using a fixed orifice. However, in patients with mitral regurgitation, VCW may not be load independent because of a

Ali M. Kizilbash; DuWayne L. Willett; M. Elizabeth Brickner; Sheila K. Heinle; Paul A. Grayburn

1998-01-01

42

Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation  

PubMed Central

AIM: To investigate the prevalence of clinically unrecognized mitral regurgitation (MR) in lone atrial fibrillation (AF). METHODS: We studied the prevalence and severity of MR by transesophageal echocardiography (TEE) in patients with “lone” AF as compared to a matched cohort of patients in normal sinus rhythm (NSR) undergoing TEE for other indications besides recognized valvular heart disease. RESULTS: A total of 157 subjects (57 in the AF group and 100 in the NSR group) with structurally normal cardiac valves were included in the study. In the AF group, moderate MR or more was noted in 66% of the patients, mild MR in 18%, trace or no MR in 16%. In the control group, moderate MR was noted in 6% of patients, mild MR 31%, trace or no MR in 63 % of patients. Moderate MR or greater was significantly more prevalent in the AF group compared to the NSR group (66% vs 6%, P < 0.0001). CONCLUSION: Clinically unrecognized moderate MR is prevalent in “lone” AF -either as an etiologic factor leading to “lone” AF or developing after onset of AF. PMID:22655166

Sharma, Sanjiv; Lardizabal, Joel; Monterroso, Mark; Bhambi, Neil; Sharma, Rohan; Sandhu, Rasham; Singh, Sarabjeet

2012-01-01

43

ACS, myocardial bridging, Tako-tsubo syndrome and mitral regurgitation  

PubMed Central

Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but well-recognised angiographic anomaly that is often considered harmless. The long-term prognosis appears to be excellent, but occasional reports of patients with angina pectoris, myocardial infarction and sudden death indicate that this is not always true. The prevalence of the anomaly in the normal population is unknown, but the incidence is low and ischaemic events are rare. Tako-tsubo-like left ventricular dysfunction syndrome (TTS) is characterised by ischaemia, anterior ST-segment elevation, no significant coronary artery disease and reversible ampulla-like left ventricular ballooning in postmenopausal females after emotional or physical stress. Dynamic left ventricular outflow tract (LVOT) obstruction is a rare but potentially fatal complication of acute anterior wall infarction. We present a patient with an acute coronary syndrome (ACS) with ST-segment elevation in the anterior leads, transient TTS and transient LVOT obstruction with systolic anterior motion (SAM) of the mitral valve and severe mitral regurgitation. This is the first report of myocardial bridging associated with TTS, and the first report of TTS associated with dynamic LVOT obstruction with SAM and mitral regurgitation. ImagesFigure 2Figure 3

Michels, R.; Brueren, G.; van Dantzig, J.-M.; Pijls, N.; Peels, C.H.; Post, H.

2005-01-01

44

Mitral valve regurgitation and left ventricular dysfunction treatment with an intravalvular spacer.  

PubMed

Attempts at transcatheter treatment of mitral valve regurgitation have generally been modeled on proven surgical procedures such as leaflet repair, annuloplasty, or prosthetic valve implantation. We introduce a novel approach to directly reducing the regurgitant orifice: the mitral valve spacer, a balloon that attempts to reduce the regurgitant orifice. doi: 10.1111/jocs.12453 (J Card Surg 2015;30:53-54). PMID:25345652

Svensson, Lars G; Ye, Jian; Piemonte, Thomas C; Kirker-Head, Carl; Leon, Martin B; Webb, John G

2015-01-01

45

Quantitative echocardiographic assessment of native mitral regurgitation: two- and three-dimensional techniques.  

PubMed

Chronic mitral regurgitation (MR) is a common valvular lesion. During recent years, it has become increasingly evident that moderate to severe MR, even in the absence of left ventricular dilatation and dysfunction, may have adverse prognostic consequences. Thus, the accurate quantification of MR, using echocardiography, is vitally important in clinical medicine. Because of the mitral valve's structural complexity, MR is often difficult to define, especially with two-dimensional (2D) imaging methods. Both qualitative and quantitative approaches to the quantification of MR are widely used. Color Doppler imaging allows measurement of the regurgitant jet area and vena contracta (VC) width; these two qualitative methods are simple to apply in daily practice but often are inaccurate, especially in patients with eccentric MR. 2D quantitative methods include the calculation of regurgitant fraction, regurgitant volume, and proximal isovelocity surface area. While these parameters are well-established indicators of MR severity, they require tailored image acquisition and additional calculations; moreover, their accuracy may be compromised in the setting of eccentric MR or aortic insufficiency. With three-dimensional (3D) echocardiography, many of the geometric assumptions necessary with 2D imaging are obviated. A realistic depiction of the VC, which often is non-circular, and of the anatomic regurgitant orifice area, which usually is non-planar, becomes possible with 3D zoom-mode imaging. Ongoing efforts to characterize MR in asymptomatic or minimally symptomatic patients include investigations into stress echocardiography and strain rate imaging. The distinct geometry of the mitral valve, and the various mechanisms of MR, will continue to challenge cardiac research teams during the coming years. PMID:22066351

Bhave, Nicole M; Lang, Roberto M

2011-09-01

46

Acute haemodynamic effects of oral prazosin in severe mitral regurgitation.  

PubMed Central

Acute haemodynamic effects of single dose oral prazosin were studied in eight patients with mitral regurgitation. Heart rate, mean systemic arterial pressure, pulmonary arterial pressure, left ventricular filling pressure, and forward cardiac output were measured in all patients. At peak effect, prazosin reduced mean systemic arterial pressure (95 +/- 4 to 86 +/- 4 mmHg), pulmonary arterial pressure (45 +/- 6 to 23 +/- 4 mmHg), and left ventricular filling pressure (30 +/- 4 to 21 +/- 3 mmHg). Pulmonary and systemic vascular resistance also fell (316 +/- 49 to 208 +/- 43 dynes s cm-5 and 2132 +/- 148 to 1491 +/- 94 dynes s cm-5, respectively). Forward cardiac index increased from 1.89 +/- 0.12 to 2.43 +/- 0.13 l/min per m2 and stroke volume from 43 +/- 5 to 57 +/- 6 ml/beat after prazosin. The onset of these changes occurred between 15 and 30 minutes, peaked between 45 and 60 minutes, and persisted for six hours. These data indicate that in patients with mitral regurgitation oral prazosin promptly improves cardiac performance (judged by increased forward cardiac output and reduced left ventricular filling pressure) as systemic and pulmonary vascular resistance are reduced. PMID:7378216

Mehta, J; Feldman, R L; Nichols, W W; Pepine, C J; Conti, C R

1980-01-01

47

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

PubMed Central

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

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

2012-01-01

48

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

49

Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation.  

PubMed

Between January 1985 and June 1992, 263 consecutive patients had mitral valve reconstruction (133 patients) or replacement (130 patients) for degenerative or ischemic mitral regurgitation. The two groups were similar in sex, age, prior infarctions or cardiac operations, hypertension, angina, and functional class. Both groups were similar in mean ejection fraction, pulmonary artery pressure, cardiac index, and incidence of coronary artery disease. More reconstruction than replacement patients had ischemic etiology (22 [16%] versus 12 [9%]; p = not significant), and fewer reconstruction patients had ruptured anterior leaflet chordae (9 [7%] versus 39 [30%]; p < 0.01). More reconstruction than replacement patients had concomitant cardiac procedures (67 [50%] versus 59 [45%]; p = not significant). Hospital death occurred in 4 reconstruction patients (3%) and 15 (12%) replacement patients (p < 0.01). Median postoperative stay was shorter in reconstruction patients (10 versus 12 days; p = 0.02). Late valve-related death occurred in 3 reconstruction patients (2%) and 8 (6%) replacement patients (p = 0.08). Six-year actuarial freedom from thromboembolism was 92% for the reconstruction group and 85% for the replacement group (p = 0.12). Freedom from all valve-related morbidity and mortality was 85% for the reconstruction patients and 73% for the replacement patients (p = 0.03). Significant multivariate predictors of hospital death were age, mitral valve replacement, functional class, congestive heart failure, no posterior chordal rupture, and nonelective operation. Mitral valve reconstruction, when technically feasible, is the procedure of choice for degenerative or ischemic mitral regurgitation because of significantly lower hospital mortality and late valve-related events. PMID:7944687

Akins, C W; Hilgenberg, A D; Buckley, M J; Vlahakes, G J; Torchiana, D F; Daggett, W M; Austen, W G

1994-09-01

50

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

51

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

52

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

53

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

PubMed Central

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

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

2012-01-01

54

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

PubMed Central

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

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

2013-01-01

55

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

PubMed

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

Quader, Nishath; Rigolin, Vera H

2014-01-01

56

Depressed contractile function due to canine mitral regurgitation improves after correction of the volume overload.  

PubMed Central

It is known that long-standing volume overload on the left ventricle due to mitral regurgitation eventually leads to contractile dysfunction. However, it is unknown whether or not correction of the volume overload can lead to recovery of contractility. In this study we tested the hypothesis that depressed contractile function due to volume overload in mitral regurgitation could return toward normal after mitral valve replacement. Using a canine model of mitral regurgitation which is known to produce contractile dysfunction, we examined contractile function longitudinally in seven dogs at baseline, after 3 mo of mitral regurgitation, 1 mo after mitral valve replacement, and 3 mo after mitral valve replacement. After 3 mo of mitral regurgitation (regurgitant fraction 0.62 +/- 0.04), end-diastolic volume had nearly doubled from 68 +/- 6.8 to 123 +/- 12.1 ml (P less than 0.05). All five indices of contractile function which we examined were depressed. For instance, maximum fiber elastance (EmaxF) obtained by assessment of time-varying elastance decreased from 5.95 +/- 0.71 to 2.25 +/- 0.18 (P less than 0.05). The end-systolic stiffness constant (k) was also depressed from 4.2 +/- 0.4 to 2.1 +/- 0.3. 3 mo after mitral valve replacement all indexes of contractile function had returned to or toward normal (e.g., EmaxF 3.65 +/- 0.21 and k 4.2 +/- 0.3). We conclude that previously depressed contractile function due to volume overload can improve after correction of the overload. PMID:1828252

Nakano, K; Swindle, M M; Spinale, F; Ishihara, K; Kanazawa, S; Smith, A; Biederman, R W; Clamp, L; Hamada, Y; Zile, M R

1991-01-01

57

Midterm Outcomes of Chordal Cutting in Combination with Downsized Ring Annuloplasty for Ischemic Mitral Regurgitation.  

PubMed

Purpose: We describe midterm outcomes after division of secondary chords (chordal cutting) combined with downsized ring annuloplasty for ischemic mitral regurgitation (IMR).Methods: We compared the clinical outcomes in patients who underwent chordal cutting with downsized ring annuloplasty (CC-group, n = 15) and those who underwent conventional ring annuloplasty only (Conventional-group, n = 35) for IMR. Follow-up was complete in all patients. The median follow-up time was 4.1 years.Results: Thirty-day mortality was 0% in CC-group and 20% in Conventional-group. The overall survival rate at 5-year was 80.8% ± 12.6% in CC-group and 61.7% ± 8.4% in Conventional-group (Log-rank, p = 0.145). The freedom rate from valve-related events at 5 year was 84.6% ± 10.0% in CC-group and 65.3% ± 10.1% in Conventional-group (Log-rank, p = 0.213). Recurrence of severe mitral regurgitation was revealed in 3 patients of CC-group. Preoperative tenting height was the significant predictor of mitral regurgitation recurrence. In CC-group, the mean left ventricular ejection fraction was 38.0% ± 14.0%, which was similar to the preoperative value of 40.0% ± 13.2% (p = 0.349).Conclusions: Chordal cutting with downsized ring annuloplasty for IMR is a simple method and provides satisfactory early outcomes. However, it carries with high recurrence of MR especially for patients with high tenting height. PMID:24492174

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

2014-02-01

58

Dissociation of end systole from end ejection in patients with long-term mitral regurgitation.  

PubMed

To determine whether left ventricular (LV) end systole and end ejection uncouple in patients with long-term mitral regurgitation, 59 patients (22 control patients with atypical chest pain, 21 patients with aortic regurgitation, and 16 patients with mitral regurgitation) were studied with micromanometer LV catheters and radionuclide angiograms. End systole was defined as the time of occurrence (Tmax) of the maximum time-varying elastance (Emax), and end ejection was defined as the time of occurrence of minimum ventricular volume (minV) and zero systolic flow as approximated by the aortic dicrotic notch (Aodi). The temporal relation between end systole and end ejection in the control patients was Tmax (331 +/- 42 [SD] msec), minV (336 +/- 36 msec), and then, zero systolic flow (355 +/- 23 msec). This temporal relation was maintained in the patients with aortic regurgitation. In contrast, in the patients with mitral regurgitation, the temporal relation was Tmax (266 +/- 49 msec), zero systolic flow (310 +/- 37 msec, p less than 0.01 vs. Tmax), and then, minV (355 +/- 37 msec, p less than 0.001 vs. Tmax and p less than 0.01 vs. Aodi). Additionally, the average Tmax occurred earlier in the patients with mitral regurgitation than in the control patients and patients with aortic regurgitation (p less than 0.01, for both), whereas the average time to minimum ventricular volume was similar in all three patient groups. Moreover, the average time to zero systolic flow also occurred earlier in the patients with mitral regurgitation than in the control patients (p less than 0.01) and patients with aortic regurgitation (p less than 0.05). Because of the dissociation of end systole from minimum ventricular volume in the patients with mitral regurgitation, the end-ejection pressure-volume relations calculated at minimum ventricular volume did not correlate (r = -0.09), whereas those calculated at zero systolic flow did correlate (r = 0.88) with the Emax slope values. We conclude that end ejection, defined as minimum ventricular volume, dissociates from end systole in patients with mitral regurgitation because of the shortened time to LV end systole in association with preservation of the time to LV end ejection due to the low impedance to ejection presented by the left atrium. Therefore, pressure-volume relations calculated at minimum ventricular volume might not be useful for assessing LV chamber performance in some patients with mitral regurgitation. PMID:2317909

Brickner, M E; Starling, M R

1990-04-01

59

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

60

Influence of Mitral Regurgitation Repair on Survival in the Surgical Treatment for Ischemic Heart Failure Trial  

PubMed Central

Background Whether mitral valve repair (MVRep) during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results Patients with ejection fraction ? 35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy (MED) with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary endpoint was mortality. Of 1212 randomized patients, 435 (36%) had none/trace, 554 (46%) mild, 181 (15%) moderate, and 39 (3%) severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace, 114 (44%) with mild and 58 (50%) in moderate-severe MR. In patients with moderate-severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (HR vs. MED 1.20, 95% CI 0.77–1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (HR vs. MED 0.62, 95% CI 0.35–1.08). After adjustment for baseline prognostic variables, the HR for CABG with mitral surgery vs. CABG alone was 0.41 (95%CI 0.22–0.77; p=0.006). Conclusions While these observational data suggest that adding MVRep to CABG in patients with LV dysfunction and moderate-severe MR may improve survival compared with CABG alone or MED alone, a prospective randomized trial would be necessary to confirm the validity of these observations. PMID:22553307

Deja, Marek A.; Grayburn, Paul A.; Sun, Benjamin; Rao, Vivek; She, Lilin; Krejca, Micha?; Jain, Anil R.; Chua, Yeow Leng; Daly, Richard; Senni, Michele; Mokrzycki, Krzysztof; Menicanti, Lorenzo; Oh, Jae K.; Michler, Robert; Wróbel, Krzysztof; Lamy, Andre; Velazquez, Eric J.; Lee, Kerry L.; Jones, Robert H.

2013-01-01

61

Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial  

PubMed Central

Aims Functional mitral regurgitation (FMR) contributes to morbidity and mortality in heart failure (HF) patients. The aim of this study was to determine whether percutaneous mitral annuloplasty could safely and effectively reduce FMR and yield durable long-term clinical benefit. Methods and results The impact of mitral annuloplasty (Carillon Mitral Contour System) was evaluated in HF patients with at least moderate FMR. Patients in whom the device was placed then acutely recaptured for clinical reasons served as a comparator group. Quantitative measures of FMR, left ventricular (LV) dimensions, New York Heart Association (NYHA) class, 6 min walk distance (6MWD), and quality of life were assessed in both groups up to 12 months. Safety and key functional data were assessed in the implanted cohort up to 24 months. Thirty-six patients received a permanent implant; 17 had the device recaptured. The 30-day major adverse event rate was 1.9%. In contrast to the comparison group, the implanted cohort demonstrated significant reductions in FMR as represented by regurgitant volume [baseline 34.5 ±11.5 mL to 17.4 ±12.4 mL at 12 months (P < 0.001)]. There was a corresponding reduction in LV diastolic volume [baseline 208.5 ±62.0 mL to 178.9 ±48.0 mL at 12 months (P =0.015)] and systolic volume [baseline 151.8 ±57.1 mL to 120.7 ±43.2 mL at 12 months (P =0.015)], compared with progressive LV dilation in the comparator. The 6MWD markedly improved for the implanted patients by 102.5 ±164 m at 12 months (P =0.014) and 131.9 ±80 m at 24 months (P < 0.001). Conclusion Percutaneous reduction of FMR using a coronary sinus approach is associated with reverse LV remodelling. Significant clinical improvements persisted up to 24 months. PMID:22613584

Siminiak, Tomasz; Wu, Justina C.; Haude, Michael; Hoppe, Uta C.; Sadowski, Jerzy; Lipiecki, Janusz; Fajadet, Jean; Shah, Amil M.; Feldman, Ted; Kaye, David M.; Goldberg, Steven L.; Levy, Wayne C.; Solomon, Scott D.; Reuter, David G.

2012-01-01

62

Quantitation of aortic and mitral regurgitation in the pediatric population: evaluation by radionuclide angiocardiography  

SciTech Connect

The ability to quantitate aortic (AR) or mitral regurgitation (MR), or both, by radionuclide angiocardiography was evaluated in children and young adults at rest and during isometric exercise. Regurgitation was estimated by determining the ratio of left ventricular stroke volume to right ventricular stroke volume obtained during equilibrium ventriculography. The radionuclide measurement was compared with results of cineangiography, with good correlation between both studies in 47 of 48 patients. Radionuclide stroke volume ratio was used to classify severity: the group with equivocal regurgitation differed from the group with mild regurgitation (p less than 0.02); patients with mild regurgitation differed from those with moderate regurgitation (p less than 0.001); and those with moderate regurgitation differed from those with severe regurgitation (p less than 0.01). The stroke volume ratio was responsive to isometric exercise, remaining constant or increasing in 16 of 18 patients. After surgery to correct regurgitation, the stroke volume ratio significantly decreased from preoperative measurements in all 7 patients evaluated. Results from the present study demonstrate that a stroke volume ratio greater than 2.0 is compatible with moderately severe regurgitation and that a ratio greater than 3.0 suggests the presence of severe regurgitation. Thus, radionuclide angiocardiography should be useful for noninvasive quantitation of AR or MR, or both, helping define the course of young patients with left-side valvular regurgitation.

Hurwitz, R.A.; Treves, S.; Freed, M.; Girod, D.A.; Caldwell, R.L.

1983-01-15

63

The role of papillary muscle relocation in ischemic mitral valve regurgitation.  

PubMed

Aim of our study was to compare the results of combined approach papillary muscles relocation (PPMr) + mitral annuloplasty (MA) vs only restrictive annuloplasty (RA) in ischemic mitral regurgitation, guided by 3-dimensional (3D) echocardiography. Sixty-nine patients with severe ischemic mitral regurgitation who had PPMr + MA and coronary artery bypass grafting were matched 1:1 with patients who underwent isolated RA and coronary artery bypass grafting. A comprehensive pre- and postoperatory 2-dimensional and 3D transesophageal echocardiographic examination followed by a 3D offline assessment of the mitral valve apparatus was performed. Five-year freedom from cardiac-related event in the PPMr + MA group and isolated RA group was 83% ± 2.1% and 65.4% ± 1.2%, respectively (P < 0.001). Recurrent mitral regurgitation equal to or greater than moderate occurred in 2 (2.8%) and 8 (11.5%) in PPMr + MA group and RA group, respectively (P < 0.02). The PPMr promoted a significant reversal in left ventricle remodeling compared with the isolated RA. PPMr + MA reduce the tenting area and the coaptation depth with respect to RA, with less incidence of recurrent mitral regurgitation. PMID:23465672

Fattouch, Khalil; Murana, Giacomo; Castrovinci, Sebastiano; Nasso, Giuseppe; Speziale, Giuseppe

2012-01-01

64

Extended posterior leaflet extension for mitral regurgitation in giant left atrium.  

PubMed

Giant left atrium is a rare condition, with a reported incidence of 0.3%, that is normally caused by rheumatic mitral valve disease but very rarely is caused by other etiologies. In such patients, annular dilatation with tenting and reduced height of the posterior leaflet result in significant mitral regurgitation. At surgery, the posterior leaflet was incised from the posterior mitral annulus, starting the incision at the mid portion of the mitral annulus and, if necessary, extending it to the anterolateral portion of the mitral annulus and the posteromedial portion of the mitral annulus. An autologous pericardial patch was harvested, depending on the incision. Herein is reported a surgical technique for posterior leaflet extension in patients with giant left atrium, without rheumatic disease. PMID:24779333

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

2014-01-01

65

Simultaneous double clipping delivery guide strategy for treatment of severe coaptation failure in functional mitral regurgitation.  

PubMed

We report on a novel treatment strategy using two clip delivery systems (CDS) simultaneously, after double transseptal puncture, for treatment of severe functional mitral regurgitation. Both CDS were used to titrate for an optimal result in a patient with a severe coaptation gap of both mitral leaflets. The patient was successfully treated with two MitraClips. Thus, even a contraindication for MitraClip can be overcome with a more complex double guide intervention. PMID:25308769

Schaefer, Ulrich; Frerker, Christian; Kreidel, Felix

2015-01-01

66

Ischemic mitral regurgitation: the role of the »edge-to-edge« repair  

Microsoft Academic Search

\\u000a Mitral insufficiency is considered to be ischemic in origin when the valve leaflet and chordae are structurally normal and\\u000a the valve dysfunction is caused by the consequences of myocardial infarction. The main mechanism responsible for ischemic\\u000a mitral regurgitation (IMR) is tethering of the leaflets which may result either from localized or diffuse left ventricular\\u000a dysfunction with changes in geometry of

M. De Bonis; O. Alfieri

67

Is ischemic mitral regurgitation an indication for surgical repair or replacement?  

Microsoft Academic Search

Ischemic mitral regurgitation (IMR) is common in patients with coronary artery disease. While it is well-known that IMR exerts\\u000a a graded effect upon survival—the greater the degree of IMR, the lower the survival—the indications for surgical treatment\\u000a and the choice of surgical procedure (repair versus replacement) are controversial. In patients with mild to moderate IMR,\\u000a the benefit of a mitral

A. Marc Gillinov

2006-01-01

68

Influence of procedural differences on mitral valve configuration after surgical repair for functional mitral regurgitation: in which direction should the papillary muscle be relocated?  

PubMed

BackgroundAfter restrictive mitral annuloplasty (RMAP) for functional mitral regurgitation (MR), the MR frequently recurs. Papillary muscle relocation (PMR) should reduce the recurrence rate. We assessed the influence of procedural differences in PMR on the postoperative mitral valve configuration.MethodsThirty-nine patients who underwent mitral valve repair for functional MR were enrolled. In limited tethering cases, RMAP alone was performed (RMAP group; n¿=¿23). In severe tethering cases, in addition to RMAP, bilateral papillary muscles were relocated in the direction of the posterior annulus (posterior PMR group; n¿=¿10) or anterior annulus (anterior PMR group; n¿=¿6). We performed pre- and postoperative transthoracic echocardiographic studies, introducing a new index, mitral inflow angle (MIA), to assess the diastolic mitral leaflet excursion. MIA was measured as the angle between the mitral annular plane and the bisector of the anterior and posterior leaflets.ResultsPostoperative MR grade was significantly reduced in each group (P¿<¿0.001). Follow-up echocardiography showed recurrent MR in 13% of the patients in RMAP group. In contrast, no recurrent MR was observed in either the anterior PMR or the posterior PMR group. After surgery, MIA was significantly reduced in both the RMAP group (P¿<¿0.01) and the posterior PMR group (P¿<¿0.001), but was preserved in the anterior PMR group (NS). None of the postoperative variables showed any significant difference between the early and late postoperative phases.ConclusionsIn the surgical treatment of functional MR, a PMR procedure in addition to RMAP was effective in reducing systolic MR. However, mitral valve opening assessed by MIA was restricted even after RMAP alone. The restriction was severely augmented after additional posterior PMR, but was attenuated after additional anterior PMR. The papillary muscle should be relocated in the direction of the anterior annulus to preserve the diastolic opening of the mitral valve. PMID:25491075

Watanabe, Taiju; Arai, Hirokuni; Nagaoka, Eiki; Oi, Keiji; Hachimaru, Tsuyoshi; Kuroki, Hidehito; Fujiwara, Tatsuki; Mizuno, Tomohiro

2014-12-10

69

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

PubMed Central

Increasing life expectancy and comorbid conditions, like obesity, especially in industrialized countries, have led to Valvular Heart Disease (VHD) becoming a major epidemic. Mitral valve disease currently accounts for nearly 10% of Valvular Heart Disease in industrialized countries worldwide. It is a known fact that, left untreated, degenerative mitral valve disease not only shortens an individual’s life, but is also associated with increased morbidity. Despite current guidelines, there is often marked delay in appropriately sending patients for consideration of surgical intervention—interventions that when performed well can dramatically restore patients to a more normal lifespan. The critical question is really not what the severity of the mitral regurgitation is, but what the effect of the mitral regurgitation is on the heart. Modern day echocardiography utilizing Transthoracic Echo, Stress Echo, and Transesophageal Echo, can provide the clinician and the surgeon with six key factors that when taken together provide clear direction as to the proper timing for consideration for mitral valve repair. Thinking of these in an integrative fashion, the clinician and the surgeon can more appropriately time proper surgical intervention in primary degenerative mitral regurgitation. PMID:24349982

2013-01-01

70

Surgical management of moderate ischemic mitral valve regurgitation: Where do we stand?  

PubMed

Ischemic mitral regurgitation (IMR) represents a common complication after myocardial infarction. The valve is anatomically normal and the incompetence is the result of papillary muscles displacement and annular dilatation, causing leaflets tethering. Functionally the leaflets present a restricted systolic motion due to tethering forces that displaces the coaptation surface toward the left ventricle apex. The patients present poor left ventricular function at the time of surgery and the severity of the mitral regurgitation increases the risk of mortality. Currently there is general agreement to treat surgically severe IMR nevertheless strong evidences for patient with moderate insufficiency remains poor and proper treatment debated. The most effective surgical approach for the treatment of IMR remains debated. Some authors demonstrated that coronary artery bypass graft (CABG) alone is beneficial in patients with IMR. Conversely, in most patients, moderate IMR will persist or worsen after CABG alone which translate in higher long-term mortality as a function of residual mitral regurgitation severity. A probable reason for this unclear surgical management of functional MR is due to the contemporary suboptimal results of reparative techniques. The standard surgical treatment of chronic IMR is CABG associated with undersized annuloplasty using complete ring. Though, the recurrence of mitral regurgitation remains high (> 30%) because of continous left ventricle remodeling. To get better long term results, in the last decade, several subvalvular procedures in adjunct to mitral anuloplasty have been developed. Among them, surgical papillary muscle relocation represents the most appreciated option capable to restore normal left ventricle geometry. In the next future new preoperative predictors of increased mitral regurgitation recurrence are certainly needed to find an individual time period of treatment in each patient with moderate IMR. PMID:25429333

Fattouch, Khalil; Castrovinci, Sebastiano; Murana, Giacomo; Moscarelli, Marco; Speziale, Giuseppe

2014-11-26

71

Surgical management of moderate ischemic mitral valve regurgitation: Where do we stand?  

PubMed Central

Ischemic mitral regurgitation (IMR) represents a common complication after myocardial infarction. The valve is anatomically normal and the incompetence is the result of papillary muscles displacement and annular dilatation, causing leaflets tethering. Functionally the leaflets present a restricted systolic motion due to tethering forces that displaces the coaptation surface toward the left ventricle apex. The patients present poor left ventricular function at the time of surgery and the severity of the mitral regurgitation increases the risk of mortality. Currently there is general agreement to treat surgically severe IMR nevertheless strong evidences for patient with moderate insufficiency remains poor and proper treatment debated. The most effective surgical approach for the treatment of IMR remains debated. Some authors demonstrated that coronary artery bypass graft (CABG) alone is beneficial in patients with IMR. Conversely, in most patients, moderate IMR will persist or worsen after CABG alone which translate in higher long-term mortality as a function of residual mitral regurgitation severity. A probable reason for this unclear surgical management of functional MR is due to the contemporary suboptimal results of reparative techniques. The standard surgical treatment of chronic IMR is CABG associated with undersized annuloplasty using complete ring. Though, the recurrence of mitral regurgitation remains high (> 30%) because of continous left ventricle remodeling. To get better long term results, in the last decade, several subvalvular procedures in adjunct to mitral anuloplasty have been developed. Among them, surgical papillary muscle relocation represents the most appreciated option capable to restore normal left ventricle geometry. In the next future new preoperative predictors of increased mitral regurgitation recurrence are certainly needed to find an individual time period of treatment in each patient with moderate IMR. PMID:25429333

Fattouch, Khalil; Castrovinci, Sebastiano; Murana, Giacomo; Moscarelli, Marco; Speziale, Giuseppe

2014-01-01

72

Advancing availability of papillary muscle sandwich plasty from functional to organic mitral valve regurgitation.  

PubMed

An original papillary muscle heads approximation procedure, commonly known as a sandwich plasty, has been successfully used for the treatment of functional mitral regurgitation (MR) associated with ischemic cardiomyopathy (ICM) and aortic valve disease (AVD). In this study, we evaluated the availability of this method as the concomitant procedure for the plasty of organic MR in comparison with the operative results in patients with functional MR. Fifty-six patients who underwent sandwich plasty were reviewed, including 45 functional MR (29 ICM and 16 AVD) patients and 11 organic MR patients. The mean age of patients was 67 years. In the organic MR patients, predominant cardiac diseases were solitary MR in six patients and combined valve diseases including aortic valve stenosis in five. Mitral valve changes included prolapse in six patients and moderate cusp thickening with calcification in five. Two heads of the papillary muscle connecting to the choldae of both the anterior and posterior leaflets are fixed with two teflon-pledgeted 3-0 TiCron™ (Covidien, Dublin, Ireland) sutures in order to achieve coaptation of the two leaflets. Prominent MR was observed in a patient with functional MR after surgery, however residual MR was not detected in organic MR patients. The tenting height (coaptation distance) of mitral valve significantly decreased after surgery from 11±1 to 7±2mm in the organic MR patients, which was similar to the results in the functional MR patients (from 12±2 to 7±2 mm). The postoperative mean mitral orifice area in the organic MR patients was 4.3±0.1cm2 without stenosis. Sandwich plasty reduces the distance of choldae connecting to anterior and posterior leaflets and achieves the better coaptation of two leaflets. This procedure is effective in the treatment of both functional and organic MR. PMID:25433409

Ishikawa, Susumu; Mishima, Hideki; Matsunaga, Hiroki; Katayama, Yasushi

2014-11-01

73

Quantitative Evaluation of Change in Co-existent Mitral Regurgitation After Aortic Valve Replacement  

PubMed Central

Objective Management of intermediate degrees of mitral regurgitation (MR) during aortic valve replacement (AVR) for aortic stenosis remains controversial. We sought to evaluate the degree of reduction of MR in patients undergoing AVR, as well as the relationship between the pre-operative gradient across the aortic valve and the degree of reduction in MR. Methods We retrospectively analyzed demographic, intraoperative, and echocardiographic data on 802 patients that underwent AVR or aortic root replacement between January 2010 and March 2011. 578 patients underwent AVR or aortic root replacement without intervention on the mitral valve. We excluded 88 patients with severe aortic insufficiency, 3 patients that underwent ventricular assist device placement, 4 patients that underwent prior mitral valve replacement, and 21 patients with incomplete data yielding 462 patients for analysis. MR was graded for each patient and the degree of change in MR for each patient was determined by subtracting the grade of pre-operative MR from the degree of post-operative MR. Results Of the 462 patients, 289 patients had at least mild MR. On average, MR was downgraded by 0.24 degrees per patient for this cohort of 289 patients. Of the 56 patients with at least moderate MR, MR was downgraded 0.54 degrees per patient. Of 62 patients that underwent AVR only, had at least mild MR, and no evidence of structural mitral valve disease, downgrading of MR was 0.24 degrees per patient. Linear regression analysis revealed no relationship between reduction in MR and pre-operative gradient across the aortic valve. Conclusions Reduction in MR after relief of aortic outflow tract obstruction is modest at best. Further, the magnitude of the pre-operative gradient across the aortic valve has little influence on the degree of reduction in MR. These observations argue in favor of performing a prospective evaluation of the clinical benefits of addressing moderate MR at the time of aortic valve intervention. PMID:23245347

Kaczorowski, David J.; MacArthur, John W.; Howard, Jessica; Kobrin, Dale; Fairman, Alex; Woo, Y. Joseph

2013-01-01

74

Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation  

PubMed Central

BACKGROUND Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation. METHODS We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD. RESULTS MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035–1.721; p = 0.026) even after adjusting for the amount of pre operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826). CONCLUSIONS Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle. PMID:23850122

Kitada, Shuichi; Kato, Tomoko S.; Thomas, Sunu S.; Conwell, Suzanne D.; Russo, Cesare; Di Tullio, Marco R.; Farr, Maryjane; Schulze, P. Christian; Uriel, Nir; Jorde, Ulrich P.; Takayama, Hiroo; Naka, Yoshifumi; Homma, Shunichi; Mancini, Donna M.

2014-01-01

75

Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry)  

Microsoft Academic Search

Aims Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventri- cular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild IMR at rest. Exercise echocardiography may help identify a subset of patients at higher risk of cardiovascular events by revealing

Patrizio Lancellotti; Erwan Donal; Bernard Cosyns; Guy Van Camp; Jean-Luc Monin; Eric Brochet; Alain Berrebi; Philippe Pibarot; Christophe Chauvel; Christian Hassager; Gabriele Tumminello; Christophe Tribouilloy; Stephane Lafitte; Alan G. Fraser; Genevieve Derumeaux; George Athanassopoulos; Jeroen Bax; Luc A. Pierard

2008-01-01

76

Severe mitral regurgitation and hepatopulmonary hydatid cysts: what should be treated first?  

PubMed

Hydatid cyst can simultaneously affect the liver and lung. Some patients might have additional comorbidities that can make management more challenging. Here, we present a 10-year-old boy with hepatopulmonary hydatid cysts and severe mitral regurgitation, who was successfully managed with a staged surgical approach treating the lung first, followed by the liver and finally, the heart. PMID:18611958

Vasquez, Julio C; DeLaRosa, Jacob; Montesinos, Efrain; Rojas, Luis; Peralta, Julio; Leon, Juan J

2008-12-01

77

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

78

The role of the edge-to-edge repair in the surgical treatment of mitral regurgitation.  

PubMed

The edge-to-edge (E-to-E) technique was introduced in the early 1990s and has provided a useful contribution to the surgical armamentarium of mitral valve repair. The free edges of the mitral leaflets have to be approximated in correspondence of the site of the regurgitant jet in such a way that mitral regurgitation is corrected without producing stenosis. A prosthetic ring is usually implanted to stabilize the repair. Middle- and long-term surgical results are now available. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. In this review the present role of the E-to-E repair, the relevant technical aspects of the procedure, and some controversial issues will be outlined and discussed. PMID:21050269

Alfieri, Ottavio; De Bonis, Michele

2010-09-01

79

Pathogenesis of acute ischemic mitral regurgitation in three dimensions  

Microsoft Academic Search

Changes in the geometric and intravalvular relationships between subunits of the ovine mitral valve were measured before and after acute posterior wall myocardial infarction in three dimensions by means of sonomicrometry array localization. In 13 sheep, nine sonomicrometer transducers were attached around the mitral anulus and to the tip and base of each papillary muscle. Five additional transducers were placed

Robert C Gorman; James S McCaughan; Mark B Ratcliffe; Krishanu B Gupta; James T Streicher; Victor A Ferrari; Martin G St. John-Sutton; Daniel K Bogen; L. Henry Edmunds

1995-01-01

80

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

81

Endocarditis with acute mitral regurgitation caused by Fusobacterium necrophorum  

Microsoft Academic Search

Infective endocarditis is uncommon in young children, especially in the absence of structural heart disease. We report the case of a 2-year-old boy who presented with acute rupture of the mitral valve chordae 6 weeks after an episode ofFusobacterium necrophorum septicemia. His heart had been structurally normal before. Mitral valve replacement was successfully performed. This is the first recorded case

Graham Stuart; Christopher Wren

1992-01-01

82

[Clinical value of the detection of diastolic mitral regurgitation by pulsed Doppler].  

PubMed

The reliability of pulsed Doppler echocardiography for the detection of mitral diastolic regurgitation was evaluated in 21 patients with severe aortic insufficiency and/or cardiomyopathy. Among these patients, 17 had sinus rhythm with a normal PR interval, while 4 had atrial fibrillation with short or normally lasting diastoles. Detection was negative in 10 cases (group A) and positive in the remaining 11 cases (group B). In all patients the data supplied by Doppler echocardiography were confirmed by angiography (100% sensitivity and specificity). A comparative study of right heart and left heart pressures in the two groups showed that group B patients had a special pressure profile, the most significant feature of which was an increase in pulmonary arterial and capillary pressures (p less than 0.01 and p less than 0.001 respectively). The diagnostic reliability of mitral valve diastolic regurgitation as to the presence of an abnormal mean pulmonary pressure was: sensitivity 80%, specificity 73%. Right heart pressures were either normal or very slightly elevated in group A patients. It is concluded that the presence of mitral diastolic regurgitation in patients with the pathology described indicates an unfavourable prognosis. This should be taken into account and lead to a systematic of mitral flow in these patients. PMID:3130007

Veyrat, C; Bas, S; Sainte Beuve, D; Gourtchiglouian, C; Abitbol, G; Kalmanson, D

1987-12-01

83

Mitral regurgitation: comparison between edge-to-edge repair and valve replacement.  

PubMed

Mitral regurgitation due to bileaflet prolapse and ischemic causes can be difficult to repair. Midterm experience of the Alfieri edge-to-edge repair as an alternative to valve replacement is reported. Twenty-six patients with severe mitral regurgitation underwent the Alfieri repair between January 1998 and December 2000 (group 1); 15 cases were due to bileaflet prolapse and 7 were of ischemic origin. During the same period, valve replacement was performed in 36 patients (group 2), 20 of whom had similar indications. Follow-up was complete to a mean of 15 months (range, 1-28 months). There was no early death in either group. During follow-up, there was no reoperation in group 1, while 2 patients in group 2 required reoperations due to prosthetic valve endocarditis. There were 4 major thromboembolic or bleeding events in group 2, and none in group 1. All patients in group 1 had trivial to mild mitral regurgitation on follow-up echocardiography. The mean mitral valve gradient was significantly higher in group 2 compared to group 1 (7.2 versus 3.2 mm Hg, p = 0.001). The edge-to-edge repair is associated with good early and midterm results. Long-term follow-up is required to evaluate the durability of this technique. PMID:12878560

Raman, Jai; Shah, Pallav; Seevanayagam, Siven; Cheung, John; Buxton, Brian

2003-06-01

84

A good surgical option for ischemic mitral regurgitation in co-morbid patients: semicircular reduction annuloplasty  

PubMed Central

Background Ring annuloplasty is the standard treatment of ischemic mitral regurgitation (MR), however, it has been associated with some drawbacks. It abolishes normal annular dynamics and freezes the posterior leaflet. In the present study, we evaluated Paneth suture annuloplasty in chronic ischemic MR and both early and mid-term outcomes of the technique on a selected population. Methods The study period was from June 2010 to June 2012. We operated on 21 patients who had the diagnosis of coronary artery disease and MR of grade 3 or 4. The patients had both a coronary artery bypass operation and the mitral semicircular reduction annuloplasty described by Paneth-Burr. The data on the patients were retrospectively collected. Patients were contacted by outpatient clinic controls for mid-term results. Results The male/female ratio was 10/11. The mean age of the patients was 71.0 ± 6.4 years. Preoperative and postoperative left ventricular ejection fraction was statistically similar (P = 0.973). Early postoperative MR grade (mean, 0.57 ± 0.51) was statistically lower than the preoperative MR grades (mean, 3.38 ± 0.50) (P < 0.001). There was no revision for excess bleeding. Two patients had prolonged hospitalization, one for sternal infection and the other for severe chronic obstructive pulmonary disease. No hospital or late postoperative deaths occurred. The mean late postoperative MR grade was 0.66 ± 0.97 degrees. One patient had progression of MR in the later follow-up, which was treated by mitral valve replacement. Conclusion Semicircular reduction annuloplasty is an effective, inexpensive and easy surgical annuloplasty technique with low mortality and morbidity in severe symptomatic ischemic MR. PMID:23888173

Emrecan, Bilgin; Onem, Gokhan; Ozdemir, Ahmet Coskun; K?l?ç, ?smail Do?u; Alihano?lu, Yusuf ?zzettin

2013-01-01

85

Superior vena cava syndrome caused by a swollen absorbable haemostat after repair of ischaemic mitral regurgitation  

PubMed Central

Surgicel, an absorbable haemostat, is widely used in cardiovascular surgery. An 81-year-old woman, who was diagnosed with ischaemic mitral regurgitation, underwent mitral valve plasty and coronary artery bypass grafting. On postoperative day two, her superior vena cava (SVC) pressure gradually rose to 38 mmHg and she developed low output syndrome. Emergent surgery revealed that the cause of SVC syndrome was external compression from a haematoma at the posterior surface of the SVC, which formed around the Surgicel. PMID:24387601

2014-01-01

86

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

87

New insights on Carpentier I mitral regurgitation from multidetector row computed tomography.  

PubMed

The underlying mechanism of mitral regurgitation (MR) because of isolated annulus dilation (Carpentier type I) remains controversial in patients with atrial fibrillation (AF). The present study evaluated changes in mitral valve geometry of patients with AF and structurally and functionally normal left ventricles and mitral leaflets. Grade of MR and left ventricular (LV) function was evaluated with echocardiography. Changes in mitral valve geometry were evaluated with multidetector row computed tomography (MDCT) performed before radiofrequency catheter ablation for AF. From a cohort of 480 patients with drug-refractory AF referred for catheter ablation, 170 patients (mean age 58 ± 10 years, 67% men) with structural and functional normal left ventricles and mitral leaflets were included. The intercommissural and anteroposterior diameter, perimeter, and area of the mitral annulus and left atrial volume were assessed with MDCT and correlated with the grade of MR as assessed with echocardiography. A total of 49 patients (29%) had MR ?2+. These patients had larger mitral annulus area compared with patients with MR <2+ (665.0 ± 100.6 mm(2)/m(2) vs 530.5 ± 66.6 mm(2)/m(2), p <0.001), whereas LV size and function (ejection fraction 64.9 ± 6.3% vs 63.1 ± 5.7%, p = 0.08) were similar. After adjusting for age, type of AF, hypertension, left atrial volume, and LV end-systolic volume and ejection fraction, the mitral annulus dimensions remained independently correlated with MR ?2+. In conclusion, in AF patients with structural and functional normal left ventricles and mitral leaflets, MDCT demonstrated that mitral annulus dilation is independently associated with type I MR. PMID:25037679

van Rosendael, Philippe J; Katsanos, Spyridon; Kamperidis, Vasileios; Roos, Cornelis J; Scholte, Arthur J H A; Schalij, Martin J; Ajmone Marsan, Nina; Bax, Jeroen J; Delgado, Victoria

2014-09-01

88

The Natural History of Unexpected Doppler Mitral Regurgitation  

Microsoft Academic Search

It is common for patients to be di agnosed as having valvular regurgita tion by Doppler echo when no such murmur has been heard by the refer ring clinician. To test the hypothesis that such patients have clinically un important heart disease, the authors evaluated the records of 213 consecu tive men in whom mitral regurgita tion had been found

Evlin L. Kinney; Robert J. Wright

1989-01-01

89

Severe mitral regurgitation requiring ECMO therapy treated by interventional valve reconstruction using the MitraClip.  

PubMed

Surgical repair is considered the gold standard in severe mitral valve regurgitation. Multi-organ failure because of acute mitral insufficiency, however, can be challenging to manage as it aggravates to an inoperable state. We report the case of a 59 year old woman who presented with pulmonary oedema because of high grade mitral regurgitation. A recompensation prior to surgery using medical therapy failed and the patient developed a progressive multi-organ failure including pulmonary, circulatory, and renal failure within days. Symptomatically, our patient could be stabilized employing an extracorporeal membrane oxygenation and an intra-aortic balloon pump. A surgical mitral valve repair was ruled out because of the multi-organ failure. We performed an interventional valve reconstruction using the MitraClip™ device continuing the extracorporeal membrane oxygenation and the intra-aortic balloon counterpulsation therapy during the procedure. After clipping, multi-organ failure regressed and the extracorporeal membrane oxygenation could be explanted at day two after intervention. © 2013 Wiley Periodicals, Inc. PMID:24323566

Staudacher, Dawid L; Bode, Christoph; Wengenmayer, Tobias

2015-01-01

90

Reduction in Mitral Regurgitation During Therapy Guided by Measured Filling Pressures in the ESCAPE Trial  

PubMed Central

Background Dynamic mitral regurgitation (MR) contributes to decompensation in chronic dilated heart failure. Reduction of MR was the primary physiologic endpoint in the ESCAPE trial, which compared acute therapy guided by JVP, edema, and weight (CLIN) to therapy guided additionally by pulmonary artery catheters (PAC) toward pulmonary wedge pressure ?15 and right atrial pressure ?8 mmHg. Methods and Results Patients were randomized to PAC or CLIN during hospitalization with chronic HF and mean LVEF 20%, and at least 1 symptom and 1 sign of congestion. MR and mitral flow patterns, measured blinded to therapy and timepoint, were available at baseline and discharge in 133 patients, and at 3 months in 104 patients. Changes in MR and related transmitral flow patterns were compared between PAC and CLIN patients. Jugular venous pressure, edema, and weights decreased similarly during therapy in the hospital for both groups. In PAC but not in CLIN patients, MR jet area, MR/LAA ratio, and E velocity were each significantly reduced and deceleration time increased by discharge. By 3 months, patients had clinical evidence of increased JVP, edema, and weight since discharge, reaching significance in the PAC arm, and the change in MR was no longer different between the 2 groups, although the change in E velocity remained greater in PAC patients. Conclusions During hospitalization, therapy guided by PAC to reduce left-sided pressures improved MR and related filling patterns more than therapy guided clinically by evidence of systemic venous congestion. This early reduction did not translate into improved outcomes out of the hospital, where volume status reverted toward baseline. PMID:19808338

Palardy, Maryse; Stevenson, Lynne W.; Tasissa, Gudaye; Hamilton, Michele A.; Bourge, Robert C.; DiSalvo, Thomas G.; Elkayam, Uri; Hill, James A.; Reimold, Sharon C.

2009-01-01

91

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

PubMed

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

Sack, Stefan; Kahlert, Philipp; Erbel, Raimund

2009-01-01

92

TandemHeart placement for cardiogenic shock in acute severe mitral regurgitation and right ventricular failure.  

PubMed

We report a case of a patient with severe mitral regurgitation (MR) due to infective endocarditis with preserved left ventricular systolic function complicated by severe pulmonary hypertension, right ventricular (RV) dysfunction, and cardiogenic shock. He was evaluated by cardiothoracic surgery for mitral valve replacement (MVR). It appeared that the high pulmonary artery pressure (PAP) had been chronic with acute worsening, thus raising concerns that it may not promptly reverse after MVR, putting him at high risk for postoperative RV failure and increasing the risk of mortality. A TandemHeart (TH) percutaneous ventricular assist device (pVAD) was placed with improvement in hemodynamics following which MVR was done. To our knowledge, this is the first report of the preoperative use of the TH pVAD in severe acute MR for hemodynamic stabilization in preparation for MVR. PMID:23907937

Hira, Ravi S; Thamwiwat, Alisa; Kar, Biswajit

2014-02-01

93

Prospective validation of an echocardiographic index for determining the severity of chronic mitral regurgitation.  

PubMed

The aim of this study is to prospectively validate a recently reported semiquantitative index of mitral regurgitation (MR) severity. MR is a common echocardiographic finding with no single reference standard to evaluate its severity. We recently developed and retrospectively tested a semiquantitative index of MR severity. The MR index is a composite of 6 echocardiographic variables: jet penetration, proximal isovelocity surface area, continuous-wave Doppler characteristics of the regurgitant jet, pulmonary artery pressure, pulmonary venous flow pattern, and left atrial size. Sixty-two consecutive patients with varying grades of MR were prospectively studied. Patients were divided into 3 groups for comparison: mild MR, moderate MR, and severe MR. Each patient was evaluated for the 6 variables, with each variable scored on a 4-point scale (0 to 3). The reference standards for MR severity were qualitative evaluation by an expert, measurement of the regurgitant fraction (RF), and the effective regurgitant orifice area. The MR index increased in proportion to MR severity with a significant difference among the 3 groups (F = 84; p <0.0001). The MR index also correlated with RF (r = 0.73; p <0.0001) and the effective regurgitant orifice area (r = 0.74; p = 0.0001). A MR index > or = 2.2 identified 13 of 16 patients with severe MR (sensitivity 82%, specificity 98%, positive predictive value 93%). No patient with severe MR had a score <2.0 and no patient with mild MR had a score >1.67. These results concurred with those obtained in a previously published retrospective study. Thus, the MR index is a simple, reproducible semiquantitative estimate of MR severity, that is widely applicable in routine clinical practice. PMID:12231085

Thomas, Liza; Foster, Elyse; Hoffman, Julian I E; Schiller, Nelson B

2002-09-15

94

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.

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

95

Afterload mismatch after MitraClip insertion for functional mitral regurgitation.  

PubMed

Afterload mismatch, defined as acute impairment of left ventricular function after mitral surgery, is a major issue in patients with low ejection fraction and functional mitral regurgitation (FMR). Safety and efficacy of MitraClip therapy have been assessed in randomized trials, but limited data on its acute hemodynamic effects are available. This study aimed to investigate the incidence and prognostic role of afterload mismatch in patients affected by FMR treated with MitraClip therapy. We retrospectively analyzed patients affected by FMR and submitted to MitraClip therapy from October 2008 to December 2012. Patients were assigned to 2 groups according to the occurrence of the afterload mismatch: patients with afterload mismatch (AM+) and without afterload mismatch (AM-). Of 73 patients, 19 (26%) experienced afterload mismatch in the early postoperative period. Among preoperative variables, end-diastolic diameter (71 ± 8 vs 67 ± 7 mm, p = 0.02) and end-systolic diameter (57 ± 9 vs 53 ± 7 mm, p = 0.04) were both significantly larger in AM+ group. An increased incidence of right ventricular dysfunction (68% vs 31%, p = 0.049) and pulmonary hypertension (49 ± 10 vs 40 ± 10 mm Hg, p = 0.0009) was found in AM+ group. Before hospital discharge, left ventricular ejection fraction (LVEF) became similar in both groups (31 ± 9% vs 33 ± 11%, p = 0.65). Long-term survival was comparable between the 2 groups (p = 0.44). A low LVEF in the early postoperative period (LVEF <17%) was significantly associated with higher mortality rate in long-term follow-up (p = 0.048). In conclusion, reduction of mitral regurgitation with MitraClip can cause afterload mismatch; however, this phenomenon is transient, without long-term prognostic implications. PMID:24837263

Melisurgo, Giulio; Ajello, Silvia; Pappalardo, Federico; Guidotti, Andrea; Agricola, Eustachio; Kawaguchi, Masanori; Latib, Azeem; Covello, Remo Daniel; Denti, Paolo; Zangrillo, Alberto; Alfieri, Ottavio; Maisano, Francesco

2014-06-01

96

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

PubMed

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

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

2012-05-01

97

Prognostic Value of Exercise Treadmill Testing in Asymptomatic Chronic Nonischemic Mitral Regurgitation  

PubMed Central

In many heart diseases, exercise treadmill testing(ETT) has useful functional correlates and/or prognostic value. However, its predictive value in mitral regurgitation(MR) is undefined. To determine whether ETT descriptors predict death or indications for mitral valve surgery among patients with MR, we prospectively followed, for 7±3 endpoint-free years, a cohort of 38 patients with chronic severe nonischemic MR who underwent modified Bruce ETT; all lacked surgical indications at study entry. Their baseline exercise descriptors also were compared with those from 46 patients with severe MR who, at entry, already had reached surgical indications. Endpoints during follow-up among the cohort included sudden death(n=1), heart failure symptoms(n=2), atrial fibrillation(n=4), LVEF<60%(n=2), LV systolic dimensions(IDs)?45 mm(n=12) and LVIDs>40mm(n=11), LVEF<60%+LVIDs 45 mm(n=3), and heart failure+LVIDs 45mm+LVEF<60%(n=1). In univariate analysis, exercise duration(p=.004), chronotropic response(p=.007), percent predicted peak heart rate(p=.01) and heart rate recovery(p<.02) predicted events; in multivariate analysis, only exercise duration was predictive(p<.02). Average annual event risk was 5-fold lower(4.62%) with exercise duration?15 minutes vs. <15 minutes(average annual risk=23.48%, p=.004). Relative risks among patients with and without exercise-inducible ST segment depression were comparable(?1.3[NS]) whether defined at entry and/or during follow-up. Exercise duration, but not prevalence of exercise-inducible ST segment depression, was lower(p<.001) among patients with surgical indications at entry vs. initially endpoint-free patients. In conclusion, among asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, progression to surgical indications generally is rapid. However, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST segment depression has no prognostic value in this population. We followed, for 7±3 endpoint-free years, 38 patients with chronic severe nonischemic mitral regurgitation (MR) who underwent modified Bruce exercise treadmill testing (ETT) to determine whether ETT descriptors predict death or indications for mitral valve surgery. At study entry, all lacked surgical indications. Exercise duration independently predicted subsequent events; event risks among patients with and without exercise-inducible ST segment depression were comparable. We conclude that among asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST segment depression has no prognostic value in this population. PMID:17920370

Supino, Phyllis G.; Borer, Jeffrey S.; Schuleri, Karlheinz; Gupta, Anuj; Hochreiter, Clare; Kligfield, Paul; Herrold, Edmund McM.; Preibisz, Jacek J.

2007-01-01

98

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

Microsoft Academic Search

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

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

2002-01-01

99

Determinants of Atrial Electromechanical Delay in Patients with Functional Mitral Regurgitation and Non-ischemic Dilated Cardiomyopathy  

PubMed Central

Introduction: Atrial conduction time has important hemodynamic effects on ventricular filling and is accepted as a predictor of atrial fibrillation. In this study we assessed atrial conduction time in patients with non ischemic dilated cardiomyopathy (NIDCMP) and functional mitral regurgitation (MR) and aimed to determine factors predicting atrial conduction time prolongation. Methods: Sixty five patients with non ischemic dilated cardiomyopathy who have moderate to severe MR and 60 control subjects were included in the study. In addition to conventional echocardiographic measures used to asses left ventricle and MR, atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intra- and interatrial electromechanical delay (intra and inter AEMD) were measured. Results: The correlations between inter AEMD and left atrial (LA) size, MR volume, isovolumetric relaxation time (IVRT), deceleration time (DT), systolic pulmonary artery pressure (PAPs), E/A ratio and E/e’ were very poor. Similarly, intra AEMD was not correlated to LA size , MR volume, IVRT, DT, PAPs, E/A ratio and E/e’. However, both inter AEMD and intra AEMD had good correlation with left ventricular mass index, tenting area (TA), tenting distance (TD), coaptation septal distance (CSD), sphericity index (SI). Conclusion: Prolongation of inter and intra AEMDs were found to be well correlated with parameters reflecting left ventricular and mitral annular remodeling. PMID:25610556

Bengi Bakal, Ruken; Hatipoglu, Suzan; Sahin, Muslum; Emiroglu, Mehmet Yunus; Bulut, Mustafa; Ozdemir, Nihal

2014-01-01

100

Intermediate-Term Outcome Of Mitral Reconstruction In Cardiomyopathy  

Microsoft Academic Search

Objective: Severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy that contributes to heart failure and predicts a poor survival. We studied the intermediate-term outcome of mitral reconstruction in 48 patients who had cardiomyopathy with severe mitral regurgitation and were operated on between June 1993 and June 1997. Methods: Ages ranged from 33 to 79 years (63 ± 6 years)

Steven F. Bolling; Francis D. Pagani; G. Michael Deeb; David S. Bach

1998-01-01

101

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

102

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

103

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

PubMed

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

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

2015-02-01

104

Effects of tilting disk heart valve gap width on regurgitant flow through an artificial heart mitral valve.  

PubMed

While many investigators have measured the turbulent stresses associated with forward flow through tilting disk heart valves, only recently has attention been given to the regurgitant jets formed as fluid is squeezed through the gap between the occluder and housing of a closed valve. The objective of this investigation was to determine the effect of gap width on the turbulent stresses of the regurgitant jets through a Björk-Shiley monostrut tilting disk heart valve seated in the mitral position of a Penn State artificial heart. A 2 component laser-Doppler velocimetry system with a temporal resolution of 1 ms was used to measure the instantaneous velocities in the regurgitant jets in the major and minor orifices around the mitral valve. The gap width was controlled through temperature variation by taking advantage of the large difference between the thermal expansion coefficients of the Delrin occluder and the Stellite housing of Björk-Shiley monostrut valves. The turbulent shear stress and mean (ensemble averaged) velocity were incorporated into a model of red blood cell damage to assess the potential for hemolytic damage at each gap width investigated. The results revealed that the minor orifice tends to form stronger jets during regurgitant flow than the major orifice, indicating that the gap width is not uniform around the circumference of the valve. Based on the results of a red blood cell damage model, the hemolytic potential of the mitral valve decreases as the gap width increases. This investigation also established that the hemolytic potential of the regurgitant phase of valve operation is comparable to, if not greater than, the hemolytic potential of forward flow, consistent with experimental data on hemolysis. PMID:9288873

Maymir, J C; Deutsch, S; Meyer, R S; Geselowitz, D B; Tarbell, J M

1997-09-01

105

Usefulness of 3D-PISA as compared to guideline endorsed parameters for mitral regurgitation quantification.  

PubMed

This study was intended to evaluate the diagnostic value of three dimensional proximal isovelocity surface area (3D PISA) derived effective regurgitant orifice area (EROA) and the accuracy of automatic 3D PISA detection in a population resembling clinical practice. Quantification of mitral regurgitation (MR) remains challenging and 3D PISA EROA is a novel diagnostic tool with promising results. However its' usefulness compared to guideline endorsed parameters has not been shown. In 93 consecutive patients examined in routine practice conventional parameters and 3D-datasets for offline 3D PISA evaluation were recorded. EROA was determined from the largest (peak) PISA and also averaged over systole for meanEROA. Results of 3D PISA calculation were compared with a combination of expert grading by two examiners and two scores for MR grading. In receiver operator characteristic-analysis the meanEROA as determined by 3D PISA had the best diagnostic value (AUC = 0.907 CI 0.832-0.983) as compared to peakEROA (AUC 0.840 CI 0.739-0.941), vena contracta width (AUC 0.831 CI 0.745-0.918) and 2D PISA (AUC 0.747 CI 0.644-0.850). A meanEROA of 0.15 cm(2) had a sensitivity of 88.2 % and a specificity of 81.4 % for distinguishing severe from non-severe MR. Semiautomatic 3D PISA detection correlated very well with manually corrected values (r = 0.955). Semiautomatic 3D PISA measurement is feasible in a clinical population and has better diagnostic value compared to 2D PISA. Calculation of mean EROA throughout systole further improves diagnostic value compared to conventional parameters. PMID:25037470

Schmidt, Frank P; Gniewosz, Theresa; Jabs, Alexander; Münzel, Thomas; Hink, Ulrich; Lancellotti, Patrizio; von Bardeleben, Ralph-Stephan

2014-12-01

106

Assessment of prognostic factors in patients undergoing surgery for non-rheumatic mitral regurgitation.  

PubMed Central

Twenty-four patients who had undegone mitral valve surgery for pure non-rheumatic mitral regurgitation were studied non-invasively six months to six years postoperatively. The long-term results of operation were assessed on the basis of clinical history, echocardiography, and treadmill stress testing using a points scoring system. The score so obtained was used to divide the patients into those with a good response to surgery (group 1) and those responding poorly (group 2). The effects on the long-term surgical outcome of several intraoperative and preoperative factors were then analysed both together and separately. A short symptomatic history (less than 1 year), a normal left ventricular end-diastolic volume index (less than or equal to 100 ml per m2), and a large post-ectopic potentiation of KV max (greater than 50 s-1) were found to be favourable prognostic factors when analysed independently. An angiographic ejection fraction less than 0.5 was uniformly associated with a poor outcome, and 71 per cent of patients in atrial fibrillation at the time of operation also responded badly. In those patients with good long-term function, cold potassium cardioplegia was more commonly used than intermittent aortic cross clamping as the means of intraoperative myocardial preservation, though this difference did not reach conventional significance. A standard analysis of variance allowed assessment of length of history, left ventricular end-diastolic volume index, and type of valve prosthesis simultaneously. This indicated that both length of history and left ventricular end-diastolic volume index were highly significant prognostic factors. The use of a Björk-Shiley as opposed to a Starr-Edwards prosthesis also emerged as significantly favouring a good long-term result. The state of the left ventricular myocardium before operation and the type of valve prosthesis used were thus shown to be the prime determinants of surgical outcome in these patients. The optimum time for operation was shown to be within one year of the onset of symptoms, and before the left left ventricular end-diastolic volume index exceeds 100 ml per m2, or the ejection fraction falls to less than 0.5. At such a time, irreversible changes in myocardial function sufficient to negate the beneficial effects of mitral valve surgery have not yet occurred. PMID:7426197

Saltissi, S; Crowther, A; Byrne, C; Coltart, D J; Jenkins, B S; Webb-Peploe, M M

1980-01-01

107

Plasma proANP and SDMA and microRNAs are associated with chronic mitral regurgitation in a pig model  

PubMed Central

Objective Non-ischemic mitral regurgitation (MR) is primarily caused by myxomatous mitral valve (MV) disease leading to adaptive remodeling, enlargement, and dysfunction of the left ventricle. The aim of this study was to examine the regulation of plasma markers and several cardiac key genes in a novel porcine model of non-ischemic MR. Methods and results Twenty-eight production pigs (Sus scrofa) were randomized to experimental MR or sham surgery controls. MR was induced by external suture(s) through the posterior MV leaflet and quantified using echocardiography. The experimental group was subdivided into mild MR (mMR, MR=20–50%, n=10) and moderate/severe MR (sMR, MR >50%, n=6) and compared with controls (CON, MR ?10%, n=12). Eight weeks postoperatively, follow-up examinations were performed followed by killing. Circulating concentrations of pro-atrial natriuretic peptide (proANP), l-arginine, asymmetric dimethylarginine, and symmetric dimethylarginine (SDMA) were measured. MV, anterior papillary muscle, and left ventricular free wall tissues were collected to quantify mRNA expression of eNOS (NOS3), iNOS (NOS2), MMP9, MMP14, ANP (NPPA), BNP (NPPB), and TGFB1, 2, and 3 and five microRNAs by quantitative real-time PCR. Pigs with sMR displayed markedly increased plasma proANP and SDMA concentrations compared with both controls and mMR (P<0.05). The expression of all genes examined differed significantly between the three localizations in the heart. miR-21 and miR-133a were differently expressed among the experimental groups (P<0.05). Conclusions Plasma proANP and SDMA levels and tissue expression of miR-21 and miR-133a are associated with severity of chronic MR in an experimental porcine model. PMID:24029364

Cirera, Susanna; Moesgaard, Sophia G; Zois, Nora E; Ravn, Nathja; Goetze, Jens P; Cremer, Signe E; Teerlink, Tom; Leifsson, Páll S; Honge, Jesper L; Hasenkam, J Michael; Olsen, Lisbeth H

2013-01-01

108

Late posterior failure after mitral valve repair in degenerative disease  

Microsoft Academic Search

Objectives: Little is known regarding the mechanisms, the feasibility and the long-term results of re-repair in 'posterior failure' of a previous mitral valve repair performed for severe degenerative mitral regurgitation. We report our 16-year experience in redo surgery for late posterior failureofmitralvalverepairindegenerativedisease.Methods:From1991to2004,13consecutivepatients(10males;medianage:65years)were reoperated for late posterior failure of mitral valve repair. All patients had grade 3+ mitral regurgitation. Repair was

Rachid Zegdi; Ghassan Sleilaty; Ziad Khabbaz; Milena Noghin; Christian Latremouille; Alain Carpentier; Alain Deloche; Jean-Noel Fabiani

109

Factors influencing survival and postoperative quality of life after mitral valve reconstruction  

Microsoft Academic Search

Objective: Mitral valve reconstruction (MVR) is the preferred treatment for regurgitant lesions. Clinical benefit is well documented, but comparative data scrutinising factors influencing survival and postoperative quality of life (QOL) in different subsets of patients are missing. We hypothesised that mitral valve reconstruction for mitral regurgitation benefits the patients, regardless of the valve pathology. Methods: In this study, 663 consecutive

Lorenz Hansen; Stephan Winkel; Jannick Kuhr; Ralf Bader; Niels Bleese; Friedrich-Christian Riess

2010-01-01

110

Late Repair of Ischemic Mitral Regurgitation does not Prevent Left Ventricular Remodeling: Importance of Timing for Beneficial Repair  

PubMed Central

Background Ischemic mitral regurgitation (MR) is a frequent complication of myocardial infarction (MI) associated with left ventricular (LV) dilatation and dysfunction that doubles mortality. At the molecular level, moderate ischemic MR is characterized by a biphasic response with initial compensatory rise in pro-hypertrophic and anti-apoptotic signals followed by their exhaustion. We have shown that early MR repair 30 days after MI is associated with LV reverse remodeling. It is not known if MR repair performed after the exhaustion of compensatory mechanisms is also beneficial. We hypothesised that late repair will not result in LV reverse remodeling. Methods and Results Twelve sheep underwent distal left anterior descending coronary artery ligation to create apical MI, and implantation of a LV-to-left atrium shunt to create standardized moderate volume overload. At 90 days, animals were randomized to shunt closure (late repair) vs sham (no repair). LV remodeling was assessed by 3D echocardiography, dP/dt, preload recruitable stroke work (PRSW) and myocardial biopsies. At 90 days, animals had moderate volume overload, LV dilatation and reduced ejection fraction (all p<0.01 vs baseline, p=NS between groups). Shunt closure at 90 days corrected the volume overload (regurgitant fraction 6±5% vs 27±16% for late repair vs sham, p<0.01), but was not associated with changes in LV volumes (end-diastolic volume 106±15 vs 110±22 ml; end-systolic volume 35±6 vs 36±6 ml), or increases in PRSW (41±7 vs 39±13 ml·mmHg) or dP/dt (803±210 vs 732±194 mmHg/sec) at 135 days (all p=NS). Activated Akt, central in the hypertrophic process, and STAT3, critical node in the hypertrophic stimulus by cytokines, were equally depressed in both groups. Conclusion Late correction of moderate volume overload after MI did not improve LV volume or contractility. Up-regulation of pro-hypertrophic intra-cellular pathways was not observed. This contrasts with previously reported study in which early repair (30 days) reversed LV remodeling. This suggests a “window of opportunity” to repair ischemic MR, after which no beneficial effect on LV is observed despite successful repair. PMID:24030415

Beaudoin, Jonathan; Levine, Robert A.; Guerrero, J. Luis; Yosefy, Chaim; Sullivan, Suzanne; Abedat, Susan; Handschumacher, Mark D.; Szymanski, Catherine; Gilon, Dan; Palmeri, Nicholas; Vlahakes, Gus J.; Hajjar, Roger J.; Beeri, Ronen

2014-01-01

111

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

112

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

113

Increased Sarcolipin Expression and Adrenergic Drive in Humans with Preserved Left Ventricular Ejection Fraction and Chronic Isolated Mitral Regurgitation  

PubMed Central

Background There is currently no therapy proven to attenuate left ventricular (LV) dilatation and dysfunction in the volume overload induced by isolated mitral regurgitation (MR). To better understand molecular signatures underlying isolated MR, we performed LV gene expression analyses and overlaid regulated genes into Ingenuity Pathway Analysis in patients with isolated MR. Methods and Results Gene arrays from LV tissue of 35 patients, taken at the time of surgical repair for isolated MR, were compared to 13 normal controls. Cine-magnetic resonance imaging (MRI) was performed in 31 patients before surgery to measure LV function and volume from serial short axis summation. LV end-diastolic volume was 2-fold (p=0.005) higher than normals and LV ejection fraction (EF) was 64±7% (50-79%) in MR patients. Ingenuity pathway analysis identified significant activation of pathways involved in ?-adrenergic, cyclic AMP, and G-protein coupled signaling; while there was downregulation of pathways associated with complement activation and acute phase response. SERCA2a and phospholamban protein were unchanged in MR vs. control LVs. However, mRNA and protein levels of the sarcoplasmic reticulum (SR) Ca2+ ATPase (SERCA) regulatory protein sarcolipin, which is predominantly expressed in normal atria, were increased 12- and 6-fold respectively. Immunofluorescence analysis confirmed the absence of sarcolipin in normal LVs and its marked upregulation in MR LVs. Conclusions These results demonstrate alterations in multiple pathways associated with ?-adrenergic signaling and sarcolipin in the LVs of patients with isolated MR and LVEF > 50%,suggesting a beneficial role for ?-adrenergic blockade in isolated MR. PMID:24297688

Zheng, Junying; Yancey, Danielle M.; Ahmed, Mustafa I.; Wei, Chih-Chang; Powell, Pamela C.; Shanmugam, Mayilvahanan; Gupta, Himanshu; Lloyd, Steven G.; McGiffin, David C.; Schiros, Chun G.; Denney, Thomas S.; Babu, Gopal J.; Dell'Italia, Louis J.

2014-01-01

114

Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study???  

PubMed Central

Background Guidelines for quantifying mitral regurgitation (MR) using “proximal isovelocity surface area” (PISA) instruct operators to measure the PISA radius from valve orifice to Doppler flow convergence “hemisphere”. Using clinical data and a physically-constructed MR model we (A) analyse the actually-observed colour Doppler PISA shape and (B) test whether instructions to measure a “hemisphere” are helpful. Methods and results In part A, the true shape of PISA shells was investigated using three separate approaches. First, a systematic review of published examples consistently showed non-hemispherical, “urchinoid” shapes. Second, our clinical data confirmed that the Doppler-visualized surface is non-hemispherical. Third, in-vitro experiments showed that round orifices never produce a colour Doppler hemisphere. In part B, six observers were instructed to measure hemisphere radius rh and (on a second viewing) urchinoid distance (du) in 11 clinical PISA datasets; 6 established experts also measured PISA distance as the gold standard. rh measurements, generated using the hemisphere instruction significantly underestimated expert values (? 28%, p < 0.0005), meaning rh2 was underestimated by approximately 2-fold. du measurements, generated using the non-hemisphere instruction were less biased (+ 7%, p = 0.03). Finally, frame-to-frame variability in PISA distance was found to have a coefficient of variation (CV) of 25% in patients and 9% in in-vitro data. Beat-to-beat variability had a CV of 15% in patients. Conclusions Doppler-visualized PISA shells are not hemispherical: we should avoid advising observers to measure a hemispherical radius because it encourages underestimation of orifice area by approximately two-fold. If precision is needed (e.g. to detect changes reliably) multi-frame averaging is essential. PMID:23245796

Moraldo, Michela; Cecaro, Fabrizio; Shun-Shin, Matthew; Pabari, Punam A.; Davies, Justin E.; Xu, Xiao Y.; Hughes, Alun D.; Manisty, Charlotte; Francis, Darrel P.

2013-01-01

115

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

116

Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure.  

PubMed

Abstract Objective: Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact. Research design and methods: This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs. Results: Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p?

Palmieri, Vittorio; Baldi, Cesare; Di Blasi, Paola E; Citro, Rodolfo; Di Lorenzo, Emilio; Bellino, Elisabetta; Preziuso, Feliciano; Ranaudo, Carlo; Sauro, Rosario; Rosato, Giuseppe

2014-11-01

117

Relation between early mitral regurgitation and left ventricular thrombus formation after acute myocardial infarction: results of the GISSI-3 echo substudy  

PubMed Central

Objective: To evaluate the prevalence and correlates of left ventricular thrombosis in patients with acute myocardial infarction, and whether the occurrence of early mitral regurgitation has a protective effect against the formation of left ventricular thrombus. Design and setting: Multicentre clinical trial carried out in 47 Italian coronary care units. Patients and methods: 757 patients from the GISSI-3 echo substudy population with their first acute myocardial infarct were studied by echocardiography at 24–48 hours from symptom onset (S1), at discharge (S2), at six weeks (S3), and at six months (S4). The diagnosis of left ventricular thrombosis was based on the detection of an echo dense mass with defined margins visible throughout the cardiac cycle in at least two orthogonal views. Results: In 64 patients (8%), left ventricular thrombosis was detected in one or more examinations. Compared with the remaining 693 patients, subjects with left ventricular thrombosis were older (mean (SD) age: 64.6 (13.0) v 59.8 (11.7) years, p < 0.005), and had larger infarcts (extent of wall motion asynergy: 40.9 (11.5)% v 24.9 (14)%, p < 0.001), greater depression of left ventricular ejection fraction at S1 (43.3 (6.9)% v 48.1 (6.8)%, p < 0.001), and greater left ventricular volumes at S1 (end diastolic volume: 87 (22) v 78 (18) ml/m2, p < 0.001; end systolic volume: 50 (17) v 41 (14) ml/m2, p < 0.001). The prevalence of moderate to severe mitral regurgitation on colour Doppler at S1 was greater in patients who had left ventricular thrombosis at any time (10.2% v 4.2%, p < 0.05). On stepwise multiple logistic regression analysis the only independent variables related to the presence of left ventricular thrombosis were the extent of wall motion asynergy and anterior site of infarction. Conclusions: Left ventricular thrombosis is not reduced, and may even be increased, by early moderate to severe mitral regurgitation after acute myocardial infarction. The only independent determinant of left ventricular thrombosis is the extent of the akinetic-dyskinetic area detected on echocardiography between 24–48 hours from symptom onset. PMID:12117831

Ascione, L; Antonini-Canterin, F; Macor, F; Cervesato, E; Chiarella, F; Giannuzzi, P; Temporelli, P L; Gentile, F; Lucci, D; Maggioni, A P; Tavazzi, L; Badano, L; Stoian, I; Piazza, R; Bosimini, E; Pavan, D; Nicolosi, G L

2002-01-01

118

Paradoxic Decrease in Ischemic Mitral Regurgitation With Papillary Muscle Dysfunction Insights From Three-Dimensional and Contrast Echocardiography With Strain Rate Measurement  

Microsoft Academic Search

Background—Ischemic mitral regurgitation (MR) was first ascribed to papillary muscle (PM) contractile dysfunction. Current theories include apical leaflet tethering caused by left ventricular (LV) distortion, but PM dysfunction is still postulated and commonly diagnosed. PM contraction, however, parallels apical tethering, suggesting the hypothesis that PM contractile dysfunction can actually diminish MR due to ischemic distortion of the inferior base alone.

Emmanuel Messas; J. Luis Guerrero; Mark D. Handschumacher; Chi-Ming Chow; Suzanne Sullivan; Ehud Schwammenthal; Robert A. Levine

119

Multi-modality guided trans-apical closure of recurrent mitral para-valvular regurgitation after failed surgical management in a patient with osteogenesis imperfecta.  

PubMed

We report a case of a 54 year-old man with osteogenesis imperfecta who developed severe para-valvular mitral regurgitation after a second heart operation to correct the same problem. The large para-valvular leak was successfully closed with an Amplatzer Vascular Plug III delivered from the apical approach. PMID:25082307

Boganashanmugam, Vimalraj; Goldstein, Jacob; Harper, Richard W

2014-11-01

120

Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography  

PubMed Central

Background Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography. Methods Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings. Results Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001). Conclusion Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography. PMID:23077412

Toufan, Mehrnoush; Javadrashid, Reza; Paak, Neda; Gojazadeh, Morteza; Khalili, Majid

2012-01-01

121

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

PubMed

In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation. PMID:7979816

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

1994-01-01

122

Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation  

Microsoft Academic Search

Objectives. We sought to determine the reliability of the proximal isovelocity surface area (PISA) method for calculation of effective regurgitant orifice (ERO) of aortic regurgitation (AR).Background. The ERO area can be calculated by the PISA method, but this method has not been validated in AR.Methods. ERO calculation by the PISA method was undertaken prospectively in 71 consecutive patients with isolated

Christophe M Tribouilloy; Maurice Enriquez-Sarano; Sara L Fett; Kent R Bailey; James B Seward; A. Jamil Tajik

1998-01-01

123

Sizing the mitral annulus in healthy subjects and patients with mitral regurgitation: 2D versus 3D measurements from cardiac CT.  

PubMed

The purpose of our study was (1) to assess retrospectively, in healthy subjects and in patients with moderate and severe functional mitral regurgitation (FMR), the normal mitral annular dimensions, (2) to determine differences in mitral annular geometry between healthy subjects and patients with FMR, and (3) to evaluate potential errors in 2-dimensional (2D) measurements given the 3D nature of the mitral annulus. 15 patients with no cardiac abnormalities (referred to as normals), 13 with moderate and 15 with severe FMR as determined by echocardiography underwent contrast-enhanced cardiac 64-slice Computed tomography (CT) with prospective electrocardiography-gating for excluding coronary artery disease. With an advanced visualization, segmentation, and image analysis software, the area, intercommissural distance (CC), septolateral distance (SLD), and the anterior and posterior circumference of the MA were measured in diastole. We found significant (P < .001) differences between normals and patients with severe FMR for area, SLD and posterior circumference in 3D (P < .001) and 2D (P < .001). Similarly, the SLD and the posterior circumference in both 3D (P = .002) and 2D (P = .001) were significantly smaller in patients with moderate FMR as compared to those with severe FMR. In contrast, there were no significant differences between groups regarding the CC and the anterior circumference both in 3D and 2D (all, P > .05). Measurements in 3D differed significantly from those with 2D for all circumference measurements and groups (P < .01), with a systematic underestimation of the posterior circumference of 2.1 ± 1.5 mm in normals, 1.8 ± 1.3 mm in patients with moderate FMR, and 1.9 ± 1.9 mm in patients with severe FMR for 2D. Our study provides in vivo human CT data on MA dimensions in normals and patients with FMR, indicating differences in patients for the area, posterior circumference and SLD but not for the anterior circumference and CC. Systematic differences exist between 2D and 3D measurements for all circumferential measurements. PMID:24306054

Gordic, Sonja; Nguyen-Kim, Thi Dan Linh; Manka, Robert; Sündermann, Simon; Frauenfelder, Thomas; Maisano, Francesco; Falk, Volkmar; Alkadhi, Hatem

2014-02-01

124

A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation  

PubMed Central

Background Mitral regurgitation (MR) is the second most common valvular heart disease after aortic stenosis. Without intervention, prognosis is poor in patients with severe symptomatic MR. While surgical repair is recommended for many patients with severe degenerative MR (DMR), as many as 49% of patients do not qualify as they are at high surgical risk. Furthermore, surgical correction for functional MR (FMR) is controversial with suboptimal outcomes and significant perioperative mortality. The percutaneous MitraClip implantation can be seen as a viable option in high surgical risk patients. The purpose of this meta-analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. Methods Six electronic databases were searched for original published studies from January 2000 to August 2013. Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures. All data were extracted and tabulated from the relevant articles’ texts, tables, and figures and checked by another reviewer. Results Overall 435 publications were identified. After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction. There was one randomized controlled trial (RCT) and three prospective observational studies. At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P<0.0001). The number of patients with post-procedure residual MR severity >2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001). 30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66). Conclusions Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. We conclude the non-inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery. PMID:24349969

Wan, Benjamin; Rahnavardi, Mohammad; Tian, David H.; Phan, Kevin; Munkholm-Larsen, Stine; Bannon, Paul G.

2013-01-01

125

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

126

Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians.  

PubMed

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

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

2015-02-15

127

Mitral valve surgery - open  

MedlinePLUS

... these is the mitral valve. The mitral valve opens so blood can flow from the left atria to the left ventricle. ... mitral regurgitation . A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis . A valve defect ...

128

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

PubMed

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

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

2014-12-01

129

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

PubMed

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

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

2010-10-15

130

[Cine-MR for the quantification of regurgitation defects by a volume method].  

PubMed

We have examined 46 patients with angiographically confirmed regurgitant lesions (26 mitral insufficiency, 20 aortic insufficiency) using a 0.5 Tesla magnet. In each patient, multiplane and multiphase spin-echo sequences were obtained in a plane angled in the sagittal and coronal direction in the long axis of the heart; left and right ventricular volumes, ejection fractions and regurgitation fractions were calculated. In addition, a blood-flow sensitive gradient echo sequence was obtained in order to determine the direction and extent of the regurgitant jet. The data was compared with the results of angiography and echocardiography. By means of the gradient echo technique, MRI was able to show the regurgitant jet in every patient. There was a linear correlation between volumes determined by MRI and angiography. The best agreement was found for left ventricular contraction volume (R = 0.82, p is less than 0.0001). Comparison of the noninvasive and angiographic method showed a linear correlation for AI patients of R = 0.91 (p is less than 0.001), which is somewhat better than for patients with MI (R = 0.84, p less than 0.001). Semiquantitative grading of MI with a gradient echo technique showed a linear correlation with angiography of R = 0.73 (p less than 0.001), for AI there was agreement between both methods in 72% of cases. A comparison between MRI and colour Doppler sonography showed only moderately good correlation R = 0.69 (p less than 0.01). PMID:2176312

Neuhold, A; Globits, S; Frank, H; Glogar, D; Mayr, H; Stiskal, M; Wicke, L

1990-12-01

131

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

132

The edge-to-edge technique for mitral valve repair.  

PubMed

The edge-to-edge technique was introduced in the surgical armamentarium of mitral valve repair in 1991 and has progressively been used to restore mitral competence in the setting of degenerative, post-endocarditis and functional mitral regurgitation. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. The free edges of the mitral leaflets have to be approximated in correspondence of the site of the regurgitant jet in such a way that mitral regurgitation is corrected without producing stenosis. A prosthetic ring is usually implanted to stabilize the repair. Middle and long-term results are now available for degenerative mitral regurgitation (bileaflet prolapse, anterior leaflet prolapse and commissural prolapse). Of particular interest is the finding that the edge-to-edge technique for correction of anterior leaflet prolapse is providing a freedom from reoperation similar to that obtained in patients with posterior leaflet prolapse treated with quadrangular resection. Degenerative or post-endocarditis commissural prolapse/flail of the mitral valve can be effectively corrected by this technique. In patients with functional mitral regurgitation, the use of the edge-to-edge repair, added to the undersized annuloplasty, has been associated with a significantly lower recurrence of mitral regurgitation in the follow-up compared to isolated undersized annuloplasty. Almost 20 years after its introduction, the edge-to-edge technique remains an effective and versatile method to treat mitral regurgitation. Its simplicity and reproducibility have led to its clinical application by percutaneous methods opening a new age in the fascinating field of reconstructive mitral valve surgery. PMID:23439938

De Bonis, M; Alfieri, O

2010-01-01

133

Percutaneous edge-to-edge MitraClip therapy in the management of mitral regurgitation.  

PubMed

MitraClip therapy consists of percutaneous edge-to-edge coaptation of the mitral leaflets that is analogous to the surgical Alfieri technique. The safety profile of the MitraClip device is favourable, and survival outcomes in high-surgical-risk patients are superior to historical controls. However, questions remain regarding long-term efficacy and durability. In the U.S.A., the MitraClip device has been studied in a safety and feasibility trial, a randomized pivotal trial against surgical mitral valve repair, and a non-randomized high-risk registry. In addition, the MitraClip now has over 2 years of CE-mark approval and a rapidly expanding clinical experience in Europe, primarily in patients at high risk for surgery. A dedicated multidisciplinary team is necessary, as well as thoughtful patient selection, familiarity with the technical aspects of the procedure including transesophageal ultrasound imaging and post-procedure monitoring. Currently available clinical data are herein reviewed, with emphasis on the current role of MitraClip therapy in relation to existing surgical techniques. Since the MitraClip procedure is still relatively new, continued investigation is required to further define patient populations that will benefit most. PMID:21606080

Rogers, Jason H; Franzen, Olaf

2011-10-01

134

24 Percutaneous mitral valve repair with the mitraclip device: a tertiary cardiac UK experience  

Microsoft Academic Search

IntroductionPercutaneous mitral valve repair using the transcatheter Mitraclip device is a novel therapy for patients with severe mitral regurgitation (MR) who are too high risk for conventional surgery. We report the largest UK series to date.MethodsPatients were screened with transthoracic (TTE) and transoesophageal echocardiography (TOE). Mitral regurgitation was graded by British Society of Echocardiography criteria. Twenty-four patients with ? grade

J Dungu; C S R Baker; M F Bellamy

2011-01-01

135

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

136

Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration†  

PubMed Central

OBJECTIVES Mitral annular calcification is associated with significant morbidity and mortality at the time of mitral valve surgery. However, few data are available describing the impact of mitral annular calcification on early and late outcomes following mitral valve repair in the current era. METHODS Between 2001 and 2011, 625 patients were referred for mitral valve repair of severe mitral regurgitation due to myxomatous degeneration. The mean patient age was 63.9 ± 12.7 years and 164 (26%) were female. Concomitant coronary artery bypass grafting was performed in 91 (15%) and 24 (4%) had previous cardiac surgery. Calcification of the mitral annulus was observed in 119 patients (19%), of whom complete debridement and extensive annulus reconstruction were performed in 14. The mean follow-up was for 2.4 ± 2.3 years. RESULTS There were no deaths within 30 days of surgery. Risk factors associated with mitral annular calcification included older age (odds ratio 1.05 ± 0.02 per increasing year), female gender (odds ratio 1.88 ± 0.42) and larger preoperative left atrial size (odds ratio 1.04 ± 0.03 per increasing mm) (all P<0.01). Severe renal impairment defined as a creatinine clearance <30 mL/min was observed in 9 patients, all of whom had mitral annular calcification. Intraoperative conversion to mitral valve replacement was performed in 19 patients (97% repair rate), 5 of whom had mitral annular calcification. Extension of mitral annular calcification into one or more leaflet scallops was observed for all patients who required conversion to valve replacement. Five-year survival, freedom from recurrent mitral regurgitation ?2+ and freedom from recurrent mitral regurgitation ?3+ was 88.1 ± 2.4, 89.6 ± 2.3 and 97.8 ± 0.8%, respectively. Mitral annular calcification was not associated with survival or recurrent mitral regurgitation. CONCLUSIONS Risk factors for mitral annular calcification in patients with myxomatous degeneration and severe mitral regurgitation include older age, female gender, severe renal dysfunction and larger preoperative left atrial size. Nevertheless, favourable early and late results can be achieved with mitral valve repair in this population. PMID:23587525

Chan, Vincent; Ruel, Marc; Hynes, Mark; Chaudry, Sophia; Mesana, Thierry G.

2013-01-01

137

Late posterior failure after mitral valve repair in degenerative disease  

Microsoft Academic Search

Objectives: Little is known regarding the mechanisms, the feasibility and the long-term results of re-repair in ‘posterior failure’ of a previous mitral valve repair performed for severe degenerative mitral regurgitation. We report our 16-year experience in redo surgery for late posterior failure of mitral valve repair in degenerative disease. Methods: From 1991 to 2004, 13 consecutive patients (10 males; median

Rachid Zegdi; Ghassan Sleilaty; Ziad Khabbaz; Milena Noghin; Christian Latrémouille; Alain Carpentier; Alain Deloche; Jean-Noël Fabiani

2008-01-01

138

Reoperation for failure of mitral valve repair  

Microsoft Academic Search

Background and Objective: Mitral valve repair is the procedure of choice to correct mitral regurgitation of all types. Up to 10% of patients who undergo mitral valvuloplasty require late reoperation for recurrent mitral valve dysfunction. To determine the causes of failed mitral valve repair, we examined the surgical pathology of patients who underwent reoperation for failed mitral valve repair. Patients

A. Marc Gillinov; Delos M. Cosgrove; Bruce W. Lytle; Paul C. Taylor; Robert W. Stewart; Patrick M. McCarthy; Nicholas G. Smedira; Derek D. Muehrcke; Carolyn Apperson-Hansen; Floyd D. Loop

1997-01-01

139

Mitral valve regurgitation  

MedlinePLUS

... doesn't close all the way, blood flows backward into the upper heart chamber (atrium) from the ... into your bloodstream can lead to this infection. Steps to avoid this problem include: Avoid unclean injections. ...

140

Robotic mitral valve repair in infective endocarditis  

PubMed Central

Background Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results. Patients From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43. Results The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or -stenosis rate was 100% at one-year follow. Conclusions Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good. PMID:24455177

Chi, Nai-Hsin; Huang, Chi-Hsiang; Huang, Shu-Chien; Yu, Hsi-Yu; Chen, Yih-Sharng; Wang, Shoei-Shen

2014-01-01

141

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

142

An effective technique to correct anterior mitral leaflet prolapse.  

PubMed

Up to one-third of the patients with degenerative mitral valve disease and severe mitral regurgitation have anterior mitral valve prolapse due to chordal rupture or elongation. Surgical treatment of such a condition is often technically demanding and not infrequently associated with suboptimal results. Techniques used to treat anterior leaflet prolapse include chordal transfer, chordal shortening, artificial chordae, and anterior leaflet resection or plication. Each of these strategies has potential shortcomings, and there is considerable controversy concerning the durability of anterior leaflet prolapse repairs using these techniques. The "edge-to-edge" technique, a simple and effective method of correcting anterior mitral leaflet prolapse is described. PMID:11021374

Alfieri, O; Maisano, F

1999-01-01

143

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

144

The minimally invasive MitraClip™ procedure for mitral regurgitation under general anaesthesia: immediate effects on the pulmonary circulation and right ventricular function.  

PubMed

A relatively new minimally invasive cardiological procedure, called the MitraClip(™), does not require sternotomy and may have a number of advantages compared with open mitral valve surgery, but its acute impact on the pulmonary circulation and right ventricular function during general anaesthesia is unclear. We prospectively assessed the effects of the MitraClip procedure in 81 patients with or without pulmonary hypertension (defined as mean pulmonary artery pressure > 25 mmHg), who were anaesthetised using fentanyl (5 ?g.kg(-1)), etomidate (0.2-0.3 mg.kg(-1)), rocuronium (0.5-0.6 mg.kg(-1)) and isoflurane. Placement of the MitraClip led to a 60% increase in mean (SD) right ventricular stroke work index (from 512 (321) to 820 (470) mmHg.ml.m(-2), p < 0.0001), while mean (SD) pulmonary vascular resistance index decreased by 24% (522 (330) to 399 (244) dyn.s.cm(-5), p < 0.0001), and mean (SD) pulmonary artery pressure decreased by 10% (30 (8) to 27 (8) mmHg, p < 0.0001). Patients with pulmonary hypertension experienced a similar decrease in mean pulmonary artery pressure compared with those without, and they also had a slight reduction in mean (SD) pulmonary artery occlusion pressure (22 (6) down to 20 (6) mmHg, p = 0.044). We conclude that successful MitraClip treatment for mitral regurgitation acutely improves right ventricular performance by reducing right ventricular afterload, regardless of whether patients have pre-operative pulmonary hypertension. PMID:24801455

Kottenberg, E; Dumont, M; Frey, U H; Heine, T; Plicht, B; Kahlert, P; Erbel, R; Peters, J

2014-08-01

145

Mitral valve reconstruction: long-term results of 120 cases  

Microsoft Academic Search

Between January 1977 and December 1992, 120 patients underwent mitral valve reconstruction for pure mitral valve regurgitation (n = 88), or associated with mitral stenosis (n = 32). The mean age was 57.6 years. Some 89 patients were in New York Heart Association (NYHA) class III and IV; 61% were in atrial fibrillation. Four mechanisms of mitral regurgitation were assessed:

R. Soyer; F. Bouchart; J. P. Bessou; A. Tabley; D. Mouton-Schleifer; M. Redonnet; J. Arrignon; B. Letac

1996-01-01

146

Edge-to-edge percutaneous repair of severe mitral regurgitation--state-of-the-art for Mitraclip® implantation.  

PubMed

MitraClip® therapy is a percutaneous edge-to-edge plication of the mitral leaflets, mimicking the Alfieri surgical technique. MitraClip® implantation is a safe procedure, and survival outcomes in high-surgical-risk patients are superior to historical controls. Despite these results, questions remain concerning long-term efficacy and durability. The MitraClip® device has been studied in a safety and feasibility trial in the USA, a randomized pivotal trial against surgical mitral valve repair. Moreover, MitraClip® now has over 2 years of CE-mark approval and a rapidly expanding clinical experience in Europe, primarily in patients at high risk for surgery. A dedicated multidisciplinary team is necessary, as well as thoughtful patient selection, familiarity with the technical aspects of the procedure, including transesophageal ultrasound imaging and post-procedure monitoring. Currently available clinical data and procedural steps are herein reviewed. Because the MitraClip® procedure is still relatively new, continued investigation is required to further better define the patient populations that will benefit most. PMID:22374149

Alegria-Barrero, Eduardo; Chan, Pak Hei; Paulo, Manuel; Duncan, Alison; Price, Susana; Moat, Neil; Di Mario, Carlo; Serra, Antoni; García, Eulogio; Franzen, Olaf

2012-01-01

147

Quantification of regurgitant lesions by MRI.  

PubMed

We examined 46 patients with angiographically documented regurgitant lesions (26 patients with mitral regurgitation, 20 patients with aortic regurgitation) using an 0.5 Tesla magnet. In each patient a multislice-multiphase spinecho sequence in sagittal-coronal double angulated plane was performed to assess left and right ventricular volumes, ejection fraction and regurgitant fraction. Additionally a blood flow sensitive gradient echo technique was done to visualize direction and extension of the regurgitant jet. MRI data were compared with quantitative and qualitative assessment of regurgitation by angiography and echocardiography. Using the gradient echo technique MRI could demonstrate the regurgitant jet in all patients. A linear correlation for volume parameters by MRI and angio was found with best correlation for the left ventricular stroke volume (r = 0.82, p less than 0.0001). Furthermore MRI regurgitant fraction correlated with angiographically determined regurgitant fraction in patients with aortic regurgitation (r = 0.91, p less than 0.0001) and mitral regurgitation (r = 0.67, p less than 0.001), respectively. Semiquantitative assessment of regurgitation by gradient echo technique showed an agreement with angiographic grading by Sellers in 70% of mitral and 75% of aortic regurgitation, respectively. The comparison of MRI and color Doppler sonography showed only moderate correlation of r = 0.72 (p less than 0.01). PMID:2097304

Globits, S; Mayr, H; Frank, H; Neuhold, A; Glogar, D

148

Intraoperative assessment of the mitral valve following reconstructive procedures.  

PubMed

A technique facilitating intraoperative assessment of the degree of mitral insufficiency during and after mitral reconstructive procedures has been developed. A multiholed left ventricular vent catheter is advanced across the aortic valve, thereby creating aortic insufficiency, filling the left ventricle with blood at aortic perfusion pressure, and approximating the leaflets of the mitral valve in the closed position. If present, mitral insufficiency can be estimated by the size of the regurgitant jet. In addition to assessing valve function following open mitral valvotomy, the method has also been helpful in managing leaks around the prosthetic valve, in assessing the closure of cleft mitral valve leaflets associated with ostium primum atrial septal defects, in confirming the completeness of closure, and in detecting obscure ventricular septal defects. PMID:7356813

King, H; Csicsko, J; Leshnower, A

1980-01-01

149

Percutaneous edge-to-edge mitral valve repair. Current clinical evidence with the MitraClip System.  

PubMed

In the past few years, a myriad of technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high risk for traditional open-heart mitral valve surgery. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. This device mimics the surgical edge-to-edge mitral valve repair initially described by Dr. Alfieri. In this article, we review the current clinical evidence on the use of the MitraClip--from the randomized control trial EVEREST II to the information derived from expert high-volume centers. PMID:23861129

Estevez-Loureiro, R; Franzen, O

2013-08-01

150

Mitral Stenosis Reversed by Medical Treatment for Heart Failure  

PubMed Central

It is reported that functional mitral stenosis frequently develops after ring annuloplasty for ischemic mitral regurgitation. The mechanism is a combination of annular size reduction by surgery and diastolic mitral valve tethering, restricting the anterior leaflet opening due to posteriorly displaced papillary muscles with left ventricular dilatation. We report the case of a 57-year-old man who had a history of successful mitral valve plasty for degenerative mitral regurgitation. Four years later he developed heart failure, severe hypertension, mild mitral regurgitation, and significant mitral stenosis, which were reversed by aggressive medical treatment for heart failure. PMID:24182508

Yukawa, Sawami; Takeuchi, Masaaki; Nakazono, Akemi; Sakamoto, Kyoko; Araya, Kiyoshi; Eto, Masataka; Nishimura, Yosuke; Harada, Masaru; Levine, Robert A.; Otsuji, Yutaka

2014-01-01

151

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

PubMed

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

Asdonk, T; Nickenig, G; Hammerstingl, C

2014-10-01

152

Mitral Valve Repair for Double-orifice Mitral Valve.  

PubMed

We present an eight year-old girl who required an operation for moderate mitral insufficiency associated with partial atrioventricular septal defect. Echocardiography disclosed an ostium primum atrial septal defect and double-orifice mitral valve with moderate mitral regurgitation secondary to a cleft in the anterior leaflet and prolapse of the anterior leaflet. Intraoperative inspection revealed that the chordae from each orifice were attached to a single papillary muscle which resulted in a unique double-orifice mitral valve. Mitral valve repair using chordal shortening and cleft closure was successfully performed. Postoperative echocardiography observed trivial MR and no mitral stenosis. PMID:25194958

Duan, Qun-Jun; Gao, Zhan

2014-12-01

153

Devices for mitral valve repair.  

PubMed

The natural history of severe mitral regurgitation (MR) is unfavorable, leading to left ventricular failure, atrial fibrillation, stroke, and death. Many patients affected by severe regurgitation (MR) do not currently undergo surgery, mainly due to the perceived risk of the procedure (old age, impaired left ventricular function, and comorbidities). Mitral transcatheter interventions carry the hope of minimizing risks while preserving clinical efficacy of surgical repair, as an alternative to conventional treatment. Multiple technologies and diversified approaches are under development with the purpose of treating MR in less invasive ways. They can be categorized based on the anatomical and patho-physiological addressed target. Among them, MitraClip (Abbott Vascular, Inc., Menlo Park, California) has emerged as a clinically safe and effective method for percutaneous mitral valve repair in patients either with degenerative and functional regurgitation. This device mimics the surgical edge-to-edge repair initially described by Alfieri in the early 1990s. Other repair technologies include percutaneous direct and indirect annuloplasty, neochordae implantation, and left ventricular reshaping. They are still in early phase clinical trials or preclinical studies. The combination of different repair techniques is likely to be required to achieve good long-lasting results. In the future, novel devices, improved knowledge, more efficient imaging, and transcatheter mitral prosthetic valve implantation may expand the indications to those patients currently not treated, as well as improve the results both in terms of early efficacy and long-term durability. These treatments are currently reserved to high-risk and inoperable patients, and their application requires an integrated Heart-Team approach. They represent the natural evolution of surgery and promise to expand treatment options and improve patients' outcomes in the near future. PMID:24452608

Denti, Paolo; Maisano, Francesco; Alfieri, Ottavio

2014-04-01

154

Percutaneous Mitral Valve Interventions: Overview of New Approaches  

Microsoft Academic Search

The percutaneous management of valvular heart disease has recently been receiving a great deal of interest as an area of great\\u000a potential. Innovative technologies are now being developed to treat mitral regurgitation. Although there are established surgical\\u000a techniques for treating organic mitral regurgitation, the surgical management of functional mitral regurgitation remains controversial,\\u000a and such patients have a poor prognosis. Therefore,

Steven L. Goldberg; Ted Feldman

2010-01-01

155

Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology  

Microsoft Academic Search

Background. Severe mitral regurgitation associated with complex mitral valve disease often precludes successful surgical repair. The feasibility and the results of valvuloplasty with glutaraldehyde-treated autologous pericardium remain largely unknown.Methods. The cases of 63 patients who underwent operation within an 11-year period were studied. A pretreated autologous pericardial patch was used for leaflet extension plasty, for paracommissural plasty, as a substitute

Choi-Keung Ng; Joachim Nesser; Christian Punzengruber; Otmar Pachinger; Johannes Auer; Herbert Franke; Peter Hartl

2001-01-01

156

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

Microsoft Academic Search

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

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

2006-01-01

157

Mitral valve repair in patients over  

Microsoft Academic Search

The question of whether to repair or replace the mitral valve in the elderly remains unanswered. The purpose of our study is to describe our experience with mitral valve repair (MVR) using Carpentier's technique in patients 70 years and older. Fifty consecutive patients underwent MVR between 1984-1992. There were 30 female patients. All had 2 + or more mitral regurgitation

H. Azar; S. Szentpetery

2009-01-01

158

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography].  

PubMed

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided. PMID:2512868

Germain, P; Baruthio, J; Roul, G; Mossard, J M; Bareiss, P; Wecker, D; Chambron, J; Sacrez, A

1989-10-01

159

Echocardiography of the mitral valve.  

PubMed

Echocardiography is the primary imaging modality for assessment of the mitral valve (MV). It provides an accurate and non-invasive tool to assess the morphology, geometry and function of the MV apparatus, which form the basis of the mechanisms and classification of MV disease. This review highlights the mechanistic insights into MV dysfunction by echocardiography and the critical role of echocardiography in the quantitative assessment of the severity of mitral regurgitation and mitral stenosis. PMID:25081402

Zeng, Xin; Tan, Timothy C; Dudzinski, David M; Hung, Judy

2014-01-01

160

Redo Mitral Valve Replacement Using the Valve-on-valve Technique: A Case Report  

Microsoft Academic Search

We report a repeated mitral valve replacement (re-do MVR) using the valve-on-valve technique for a degenerated bioprosthesis. A 49-year-old female, who had had a 29 mm Carpentier-Edwards mitral bioprosthesis for mitral regurgitation 20 years previously, was referred to our institution for dyspnea. She presented with pulmonary edema secondary to severe mitral bioprosthetic valve regurgitation. We replaced the degenerated mitral bioprosthesis

Yamato Tamura; Tetsuji Kawata; Yoichi Kameda

161

Midterm Outcomes Using the Physio Ring in Mitral Valve Reconstruction: Experience in 492 Patients  

Microsoft Academic Search

Background. Mitral valve reconstruction using stan- dardized Carpentier techniques is the treatment of choice for most patients with regurgitant lesions. Demonstrated predictability and stability make it an attractive alterna- tive to valve replacement. The Physio Ring's inherent flexibility provides a viable alternative in the application of remodeling techniques and appears to be physiologi- cally superior to traditional approaches. Methods. Between

Kevin D. Accola; Meredith L. Scott; Paul A. Thompson

2009-01-01

162

Ventricular Reconstruction Results in Improved Left Ventricular Function and Amelioration of Mitral Insufficiency  

PubMed Central

Introduction Surgical restoration of the left ventricular wall (Dor procedure) has been advocated as a therapy for left ventricular dysfunction due to ischemic cardiomyopathy. This procedure involves placement of an endoventricular patch through a ventriculotomy. Methods We reviewed our series of patients that underwent the Dor procedure within the past 4 years and examined their pre and postoperative ventricular function and mitral valve function. Pre and postoperative ejection fraction and degree of mitral regurgitation were analyzed using the paired Student t-test. We hypothesized that this procedure would result in improved ventricular function and that it would also help improve mitral valve function. Results Thirty-four patients underwent this procedure, with one death. Of these, 30 patients underwent concomitant coronary artery bypass grafting and 8 patients had mitral intervention (seven had an Alfieri repair of the mitral valve, and one had mitral valve annuloplasty). The average preoperative ejection fraction among these patients was 26.8% (range 10–45%). The postoperative ejection fraction was significantly higher at 35.4% (range 25–52%) (P < .001). We noted an improvement in ejection fraction in 27 patients (82%). We also noted that 21 of 33 patients (64%) had improvement in the degree of mitral regurgitation based on echocardiography data (P < .001). Conclusions We conclude that the Dor procedure results in improvement in the left ventricular function. Furthermore, we also note that this procedure ameliorates mitral regurgitation in a majority of these patients even in the absence of associated mitral valve procedures, probably due to reduction in the size of the ventricle and improved orientation of the papillary muscles. PMID:12035039

Kaza, Aditya K.; Patel, Mayank R.; Fiser, Steven M.; Long, Stewart M.; Kern, John A.; Tribble, Curtis G.; Kron, Irving L.

2002-01-01

163

Ischemic mitral valve prolapse: mechanisms and implications for valve repair  

Microsoft Academic Search

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

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

2010-01-01

164

Ischemic mitral valve prolapse: mechanisms and implications for valve repair  

Microsoft Academic Search

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

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

2004-01-01

165

Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography  

PubMed Central

Objective: To assess the prevalence, mechanisms, and significance of paraprosthetic regurgitation detected incidentally by transoesophageal echocardiography (TOE) in patients after heart valve replacement. Design: Prospective observational study. Setting: Tertiary referral centre. Patients: 360 consecutive patients (mean (SD) age 65.8(9.5) years, 193 women) undergoing elective first ever valve replacement. Methods: Postoperative and follow up TOE, and tests for haemolysis and anaemia. Results: There were 243 aortic, 90 mitral, and 27 double valve replacements, using 316 mechanical and 44 tissue valves, giving 270 aortic and 117 mitral valves. One patient with severe paraprosthetic mitral regurgitation underwent immediate reoperation and was excluded from subsequent analyses. Paraprosthetic jets were detected around 16 (6%) of the aortic and 38 (32%) of the mitral valves (p < 0.05) at the postoperative study. Follow up TOE was available for 151 aortic and 67 mitral valves, 0.9 (0.5) years after operation. Paraprosthetic jets were present in 15 (10%) of the aortic and 10 (15%) of the mitral valves (NS). Two thirds of the aortic and a fifth of the mitral jets were new. Paraprosthetic jets were more common in aortic valves in a supra-annular (12 of 88, 14%) than in an intra-annular position (4 or 182, 2%; p < 0.005) and in mitral valves inserted with continuous (36 of 88, 41%) rather than interrupted sutures (2 of 28, 7%; p < 0.001). Lactate dehydrogenase concentration was higher in patients with paraprosthetic jets than in those without (752 (236) v 654 (208) IU/l, p < 0.001). Haemoglobin and haptoglobin concentrations were not different. Conclusions: Small paraprosthetic leaks are common, are related to surgical factors, are not associated with increased subclinical haemolysis, and are benign during the first year after heart valve replacement. PMID:14594888

Ionescu, A; Fraser, A G; Butchart, E G

2003-01-01

166

Mitral valve replacement in the first year of life.  

PubMed

From 1973 through 1987 25 patients underwent mitral valve replacement in the first year of life for mitral stenosis and mitral regurgitation. The patients with mitral stenosis included two with mitral arcade, two with supravalvular mitral stenosis with hypoplastic mitral valve, and one with parachute mitral valve. Included in the group of patients with mitral regurgitation were 12 with atrioventricular canal defect, six with chordal and leaflet defects, one with Marfan's syndrome, and one with bacterial endocarditis. Prostheses included 12 Björk-Shiley (17 mm), seven St. Jude Medical (19 mm in four, 21 mm in three), five stent-mounted dura mater valves (12 mm to 16 mm), and one porcine xenograft (19 mm). In four patients the valves were placed in the left atrium in a supraannular location. There were nine operative (atrioventricular canal defect seven, mitral regurgitation two) and five late (atrioventricular canal defect four, mitral stenosis one) deaths, giving actuarial 1- and 5-year survival rates of 52% and 43%, respectively. All 6 patients with tissue valves died; the four with supraannular mitral valve replacement survived. Since 1983 operative mortality has been reduced to 0% (70% confidence limits 0% to 24%). Nine patients required a second mitral valve replacement for prosthetic stenosis 5 to 69 (mean 30) months after the original mitral valve replacement (one operative death). Because of improvements in repair of atrioventricular canal defect in infancy, the need for mitral valve replacement at atrioventricular canal defect repair has decreased. Although valvuloplasty has been advocated for repair of congenital mitral valve disease and is applicable in some infants with mitral regurgitation, mitral valve replacement is frequently unavoidable for congenital mitral disease and can now be accomplished at a low operative risk, even when the prosthesis has to be positioned supraannularly. PMID:2232838

Kadoba, K; Jonas, R A; Mayer, J E; Castaneda, A R

1990-11-01

167

Rate of repair in minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

168

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

169

Structure, function, and dynamics of the mitral annulus: importance in mitral valve repair for myxamatous mitral valve disease.  

PubMed

The first successful open repair of a mitral valve for mitral insufficiency was performed by Dr. Dwight McGoon in 1958. He employed a triangular plication of the prolapsing portion of the posterior leaflet and no annuloplasty. Other surgeons subsequently introduced a variety of techniques. Of these, the repair techniques developed by Dr. Alain Carpentier, which incorporated both leaflet repair by a quadrangular resection and annuloplasty, soon proved to be the most effective and reproducible method at that time. Because of the limited knowledge of normal and pathological mitral valve function available in the late 1960s, this repair was based on anatomical and pathological studies obtained through autopsies as well as intraoperatively. While the Carpentier technique continues to be used widely, most centers have found it difficult to repair more than 50-60% of insufficient valves. Only a few centers have achieved higher early success rates. Most have done this by modifications of the classical techniques. Recent reports have documented high rates of recurrence of significant mitral regurgitation in the 5- to 10-year follow-up interval. Our own experience with the Carpentier technique began in 1983. By this time, a growing body of knowledge was accumulating that demonstrated the highly dynamic behavior and important interactions of the six elements of the mitral complex: the left atrium, leaflets, mitral annulus, chordae, papillary muscles, and left ventricle. Because the Carpentier technique uses leaflet resection and rigid or semi-rigid annuloplasty rings, it produces a substantial disruption of these important functions. The mitral annulus is flattened and fully immobilized, and the leaflets also are flattened at their annular attachment. The loss of surface area amd distortion of the subvalvular chordae and papillary muscles from the leaflet resection produces diminished or absent leaflet movement. The entire mitral valve is left in a highly stressed state. In order to overcome these problems, we developed a new technique called the American Correction (Figure 1). The mitral leaflets are never resected, regardless of size. Artificial polytetrafluoroethylene (PTFE) chordae are used to correct localized leaflets prolapse. A full, totally flexible annuloplasty ring is utilized. Most importantly, all adjustments of leaflet position and annular sizing are done during inflation of the heart, with pressurized normal saline delivered at 4 liters a minute into the cavity of the left ventricle. In a controllable fashion, the left ventricular intracavitary and aortic root pressure can be elevated to systolic levels. This produces a series of reproducible changes in the leaflets and annulus that can be correlated with the normally functioning mitral valve in the beating heart (Figures 2-5). PMID:20360652

Lawrie, Gerald M

2010-01-01

170

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

PubMed

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

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

2014-12-01

171

"Edge-to-edge" repair for anterior mitral leaflet prolapse.  

PubMed

The aim of this study is to report our results in a series of 150 consecutive patients (mean age 53 +/- 15.4 years) in whom mitral regurgitation (MR) due to isolated anterior mitral leaflet (AML) prolapse was corrected using the edge-to-edge (E to E) technique over a period of more than 10 years. At admission, 49 (32.6%) patients were in NYHA class I, 46 (30.6%) in II, 51 (34%) in III and 4 (2.6%) in IV. In the great majority of the cases (111 patients, 74%), degenerative disease was the cause of MR. Hospital mortality was 0.6% (1/150). There were 7 late deaths. The actuarial overall survival and freedom from reoperation at 9 years were 91.6% +/- 3.16% and 96.6% +/- 1.74%, respectively. At follow-up (4.5 +/- 3.21 years, range 2 months-12 years), the mean mitral valve area was 2.7 +/- 0.5 cm(2) and mitral regurgitation was absent or mild in 132 patients (88%). The results of this study demonstrate the effectiveness and durability of the E to E repair in the setting of AML prolapse. In our institution, this technique, in conjunction with annuloplasty, remains the method of choice to correct segmental prolapse of the AML. PMID:15197695

Alfieri, Ottavio; De Bonis, Michele; Lapenna, Elisabetta; Regesta, Tommaso; Maisano, Francesco; Torracca, Lucia; La Canna, Giovanni

2004-01-01

172

Transapical Approach for Mitral Valve Repair during Insertion of a Left Ventricular Assist Device  

PubMed Central

Background. Severe mitral regurgitation (MR) is common in patients who are undergoing insertion of a left ventricular assist device (LVAD). This study analyzes the outcomes of a transapical approach for edge-to-edge repair of the mitral valve during insertion of a left ventricular assist device in 19 patients with MR. Methods. This retrospective study includes 19 patients who were implanted between March 21, 2011, and August 31, 2011, at the University of Chicago. Clinical data include preoperative ejection fraction, post- and preoperative pulmonary arterial pressures, cardiopulmonary bypass time, post- and preoperative mitral regurgitation severity, endotracheal CO2, and LVAD pulse index. Results. All of the 19 patients had a reduction in mitral regurgitation. Fourteen of the 19 patients had at least a three-point reduction in MR severity. The average postoperative pulmonary arterial pressure (PAP) decreased after the surgical procedure from 44/22 ± 14/5?mmHg to 57/28 ± 9/5?mmHg. Average CPB time was 128 ± 27 minutes. Average length-of-stay (LOS) was 21 ± 10 days. Conclusions. Concomitant MV repair using a transapical approach is advantageous for this small cohort of patients. The surgical procedure is less complex and has a shorter CPB time and LOS, and all of the patients demonstrated significant improvement in postoperative MR and moderate improvement in PAP. PMID:23878531

Russo, Mark J.; Merlo, Aurelie; Johnson, Elizabeth M.; McCarney, Sean; Steiman, Jennifer; Anderson, Allen; Jeevanandam, Valluvan

2013-01-01

173

Percutaneous Transvenous Melody® Valve-In-Ring Procedure For Mitral Valve Replacement  

PubMed Central

Objective The purpose of this study was to demonstrate the feasibility of percutaneous transvenous mitral valve-in-ring (VIR) implantation using the Melody® valve in an ovine model. Background The recurrence of mitral regurgitation (MR) following surgical mitral valve (MV) repair in both adult and pediatric patients remains a significant clinical problem. Mitral annuloplasty rings are commonly used in MV repair procedures and may serve as secure landing zones for percutaneous valves. Methods Five sheep underwent surgical MV annuloplasty (24mm, n=2; 26mm, n=2; 28mm, n=1). Animals underwent cardiac catheterization with valve-in-ring implantation via a trans-femoral venous, trans-atrial septal approach 1 week following surgery. Hemodynamic, angiographic, and echocardiographic data were recorded before and after VIR. Results VIR was technically successful and required less than 1 hour of procedure time in all animals. Fluoroscopy demonstrated securely positioned Melody® valves within the annuloplasty ring in all animals. Angiography revealed no significant MV regurgitation in 4, and moderate central MV regurgitation in the animal with the 28mm annuloplasty. All animals demonstrated vigorous LV function, no outflow tract obstruction, and no aortic valve insufficiency. There were no differences in the hemodynamic measures following valve implantation. Conclusions This study demonstrates the feasibility of a purely percutaneous approach to MV replacement in patients with preexisting annuloplasty rings. This novel approach may be of particular benefit to patients with failed repair of ischemic MR, and in pediatric patients with complex structural heart disease. PMID:22133846

Shuto, Takashi; Kondo, Norihiro; Dori, Yoav; Koomalsingh, Kevin J.; Glatz, Andrew C.; Rome, Jonathan J.; Gorman, Joseph H.; Gorman, Robert C.; Gillespie, Matthew J.

2011-01-01

174

Mitral Transcatheter Technologies  

PubMed Central

Mitral valve regurgitation (MR) is often diagnosed in patients with heart failure and is associated with worsening of symptoms and reduced survival. While surgery remains the gold standard treatment in low-risk patients with degenerative MR, in high-risk patients and in those with functional MR, transcatheter procedures are emerging as an alternative therapeutic option. MitraClip® is the device with which the largest clinical experience has been gained to date, as it offers sustained clinical benefit in selected patients. Further to MitraClip implantation, several additional approaches are developing, to better match with the extreme variability of mitral valve disease. Not only repair is evolving, initial steps towards percutaneous mitral valve implantation have already been undertaken, and initial clinical experience has just started. PMID:23908865

Maisano, Francesco; Buzzatti, Nicola; Taramasso, Maurizio; Alfieri, Ottavio

2013-01-01

175

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

176

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

PubMed

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; Agmon, Yoram

2013-03-01

177

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

178

[Early and late postoperative results of mitral and tricuspid valve insufficiency surgical treatment using edge-to-edge central coaptation procedure].  

PubMed

Edge-to-edge approximation of the mitral leaflets and creation of a double-orifice mitral valve (Jatene-Alfieri procedure), for mitral regurgitation surgical treatment was effective in most cases, especially for patients who had rheumatic and degenerative valve disease, traumatic or ischemic mitral valve insufficiency. Positive results of double-orifice technique encourages to use this method to correct some forms of tricuspid insufficiency. Triple-orifice repair procedure is a lot more effective to correct central prolapses in all of the three leaflets (extraordinary elongated chordaes) and/or degenerative tricuspid annular dilation than the ordinary routine procedures. This study aims to evaluate early and long-term postoperative outcomes for 29 patients after mitral double-orifice and/or triple orifice repair procedures. It also determines clinical and echocardiographic results at follow-up period for more than two years. PMID:12560653

Gateliene, Egle; Voluckiene, Elvyra; Ivaskeviciene, Loreta; Uzdavinys, Giedrius; Semetiene, Giedre

2002-01-01

179

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

PubMed Central

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

2015-01-01

180

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

PubMed Central

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

2013-01-01

181

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

182

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

183

Percutaneous Mitral Repair: Patient Selection, Results, and Future Directions  

Microsoft Academic Search

Percutaneous heart valve therapies are rapidly changing our approach to valvular heart diseases. Currently, mitral valve surgery\\u000a is the treatment of choice for patients suffering from severe symptomatic mitral regurgitation. However surgery, because of\\u000a its inherent risks, is not applicable to all patients, particularly for the elderly with comorbidities. Catheter-based mitral\\u000a repair systems offer a new option to those high-risk

Uygar C. Yuksel; Samir R. Kapadia; E. Murat Tuzcu

2011-01-01

184

Quantitative analysis of 3D mitral complex geometry using support vector machines.  

PubMed

Quantitative analysis of 3D mitral complex geometry is crucial for a better understanding of its dysfunction. This work aims to characterize the geometry of the mitral complex and utilize a support-vector-machine-based classifier from geometric parameters to support the diagnosis of congenital mitral regurgitation (MR). The method has the following steps: (1) description of the 3D geometry of the mitral complex and establishment of its local reference coordinate system, (2) calculation of geometric parameters and (3) analysis and classification of these parameters. With a control group of 20 normal young children (11 boys, 9 girls, mean age 5.96 ± 3.12 years) and with the normal structure of mitral apparatus, 20 patients (9 boys, 11 girls, mean age 5.59 ± 3.30 years) suffering from severe congenital MR are studied in this study. The average classification accuracy is up to 90.0% of the present population, with the possibility of exploring quantitative association between the mitral complex geometry and the mechanism of congenital MR. PMID:22735308

Song, Wei; Yang, Xin; Sun, Kun

2012-07-01

185

Mitral stenosis  

MedlinePLUS

... in which the mitral valve does not fully open. This restricts the flow of blood. ... your heart is called the mitral valve. It opens up enough so that blood can flow from the upper chamber of your heart (left ...

186

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

187

Tricuspid regurgitation: contemporary management of a neglected valvular lesion  

Microsoft Academic Search

Right-sided cardiac valvular disease has traditionally been considered less clinically important than mitral or aortic valve pathology. However, detectable tricuspid regurgitation (TR) is common and recent data suggest that significant TR can lead to functional impairment and reduced survival, particularly in patients with concomitant left-sided valvular disease. The tricuspid valve is a complex anatomical structure and advances in three dimensional

Richard Bruce Irwin; Matthew Luckie; Rajdeep S Khattar

2010-01-01

188

Mitral Valve Repair: The Chordae Tendineae  

PubMed Central

Repair of the mitral valve is the treatment of choice for mitral valve regurgitation when the anatomy is favorable. It is well known that mitral valve repair enjoys better clinical and functional results than any other type of valve substitute. This fact is beyond doubt regardless of the etiology of the valve lesion and is of particular importance in degenerative diseases. This review analyzes the most important advances in the knowledge of the anatomy, pathophysiology, and chordal function of the mitral valve as well as the different alternatives in the surgical repair and clinical results of the most prevalent diseases of the mitral valve. An attempt has been made to organize the acquired information available in a practical way. PMID:23304176

Mestres, Carlos-A.; Bernal, José M.

2012-01-01

189

New techniques for percutaneous repair of the mitral valve.  

PubMed

A variety of innovative techniques and devices are being developed for the percutaneous management of mitral insufficiency. More than 30 devices are in stages of development from early stage to human pivotal trials. Two devices for the management of degenerative myxomatous disease of the mitral valve replicate the Alfieri edge-to-edge surgical repair. One of those devices, the Evalve Mitraclip, is in a pivotal trial at the current time. The other devices address functional mitral regurgitation by a variety of techniques for performing mitral valve annuloplasty. The majority of devices take advantage of the proximity of the coronary sinus to the posterior mitral annulus to deliver devices that remodel the mitral annulus. Two devices perform septal lateral cinching decreasing the anterior posterior diameter of the mitral annulus and correcting leaflet malcoaptation. Numerous issues are discussed including regulatory hurdles and the integration of percutaneous techniques into clinical practice in a safe and efficacious manner. PMID:17041765

Mack, Michael J

2006-09-01

190

First-in-man report of residual "intra-clip" regurgitation between two MitraClips treated by AMPLATZER Vascular Plug II.  

PubMed

Aims: We present here the first-in-man case report of a patient with a significant residual "intra-clip" jet treated by the implantation of an AMPLATZER Vascular Plug II. Methods and results: A 64-year-old gentleman came to our attention for mitral regurgitation (MR) recurrence four years after transcatheter mitral repair with MitraClip. After the implantation of two further MitraClips, residual intra-clip MR was present, without room for a further clip. An AMPLATZER Vascular Plug II was successfully deployed between the two clips. Final echocardiography showed residual mild MR, without any sign of mitral stenosis. Conclusions: This case demonstrates the feasibility of the implantation of an AMPLATZER Vascular Plug between two MitraClips to treat significant residual "intra-clip" MR, when the implantation of an adjunctive clip is not feasible. This approach may represent an effective therapeutic solution in case of a significant residual intra-clip jet. PMID:25493913

Taramasso, Maurizio; Zuber, Michel; Gruner, Christiane; Gaemperli, Oliver; Nietlispach, Fabian; Maisano, Francesco

2014-12-10

191

Evaluation of a transient, simultaneous, arbitrary Lagrange-Euler based multi-physics method for simulating the mitral heart valve.  

PubMed

A transient multi-physics model of the mitral heart valve has been developed, which allows simultaneous calculation of fluid flow and structural deformation. A recently developed contact method has been applied to enable simulation of systole (the stage when blood pressure is elevated within the heart to pump blood to the body). The geometry was simplified to represent the mitral valve within the heart walls in two dimensions. Only the mitral valve undergoes deformation. A moving arbitrary Lagrange-Euler mesh is used to allow true fluid-structure interaction (FSI). The FSI model requires blood flow to induce valve closure by inducing strains in the region of 10-20%. Model predictions were found to be consistent with existing literature and will undergo further development. PMID:22640492

Espino, Daniel M; Shepherd, Duncan E T; Hukins, David W L

2014-01-01

192

Clinical trial experience with the MitraClip catheter based mitral valve repair system  

Microsoft Academic Search

Severe mitral regurgitation (MR) confers a poor prognosis, in particular for patients with heart failure. Based on the results\\u000a of the Euro Heart Survey, a large proportion of patients with mitral regurgitation is not referred to surgery and many other\\u000a patients are rejected for cardiac surgery due to the high surgical risk or co-pathologies. Improving ventricular function\\u000a with ACE inhibitors,

Francesco Maisano; Cosmo Godino; Andrea Giacomini; Paolo Denti; Iryna Arendar; Nicola Buzzatti; Giovanni La Canna; Ottavio Alfieri; Antonio Colombo

193

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

Microsoft Academic Search

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

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

2001-01-01

194

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

195

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

196

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

PubMed Central

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

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

2013-01-01

197

The edge-to-edge technique: a simplified method to correct mitral insufficiency 1 Presented at the 11th Annual Meeting of the European Association for Cardiothoracic Surgery, Copenhagen, Denmark, 28 September–1 October 1997. 1  

Microsoft Academic Search

Objective: Repair of mitral regurgitation (MR) is more demanding in case of prolapse of the anterior leaflet, posterior leaflet with calcified annulus, or prolapse of both leaflets. We evaluated a repair which consists of anchoring the free edge of the prolapsing leaflet to the corresponding free edge of the facing leaflet: the ‘edge-to-edge’ (E-to-E) technique. The correction results in a

F. Maisano; L. Torracca; M. Oppizzi; P. L. Stefano; G D’Addario; G. La Canna; M. Zogno; O. Alfieri

1998-01-01

198

Beating-heart Mitral Valve Chordal Replacement  

PubMed Central

Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma and risk of a procedure. One of the most challenging procedures to perform on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve chordae to correct regurgitation. The chordae is secured to the papillary muscle and leaflet using NiTi tissue anchors that also incorporate an internal adjustment mechanism to enable initial adjustment as well as subsequent readjustment of chordae length. Efficacy of the proposed tool for chordae replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator. PMID:22254843

Laing, Genevieve; Dupont, Pierre E.

2011-01-01

199

Percutaneous mitral heart valve repair--MitraClip.  

PubMed

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

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

2014-01-01

200

Mitral valve function following ischemic cardiomyopathy: a biomechanical perspective  

PubMed Central

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

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

2014-01-01

201

Edge-to-edge mitral valve repair: the Columbia Presbyterian experience  

Microsoft Academic Search

BackgroundThe edge-to-edge mitral valve repair, first described by Alfieri in 1995 treats mitral regurgitation when standard reparative techniques are difficult, unlikely to succeed, or have failed. This study examines one institution's medium-term experience with this procedure.

Aftab R Kherani; Faisal H Cheema; Jennifer Casher; Jennifer M Fal; Christopher J Mutrie; Jonathan M Chen; Jeffrey A Morgan; Deon W Vigilance; Mauricio J Garrido; Craig R Smith; Mehmet C Oz

2004-01-01

202

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

203

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

204

Mitral commissurotomy through the left ventricle apical orifice with Heart Ware left ventricular assist device implantation  

PubMed Central

Diseased, replaced or repaired mitral valve can lead to restricted blood flow to left ventricle and inadequate flow in left ventricular assist device (LVAD). A middle age woman with ‘burnt out’ hypertrophic cardiomyopathy had mitral valve repair for mitral regurgitation. She needed LVAD to support severe decompensating heart failure. Repaired mitral valve posed a risk of restricted flow through the device. Mitral commissurotomy was performed on beating heart through the left ventricular apical hole created for insertion of inflow cannula of LVAD. PMID:23758964

2013-01-01

205

Re-do mitral valve replacement using the valve-on-valve technique: a case report.  

PubMed

We report a repeated mitral valve replacement (re-do MVR) using the valve-on-valve technique for a degenerated bioprosthesis. A 49-year-old female, who had had a 29 mm Carpentier-Edwards mitral bioprosthesis for mitral regurgitation 20 years previously, was referred to our institution for dyspnea. She presented with pulmonary edema secondary to severe mitral bioprosthetic valve regurgitation. We replaced the degenerated mitral bioprosthesis with a 25 mm mechanical prosthesis using the valve-on-valve technique, as the struts of the bioprosthesis were embedded in the left ventricular myocardium. Removal of the bioprosthesis may be not only time-consuming but also complicated by cardiac rupture at the atrioventricular junction or the posterior left ventricular wall. The valve-on-valve technique is a simplified procedure that can avoid the potential complications of complete excision of the bioprosthesis. We believe this technique can be a useful strategy for patients with a degenerated mitral bioprosthesis. PMID:15900246

Tamura, Yamato; Kawata, Tetsuji; Kameda, Yoichi; Taniguchi, Shigeki

2005-04-01

206

“Edge-to-edge” repair for anterior mitral leaflet prolapse  

Microsoft Academic Search

The aim of this study is to report our results in a series of 150 consecutive patients (mean age 53 ± 15.4 years) in whom mitral regurgitation (MR) due to isolated anterior mitral leaflet (AML) prolapse was corrected using the edge-to-edge (E to E) technique over a period of more than 10 years. At admission, 49 (32.6%) patients were in

Ottavio Alfieri; Michele De Bonis; Elisabetta Lapenna; Tommaso Regesta; Francesco Maisano; Lucia Torracca; Giovanni La Canna

2004-01-01

207

Accessory mitral papillary muscle causing severe aortic insufficiency.  

PubMed

Accessory mitral papillary muscle originating from the interventricular septum is a rare congenital anomaly. A 20-year-old male patient presented with a complaint of exertional dyspnea. On cardiac examination, a grade 3/4 diastolic murmur was heard over the right upper parasternal area, and the apical pulsations were easily palpable over the precordium. Transthoracic echocardiography showed severe aortic regurgitation, dilatation of the left ventricle, and an accessory papillary muscle with its chordae, extending from the interventricular septum to the anterior mitral leaflet in the left ventricular outflow tract (LVOT). There was no mitral regurgitation. Color Doppler imaging showed turbulence set up by the abnormal mitral attachment and an associated mild pressure gradient of 20 mmHg across the LVOT. At surgery for aortic valve replacement, degenerative changes in the aortic leaflets were noted. The accessory papillary muscle was spared to maintain mitral valve functions and an aortic bileaflet mechanical prosthetic valve was implanted. During eight months of follow-up, he was well without any signs of left ventricular systolic dysfunction and mitral regurgitation, with a functioning prosthetic valve. PMID:21248456

Ucak, Alper; Onan, Burak; Alp, Ibrahim; Y?lmaz, Ahmet Turan

2010-12-01

208

How I Assess and Repair the Barlow Mitral Valve: The Edge-to-Edge Technique  

Microsoft Academic Search

\\u000a The main cause of mitral regurgitation (MR) in the western world is degenerative mitral valve disease, which usually leads\\u000a to prolapse or flail of the posterior, anterior, or both leaflets. Mitral valve repair has become the treatment of choice\\u000a of degenerative MR providing predictable and durable results in most patients.1,2 The most favorable outcomes have always been reported with isolated

Michele De Bonis; Ottavio R. Alfieri

209

Mechanics of the Mitral Annulus in Chronic Ischemic Cardiomyopathy  

PubMed Central

Approximately one third of all patients undergoing open-heart surgery for repair of ischemic mitral regurgitation present with residual and recurrent mitral valve leakage upon follow up. A fundamental quantitative understanding of mitral valve remodeling following myocardial infarction may hold the key to improved medical devices and better treatment outcomes. Here we quantify mitral annular strains and curvature in nine sheep 5 ± 1 weeks after controlled inferior myocardial infarction of the left ventricle. We complement our marker-based mechanical analysis of the remodeling mitral valve by common clinical measures of annular geometry before and after the infarct. After 5 ± 1 weeks, the mitral annulus dilated in septal-lateral direction by 15.2% (p=0.003) and in commissure-commissure direction by 14.2% (p<0.001). The septal annulus dilated by 10.4% (p=0.013) and the lateral annulus dilated by 18.4% (p<0.001). Remarkably, in animals with large degree of mitral regurgitation and annular remodeling, the annulus dilated asymmetrically with larger distortions toward the lateral-posterior segment. Strain analysis revealed average tensile strains of 25% over most of the annulus with exception for the lateral-posterior segment, where tensile strains were 50% and higher. Annular dilation and peak strains were closely correlated to the degree of mitral regurgitation. A complementary relative curvature analysis revealed a homogenous curvature decrease associated with significant annular circularization. All curvature profiles displayed distinct points of peak curvature disturbing the overall homogenous pattern. These hinge points may be the mechanistic origin for the asymmetric annular deformation following inferior myocardial infarction. In the future, this new insight into the mechanism of asymmetric annular dilation may support improved device designs and possibly aid surgeons in reconstructing healthy annular geometry during mitral valve repair. PMID:23636575

Rausch, Manuel K.; Tibayan, Frederick A.; Ingels, Neil B.; Miller, D. Craig; Kuhl, Ellen

2013-01-01

210

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

211

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

212

Congenital mitral incompetence and coarctation of aorta  

PubMed Central

Two patients with congenital mitral incompetence and coarctation of the aorta are presented. One patient had associated patent ductus arteriosus, bicuspid aortic valve, and endocardial fibroelastosis. The diagnosis in the two patients presented is well established by clinical, laboratory, and surgical findings and also by necropsy examination in one case. It is proposed that the rarity of reported cases in the literature may have resulted from the frequent diagnosis of left ventricular failure in infancy secondary to coarctation, leading to the assumption that a mitral insufficiency murmur, when present, is due to functional regurgitation. Likewise, the murmur may be mistakenly thought to originate from a ventricular septal defect. The diagnosis of coarctation of the aorta presented no problem in either patient, while detection of the mitral incompetence was difficult. Coarctation of the aorta complicated by pulmonary hypertension in the absence of intracardiac shunt should draw attention to the possibility of associated mitral incompetence. Congestive heart failure, especially after correction of coarctation, was also an indication of possible associated mitral insufficiency. The two patients were treated by repair of coarctation of the aorta at 3 months and 3 years of age and by mitral valve replacement at the age of 18 months and 5 years, respectively. One patient was in terminal heart failure and died following mitral valve surgery. The other patient benefited from the operation and her case has been followed for over one year. Correction of coarctation of the aorta provided only temporary relief of heart failure. Until both anomalies are corrected response will generally be unsatisfactory. The aetiology of combined mitral incompetence and coarctation of the aorta can be explained on a congenital basis. Endocardial fibroelastosis of the left ventricle is thought to be secondary to coarctation of the aorta, mitral incompetence, or both. Images PMID:4647632

Terzaki, Abdel K.; Leachman, Robert D.; Ali, M. Khalil; Hallman, Grady L.; Cooley, Denton A.

1972-01-01

213

Delayed left atrial wall dissection after mitral valve replacement.  

PubMed

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

Idir, M; Deville, C; Roudaut, R

2000-04-01

214

Percutaneous mitral repair with the MitraClip  

Microsoft Academic Search

Mitral regurgitation (MR) is associated with poor prognosis and high incidence of clinical events if left untreated. To reduce the invasiveness of the surgical approach, different types of trans-catheter procedures are becoming available. The MitraClip procedure (Abbott Vascular Inc. Menlo Park, CA) is yet the only available at the moment. The procedure is used to treat high risk surgical candidates

F. Maisano; O. Alfieri; G. La Canna

2011-01-01

215

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

216

Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. Experience in 25 patients.  

PubMed

Double-orifice mitral valve is an uncommon but surgically important condition. The experience in 25 cases of double-orifice mitral valve associated with atrioventricular canal defects was reviewed. This constituted 4.3% of the 581 cases of atrioventricular canal defects operated upon between 1961 and July, 1984. The combined mitral orifice area ranged from 85% to 91% of normal in those patients whose valves were sized intraoperatively. Ten associated cardiac defects were repaired in six patients. Of 23 patients having cleft mitral valve, 21 had partial closure of the cleft. There was one operative death (4.0%), which occurred early in the series in a patient in whom the tissue bridge was severed and massive mitral regurgitation resulted. In the remaining 24 patients the tissue bridge was left intact, and all survived operation. No patient had clinically significant mitral stenosis during a follow-up of 1 to 14 years (mean 4.9 years). Two patients (8%) developed progressive mitral regurgitation and required mitral valve replacement 3 and 11 years postoperatively. One of these patients died and a second death occurred suddenly 2 years following operation. All survivors are in Functional Class I or II. The noncleft orifice of a double-orifice mitral valve usually is competent and rarely requires closure. The cleft, because it constitutes a type of parachute (single papillary muscle) valve, should be closed partially so as to relieve valve incompetence without causing undue stenosis. The incidence of late development of mitral regurgitation is similar to that of atrioventricular canal without double-orifice mitral valve. Repair of atrioventricular canal associated with double-orifice mitral valve can be achieved with a low operative mortality and excellent late results. PMID:4058042

Lee, C N; Danielson, G K; Schaff, H V; Puga, F J; Mair, D D

1985-11-01

217

Electrocardiographic P-wave Indices as a Useful Tool to Predict Successful Percutaneous Balloon Mitral Valvotomy in Patients with Mitral Stenosis  

PubMed Central

Introduction: Patients with hemodynamically significant mitral stenosis (MS) have prolonged P-wave duration and increased P-wave dispersion (PWD) that decrease after successful percutaneous balloon mitral valvotomy (PBMV). The purpose of this study was to investigate if the changes in these indices may predict a successful procedure. Methods: Fifty two patients with MS in sinus rhythm underwent PBMV (90.4% female; mean age 38±10 years). Mitral valve area (MVA), valve score, mean diastolic mitral gradient (mMVG), mitral regurgitation severity, and systolic pulmonary artery pressure (sPAP) were evaluated by echocardiography before PBMV and repeated after one month. P-wave duration (Pmax /Pmin) and PWD were measured before and immediately after PBMV, at discharge, and at the end of the first month after discharge. Results: Among all procedures, 38 (73.1%) were defined as successful. Mean age, valve score, mMVG, and MVA before PBMV were similar for both groups. MVA was significantly greater in the successful PBMV group (1.65±0.27 vs. 1.41±0.22; P= 0.003). sPAP was reduced after PBMV in all patients and there were no significant differences in the mean sPAP before and after PBMV in both successful and unsuccessful groups. Pmax and PWD were significantly decreased immediately after the procedure (P= 0.035), the next day (P= 0.005) and at one month (P= 0.002) only in patients with successful PBMV. Pmin did not change significantly in either group. Conclusion: Only is successful PBMV associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV. PMID:24753825

Kazemi, Babak; Rostami, Ali; Aslanabadi, Naser; Ghaffari, Samad

2014-01-01

218

Outcome of mitral valve plasty or replacement: atrial fibrillation an effect modifier  

PubMed Central

Background Advances in the understanding of mitral valve pathology have laid to mitral valve plasty (MPL) as the procedure of choice of all the mitral intervention as compared to mitral valve replacement (MVR). This study is aimed to compare the outcome mortality and reoperation and to estimate failure of repair between the two procedures during the follow up time. Material and methods A cohort of 355 patients with mitral valve disease operated between January 1993 to January 2007 with closing date first of mars 2011. There were 214 MPL and 141 MVR at the Hospital discharge. This retrospective cohort had the design of exposed (MPL) versus non-exposed (MVR) with outcome total mortality and reoperation during follow up. Also echocardiography follow-up was undertaken to estimate the true long-term failure rate of repair. Results The mean follow up was 5.3 years SE (3.82) maximum follow up was 14.1 years. Considering the patient time model the association between repair/replacement and total mortality RR?=?0.43 95% (0.28-074) p?=?0.002 controlling for the confounding effect of 3-vessels disease. Those results were confirmed by propensity score analysis. As far as outcome re-operation, presence of atrial fibrillation AF was an effect modifier indicating lower reoperation rate for MPL compared to MVR for patients without AF, RR?=?0.32 95% CL (0.13-0.81) p?=?0.017 while no difference in reoperation rates between MPL/MVR for patients with AF RR?=?1.82 95% CL (0.52-6.4) p?=?0.344. Echocardiography follows up showed incidence of moderate and severe recurrent mitral regurgitation was 1.34 per 100 patients years and 0.27 per 100 patients years during the follow-up time. Conclusion In a cohort of patient with mitral valve disease undergoing MPL/MVR was examined. MPL was associated with better survival, and lower reoperation rate for patients without AF but same rate for patients with AF. We advocate more attention in controlling risk factors of AF in the clinical management of mitral disease. Long-term failure rate of MPL was low during follow up time. A replication of our results by a randomized clinical trial is mandatory. PMID:23724788

2013-01-01

219

The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation.  

PubMed

The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve regurgitation. In a cross-sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve regurgitation by spatial and temporal parameters was performed in the four-chamber view by color Doppler flow imaging and by color Doppler M-mode echocardiography (M-Q mode). The prevalence of fetal tricuspid valve regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid regurgitation was part-systolic (non-holosystolic, early and mid-systolic tricuspid regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid regurgitation (U test, p > 0.05). Re-examination of 14 of the 18 fetuses with tricuspid regurgitation showed that tricuspid regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses. Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve regurgitation. In one fetus the tricuspid regurgitation ws only part-systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral regurgitation occurred immediately before intrauterine death. Fetal tricuspid valve regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological. PMID:9239822

Gembruch, U; Smrcek, J M

1997-06-01

220

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

PubMed Central

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

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

2010-01-01

221

Percutaneous mitral repair: patient selection, results, and future directions.  

PubMed

Percutaneous heart valve therapies are rapidly changing our approach to valvular heart diseases. Currently, mitral valve surgery is the treatment of choice for patients suffering from severe symptomatic mitral regurgitation. However surgery, because of its inherent risks, is not applicable to all patients, particularly for the elderly with comorbidities. Catheter-based mitral repair systems offer a new option to those high-risk patients. The edge-to-edge repair using the MitraClip device (Evalve, Menlo Park, CA), simulating the surgical Alfieri stitch via percutaneous approach proved to be a safe and feasible technique. This article discusses the currently available data for the MitraClip transcatheter mitral repair system. PMID:21184204

Yuksel, Uygar C; Kapadia, Samir R; Tuzcu, E Murat

2011-04-01

222

Mitral Annulus Segmentation From 3D Ultrasound Using Graph Cuts  

E-print Network

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

Schneider, Robert J.

223

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

PubMed

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

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

2014-12-01

224

Redo MitraClip mitral valve repair after a late single leaflet detachment.  

PubMed

Percutaneous mitral valve repair with the MitraClip® (Abbott, Abbott Park, IL) can reduce mitral regurgitation (MR) and improve symptoms and quality of life in patients with severe mitral regurgitation. While this therapy is safe, there have been reports of single leaflet detachment where the MitraClip remains attached only to one leaflet of the mitral valve after deployment. Most of these cases occur within the first month of the procedure but there have been reports of late detachment occurring after this period. This case report describes a patient with severe functional MR who underwent an initial successful MitraClip procedure with implantation of two clips but subsequently developed late detachment of one clip. It also discusses the challenges and feasibility of performing a repeat MitraClip procedure in these patients. PMID:24339265

Tay, Edgar L W; Lim, D Scott; Yip, James

2014-07-01

225

Clinical trial experience with the MitraClip catheter based mitral valve repair system.  

PubMed

Severe mitral regurgitation (MR) confers a poor prognosis, in particular for patients with heart failure. Based on the results of the Euro Heart Survey, a large proportion of patients with mitral regurgitation is not referred to surgery and many other patients are rejected for cardiac surgery due to the high surgical risk or co-pathologies. Improving ventricular function with ACE inhibitors, beta-blockers and CRT may reduce mitral regurgitation, but for most patients a mechanical intervention is ultimately preferable. Mitral valve surgery is invasive and requires a long recovery period; therefore, less invasive and effective approaches are highly desirable, particularly in high risk patients. Therefore, new techniques have been recently developed to treat MR with percutaneous approach. The MitraClip device (Abbott Vascular, Menlo Park, CA) is used to treat both functional and degenerative mitral valve regurgitation. Its safety and efficacy has been initially tested in the Endovascular Valve Edge-to-Edge REpair Study (EVEREST), while MitraClip has been compared to surgery in the EVEREST II randomized trial. Besides EVEREST trials, safety and efficacy of the device as well as its health economic value is under evaluation in ongoing registries. Although the field of catheter based management of MR is at an early stage, initial clinical results have demonstrated that catheter based approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR. PMID:21503702

Maisano, Francesco; Godino, Cosmo; Giacomini, Andrea; Denti, Paolo; Arendar, Iryna; Buzzatti, Nicola; Canna, Giovanni La; Alfieri, Ottavio; Colombo, Antonio

2011-12-01

226

Mitral Valve Restenosis after Percutaneous Transmitral Valvuloplasty, Role of Continuous Inflammation  

PubMed Central

Introduction: High sensitive C-Reactive Protein (hs-CRP) is increased in acute and chronic rheumatic fever (RF), but is unknown whether serum levels of hs-CRP is correlated with late restenosis of mitral valve (MV) after Percutaneous transvenous mitral commissurotomy (PTMC). The aim of this study is to determine relationship between hs-CRP and MV restenosis 48-36 months after performing PTMC. Methods: A total of 50 patients who had undergone PTMC due to rheumatic etiology (41 female, 9 male; mean age 46 ± 11, range 27-71), all followed up on an out patients basis 36 months after PTMC, were included in the study. The hs-CRP was measured using an enzyme-linked immunosorbent assay (ELISA) kits. Results: No association was found between hs-CRP level and mean transmitral valve gradient 36 months after PTMC, MV area by planimetry, pulmonary artery systolic pressure, mitral regurgitation grade, left atrial diameter, atrial fibrillation (AF) rhythm and Wilkins score. Conclusion: Our study have shown that there is no association between hs-CRP and MV restenosis in patients with rheumatic heart disease (RHD) who underwent PTMC. Therefore, it has been postulated that inflammation is not a cause of post PTMC restenosis. PMID:25320668

Ostovan, Mohammadali; Aslani, Amir; Abounajmi, Shahima; Razazi, Vida

2014-01-01

227

Institutional report - Valves Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease  

Microsoft Academic Search

The gold standard for the surgical treatment of prolapse of the posterior leaflet of the mitral valve (MV) for degenerative myxomatous disease has been represented by the quadrangular resection of the leaflet, according to the Carpentier technique. Since 2006 we performed a triangular resection of the prolapsing leaflet in 20 patients with myxomatous mitral regurgitation (MR). Seventeen patients (85%) underwent

Bruno Chiappini; Renato Gregorini; Franco De Remigis; Licia Petrella; Carmine Villani; Fabrizio Di Pietrantonio; Srdan Pavicevic; Alessandro Mazzola

228

Absence of the aortic valve cusps with mitral atresia, normal left ventricle, and intact ventricular septum.  

PubMed Central

A case of a previously unreported anomaly is presented in which absence of the aortic valve cusps, mitral atresia, a normal left ventricle, and an intact ventricular septum were diagnosed by cross sectional echocardiography. The development of a normal left ventricle, rather than the hypoplastic ventricle usually associated with mitral atresia, is explained by filling of the ventricular cavity via the regurgitant aortic valve. Images PMID:2328173

Cabrera, A; Galdeano, J M; Pastor, E

1990-01-01

229

Mitral Valve Replacement and Repair: Report of 5 Patients with Systemic Lupus Erythematosus  

PubMed Central

Severe mitral valve regurgitation due to systemic lupus erythematosus is a rare cause of valvular heart disease, necessitating valve surgery. Currently, there are 36 case reports in the world medical literature of mitral valve replacement or repair in patients who have lupus. The current trend in mitral valve surgery is toward anatomic valve repair. In patients who have systemic lupus erythematosus, however, valve repair often leads to repeat surgery and valve replacement. We report the cases of 5 patients with lupus and severe mitral valve regurgitation who underwent mitral valve surgery. In 3 of these patients, replacement with a mechanical prosthetic mitral valve was performed with good long-term results. In the other 2 patients, mitral valve repair was performed, but only 1 of the repairs was successful. The 2nd patient required subsequent replacement with a mechanical valve. To our knowledge, this report of 5 patients is the largest series of mitral valve surgery in patients with lupus. These results, along with a review of the literature, suggest the superiority of mechanical prosthetic valve replacement to repair in patients who have systemic lupus erythematosus. PMID:11330742

Hakim, John P.; Mehta, Anurag; Jain, Abnash C.; Murray, Gordon F.

2001-01-01

230

[Clinical evaluation of regurgitant blood flow by rapid cine magnetic resonance imaging in patients with valvular heart disease].  

PubMed

The clinical usefulness of magnetic resonance imaging (MRI) for evaluating regurgitant blood flow in patients with valvular heart disease was studied. The study subjects comprised three healthy volunteers and nine patients with valvular heart disease (aortic regurgitation 3, mitral regurgitation 2, tricuspid regurgitation 2, and pulmonary regurgitation 2). Five were men and seven were women, ranging in age from 31 to 85 years. Valvular heart disease was diagnosed by two-dimensional Doppler echocardiography. MRI was performed using a 1.5 tesla super-conductive magnet system (MAGNETOM, Siemens AG). A rapid MRI technique (fast low-angle shot [FLASH], flip angle = 30 degrees, TR = 65-90 msec, TE = 10-38 msec) was used to generate 11 frames throughout one cardiac cycle in the transaxial, coronal and oblique planes. These sequential frames were displayed in cine mode on a CRT. 1. Intracavitary blood was imaged as a high signal intensity on gradient echo images, while surrounding cardiac structures had somewhat lower signal intensities. 2. In healthy volunteers, systolic ejection blood flow from the left ventricle was observed on coronal images in the cine mode display. The influx of atrial blood into the left and right ventricles was also clearly observed on transaxial cine images. 3. Aortic regurgitant flow was observed as areas of no signal intensity within the left ventricular cavity during diastole on coronal images. 4. Mitral and tricuspid regurgitations were observed within the left and right atria, respectively, as areas of no signal intensity on transaxial images. The extent of regurgitant flow was determined in the vertical long-axis plane, equivalent to the right anterior oblique projection. 5. The vertical oblique scan was suitable for detecting pulmonary regurgitant flow. These results indicate that the rapid cine MRI technique is a useful tool for noninvasively determining regurgitant blood flow in patients with various valvular heart diseases. PMID:2636635

Onishi, S; Fukui, S; Atsumi, C; Morita, R; Fujii, K; Kusuoka, H; Kitabatake, A; Kamada, T; Takizawa, O

1989-06-01

231

Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography  

Microsoft Academic Search

Background  Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation.\\u000a It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time\\u000a three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has\\u000a not been evaluated.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In 28 high-surgical risk patients with moderate or

Ertunc Altiok; Michael Becker; Sandra Hamada; Sebastian Reith; Nikolaus Marx; Rainer Hoffmann

232

[Robot-assisted Mitral Valve Plasty].  

PubMed

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

Ishikawa, Norihiko; Watanabe, Gou

2015-01-01

233

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

234

Mitral valve repair for degenerative disease.  

PubMed

Degenerative mitral valve disease is the most common cause of mitral regurgitation in North America. Using techniques developed by Carpentier and others, up to 90% of degenerative mitral valves can be repaired. These valves are characterized by annular dilatation and chordal rupture or elongation; chordal changes are mainly localized to the posterior leaflet. The most common repair technique for posterior leaflet prolapse is quadrangular resection. When the leaflet is >1.5 cm long, a sliding repair is added to reduce the risk of systolic anterior motion. Anterior leaflet prolapse is usually treated by transfer of chords from the posterior leaflet or adjacent areas of the anterior leaflet. Other useful techniques for correction of anterior leaflet prolapse are creation of artificial chords and the Alfieri edge-to-edge repair. Chordal shortening is rarely employed as it jeopardizes repair durability. Annuloplasty accompanies all repairs. A posterior annuloplasty provides results equivalent to those obtained with a circumferential annuloplasty. Flexible annuloplasty has theoretical advantages, but clinical benefits have not been shown. After mitral valve repair for degenerative disease, 10-year freedom from reoperation is 93%. Risk of reoperation is increased by anterior leaflet prolapse, chordal shortening, failure to use an annuloplasty, and lack of intraoperative echocardiography. In the ideal situation, when posterior leaflet resection is corrected by quadrangular resection with annuloplasty and the result is confirmed by intraoperative echocardiography, the 10-year durability is 98%. PMID:11843514

Gillinov, A Marc; Cosgrove, Delos M

2002-01-01

235

Less invasive techniques for mitral valve surgery  

Microsoft Academic Search

Objective: Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain, and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mitral valve surgery, with particular attention to approach and techniques. Methods: From

Didier F. Loulmet; Alain Carpentier; Peter W. Cho; Alain Berrebi; Nicola d'Attellis; Conal B. Austin; Jean-Paul Couëtil; Paul Lajos

1998-01-01

236

Consecutive transcatheter valve-in-valve implantations: the first in the aortic position, the second in the mitral position, in a patient with failing aortic and mitral bioprostheses.  

PubMed

A 69-year-old man with a failing aortic valve homograft and failing mitral valve xenograft was admitted with an inability to complete full sentences and pulmonary oedema with right ventricular overload. Severe aortic and mitral regurgitation, severe biventricular impairment and pulmonary hypertension were confirmed on transthoracic and transoesophageal echocardiography. An urgent transfemoral valve-in-valve transcatheter valve implantation (TAVI) was performed within the aortic valve homograft with full resolution of aortic regurgitation. Three months later, a semielective trans-apical valve-in-valve procedure was performed in the mitral position, under cardiopulmonary bypass, with full resolution of mitral regurgitation. His exercise tolerance increased from 5 yards to half a mile. This case report summarises a staged double valve-in-valve procedure in a patient who had three previous sternotomies and who had severe heart failure due to failing aortic and mitral bioprostheses. We report two different delivery approaches, using two different transcatheter devices, and describe valve-in-valve techniques, including cardiopulmonary bypass, in the catheter laboratory. PMID:25053698

Duncan, Alison; Davies, Simon; Rosendahl, Ulrich; Moat, Neil

2014-01-01

237

Percutaneous Mitral Valve Repair: Potential in Heart Failure Management  

Microsoft Academic Search

As a large portion of the US demographic advances into the later decades of life, the incidence of valvular heart disease\\u000a is expected to increase. Mitral regurgitation (MR) caused by primary valve abnormality (degenerative) or secondary to cardiomyopathy\\u000a (functional) is an important cause of heart failure. Management of valvular heart disease is expected to account for a large\\u000a segment of

Asma Hussaini; Saibal Kar

2010-01-01

238

Transaortic edge-to-edge mitral valve repair and left ventricular myectomy.  

PubMed

Systolic anterior motion of mitral anterior leaflet is a serious clinical condition and it is hard to control medically. Alfieri edge-to-edge repair has been thought one of the useful techniques to improve abnormal anterior systolic motion with hypertrophic obstructive cardiomyopathy. Here, we present a 71-year-old lady who had the left ventricular outflow tract obstruction, severe mitral valve regurgitation with systolic anterior motion. The patient had a history of aortic valve replacement 5 years ago. She was successfully treated with transaortic edge-to-edge mitral valve plasty and myectomy of the left ventricle. Postoperative course was uneventful. PMID:22851405

Tsutsumi, Yasushi; Numata, Satoshi; Seo, Hiroyuki; Ohashi, Hirokazu

2013-04-01

239

Mitral Valve Prolapse  

MedlinePLUS

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

240

[Doppler echocardiography in mitral insufficiency].  

PubMed

The Doppler method (pulsatile and continuous) was used for finding out and semiquantitatively evaluating the mitral insufficiency of various etiologies: inflammatory (rheumatic); prolapse of mitral valve; obstructive hypertrophic cardiomyopathy; dilatative cardiomyopathy; calcification of valvular ring. The Doppler parameters obtained after automatic processing of the image (speed transvalvular pressure gradient, flow period and acceleration) offer data on the diastolic performance of the left ventricle. Registration of the aortic flow makes possible the calculation of the cardiac flow (the diameter of the aorta is measured in echo-B), and of the aortic flow permits the noninvasive evaluation of the lung arterial pressure. The method offers a large vista in the noninvasive evaluation of the patients suffering from mitral insufficiency. PMID:1978395

Streian, C; Dr?gulescu, S I; Brânzan, L; Streian, C G; Turcan, M

1990-01-01

241

Quality of life following percutaneous mitral valve repair with the MitraClip System  

Microsoft Academic Search

BackgroundPercutaneous valve repair with MitraClip System is an emerging alternative for high surgical risk patients with severe mitral regurgitation (MR). QoL is a critical measure of effectiveness of this procedure. We sought to evaluate quality of life (QoL) and NYHA class following this novel procedure.

Gian Paolo Ussia; Valeria Cammalleri; Kunal Sarkar; Salvatore Scandura; Sebastiano Immè; Anna Maria Pistritto; Anna Caggegi; Marta Chiarandà; Sarah Mangiafico; Marco Barbanti; Marilena Scarabelli; Massimiliano Mulè; Patrizia Aruta; Corrado Tamburino

242

Edge-to-edge (Alfieri) mitral repair: results in diverse clinical settings  

Microsoft Academic Search

BackgroundComplex mitral regurgitation (MR) jets can make repair challenging; edge-to-edge (Alfieri) repair augments the repertoire of repair techniques. Objectives of this study were to demonstrate causes of MR amenable to edge-to-edge repair and to determine safety, obstructive potential, and durability of edge-to-edge repair.

Sunil K Bhudia; Patrick M McCarthy; Nicholas G Smedira; Buu-Khanh Lam; Jeevanantham Rajeswaran; Eugene H Blackstone

2004-01-01

243

Mitral Valve Prolapse  

PubMed Central

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

Rosser, Walter W.

1992-01-01

244

Robotic mitral valve surgery  

Microsoft Academic Search

Traditionally mitral valve surgery has been performed via median sternotomy. However, a renaissance in cardiac surgery is occurring. Cardiac operations are being performed through smaller and alternative incisions with enhanced technological assistance. Specifically, minimally invasive mitral valve surgery has become standard for many surgeons. At our institution, we have developed a robotic mitral surgery program with the da VinciTM telemanipulation

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

2003-01-01

245

Robotic Mitral Valve Repair for All Categories of Leaflet Prolapse: Improving Patient Appeal and Advancing Standard of Care  

PubMed Central

OBJECTIVE: To characterize the early outcomes of robotic mitral valve (MV) repair using standard open techniques. PATIENTS AND METHODS: We prospectively studied 100 patients with severe mitral regurgitation due to leaflet prolapse who underwent robot-assisted MV repair using conventional open-repair techniques between January 1, 2008, and December 31, 2009, at Mayo Clinic, Rochester, MN. RESULTS: The mean age of the patients was 53.9 years; 77 patients (77%) were male. Fifty-nine patients (59%) had posterior leaflet prolapse, 38 (38%) had bileaflet disease, and 3 (3%) had isolated anterior leaflet prolapse. Median cross-clamp and bypass times decreased significantly during the course of the study (P<.001). Median postoperative ventilation time was 0 hours for the last 25 patients, with most patients extubated in the operating room. No deaths occurred. Reexploration for postoperative bleeding occurred in 1 patient (1%); 3 patients (3%) required percutaneous coronary intervention. Median hospital stay was 3 days. One patient (1%) underwent mitral reoperation for annuloplasty band dehiscence. Residual regurgitation was mild or less in all patients at dismissal and 1 month postoperatively. Significant reverse remodeling occurred by 1 month, including decreased left ventricular end-diastolic diameter (–7.2 mm; P<.001) and left ventricular end-diastolic volume (–61.0 mL;P<.001). CONCLUSION: Robot-assisted MV repair using proven, conventional open-repair techniques is reproducible and safe and hastens recovery for all categories of leaflet prolapse. One month after surgery, significant regression in left ventricular size and volume is evident. PMID:21757782

Suri, Rakesh M.; Burkhart, Harold M.; Rehfeldt, Kent H.; Enriquez-Sarano, Maurice; Daly, Richard C.; Williamson, Eric E.; Li, Zhuo; Schaff, Hartzell V.

2011-01-01

246

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

247

Minimally invasive transaortic mitral valve repair during aortic valve replacement.  

PubMed

Herein, we report the case of a 77-year-old man who presented with congestive heart failure. Echocardiography and cardiac catheterization revealed severe aortic stenosis with severe mitral regurgitation and a left ventricular ejection fraction of 0.20. Because of comorbidities, the patient was considered to be at high risk for double-valve surgery. In order to reduce the operative risk, a minimally invasive aortic valve replacement was performed together with a transaortic edge-to-edge repair (Alfieri stitch) of the mitral valve. We discuss the surgical technique and note the positive outcome. To our knowledge, this is the 1st report of minimally invasive aortic valve replacement and transaortic mitral valve repair with use of the Alfieri stitch. PMID:21720478

Santana, Orlando; Lamelas, Joseph

2011-01-01

248

Minimally Invasive Transaortic Mitral Valve Repair during Aortic Valve Replacement  

PubMed Central

Herein, we report the case of a 77-year-old man who presented with congestive heart failure. Echocardiography and cardiac catheterization revealed severe aortic stenosis with severe mitral regurgitation and a left ventricular ejection fraction of 0.20. Because of comorbidities, the patient was considered to be at high risk for double-valve surgery. In order to reduce the operative risk, a minimally invasive aortic valve replacement was performed together with a transaortic edge-to-edge repair (Alfieri stitch) of the mitral valve. We discuss the surgical technique and note the positive outcome. To our knowledge, this is the 1st report of minimally invasive aortic valve replacement and transaortic mitral valve repair with use of the Alfieri stitch. PMID:21720478

Santana, Orlando; Lamelas, Joseph

2011-01-01

249

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

PubMed

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

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

2011-11-15

250

Percutaneous mitral valve repair with the edge-to-edge technique.  

PubMed

Percutaneous treatment of mitral valve regurgitation with the MitraClip™ system is emerging as an alternative to surgery in high-risk and inoperable patients. The device is designed to bond the opposing leaflets at the site of regurgitation, reproducing the results of the Alfieri technique in a beating heart approach. We describe the selection criteria and the procedural steps of the procedure, which is performed under general anesthesia and guided by trans-esophageal echocardiography, using a sophisticated delivery system to deliver the clip at the desired target. We also briefly report the currently available data which supports the application of this therapy in selected patients with either degenerative or functional mitral regurgitation. PMID:24413023

Maisano, Francesco; Denti, Paolo; Michev, Iassen; La Canna, Giovanni; Arendar, Iryna; Colombo, Antonio; Alfieri, Ottavio

2010-01-01

251

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

252

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

PubMed

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

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

2014-08-01

253

MitraClip: a novel percutaneous approach to mitral valve repair  

PubMed Central

As life expectancy increases, valvular heart disease is becoming more common. Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population. Recent years have brought a progression of surgical treatments toward less invasive strategies. This has given rise to percutaneous approaches for the correction of valvular heart disease. Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation. We review the rationale, procedural aspects, and clinical data thus far available for the MitraClip approach to mitral regurgitation. PMID:21796803

Jilaihawi, Hasan; Hussaini, Asma; Kar, Saibal

2011-01-01

254

[Update on tricuspid regurgitation].  

PubMed

Although commonly detected by transthoracic echocardiography, tricuspid regurgitation (TR) has been somehow neglected, and recent data have emerged on the need for careful examination of the tricuspid valve. Functional or secondary TR is the most frequent etiology of tricuspid valve pathology in western countries and is related to tricuspid annular dilation and leaflet tethering. The prognostic role of TR associated with organic left-sided valvular heart disease is well known. However, the value of functional TR in outcome stratification of patients with advanced left ventricular dysfunction is less clear. Surgical tricuspid repair has been avoided for years, because of the misconception that TR should disappear once the primary left-sided problem is treated; this results in a large number of untreated patients with functional TR. Over the past few years, many investigators have reported evidence in favor of a more aggressive surgical approach to functional TR. Consequently, interest has been growing in the pathophysiology and treatment of functional TR. The purpose of this article is to provide a comprehensive review of TR incorporating a description of valve anatomy, etiological factors, pathophysiology, epidemiological data, natural history, clinical evaluation, along with a discussion of the important role in prognostic stratification and a summary of management guidelines. PMID:25174595

Bellavia, Diego; Pentiricci, Samuele; Senni, Michele; Gavazzi, Antonello

2014-01-01

255

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

256

[Mitral valve reconstruction: for ruptured chordae to the posteromedial commissural scallop].  

PubMed

The advantages of mitral valve repair for pure mitral incompetence are established. It is necessary for us to describe suture points more detailed. This article presents our standardized maneuver for mitral regurgitation due to ruptured chordae to the posteromedial commissural scallop. The first step in the repair is placement of a temporary suture in the annulus at attachment of posterior commissural chordae and one of posterior cleft chordae. After measuring the annular diameter and estimating coaptation, this suture is removed. Secondary, rupture of chordae tendinease and adjacent margin of posteromedial commissural scallop are resected. Then, one end of a thread is passed through the margin at end of this untethered segment of leaflet, and another end is passed through the margin of leaflet at opposite end of this segment. Finally, a mattress suture using 3-0 Prolene with pledget is placed as a temporary suture. Between April 1993 and December 1994, four patients underwent reconstruction of mitral regurgitation with ruptured chordae to the posteromedial commissural scallop. Left ventriculogram 4 weeks postoperatively showed no regurgitant jet in all patients. PMID:7643508

Sato, K; Ishihara, S; Tezuka, M; Isomatsu, Y; Oshitomi, T

1995-07-01

257

Surgical treatment of the "parachute mitral valve" complex in infancy (report of a case).  

PubMed

The case is presented of a 15-month-old male, affected by severe mitral valve regurgitation associated to aortic coarctation. The surgical treatment consisted in replacement of the mitral valve by a Hancock prosthesis followed, at a second state, by resection of the coarctation. The mitral insufficiency was secondary to an anomaly of the subvalvular apparatus of the "Parachute Valve" type. The incidence of defects associated to congenital mitral insufficiency is commented. The surgical indications for replacement or repair of these anomalies in infancy are discussed, and the surgical results achieved to data are analysed. Emphasis is made on the convenience, in case the corrective procedure requires valvular replacement, of implanting a low-profile biological prosthesis, which does not require anticoagulant therapy. PMID:681446

Nojek, C; Agosti, J; Castro, A; Valles, F; Figuera, D

1978-01-01

258

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

259

Future of transcatheter repair of the mitral valve.  

PubMed

Percutaneous mitral valve repair is under investigation as a novel method to treat mitral valve insufficiency with a catheter-based, closed-heart, nonsurgical approach. Two techniques of mitral valve reconstruction have been adapted from surgery to the percutaneous approach: edge-to-edge repair and annuloplasty. The devices that have been developed to perform these 2 procedures are described, and preliminary clinical experience is presented. Expectations for the future are discussed. PMID:16399096

Alfieri, Ottavio; Maisano, Francesco; Colombo, Antonio

2005-12-19

260

MITRAL VALVULOPLASTY WITH  

Microsoft Academic Search

From January 1992 to January 1997, 586 patients with mitral incompetence were treated by Carpentier's techniques in the Heart Institute of Ho Chi Minh City, Vietnam. Ages ranged from 6 to 60 years (mean, 26.4± 9.9 years) and 124 patients were younger than 15 years of age. Mitral valve incompetence was classified into three types according to leaflet pliability: type

Phan Nguyen Van; Phuong Phan Kim; Vinh Pham Nguyen; Yen Dang Thi Bach; Trung Dao Huu; Hiep Chu Trong; Quy Nguyen Thi; Hào Nguyen Tiên; Alain Deloche; Alain Carpentier

2010-01-01

261

Use of the Alfieri edge-to-edge technique to eliminate left ventricular outflow tract obstruction caused by mitral systolic anterior motion.  

PubMed

A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow tract obstruction; the peak pressure gradient across the left ventricular outflow tract was 130 mm Hg, and there was moderately severe (3+) mitral regurgitation. After reinstitution of cardiopulmonary bypass, a central Alfieri edge-to-edge stitch was placed between the anterior and posterior leaflets of the mitral valve. This reduced the gradient across the left ventricular outflow tract to 10 mm Hg and eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass. PMID:15560993

Gillinov, A Marc; Smedira, Nicholas G; Shiota, Takahiro

2004-12-01

262

Total reconstruction of the mitral valve with autopericardium: anatomical study.  

PubMed

Mitral valve repair has several advantages over prosthetic valve replacement. A new technique of total reconstruction of the mitral valve with autologous pericardium is described. The native mitral valve leaflets and chordae were excised from 10 human cadaver hearts, in the same way as for prosthetic valve replacement. The dimensions of the physiologically normal mitral valve were used to calculate the parameters for tailoring a corresponding new valve. Autologous pericardium was fixed in 0.625% glutaraldehyde solution for 10 minutes. The calculated parameters of the mitral valve were marked on the pericardium. The new valve was fashioned and inserted in the native valve position. Hydraulic probes showed good competence in all 10 reconstructed mitral valves. This method might be a good alternative to prosthetic valve replacement. PMID:12079937

Gasparyan, Vahe C; Galstyan, Van S

2002-06-01

263

Captopril mediated decrease of aortic regurgitation.  

PubMed Central

The effect of captopril mediated afterload reduction on aortic regurgitation was investigated in 10 patients. Regurgitation was quantitated by means of the regurgitation fraction and the relation of regurgitant volume to end diastolic volume. These variables were derived from gated radionuclide ventriculography. After captopril treatment the blood concentration of angiotensin I rose whereas that of angiotensin II fell significantly. The conversion of angiotensin I to II was reduced to about 50% of the control value. Whereas blood pressure and heart rate did not change significantly, the regurgitation fraction and the regurgitant volume, normalised to end diastolic volume, were significantly reduced by captopril treatment. The ejection fraction remained essentially unchanged. These findings suggest that captopril reduces aortic regurgitation by reducing afterload. Images PMID:3902067

Reske, S N; Heck, I; Kropp, J; Mattern, H; Ledda, R; Knopp, R; Winkler, C

1985-01-01

264

Mitral Valve Replacement With the St. Jude Medical Prosthesis: A 15Year Follow-up  

Microsoft Academic Search

Background. A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement. Methods. From January 1979 to December 1989, 870 patients (54% women, 46% men; mean age, 55.8 6 6.2 years) underwent mitral valve replacement with the St. Jude Medical prosthesis. Of these operations 616 were isolated mitral valve replacements and 254 were double valve

Jean-Paul Remadi; Philippe Bizouarn; Olivier Baron; Phillipe Despins; Jean-Luc Michaud; Daniel Duveau

2010-01-01

265

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

Microsoft Academic Search

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

Roland Fasol; Katja Mahdjoobian

266

Iatrogenic Circumflex Coronary Lesion in Mitral Valve Surgery  

PubMed Central

Ischemic iatrogenic lesions can complicate surgical procedures on the mitral valve. One of the causative mechanisms is direct injury to or distortion of the circumflex coronary artery. The risk of damaging the circumflex coronary artery depends mainly upon the proximity of that vessel to the posterior segment of the mitral annulus, and this varies from patient to patient. Herein, we report a case of iatrogenic circumflex coronary artery lesion after mitral annuloplasty, and we review the literature on the subject, in order to highlight a possible relationship between iatrogenic circumflex lesions and coronary dominance. In a 60-year-old man who had severe mitral regurgitation due to prolapse of both leaflets, preoperative coronary angiography showed irregularities only along the left anterior descending coronary artery and a coronary network of right dominance. The patient underwent mitral annuloplasty (32-mm Carpentier-Edwards ring) by means of minimally invasive right thoracotomy through the right 4th intercostal space (HeartPort®). When the procedure was over, and before the patient was taken to intensive care, ventricular fibrillation developed; the administration of direct-current shock (200 joules) resulted in a resumption of sinus rhythm. Repeat transesophageal echocardiography showed posterolateral dyskinesis of the left ventricle and ST-segment elevation suggestive of acute lateral myocardial infarction. Emergency cardiac catheterization revealed a subocclusion of the distal circumflex coronary artery. Dual percutaneous angioplasty and stenting (Taxus, 2.5 × 24 mm) was performed with optimal result. At the 1-year follow-up, the patient showed good results of the mitral annuloplasty. PMID:18612492

Grande, Antonino M.; Fiore, Antonio; Massetti, Massimo; Viganò, Mario

2008-01-01

267

Three-dimensional reconstruction of color doppler flow convergence regions and regurgitant jets: An in vitro quantitative study  

Microsoft Academic Search

Objectives. This study sought to investigate the applicability of a current implementation of a three-dimensional echocardiographic reconstruction method for color Doppler flow convergence and regurgitant jet imaging.Background. Evaluation of regurgitant flow events, such as flow convergences or regurgitant jets, using two-dimensional imaging ultrasound color flow Doppler systems may not be robust enough to characterize these spatially complex events.Methods. We studied

Takahiro Shiota; Brian Sinclair; Masahiro Ishii; Xiaodong Zhou; Shuping Ge; Dag E. Teien; Morteza Gharib; David J. Sahn

1996-01-01

268

Mitral Valve Repair  

MedlinePLUS

... often today, rheumatic mitral stenosis is treated by balloon valvuloplasty , a procedure performed in the cardiac catheterization ... by interventional cardiologists . Using a catheter with a balloon on the end, the balloon is expanded inside ...

269

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

270

Video-assisted minimally invasive mitral valve surgery  

Microsoft Academic Search

Objective: This study was done to determine the potential benefits of minimally invasive mitral surgery performed with intraoperative video assistance. Methods: From May 1996 until March 1997, a minithoracotomy and video assistance were used in 31 consecutive patients undergoing mitral repair (n = 20) and replacement (n = 11). Their ages ranged from 18 to 77 years (59 ± 2.6

W. Randolph Chitwood; Christopher L. Wixon; Joseph R. Elbeery; Jon F. Moran; William H. H. Chapman; Robert M. Lust

1997-01-01

271

Intraoperative Evaluation of Transmitral Pressure Gradients after Edge-to-Edge Mitral Valve Repair  

PubMed Central

Objective Edge-to-edge repair of the mitral valve (MV) has been described as a viable option used for the surgical management of mitral regurgitation (MR). Based on the significant changes in MV geometry associated with this technique, we hypothesized that edge-to-edge MV repairs are associated with higher intraoperative transmitral pressure gradients (TMPG) compared to conventional methods. Methods Patient records and intraoperative transesophageal echocardiography (TEE) examinations of 552 consecutive patients undergoing MV repair at a single institution over a three year period were assessed. After separation from cardiopulmonary bypass (CPB), peak and mean TMPG were recorded for each patient and subsequently analyzed. Results 84 patients (15%) underwent edge-to-edge MV repair. Peak and mean TMPG were significantly higher compared to gradients in patients undergoing conventional repairs: 10.7±0.5 mmHg vs 7.1±0.2 mmHg; P<0.0001 and 4.3±0.2 mmHg vs 2.8±0.1 mmHg; P<0.0001. Only patients with mean TMPG ?7 mmHg (n?=?9) required prompt reoperation for iatrogenic mitral stenosis (MS). No differences in peak and mean TMPG were observed among edge-to-edge repairs performed in isolation, compared to those performed in combination with annuloplasty: 11.0±0.7 mmHg vs 10.3±0.6 mmHg and 4.4±0.3 mmHg vs 4.3±0.3 mmHg. There were no differences in TMPG between various types of annuloplasty techniques used in combination with the edge-to-edge repairs. Conclusions Edge-to-edge MV repairs are associated with higher intraoperative peak and mean TMPG after separation from CPB compared to conventional repair techniques. Unless gradients are severely elevated, these findings are not necessarily suggestive of iatrogenic MS. Thus, in the immediate postoperative period mildly elevated TMPG can be expected and tolerated after edge-to-edge mitral repairs. PMID:24023891

Hilberath, Jan N.; Eltzschig, Holger K.; Shernan, Stanton K.; Worthington, Andrea H.; Aranki, Sary F.; Nowak-Machen, Martina

2013-01-01

272

Percutaneous Mitral Valve Repair with the Edge-to-Edge Technique  

Microsoft Academic Search

Mitral regurgitation (MR), a common finding, is clinically significant, in part the result of its detrimental effect on left\\u000a ventricular function. Patients with mild MR can remain asymptomatic for many years. However, moderate to severe MR gradually\\u000a produces ventricular contractile dysfunction and dilation. Although left ventricular filling pressures are initially maintained\\u000a in the near-normal range, ultimately left ventricular failure occurs

Frederick G. St. Goar; James I. Fann; Ted E. Feldman; Peter C. Block; Howard C. Herrmann

273

Minimally invasive mitral surgery through right mini-thoracotomy under direct vision  

PubMed Central

In the 1990s, the success of ‘minimally invasive’ laparoscopic operations in other surgical subspecialties sparked an interest in minimally-invasive approaches for cardiac surgery, specifically for mitral valve repair. In 1996 at New York University (NYU) we began our experience with minimally invasive mitral valve repair performed through a small right anterior mini-thoracotomy incision using the Port-Access system in a phase I clinical trial. This was the beginning of our extensive right mini-thoracotomy experience for mitral valve repair at NYU. Currently at our institution the preferred approach for the right mini-thoracotomy mitral valve surgery is through the 3rd or 4th interspace mini-thoracotomy incision. Perfusion is accomplished with direct aortic or femoral cannulation, long femoral venous cannula drainage, and a retrograde cardioplegia catheter placed trans-atrialy in the coronary sinus under TEE guidance. An antegrade cardioplegia and venting needle is placed in the ascending aorta and direct external aortic clamping is achieved with one of several specialized crossclamps. With over four decades of experience, more than 4,000 patients have undergone mitral valve repair at NYU including 1,922 performed through a right mini-thoracotomy. We have reported an overall operative mortality of 1.3%, 8-year freedom from reoperation of 95%, freedom from reoperation or severe recurrent mitral regurgitation of 93%, and freedom from all valve-related complications of 90% for our initial series of 1,071 right mini-thoracotomy mitral valve repair. Based on our extensive experience we believe that mitral valve repair through a right mini-thoracotomy provides a durable and safe alternative to a traditional sternotomy with the benefits of improved cosmesis, reduced post-operative pain, less blood loss with fewer blood transfusions, fewer infections, shorter length of stay, and faster return to activity. It is our standard of care approach for mitral valve surgery. PMID:24251027

Ward, Alison F.; Grossi, Eugene A.

2013-01-01

274

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

275

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

276

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.

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

2014-01-01

277

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy.  

PubMed

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

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

2014-12-01

278

Brucella melitensis endocarditis: successful treatment of an infected prosthetic mitral valve  

PubMed Central

O'Meara, J. B., Eykyn, Susannah, Jenkins, B. S., Braimbridge, M. V., and Phillips, I. (1974).Thorax, 29, 377-381. Brucella melitensis endocarditis: successful treatment of an infected prosthetic mitral valve. A 38-year-old man had a mitral valve replacement for rheumatic calcific mitral stenosis and regurgitation; following this operation he remained well for 10 months. He then presented with cough, abdominal pain, and rigors, and Brucella melitensis type 3 was repeatedly isolated from blood cultures. His clinical condition deteriorated rapidly and an emergency valve replacement was performed. He was then treated with co-trimoxazole for 12 months and made an excellent recovery. This is the first reported case of brucella endocarditis arising de novo on a prosthetic heart valve. Images PMID:4850832

O'Meara, J. B.; Eykyn, Susannah; Jenkins, B. S.; Braimbridge, M. V.; Phillips, I.

1974-01-01

279

Evaluation of a Shape Memory Alloy Reinforced Annuloplasty Band for Minimally Invasive Mitral Valve Repair  

PubMed Central

Purpose An in vitro study using explanted porcine hearts was conducted to evaluate a novel annuloplasty band, reinforced with a two-phase, shape memory alloy, designed specifically for minimally invasive mitral valve repair. Description In its rigid (austenitic) phase, this band provides the same mechanical properties as the commercial semi-rigid bands. In its compliant (martensitic) phase, this band is flexible enough to be introduced through an 8-mm trocar and is easily manipulated within the heart. Evaluation In its rigid phase, the prototype band displayed similar mechanical properties to commercially available semi-rigid rings. Dynamic flow testing demonstrated no statistical differences in the reduction of mitral valve regurgitation. In its flexible phase, the band was easily deployed through an 8-mm trocar, robotically manipulated and sutured into place. Conclusions Experimental results suggest that the shape memory alloy reinforced band could be a viable alternative to flexible and semi-rigid bands in minimally invasive mitral valve repair. PMID:19766827

Purser, Molly F.; Richards, Andrew L.; Cook, Richard C.; Osborne, Jason A.; Cormier, Denis R.; Buckner, Gregory D.

2013-01-01

280

The MitraClip experience and future percutaneous mitral valve therapies.  

PubMed

Mitral regurgitation is the most common valve abnormality worldwide and its prevalence is expected to increase in the future due to aging of the population. Percutaneous mitral valve repair therapies may offer an opportunity to treat severe MR in the elderly or other high-risk groups who would otherwise be ineligible for surgery. The MitraClip system uses edge-to-edge coaptation of the mitral leaflets to create a double-orifice valve and reduce MR. It has been performed in over 10 000 patients to date, and as experience has improved, procedural times have shortened from over 200 minutes to less than 100 minutes, with increasing numbers of patients being left with ? grade 2+ MR. This review will focus on the literature available on MitraClip and other novel percutaneous techniques that are being developed for the treatment of severe MR. PMID:25035158

Bhamra-Ariza, Paul; Muller, David W M

2014-11-01

281

Alfieri repair for post-repair mitral systolic anterior motion in a young child.  

PubMed

An 11-year-old patient with Marfan syndrome presented with severe mitral and tricuspid regurgitation and underwent mitral valve repair consisting of a vertical folding plasty of a redundant and prolapsing A1, closure of a deep cleft-like A1-A2 indentation, and annuloplasty to 28 mm, and tricuspid valve repair. Post-bypass echocardiography showed significant systolic anterior motion of the mitral valve. The annuloplasty was upsized to 34 mm and the A1 folding plasty taken down. Echocardiography showed persistent systolic anterior motion. An edge-to-edge repair was placed at A1-P1, eliminating all systolic anterior motion. The patient had an uneventful postoperative course and 6-week follow-up. PMID:23522214

Khalpey, Zain; Baird, Christopher W; Myers, Patrick O

2013-04-01

282

Functional effect of new atrial septal defect after percutaneous mitral valve repair using the MitraClip device.  

PubMed

Percutaneous mitral valve repair using the MitraClip device has become a therapeutic alternative for high surgical risk patients with symptomatic mitral regurgitation. The procedure involves transseptal puncture and results in a new atrial septal defect (ASD) after withdrawal of the 22Fr guiding catheter. The functional effect of the new ASD is not defined. In 28 patients with symptomatic mitral regurgitation undergoing percutaneous mitral valve repair using the MitraClip device, 3-dimensional transesophageal echocardiography was used to measure by direct en face imaging the area of the new ASD. Analysis of the velocity-time integral (VTI) across the ASD after withdrawal of the guiding catheter allowed calculation of the shunt volume. Diastolic VTI of the mitral flow was determined before and after withdrawal of the guiding catheter to determine left ventricular inflow changes. Invasive left atrial pressure measurements were obtained during withdrawal of the guiding catheter. Regurgitant volume was reduced from 86±21 ml/beat before intervention to 43±22 ml/beat after intervention. The new ASD had an area of 0.19 cm2, 44% of the area of the 22Fr guiding catheter. Considering the VTI across the septal defect of 72±26 cm/s, the left-to-right atrial shunt volume was calculated to be 14±6 ml/beat. The diastolic forward flow across the mitral valve was reduced by 13±6 ml/beat immediately after withdrawal of the MitraClip guiding catheter. Mean left atrial pressure was reduced from 17±8 mm Hg with the guiding catheter still in the left atrium to 15±8 mm Hg after withdrawal of the guiding catheter. In conclusion, the creation of a new ASD as consequence of the large-diameter MitraClip guiding catheter results in volume and pressure relief of the left atrium. This contributes to the immediate hemodynamic changes implemented by the MitraClip procedure. PMID:24513477

Hoffmann, Rainer; Altiok, Ertunc; Reith, Sebastian; Brehmer, Kathrin; Almalla, Mohammad

2014-04-01

283

Right Pulmonary Artery Distensibility Index (RPAD Index). A field study of an echocardiographic method to detect early development of pulmonary hypertension and its severity even in the absence of regurgitant jets for Doppler evaluation in heartworm-infected dogs.  

PubMed

Despite the term "heartworm disease" Dirofilaria immitis infection in dogs should be considered a pulmonary arterial disease that might only involve the right heart structures in its late stage. Chronic infection by adult heartworms in dogs results in proliferative endoarteritis leading to progressively increasing pulmonary artery pressure due to reduced elasticity. Elasticity allows the pulmonary arteries to stretch in response to each pulse and helps maintain a relatively constant pressure in the arteries despite the pulsating nature of the blood flow. Pulmonary artery distensibility for both acute and chronic pulmonary hypertension has been investigated in humans using MRI and has been correlated with the severity of hypertension and its outcome and treatment response. The aim of the present study was to investigate whether echocardiographic measurement of the percentage change in diameter of the right pulmonary artery in systole and diastole (distensibility) may be of value in assessing the presence and severity of pulmonary hypertension in heartworm-infected dogs. The Right Pulmonary Artery Distensibility Index (RPAD Index) (which is calculated as the difference in diameter of the right pulmonary artery in systole and diastole) was calculated in healthy and naturally infected heartworm-positive dogs. The right pulmonary artery was chosen because it is usually affected earlier and to a greater degree. Data were obtained from healthy heartworm-free dogs without any clinical, radiographic, or echocardiographic signs of pulmonary hypertension; naturally infected heartworm-positive dogs in different stages of the disease in which pulmonary pressure could be measured by Doppler echocardiography (using tricuspid and or pulmonary regurgitation velocity and pressure gradient); and naturally infected heartworm-positive dogs in different stages of the disease (with or without tricuspid and or pulmonary regurgitation) in which the pulmonary pressure was measured invasively and noninvasively if possible. Results of these evaluations indicated that RPAD Index is a valuable method for early detection of the presence and severity of pulmonary hypertension in heartworm-infected dogs even in the absence of regurgitant jets for Doppler evaluation and that there is a strong correlation between the RPAD Index and the level of pulmonary hypertension. PMID:25218885

Venco, Luigi; Mihaylova, Liliya; Boon, June A

2014-11-15

284

Melody® Valve-in-Ring Procedure for Mitral Valve Replacement: Feasibility in Four Annuloplasty Types  

PubMed Central

Background The recurrence of regurgitation following surgical mitral valve (MV) repair remains a significant clinical problem. Mitral annuloplasty rings are commonly used in MV repair procedures. The purpose of this study was to demonstrate the feasibility of transvenous valve-in-ring (VIR) implantation using the Melody® valve, which is a valved-stent designed for percutaneous pulmonary valve replacement, and 4 distinct types of annuloplasty ring (AR) in an ovine model. Methods Ten sheep underwent surgical MV annuloplasty ring placement (N=10: CE-Physio [N=5]; partial ring [N=3]; flexible ring [N=1]; saddle ring [N=1]). All animals underwent cardiac catheterization, hemodynamic assessment, and Melody ViR implantation via a trans-femoral venous, trans-atrial septal approach, 1 week following surgery. Follow-up hemodynamic, angiographic, and echocardiographic data were recorded. Results Melody ViR implantation was technically successful in all but one animal. In this animal a 26 mm partial AR proved too large for secure anchoring of the Melody valve. In the remaining 9 animals, fluoroscopy showed the Melody devices securely positioned within the annuloplasty rings. Echocardiography revealed no perivalvular leak, and angiography revealed no left ventricular (LV) outflow tract obstruction, vigorous LV function, and no aortic valve insufficiency. The median procedure time was 55.5 (range 45–78) minutes. Conclusions This study demonstrates the feasibility of a purely percutaneous approach to MV replacement in patients with preexisting annuloplasty rings, regardless of ring type. This novel approach may be of particular benefit to patients with failed repair of ischemic MR, and in pediatric patients with complex structural heart disease. PMID:22364973

Kondo, Norihiro; Shuto, Takashi; McGarvey, Jeremy R.; Koomalsingh, Kevin J.; Takebe, Manabu; Gomran, Robert C.; Gorman, Joseph H.; Gillespie, Matthew J.

2012-01-01

285

Concomitant mitral valve surgery with aortic valve replacement: a 21-year experience with a single mechanical prosthesis  

Microsoft Academic Search

BACKGROUND: Long-term survival for combined aortic and mitral valve replacement appears to be determined by the mitral valve prosthesis from our previous studies. This 21-year retrospective study assess long-term outcome and durability of aortic valve replacement (AVR) with either concomitant mitral valve replacement (MVR) or mitral valve repair (MVrep). We consider only a single mechanical prosthesis. METHODS: Three hundred and

Niall C McGonigle; J Mark Jones; Pushpinder Sidhu; Simon W MacGowan

2007-01-01

286

Impact of Vascular Adaptation to Chronic Aortic Regurgitation on Left Ventricular Performance  

Microsoft Academic Search

Background—This investigation was designed to test the hypothesis that vascular adaptation occurs in patients with chronic aortic regurgitation to maintain left ventricular (LV) performance. Methods and Results—Forty-five patients with chronic aortic regurgitation (mean age 50 614 years) were studied using a micromanometer LV catheter to obtain LV pressures and radionuclide ventriculography to obtain LV volumes during multiple loading conditions and

William H. Devlin; Janet Petrusha; Kerri Briesmiester; Daniel Montgomery; Mark R. Starling

287

A novel finite element-based patient-specific mitral valve repair: virtual ring annuloplasty.  

PubMed

Alterations of normal mitral valve (MV) function lead to mitral insufficiency, i.e., mitral regurgitation (MR). Mitral repair is the most popular and most efficient surgical intervention for MR treatment. An annuloplasty ring is implanted following complex reconstructive MV repairs to prevent potential reoccurrence of MR. We have developed a novel finite element (FE)-based simulation protocol to perform patient-specific virtual ring annuloplasty following the standard clinical guideline procedure. A virtual MV was created using 3D echocardiographic data in a patient with mitral annular dilation. Proper type and size of the ring were determined in consideration of the MV apparatus geometry. The ring was positioned over the patient MV model and annuloplasty was simulated. Dynamic simulation of MV function across the complete cardiac cycle was performed. Virtual patient-specific annuloplasty simulation well demonstrated morphologic information of the MV apparatus before and after ring implantation. Dynamic simulation of MV function following ring annuloplasty demonstrated markedly reduced stress distribution across the MV leaflets and annulus as well as restored leaflet coaptation compared to pre-annuloplasty. This novel FE-based patient-specific MV repair simulation technique provides quantitative information of functional improvement following ring annuloplasty. Virtual MV repair strategy may effectively evaluate and predict interventional treatment for MV pathology. PMID:24211915

Choi, Ahnryul; Rim, Yonghoon; Mun, Jeffrey S; Kim, Hyunggun

2014-01-01

288

A novel finite element-based patient-specific mitral valve repair: virtual ring annuloplasty  

PubMed Central

Alterations of normal mitral valve (MV) function lead to mitral insufficiency, i.e., mitral regurgitation (MR). Mitral repair is the most popular and most efficient surgical intervention for MR treatment. An annuloplasty ring is implanted following complex reconstructive MV repairs to prevent potential reoccurrence of MR. We have developed a novel finite element (FE)-based simulation protocol to perform patient-specific virtual ring annuloplasty following the standard clinical guideline procedure. A virtual MV was created using 3D echocardiographic data in a patient with mitral annular dilation. Proper type and size of the ring were determined in consideration of the MV apparatus geometry. The ring was positioned over the patient MV model and annuloplasty was simulated. Dynamic simulation of MV function across the complete cardiac cycle was performed. Virtual patient-specific annuloplasty simulation well demonstrated morphologic information of the MV apparatus before and after ring implantation. Dynamic simulation of MV function following ring annuloplasty demonstrated markedly reduced stress distribution across the MV leaflets and annulus as well as restored leaflet coaptation compared to pre-annuloplasty. This novel FE-based patient-specific MV repair simulation technique provides quantitative information of functional improvement following ring annuloplasty. Virtual MV repair strategy may effectively evaluate and predict interventional treatment for MV pathology. PMID:24211915

Choi, Ahnryul; Rim, Yonghoon; Mun, Jeffrey S.; Kim, Hyunggun

2014-01-01

289

Inversion of the radionuclide regurgitant index in right-sided valvular regurgitation  

Microsoft Academic Search

Estimation of left-sided valvular insufficiency has been obtained using the ratio of left- to right-ventricular stroke counts, i.e., the regurgitant index. The present study was designed to evaluate the usefulness of the regurgitant index in identifying patients with isolated right-sided valvular insufficiency. We identified 12 patients with tricuspid or pulmonic regurgitation by at least two of the following criteria: (1)

Henry Novack; Josef Machac; Steven F. Horowitz

1985-01-01

290

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 ...

291

Mitral Valve Replacement in a 14-Month-Old Child  

PubMed Central

In a 14-month-old child with severe congenital mitral insufficiency, the mitral valve was replaced with a Starr-Edwards valve. This resulted in dramatic improvement and the child continues to thrive one year after surgery. The authors conclude that valve replacement should be considered in a child of any age if other methods of valve repair cannot be relied upon to produce a good result. ImagesFig. 1Fig. 2Fig. 3 PMID:5928527

Trusler, G. A.; MacGregor, D. C.; Keith, J. D.

1966-01-01

292

Abnormal mitral valve anatomy in d-transposition of the great arteries: anatomic characterization and surgical outcomes.  

PubMed

Mitral valve anomalies can occur with S,D,D-transposition of the great arteries (d-TGA). Their influence on surgical technique and outcome after an arterial switch operation (ASO) has not been well described. Patients with d-TGA who underwent ASO from February 1990 to January 2011 were identified. Echocardiograms, operative reports, hospital course, and latest follow-up evaluation were reviewed. A total of 218 infants underwent ASO at a median age of 15.8 days. Survival was 95 % during a mean follow-up period of 60 months. Nine patients (4 %) were found to have similar mitral valve anomalies including anterior malalignment conoventricular septal defect, anterior displacement of the mitral valve toward the left ventricular outflow tract (LVOT), malpositioning of the posteromedial papillary muscle, unusual rotation of the mitral valve leaflets orienting the commissure toward the anterior ventricular septum, and redundant mitral valve tissue extending into the LVOT. Coarctation was more frequent in this subgroup (33 vs. 10 %; p = 0.05). Preoperative echocardiography consistently indicated suspicion of a cleft mitral valve with chordal attachments to the ventricular septum causing potential LVOT obstruction. Operative inspection did not identify a cleft or anomalous attachments in any patient, and no valvuloplasty or chordal manipulation was performed. The average hospital length of stay were similar (30.7 vs. 25.3 days; p = 0.54). One patient died late due to progressive LVOT obstruction, and one required heart transplantation. No patient had significant mitral valve regurgitation. We conclude that mitral valve anomalies associated with d-TGA are rare but present with consistent anatomic features and higher risk of coarctation. Unusual mitral valve apparatus positioning and chordal redundancy can suggest the need for valvuloplasty and chordal resection preoperatively, but this is rarely needed. PMID:22660521

Camarda, Joseph A; Harris, Susan E; Hambrook, John; Frommelt, Michele A; Tweddell, James S; Frommelt, Peter C

2013-01-01

293

Mechanics of the mitral valve: a critical review, an in vivo parameter identification, and the effect of prestrain.  

PubMed

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 119,021 kPa at 0 % prestrain via 36 kPa at 30 % prestrain to 9 kPa 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; Kuhl, Ellen

2013-10-01

294

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

295

Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair  

Microsoft Academic Search

ObjectiveAcute mitral stenosis (MS) following mitral valve (MV) repair is a rare but severe complication. We hypothesize that intraoperative echocardiography can be utilized to diagnose iatrogenic MS immediately after MV repair.MethodsThe medical records of 552 consecutive patients undergoing MV repair at a single institution were reviewed. Post-cardiopulmonary bypass peak and mean transmitral pressure gradients (TMPG), and pressure half time (PHT)

Ann K. Riegel; Raila Busch; Scott Segal; John A. Fox; Holger K. Eltzschig; Stanton K. Shernan

2011-01-01

296

Mitral valve replacement with the St. Jude medical prosthesis: a 15-year follow-up  

Microsoft Academic Search

Background. A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement.Methods. From January 1979 to December 1989, 870 patients (54% women, 46% men; mean age, 55.8 ± 6.2 years) underwent mitral valve replacement with the St. Jude Medical prosthesis. Of these operations 616 were isolated mitral valve replacements and 254 were double valve replacements.

Jean-Paul Remadi; Philippe Bizouarn; Olivier Baron; Oussama Al Habash; Phillipe Despins; Jean-Luc Michaud; Daniel Duveau

1998-01-01

297

Homograft replacement of the mitral valve  

Microsoft Academic Search

Because of experience gained in reconstructive mitral valve surgery, we have reevaluated the implantation of cryopreserved homografts in the mitral position. Forty-three patients, aged 11 to 69 years (mean 34 years), underwent mitral valve replacement with cryopreserved mitral homografts. The indications for the procedure were acute endocarditis (n = 14), rheumatic stenosis (n = 26), systemic lupus endocarditis (n =

Christophe Acar; Michael Tolan; Alain Berrebi; Jullien Gaer; Roger Gouezo; Thierry Marchix; Jean Gerota; Sylvain Chauvaud; Jean-Noel Fabiani; Alain Deloche; Alain Carpentier

1996-01-01

298

Morphological analysis of systolic anterior motion after mitral valve repair  

PubMed Central

OBJECTIVES The systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures. METHODS Components of mitral valves were measured before and after operative procedures by transoesophageal echocardiography in 179 patients who underwent mitral valve repair. Comparisons were made between 15 patients with SAM (SAM group) and 164 patients without SAM (non-SAM group). RESULTS Morphological analysis in all the studied patients revealed that operative procedures shifted the coaptation point towards the left ventricular outflow tract by 6.9 mm and increased the extra portion of anterior leaflet that extended beyond the coaptation point by 5.4 mm. These changes were enhanced in the SAM group. Intergroup comparison revealed that there were no differences in the preoperative mitral valve morphologies between the two groups. After operative procedures, however, the SAM group showed smaller annular diameter and smaller coapted anterior/posterior length ratio compared with the non-SAM group. CONCLUSIONS The results of this study show that operative procedures might modify the morphology of mitral valves susceptible to developing SAM. Postoperative smaller annular diameter and anterior shift of coaptation point were considered to contribute to the development of SAM. PMID:22586070

Manabe, Susumu; Kasegawa, Hitoshi; Fukui, Toshihiro; Tabata, Minoru; Shimokawa, Tomoki; Takanashi, Shuichiro

2012-01-01

299

Study of Mitral Valve in Human Cadaveric Hearts  

PubMed Central

Objectives: The mitral valve is a complex structure that is altered by disease states. The classical image of the mitral valve is a bicuspid valve with two leaflets and two papillary muscles. The reason for the present study is to study the morphology and morphometry of the mitral valve. Materials and Methods: This study was carried out on 116 human cadaveric hearts. Hearts were opened along the left border through the atrioventricular valve. The diameter and circumference of the annulus was measured and the number of valve leaflets was observed. Results: The mean annular diameter was 2.22 cm. The mean circumference of mitral valve annulus was 9.12 cm. The standard description of the mitral valve is bicuspid. In the present study, we found the number of cusps to be variable, from monocuspid to hexacuspid and classified them accordingly. Conclusions: The mitral valve is not always a bicuspid valve. The number of cusps varies greatly. An increase in the number of the cusp and their improper approximation most likely causes various valvular disorders. PMID:23439693

Gunnal, S. A.; Farooqui, M. S.; Wabale, R. N.

2012-01-01

300

Percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population  

PubMed Central

Background. Percutaneous mitral valve (MV) repair using the edge-to-edge clip technique might be an alternative for patients with significant mitral regurgitation (MR) and an unacceptably high risk for operative repair or replacement. We report the short-term safety and efficacy of this new technique in a high-risk population. Methods. All consecutive high-risk patients who underwent percutaneous MV repair with the Mitraclip® between January and August 2009 were included. All complications related to the procedure were reported. Transthoracic echocardiography for MR grading and right ventricular systolic pressure (RVSP) measurement were performed before, and at three and 30 days after the procedure. Differences in NYHA functional class and quality of life (QoL) index were reported. Results. Nine patients were enrolled (78% male, age 75.9±9.0 years, logistic EuroSCORE 33.8±9.0%). One patient developed inguinal bleeding. In one patient partial clip detachment occurred, a second clip was placed successfully. The MR grade before repair was ?3 in 100%, one month after repair a reduction in MR grade to ?2 was present in 78% (p=0.001). RVSP decreased from 43.9±12.1 to 31.6±11.7 mmHg (p=0.009), NYHA functional class improved from median 3 (range 3 to 4) to 2 (range 1 to 4) (p=0.04), and QoL index improved from 62.9±16.3 to 49.9±30.7 (p=0.12). Conclusion. In high-risk patients, transcatheter MV repair seems to be safe and a reduction in MR can be achieved in most patients, resulting in a short-term improvement of functional capacity and QoL. (Neth Heart J 2010;18:437–43.) PMID:20862239

Van den Branden, B.J.L.; Post, M.C.; Swaans, M.J.; Rensing, B.J.W.M.; Eefting, F.D.; Plokker, H.W.M.; Jaarsma, W.; Van der Heyden, J.A.S.

2010-01-01

301

Semi-Automated Mitral Valve Morphometry and Computational Stress Analysis Using 3D Ultrasound  

PubMed Central

In vivo human mitral valves (MV) were imaged using real-time 3D transesophageal echocardiography (rt-3DTEE), and volumetric images of the MV at mid-systole were analyzed by user-initialized segmentation and 3D deformable modeling with continuous medial representation, a compact representation of shape. The resulting MV models were loaded with physiologic pressures using finite element analysis (FEA). We present the regional leaflet stress distributions predicted in normal and diseased (regurgitant) MVs. Rt-3DTEE, semi-automated leaflet segmentation, 3D deformable modeling, and FEA modeling of the in vivo human MV is tenable and useful for evaluation of MV pathology. PMID:22281408

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

2012-01-01

302

Ten-year clinical evaluation of isolated mitral valve and double-valve replacement with the Starr-Edwards prostheses.  

PubMed

From 1974 through 1983, 689 hospital survivors of Starr-Edwards (SE) valve replacement were identified; 279 (40.4%) patients with complete follow-up had an isolated mitral valve (SE model 6120 or 6400) replacement: 60.6% of these patients were women, 33.4% were in sinus rhythm, 32.3% had predominantly mitral stenosis, and 23.6% had predominantly regurgitation. Forty-six (6.7%) patients had mitral and aortic valve (SE model 1260 or 2400) replacement, 60.9% were women, and 13% were in sinus rhythm. To determine the long-term outcome of these SE valve prostheses, 325 (97.8%) patients were observed for up to 10 years. Total 10-year mortality was 40 patients (2.54% patients/yr) in the mitral group, of which 26 deaths (9.3%) were cardiac in origin; 8 deaths (2.8%) were directly valve related. Eight patients died (3.47% patients/yr) in the double-valve group, of which 5 deaths (10.8%) had a cardiac cause; 2 deaths (4.3%) were directly valve related. Primary valve failure was never proved. Actuarial estimates of survival at 10 years were 82 +/- 2.6% for the mitral valve group and 81 +/- 6% for the double-valve group. Actuarial estimates of freedom from valve-related morbidity were 87 +/- 2% for the mitral valve group and 59 +/- 7% for the double-valve group. Actuarial estimates of freedom from thromboembolism were 93 +/- 2% for the mitral valve group and 70 +/- 7% for the double-valve group. This prosthesis-based assessment has shown satisfactory long-term performance characteristics of the SE mitral models 6120 and 6400 without any recorded episodes of mechanical valve dysfunctions. PMID:3566382

Fessatidis, I; Hackett, D; Oakley, C M; Sapsford, R N; Bentall, H H

1987-04-01

303

Giant Pulmonary Artery Aneurysm in a Patient with Rheumatic Mitral Stenosis  

PubMed Central

Pulmonary artery (PA) aneurysm is a rare condition, frequently associated with pulmonary hypertension. However, the evolution and treatment of this pathology is still not clear. We report a case of a 45-year-old female patient with giant PA aneurysm associated with rheumatic mitral stenosis and severe pulmonary arterial hypertension. The patient had undergone balloon mitral valvotomy around 7 years back; aneurysm was first identified 3 years back during routine follow-up. The PA aneurysm size, however, had remained almost unchanged with associated severe pulmonary regurgitation. Surgical correction was advised but denied by the patient. To our knowledge, this is the first case report of such a large PA aneurysm in association with rheumatic heart disease. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was advised in order to prevent the future complications.

Singh, Vikas; Khare, Rashi; Chandra, Sharad; Dwivedi, Sudhanshu Kumar

2014-01-01

304

[Mitral valve replacement for congenital parachute mitral valve].  

PubMed

A one-year-old boy was admitted with refractory congestive biventricular heart failure for medical treatment. On echocardiogram and cardiac catheterization revealed severe mitral stenosis from parachute deformity with pulmonary hypertension. During the operation, a single round orifice of 7 mm in diameter was detected in the mitral valve and adhered chordae were attached to a large single papillary muscle which was located at the posteromedial portion of the left ventricle. An isolated muscle band which was not attached to the mitral valve was observed at the anterolateral wall of the left ventricle. The mitral valve was replaced with 16 mm Carbo-Medicus prosthesis. Postoperative catheterization revealed residual pulmonary hypertension which was responsive to Imidarine infusion. He was discharged from the hospital without any sequelae, and has been on regimen including anticoaglant and vasodilator. PMID:7561327

Sasahashi, N; Ando, F; Okamoto, F; Yamanaka, K; Hanada, T; Makino, S

1995-07-01

305

Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: New insights from anatomic study  

Microsoft Academic Search

Objective: The purpose of this study was to analyze the behavior of the mitral valve ring and the left ventricle in dilated cardiomyopathy.Methods: We analyzed 68 fixed adult human hearts, divided into 48 hearts with dilated cardiomyopathy of ischemic or idiopathic origin and 20 hearts free of pathologic heart conditions. Digital images of the mitral ring perimeter, attachment of the

Alexandre Ciappina Hueb; Fabio Biscegli Jatene; Luiz Felipe Pinho Moreira; Pablo Maria Pomerantzeff; Elias Kallás; Sérgio Almeida de Oliveira

2002-01-01

306

Risk of Reoperative Valve Replacement for Failed Mitral and Aortic Bioprostheses  

Microsoft Academic Search

Background. One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure.Methods. Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed.Results. Reoperations were for

Cary W. Akins; Mortimer J. Buckley; Willard M. Daggett; Alan D. Hilgenberg; Gus J. Vlahakes; David F. Torchiana; Joren C. Madsen

1998-01-01

307

Reoperation for Failure of Mitral Valve Repair in Degenerative Disease: A Single-Center Experience  

Microsoft Academic Search

Background. The purpose of this study was to report our 19-year experience in redo surgery for failure of mitral valve repair (MVRep) in degenerative disease. Methods. From 1987 to 2006, 43 consecutive patients (32 males) underwent either redo MVRep (n 21) or redo mitral valve replacement (n 22) for failure of MVRep. Age ranged from 10 to 78 years (median,

Rachid Zegdi; Ghassan Sleilaty; Christian Latrémouille; Alain Berrebi; Alain Carpentier; Alain Deloche; Jean-Noël Fabiani

2008-01-01

308

Minimally invasive mitral valve surgery: “The Leipzig experience”  

PubMed Central

Background Minimally invasive mitral valve surgery has become a routine procedure at our institution. The present study analyzed the early and long-term outcomes of patients undergoing minimally invasive mitral valve surgery over the last decade, with special focus on mitral valve repairs (MVRp). Methods The preoperative variables, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were prospectively collected in our database from May 1999 to December 2010. The survival and freedom from reoperation were evaluated with life tables and Kaplan-Meier analyses. Results A total of 3,438 patients underwent minimally invasive mitral valve surgery, of which 2,829 were MVRps and 609 were mitral valve replacements (MVR). Forty-five patients (1.6%) required MVR due to failure of repair. The mean age was 60.3±13 years. More than a third of patients underwent concomitant procedures like tricuspid valve surgery, atrial septal defect (ASD) closure and cryoablation. The rate of conversion to sternotomy was less than 1.4%. The 30-day mortality was 0.8%. The 5- and 10-year survival of all patients (MVR and MVRp) undergoing minimally invasive mitral valve surgery was 85.7±0.6% and 71.5±1.2%, respectively. For MVRp, the survival was 87.0±0.7% and 74.2±1.4% at 5 and 10 years, respectively. Freedom from reoperation was 96.6±0.4% and 92.9±0.9% at 5 and 10 years, respectively. Conclusions Minimally invasive MVRp can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable. PMID:24349976

Seeburger, Joerg; Pfannmueller, Bettina; Garbade, Jens; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich W.

2013-01-01

309

Edge-to-edge mitral repair: gradients and three-dimensional annular dynamics in vivo during inotropic stimulation  

Microsoft Academic Search

Objective: The edge-to-edge (Alfieri) mitral repair technique appears to be clinically promising, but the potential for functional mitral stenosis, especially with exercise, remains a concern. We used the myocardial marker method combined with Doppler echocardiography to evaluate mitral annular (MA) three-dimensional (3-D) dynamics and transvalvular gradients after leaflet approximation before and during dobutamine infusion. Methods: Eight adult sheep underwent implantation

Tomasz A Timek; Sten L Nielsen; David Liang; David T Lai; Paul Dagum; George T Daughters; Neil B Ingels; D. Craig Miller

2001-01-01

310

Edge-to-edge mitral repair: gradients and three-dimensional annular dynamics in vivo during inotropic stimulationq  

Microsoft Academic Search

Objective: The edge-to-edge (Alfieri) mitral repair technique appears to be clinically promising, but the potential for functional mitral stenosis, especially with exercise, remains a concern. We used the myocardial marker method combined with Doppler echocardiography to evaluate mitral annular (MA) three-dimensional (3-D) dynamics and transvalvular gradients after leaflet approximation before and during dobutamine infusion. Methods: Eight adult sheep underwent implantation

Tomasz A. Timek; Sten L. Nielsen; David Liang; David T. Lai; Paul Daguma; George T. Daughters; Neil B. Ingels Jr; D. Craig Miller

311

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. D.; Packard, Jane M.; Wolf, Paul C.

2000-01-01

312

[Usefulness of magnetic resonance imaging for managing patients with prosthetic carbon valve in the mitral position].  

PubMed

The safety, findings and clinical usefulness of magnetic resonance (MR) imaging were assessed in patients with a prosthetic carbon valve in the mitral position. In vitro deflection, heating and image distortion due to the magnetic field of a 1.5 tesla MR machine were examined in three carbon valves (CarboMedics, St. Jude Medical and Björk-Shiley valves). In vivo MR imaging of the left ventricular horizontal long-axis, vertical long-axis and short-axis views was performed by electrocardiographically synchronized spin echo and field (gradient) echo techniques in eight patients with prosthetic mitral carbon valves, consisting of six CarboMedics valves, one St. Jude Medical valve and one Björk-Shiley valve. No deflection and significant heating was seen in all three valves in vitro. Although little image distortion was shown in the CarboMedics and St. Jude Medical valves, a small distortion toward the frequency encoded direction was seen in the Björk-Shiley valve but caused no difficulty in assessing the surrounding images. Four of the eight patients had normal sinus rhythm and the other four had atrial fibrillation. The prosthetic valves were depicted as signal voids in the images taken by both spin echo and field echo techniques in vivo. Clear structural information with little image distortion of the adjacent tissues of the prosthetic valves were obtained in all patients, although the image of the Björk-Shiley valve which contained stainless steel in the frame had a slightly stronger distortion than those of the CarboMedics and St. Jude Medical valves which contained titanium. The stainless wire suture material used to close the sternal incision was depicted as a signal void, and the areas of the signal loss were larger in the images taken by the field echo technique than those by the spin echo technique. The images taken by the spin echo technique in patients with atrial fibrillation had reduced quality due to the irregularity of repetition time. Cine MR imaging by the field echo technique showed physiological mitral regurgitant jets as signal loss within the flowing blood, which appeared as high signal intensity, bidirectionally in the bileaflet mechanical valve and unidirectionally in the monoleaflet mechanical valve. An abnormal cavity was seen behind the basal left ventricular myocardium in one patient with a CarboMedics valve. The wall of the abnormal cavity was disrupted abruptly and the rest of the wall consisted of pericardium and adjacent tissue in the image taken by the spin echo technique. The image taken by the field echo technique showed an abnormal jet flow from the basal part of the left ventricular cavity into the abnormal cavity, which was compatible with left ventricular pseudoaneurysm. Two-dimensional echocardiography and Doppler color flow mapping disclosed the abnormal cavity and the abnormal flow inside, but failed to show the connection between the left ventricle and the cavity due to reverberation of the ultrasound signal by the prosthetic valve. These findings suggest that MR imaging is a safe and promising method to assess the complications and valvular function in patients with a prosthetic carbon valve in the mitral position. PMID:9395956

Koito, H; Imai, Y; Suzuki, J; Ohkubo, N; Nakamura, C; Takahashi, H; Iwasaka, T; Inada, M

1997-11-01

313

The pathological anatomy of surgically reconstructable or prosthetically correctable congenital valvular malformation of the mitral region.  

PubMed

The special pathology of reconstructable or only prosthetically correctable congenital malformations of the mitral valve is described on the basis of the following examples taken from our own operative and autopsy material of the last 5 years: 1. Congenital isolated mitral stenosis in female twins (7 month old infant and 33 month old child). 2. Congenital isolated mitral insufficiency in a 7 1/2 year old boy. 3. Combined mixed mitral valve malformations with a parachute valve-like mitral valve anomaly, combined with hypoplasia of the ascending and descending aortas, in a 6 1/2 year old girl. 4. Congenital mitral insufficiency with a parachute mitral valve, combined with supravalvular aortic stenosis and multiple peripheral stenoses of the pulmonary arteries in a 13 1/4 year old boy. 5. Insufficiency of the mitrally inverted tricuspid valve with so-called corrected transposition of the great vessels in a 6 year old boy and with Ebstein's anomaly in a 2 1/2 year old boy. 6. A second mitral ostium in the aortic mitral leaflet with a partial atrioventricular canal in a 6 3/4 year old girl with Ellis-van Creveld syndrome. 7. Bland-White-Garland syndrome with relative mitral insufficiency in a 5 month old and a 4 month old boy. Despite the recurrence of similar and comparable findings, each of our cases of congenital or early acquired noninfectious mitral valve malformation was formally different. n his was also true for the cases of congenital isolated mitral stenosis in twins. Therefore, surgical correction requires a unique procedure for each case. It is possible to reliably infer the degree of malfunction of the atrioventricular valve in a mitral position from the special pathology only by considering the clinical data. On the other hand, a detailed evaluation of congenital mitral valve malformations is possible only through direct inspection--either by the surgeon or through an autopsy--despite modern cardiodiagnostic methods. Typical secondary findings are also discussed--for instance, endocardial fibrosis of the left atrium and the configuration of the heart. The anatomical prerequisites for surgical reconstruction or replacement of the valve with a prosthesis are mentioned. PMID:808894

Schwarze, E W; Bernhard, A

1975-07-17

314

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

315

Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease.  

PubMed

The gold standard for the surgical treatment of prolapse of the posterior leaflet of the mitral valve (MV) for degenerative myxomatous disease has been represented by the quadrangular resection of the leaflet, according to the Carpentier technique. Since 2006 we performed a triangular resection of the prolapsing leaflet in 20 patients with myxomatous mitral regurgitation (MR). Seventeen patients (85%) underwent the triangular resection of P2; one patient (5%) had a triple scallops triangular resection (P1, P2, P3) and two (10%) a double scallops (P2, P3) resection. In this study, we report the immediate and mid-term clinical and echocardiographic results of a cohort of 20 patients, who underwent this technique. Thirty-day mortality was 0. Acute renal failure occurred in three patients (15%) and they resolved with conservative management. One patient (5%) required re-exploration for bleeding. At the mean follow-up of 13.1+/-4.2 months survival was 95%; one patient died of lymphoma during the follow-up time. All the cases were in New York Heart Association (NYHA) class I. Nineteen survivors underwent transthoracic echocardiography (TTE) (5), or transesophageal echocardiography (TEE) (13), performed by two skilled cardiologists. All patients showed no or trivial MV regurgitation. We believe that triangular resection of posterior MV leaflet (PMVL) provides excellent mid-term results providing the surgeon with a reliable and reproducible surgical option for myxomatous degenerative MV regurgitation. PMID:19414490

Chiappini, Bruno; Gregorini, Renato; De Remigis, Franco; Petrella, Licia; Villani, Carmine; Di Pietrantonio, Fabrizio; Pavicevic, Srdan; Mazzola, Alessandro

2009-08-01

316

[Evaluation of regurgitant fraction of aortic regurgitation by means of pulsed Doppler echocardiography as compared with cine angiography].  

PubMed

The regurgitant fraction (RF) of aortic regurgitation (AR) was calculated using pulsed Doppler echocardiography (PDE), and the results were compared with those of aortography. Two-dimensional echocardiography (2DE), PDE and cine angiography were performed for 33 patients, including nine in whom aortic regurgitation (AR) was ruled out by contrast 2DE and 24 in whom AR was confirmed by aortography (AOG). The latter were subdivided into six of Sellers' degree I, seven of degree II, eight of degree III and three of degree IV. Sampling was obtained from the main pulmonary artery, the left ventricular outflow tract, and the mean circulation velocity (f1) was calculated from the power spectrum wave pattern obtained from each source. With the following formula, Qp (pulmonary arterial blood flow), Qs (left ventricular ejection blood flow) and RF [= (Qs--Qp)/Qs] were calculated, and compared with the findings obtained from invasive methods: (formula; see text) (L = vascular diameter; theta = angle of incidence; C = velocity of sound; fo = oscillating frequency; ET = ejection time; HR = heart rate) A correlation of r = 0.81 was found between Qp calculated with PDE and right cardiac output (CO) by the thermodilution method. A correlation of r = 0.66 was observed between Qs and left ventricular ejection volume obtained from left ventriculography using Dodge's method. Comparison of RF using Sellers' classification with AOG revealed that the RF in the group uncomplicated with AR was 0.14 +/- 0.10, and Sellers' degrees I, 0.27 +/- 0.08; II, 0.36 +/- 0.04; III, 0.53 +/- 0.05; and IV, 0.64 +/- 0.06, indicating consistency with severity and RF.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4067337

Morita, K; Suzuki, S; Sasaki, T; Miyazawa, S; Mizuno, A; Horiguchi, T; Kubouchi, Y; Arai, T

1985-03-01

317

[Problems in estimating the severity of aortic regurgitation by pulsed Doppler echocardiography: with special reference to its distribution pattern].  

PubMed

We categorized the findings of aortic regurgitation (AR) by aortography (AOG) into the following four types, and compared them with the corresponding findings obtained by pulsed Doppler echocardiography (PDE) in 30 patients, and assessed the ability of PDE to observe the distribution of an aortic regurgitant flow. Type 1: A wide regurgitant jet distributed within the entire left ventricle (5 cases). Type 2: A narrow regurgitant jet passing through the center of the left ventricular outflow tract (9 cases). Type 3: A regurgitant jet with the shift of its direction to the either side (10 cases). Type 4: A regurgitant jet which is localized below the aortic valve (6 cases). AOG findings in 40% of Type 1 cases, 78% of Type 2, 80% of Type 3 and 67% of Type 4 were well consistent with those of PDE (an average of 70%). Therefore, we could predict the distribution of AR by PDE, although a correlation between both methods was not complete. The reasons of the inconsistence of these two methods were discussed. PDE is an possible method for evaluating the severity of AR. PMID:6520420

Miyazawa, S; Suzuki, S; Sasaki, T; Nakamura, Y; Morita, K; Mizuno, A; Arai, T

1984-06-01

318

The effect of patient-specific annular motion on dynamic simulation of mitral valve function.  

PubMed

Most surgical procedures for patients with mitral regurgitation (MR) focus on optimization of annular dimension and shape utilizing ring annuloplasty to restore normal annular geometry, increase leaflet coaptation, and reduce regurgitation. Computational studies may provide insight on the effect of annular motion on mitral valve (MV) function through the incorporation of patient-specific MV apparatus geometry from clinical imaging modalities such as echocardiography. In the present study, we have developed a novel algorithm for modeling patient-specific annular motion across the cardiac cycle to further improve our virtual MV modeling and simulation strategy. The MV apparatus including the leaflets, annulus, and location of papillary muscle tips was identified using patient 3D echocardiography data at end diastole and peak systole and converted to virtual MV model. Dynamic annular motion was modeled by incorporating the ECG-gated time-varying scaled annular displacement across the cardiac cycle. We performed dynamic finite element (FE) simulation of two sets of patient data with respect to the presence of MR. Annular morphology, stress distribution across the leaflets and annulus, and contact stress distribution were determined to assess the effect of annular motion on MV function and leaflet coaptation. The effect of dynamic annular motion clearly demonstrated reduced regions with large stress values and provided an improved accuracy in determining the location of improper leaflet coaptation. This strategy has the potential to better quantitate the extent of pathologic MV and better evaluate functional restoration following MV repair. PMID:23433464

Rim, Yonghoon; McPherson, David D; Chandran, Krishnan B; Kim, Hyunggun

2013-04-01

319

The effect of patient-specific annular motion on dynamic simulation of mitral valve function  

PubMed Central

Most surgical procedures for patients with mitral regurgitation (MR) focus on optimization of annular dimension and shape utilizing ring annuloplasty to restore normal annular geometry, increase leaflet coaptation, and reduce regurgitation. Computational studies may provide insight on the effect of annular motion on mitral valve (MV) function through the incorporation of patient-specific MV apparatus geometry from clinical imaging modalities such as echocardiography. In the present study, we have developed a novel algorithm for modeling patient-specific annular motion across the cardiac cycle to further improve our virtual MV modeling and simulation strategy. The MV apparatus including the leaflets, annulus, and location of papillary muscle tips was identified using patient 3D echocardiography data at end diastole and peak systole and converted to virtual MV model. Dynamic annular motion was modeled by incorporating the ECG-gated time-varying scaled annular displacement across the cardiac cycle. We performed dynamic finite element (FE) simulation of two sets of patient data with respect to the presence of MR. Annular morphology, stress distribution across the leaflets and annulus, and contact stress distribution were determined to assess the effect of annular motion on MV function and leaflet coaptation. The effect of dynamic annular motion clearly demonstrated reduced regions with large stress values and provided an improved accuracy in determining the location of improper leaflet coaptation. This strategy has the potential to better quantitate the extent of pathologic MV and better evaluate functional restoration following MV repair. PMID:23433464

Rim, Yonghoon; McPherson, David D.; Chandran, Krishnan B.; Kim, Hyunggun

2013-01-01

320

Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography  

PubMed Central

Background This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR). Methods Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR), including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed. Results Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%), 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity). Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic accuracy). None of the 8 non-concordant 2D-TTE reports were in complete disagreement with SR. P2 scallop was always involved in posterior leaflet prolapse or flail and was described correctly by 2D-TTE in 68 out of 69 patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior leaflet was involved in 14 patients (18%); A2 segment was involved in all of those cases and was correctly detected by 2D-TTE in 13 (98,7% agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial para-commissural prolapse or flail had a lower prevalence (14% and 10% respectively), with 2D-TTE sensitivity respectively of 64% and 50%. Conclusions 2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2), which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases. PMID:20044927

2010-01-01

321

Use of barbed suture in robot-assisted mitral valvuloplasty.  

PubMed

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

Watanabe, Go; Ishikawa, Norihiko

2015-01-01

322

Mitral leaflet modeling: Importance of in vivo shape and material properties.  

PubMed

The anterior mitral leaflet (AML) is a thin membrane that withstands high left ventricular (LV) pressure pulses 100,000 times per day. The presence of contractile cells determines AML in vivo stiffness and complex geometry. Until recently, mitral valve finite element (FE) models have neglected both of these aspects. In this study we assess their effect on AML strains and stresses, hypothesizing that these will differ significantly from those reported in literature. Radiopaque markers were sewn on the LV, the mitral annulus, and AML in sheep hearts, and their four-dimensional coordinates obtained with biplane video fluoroscopy. Employing in vivo data from three representative hearts, AML FE models were created from the marker coordinates at the end of isovolumic relaxation assumed as the unloaded reference state. AML function was simulated backward through systole, applying the measured trans-mitral pressure on AML LV surface and marker displacements on AML boundaries. Simulated AML displacements and curvatures were consistent with in vivo measurements, confirming model accuracy. AML circumferential strains were mostly tensile (1-3%), despite being compressive (-1%) near the commissures. Radial strains were compressive in the belly (-1 to -0.2%), and tensile (2-8%) near the free edge. These results differ significantly from those of previous FE models. They reflect the synergy of high tissue stiffness, which limits tensile circumferential strains, and initial compound curvature, which forces LV pressure to compress AML radially. The obtained AML shape may play a role not only in preventing mitral regurgitation, but also in optimizing LV outflow fluid dynamics. PMID:21704316

Stevanella, Marco; Krishnamurthy, Gaurav; Votta, Emiliano; Swanson, Julia C; Redaelli, Alberto; Ingels, Neil B

2011-08-11

323

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

324

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

325

Impact of valvular regurgitation and ventricular dysfunction on long-term survival in patients with chest pain.  

PubMed

Doppler echocardiography is often used in evaluating patients with chest pain, but information on prognostic value of this testing and data to help guide selective use are limited. We prospectively studied 448 patients admitted from the emergency department for acute chest pain to assess the utility of qualitative echocardiographic data in predicting long-term survival and the incremental value of this information over routine clinical and electrocardiographic data. Doppler echocardiograms, recorded an average of 21 hours after presentation, were analyzed independently by 2 echocardiographers for global left and right ventricular function and valvular disease. Regional function was assessed by wall motion index. Data on long-term survival were collected with an average follow-up of 35.0 +/- 12.1 months. In univariate Cox regression analysis, left ventricular function and size, wall motion index, right ventricular function, and aortic, mitral, and tricuspid insufficiency were significant predictors of total and cardiovascular mortality. In multivariate analysis, moderate or severe left ventricular dysfunction (mortality rate ratio 3.2, 95% confidence intervals 1.8 to 5.8] and more than mild valvular regurgitation (mortality rate ratio 2.0, 95% confidence interval 1.1 to 3.6) were independent predictors of mortality in a model adjusted for clinical and electrocardiographic data. These factors were more common in patients aged >60 years, in those with prior acute myocardial infarction or angina, and in those with rales on physical examination. In the absence of these clinical characteristics, only 8 of 124 patients (7%) had moderate or severe left ventricular dysfunction or valvular regurgitation. In patients with moderate or severe regurgitation, a murmur was noted on the admission physical examination in 41 of 69 cases (59%). We conclude that echocardiographic evidence of moderate or severe left ventricular dysfunction or valvular regurgitation identifies a high-risk group for overall and cardiovascular mortality in patients with chest pain, and this evidence may not be detected clinically. PMID:9388096

Fleischmann, K E; Lee, R T; Come, P C; Goldman, L; Cook, E F; Weissman, M A; Johnson, P A; Lee, T H

1997-11-15

326

Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation  

PubMed Central

OBJECTIVE—To identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.?DESIGN—Cross sectional study.?PATIENTS—Left ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class ? 2a) but severe aortic regurgitation (jet area/left ventricular outflow tract area > 40%).?MAIN OUTCOME MEASURES—Left ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus).?RESULTS—In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no differences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%).?CONCLUSIONS—Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.???Keywords: aortic regurgitation; long axis function; tissue Doppler echocardiography; exercise echocardiography PMID:11119457

Vinereanu, D; Ionescu, A; Fraser, A

2001-01-01

327

Influence of Heart Rate on Doppler Aortic Regurgitant Velocity Curve: Clinical Role of Heart Rate Correction of Regurgitant Pressure Half-Time.  

PubMed

Because it was recently suggested that pressure half-time (PHT) of aortic regurgitant velocity curve is influenced by heart rate (HR), we retrospectively analyzed 76 patients with aortic regurgitation (AR) to determine whether PHT independently correlates with HR and whether HR correction of PHT can be clinically useful. PHT correlated significantly (P < 0.001) with color Doppler relative regurgitant jet height (r = -0.62), with angiographic grading (r = -0.65), and with HR (r = -0.54); such correlations were confirmed by multivariate analysis. Tachycardia influences aortic velocity curve more than bradycardia, and this effect is more evident in patients with milder regurgitation. Two methods of HR correction of PHT were tested: relative PHT (PHT/diastolic time x 100) and corrected PHT (PHT/ radicalRR): only corrected PHT was independently related to both relative regurgitant jet height and angiographic grading (P < 0.001). HR correction of PHT by corrected PHT was of limited clinical usefulness: in fact, in the entire study population, the accuracy of the usual cutoff (< 300 msec) in detecting relevant AR was not improved by corrected PHT. However, in patients with higher HR (>/= 85 beats/min), in whom the effect of HR on aortic velocity curve appeared to be greater, corrected PHT was superior to PHT because the cutoff value of < 300 msec showed a good specificity (100%), a moderate sensitivity (66%), and a good accuracy (80%) in detecting relevant AR. Corrected PHT can be useful to confirm AR severity when a short PHT is observed in tachycardic patients. PMID:11175115

Gozzelino, Giovanni; Molendi, Vittorio; Pizzetti, Fabrizio; Aletto, Carlo; Ivaldi, Mario

1999-01-01

328

Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation  

Microsoft Academic Search

Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation.Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality

Renzo Pessotto; Francesco Santini; Peppino Pugliese; Giuseppe Montalbano; Giovanni Battista Luciani; Giuseppe Faggian; Paolo Bertolini; Alessandro Mazzucco

1999-01-01

329

Surgical reconstruction of the mitral valve  

PubMed Central

From Cutler's first attempt to treat the mitral valve by inserting a tenotomy knife through the left ventricle, to Carpentier's introduction of several repair techniques and a functional classification for assessing mitral valve lesions, the history of mitral valve treatment is exciting. Mitral diseases may be degenerative, ischaemic, infective or rheumatic, with or without superimposed impaired left ventricular function and calcification. Understanding the underlying pathological features is also important in determining whether mitral valve repair is feasible, how the valve should be repaired and the prospect for long?term durability of the repair. Recent advances in minimally invasive mitral valve surgery are promising but more effort is needed to ensure timely mitral valve repair. PMID:16339815

Tuladhar, S M; Punjabi, P P

2006-01-01

330

Natural History of Mitral Valve Prolapse in Military Aircrew  

Microsoft Academic Search

Objective: Mitral valve prolapse (MVP) is a common cardiac abnormality whose natural history differs among various patient populations. High-performance flight is associated with exposure to varying acceleration forces and strenuous isometric physical activity. The effect of the military flying environment on the natural history and progression of MVP is poorly defined. Methods: We evaluated a cohort which included all military

Ori Wand; Alex Prokupetz; Alon Grossman; Amit Assa

2011-01-01

331

Novel Suture Device for Beating-Heart Mitral Leaflet Approximation  

Microsoft Academic Search

Background. This investigation evaluates the potential of using a novel suturing device to achieve mitral valve repair (Alfieri type) on a beating heart without cardiopul- monary bypass. Methods. Eight healthy adult sheep were anesthetized and the chest was opened via a left thoracotomy. The suture device was directly inserted into the appendage of the left atrium. Suction ports on the

Ottavio Alfieri; John A. Elefteriades; Robert J. Chapolini; Robert Steckel; William J. Allen; Scott W. Reed; Stefan Schreck

2010-01-01

332

Minimally-Invasive Fibrillating Mitral Valve Replacement for Patients with Advanced Cardiomyopathy: a Safe and Effective Approach to Treat a Complex Problem  

PubMed Central

Objective The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy is controversial. Mini-MVR may limit post-operative morbidity and mortality by minimizing recurrent MR. We hypothesized that minimally-invasive fibrillating mitral valve replacement (mini-MVR) with complete chordal sparing would offer a low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR. Methods and Results Between 1/06 - 8/09, 65 patients with LVEF ? 35% underwent mini-MVR. Demographic, echocardiographic, and clinical outcomes were analyzed. Results Operative mortality compared to Society for Thoracic Surgery (STS)-predicted mortality was 6.2 versus 6.6%; 5.6 versus 7.4% among patients with LVEF ? 20%; and 8.3 versus 17.9% among patients with STS-predicted mortality of ? 10%. At median follow-up of 17 months there was no recurrent MR or change in LV dimensions or LVEF, but there was a decrease (p = 0.02) in right ventricular systolic pressure (RVSP). At the first post-operative visit and longest follow-up, NYHA class decreased from 3.0 ± 0.6 to 1.7 ± 0.7 and 2.0 ± 1.0, respectively (both p < 0.0001). Patients with LVEF ? 20% and LVEDD ? 6.5cm were more likely to meet a composite of death, transplant, or LV assist device insertion (p = 0.046). Conclusions Mini-MVR is safe in advanced cardiomyopathy, and resulted in no recurrent MR, stabilization of LVEF and LV dimensions, and a decrease in RVSP. This mini-MVR fibrillating technique can be used to address severe MR in patients with advanced cardiomyopathy. PMID:24332110

Brittain, Evan L.; Goyal, Sandeep K.; Sample, Matthew; Leacche, Marzia; Absi, Tarek; Papa, Frank; Churchwell, Keith; Ball, Stephen; Byrne, John; Maltais, Simon; Petracek, Michael; Mendes, Lisa

2014-01-01

333

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

334

Quantitative assessment of tricuspid regurgitation using pulsed Doppler echocardiography.  

PubMed Central

Tricuspid valve regurgitation was assessed quantitatively by measuring blood flow velocity in the vena cava using a pulsed Doppler velocimeter. A non-invasive index of regurgitation was obtained by calculating the ratio between the maximum amplitudes of the systolic and diastolic components of the velocity curves. The index was compared with the angiographic grading of regurgitation in 70 patients after right heart catheterisation; the results were closely correlated. Using the Doppler index the differences between the groups defined according to their angiographic grade were significant. Thus measurement of blood flow velocity in the vena cava appears to quantify accurately the severity of tricuspid regurgitation. Images PMID:6639815

Diebold, B; Touati, R; Blanchard, D; Colonna, G; Guermonprez, J L; Peronneau, P; Forman, J; Maurice, P

1983-01-01

335

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

PubMed Central

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

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

2003-01-01

336

Pathogenesis of Mitral Valve Disease in Mucopolysaccharidosis VII Dogs  

PubMed Central

Mucopolysaccharidosis VII (MPS VII) is due to deficient activity of ?-glucuronidase (GUSB) and results in the accumulation of glycosaminoglycans (GAGs) in lysosomes and multisystemic disease with cardiavascular manifestations. The goal here was to determine the pathogenesis of mitral valve (MV) disease in MPS VII dogs. Untreated MPS VII dogs had a marked reduction in the histochemical signal for structurally-intact collagen in the MV at 6 months of age, when mitral regurgitation had developed. Electron microscopy demonstrated that collagen fibrils were of normal diameter, but failed to align into large parallel arrays. mRNA analysis demonstrated a modest reduction in the expression of genes that encode collagen or collagen-associated proteins such as the proteoglycan decorin which helps collagen fibrils assemble, and a marked increase for genes that encode proteases such as cathepsins. Indeed, enzyme activity for cathepsin B (CtsB) was 19-fold normal. MPS VII dogs that received neonatal intravenous injection of a gamma retroviral vector had an improved signal for structurally-intact collagen, and reduced CtsB activity relative to that seen in untreated MPS VII dogs. We conclude that MR in untreated MPS VII dogs was likely due to abnormalities in MV collagen structure. This could be due to upregulation of enzymes that degrade collagen or collagen-associated proteins, to the accumulation of GAGs that compete with proteoglycans such as decorin for binding to collagen, or to other causes. Further delineation of the etiology of abnormal collagen structure may lead to treatments that improve biomechanical properties of the MV and other tissues. PMID:23856419

Bigg, Paul W.; Baldo, Guilherme; Sleeper, Meg M.; O'Donnell, Patricia A.; Bai, Hanqing; Rokkam, Venkata R.P.; Liu, Yuli; Wu, Susan; Giugliani, Roberto; Casal, Margret L.; Haskins, Mark E.; Ponder, Katherine P.

2013-01-01

337

[A new quantitative method for quantifying left heart jets by Doppler color imaging].  

PubMed

Quantification of valvular lesions by Color Doppler is based on jet measurements. The aim of this new method is to reduce some of the errors in these measurements: uncertainty in delimiting the colored areas of the jets; spontaneous beat-to-beat variations of the jets entailing interpretative difficulties. The first step was to determine the correlations between the colored areas and previously established single-gated Doppler criteria, retaining spectral criteria to define the borders of the jets, so overcoming some of the limitations of color Doppler. The association of these methods resulted in better discrimination between grades and a better correlation in 45 angiographically controlled mitral and aortic regurgitations than with color Doppler alone. In stenotic lesions, spectral criteria from single-gated associated exploration enabled localisation of the level for planimetry of the section of the jet at its origin visualised by color Doppler. Satisfactory correlations were obtained with the Gorlin surface area in a group of 43 patients with mitral and aortic stenosis. A coefficient of variation of 13 to 14 per cent was found with planimetry of the regurgitant jet in the upstream cardiac chamber. Uni-dimensional measurement decreased this variation to 6 to 11 per cent in the same patients. The largest decrease in variability (6 to 8 per cent) was observed in stenotic and regurgitant lesions with planimetry of the section of jet at its origin performed in held mid-expiration and so this would appear to be the best method. The guide lines and technological improvement associated with the physiopathological information provided by color Doppler should refine the quantification of valvular heart lesions. PMID:2514635

Veyrat, C; Legeais, S; Gourtchiglouian, C; Sainte Beuve, D; Abitbol, G; Kalmanson, D

1989-11-01

338

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

339

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

340

The Effect of Surgical and Transcatheter Aortic Valve Replacement on Mitral Annular Anatomy  

PubMed Central

Background The effect of aortic valve replacement on three-dimensional (3D) mitral annular geometry has not been well-described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy. Methods Real-time 3D echocardiography was performed in patients undergoing TAVR using the Edwards Sapien® valve (n=10) or AVR (n=10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView to assess regional and global annular geometry. Results Mixed between-within ANOVA showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices pre-operatively. However, post-operative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter and mitral annular area after valve replacement (P?.006). Similar changes were not noted in the TAVR group. Conclusions TAVR preserves mitral annular geometry better than AVR. Thus, TAVR may be a more physiological approach to aortic replacement. PMID:23245440

Vergnat, Mathieu; Levack, Melissa M.; Jackson, Benjamin M.; Bavaria, Joseph E.; Herrmann, Howard C.; Cheung, Albert T.; Weiss, Stuart J.; Gorman, Joseph H.; Gorman, Robert C.

2013-01-01

341

Mitral and mitro-aortic valve replacement with Sorin Bicarbon valves compared with St. Jude Medical valves  

Microsoft Academic Search

Objective: We assessed the clinical results of two bileaflet mechanical valves: the St. Jude Medical (SJM) and the Sorin Bicarbon (Sorin Bicarbon) used either in single mitral valve replacement (MVR) or in double, aortic and mitral, valve replacement (DVR).Methods: Between September 1990 and November 1995, 217 patients received either a St. Jude Medical (n=134) or a Sorin Bicarbon (n=86): 136

L. F Camilleri; P Bailly; B. J Legault; B Miguel; M.-C D'Agrosa-Boiteux; C. M de Riberolles

2001-01-01

342

Doppler echocardiographic assessment with the continuity equation of St. Jude medical mechanical prostheses in the mitral valve position  

Microsoft Academic Search

Evaluation of the St. Jude Medical (SJM) valve in the mitral position with Doppler echocardiography has usually involved the use of gradients across the valve and the application of the pressure half-time (PHT) method to derive a mitral valve area. The purpose of this study was, first, to determine the normal values of effective orifice areas for the SJM valve

Jamil N. Bitar; Marcel E. Lechin; Gabriel Salazar; William A. Zoghbi

1995-01-01

343

Missed diagnosis of Behçet disease causing aortic regurgitation.  

PubMed

Aortic regurgitation is a rare and serious presentation of Behçet's disease. Here we describe a case of missed diagnosis of Behçet's disease in a 37-year-old man, causing symptomatic aortic regurgitation. Perioperative diagnosis of Behçet's aortitis is crucial because surgical intervention carries high reoperative morbidity and mortality. PMID:25186424

Chuan Tham, Yi; Kong Sin, Yoong

2014-09-01

344

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

PubMed Central

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

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

2014-01-01

345

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

PubMed

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

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

2012-02-01

346

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

347

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

348

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

349

Giant T wave inversion associated with severe aortic regurgitation.  

PubMed

Two patients with haemodynamically significant aortic regurgitation and angiographically normal coronary arteries developed giant T wave inversion. The T wave abnormality partially resolved in both, following valve replacement in one and medical treatment in the other. This unusual electrocardiographic appearance may be related to myocardial ischaemia caused by increased left ventricular wall stress and changes in phasic coronary blood flow, abnormalities in cerebral perfusion associated with severe aortic regurgitation, or to coincidental neurological disease. PMID:8818753

Weston, C F; Fonfe, G; Wahbi, Z; Wilson, J I

1996-06-01

350

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

2014-08-12

351

Development of an intraluminal device for the treatment of aortic regurgitation: Prototype and in vitro testing system  

Microsoft Academic Search

Objectives: Development of an intraluminal device to reduce aortic regurgitation could provide a strategy intermediate between medical treatment and aortic valve replacement. An initial prototype and a testing system have been designed. Methods: Aortic valves obtained from heart transplant recipients were explanted and assessed in a mock circulatory loop with resistive and capacitive elements, including pressure-flow characteristics, similar to those

Robert C. Ashton; Daniel J. Goldstein; David D'Alessandro; Alan D. Weinberg; Daniel Burkhoff; Heinz D. Rosskothen; Gerald M. Lemole; Mehmet C. Oz

1996-01-01

352

Robust physically-constrained modeling of the mitral valve and subvalvular apparatus.  

PubMed

Mitral valve (MV) is often involved in cardiac diseases, with various pathological patterns that require a systemic view of the entire MV apparatus. Due to its complex shape and dynamics, patient-specific modeling of the MV constitutes a particular challenge. We propose a novel approach for personalized modeling of the dynamic MV and its subvalvular apparatus that ensures temporal consistency over the cardiac sequence and provides realistic deformations. The idea is to detect the anatomical MV components under constraints derived from the biomechanical properties of the leaflets. This is achieved by a robust two-step alternate algorithm that combines discriminative learning and leaflet biomechanics. Extensive evaluation on 200 transesophageal echochardiographic sequences showed an average Hausdorff error of 5.1 mm at a speed of 9 sec, which constitutes an improvement of up to 11.5% compared to purely data driven approaches. Clinical evaluation on 42 subjects showed, that the proposed fully-automatic approach could provide discriminant biomarkers to detect and quantify remodeling of annulus and leaflets in functional mitral regurgitation. PMID:22003737

Voigt, Ingmar; Mansi, Tommaso; Ionasec, Razvan Ioan; Mengue, Etienne Assoumou; Houle, Helene; Georgescu, Bogdan; Hornegger, Joachim; Comaniciu, Dorin

2011-01-01

353

Improved results with mitral valve repair using new surgical techniques.  

PubMed

From January 1987 to July 1994, 299 consecutive patients ranging from 4 to 80 years of age underwent mitral repair for pure valve insufficiency due to degenerative disease (59%), rheumatic disease (23%), endocarditis (12%) or ischemic heart disease (6%). During the initial period, a variety of reparative methods were used following the principles originally described by Carpentier. More recently, in our institution other surgical techniques have been introduced: specifically, prolapse of the anterior leaflet was corrected either by replacing the chordae with polytetrafluoroethylene (PTFE) sutures or simply by anchoring the prolapsing free edge to the facing edge of the posterior leaflet ("edge-to-edge" technique). Chordal transposition has also been used occasionally to correct the prolapse of the anterior leaflet. The hospital mortality rate was 1.3%. According to actuarial methods, the overall survival rate was 94% at 7 years, and freedom from reoperation was 86%. Significant incremental risk factors for reoperation were: no use of prosthetic ring, correction of the prolapse of the anterior leaflet by triangular resection or chordal shortening and ischemic etiology of the mitral insufficiency (freedom from reoperation at 7 years was 61%, 56% and 51%, respectively). In the late postoperative period (mean follow-up 3.6 years), 95% of the patients were in NYHA class I or II; four patients had thromboembolic episodes, two hemorrhagic complications and two endocarditis. No patient in whom the prolapse of the anterior leaflet was corrected by the recently introduced technique has required reoperation. The anterior mitral leaflet prolapse was therefore neutralized as an incremental risk factor for reoperation and this has contributed to the improved overall results of mitral valve repair. PMID:8751250

Fucci, C; Sandrelli, L; Pardini, A; Torracca, L; Ferrari, M; Alfieri, O

1995-01-01

354

Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis.  

PubMed

Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010. Before AVR, CT scans were performed to identify MAC, whose severity was graded on a scale of 0-4, with grade 0 denoting no MAC and grade 4 indicating severe MAC. Echocardiography was performed before AVR and at follow-up over 2 years after AVR. MAC was identified in 56 patients with grade 1 (30 %), 2 (39 %), 3 (18 %), and 4 (13 %), respectively. Patients with MAC presented older age (72 ± 8 versus 66 ± 11 years), higher rate of dialysis-dependent renal failure (43 versus 4 %), and less frequency of bicuspid aortic valve (9 versus 36 %), when compared to those without MAC. No significant differences were seen in short- and mid-term mortality after AVR between the groups. In patients with MAC, progression of neither mitral regurgitation nor stenosis was observed at follow-up of 53 ± 23 months for 102 survivors, although the transmitral flow velocities were higher than in those without MAC. In conclusion, MAC represented 53 % of the patients undergoing isolated AVR for AVS, usually appeared in dialysis-dependent elder patients with tricuspid AVS. MAC does not affect adversely upon the survival, without progression of mitral valve disease, at least within 2 years after AVR. PMID:25252778

Takami, Yoshiyuki; Tajima, Kazuyoshi

2014-09-25

355

Statistical Assessment of Normal Mitral Annular Geometry Using Automated 3D Echocardiographic Analysis  

PubMed Central

Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of annular geometry with quantitative imaging techniques. In this work, we present an automated 3D echocardiographic (3DE) image analysis method that can be used to statistically assess variability in normal mitral annular geometry to support advancement in annuloplasty ring design. Methods 3D patient-specific models of the mitral annulus were automatically generated from 3DE images acquired from subjects with normal mitral valve structure and function. Geometric annular measurements including annular circumference (AC), annular height (AH), septolateral diameter (SLD), intercommissural width (ICW), and the AH to ICW ratio (AHCWR) were automatically calculated. A mean 3D annular contour was computed, and principal component analysis (PCA) was used evaluate variability in normal annular shape. Results The following mean ± standard deviations were obtained from 3DE image analysis: 107.0 ± 14.6 mm (AC), 7.6 ± 2.8 mm (AH), 28.5 ± 3.7 mm (SLD), 33.0 ± 5.3 mm (ICW), and 22.7 ± 6.9 % (AHCWR). PCA indicated that shape variability was primarily related to overall annular size, with more subtle variation in the skewness and height of the anterior annular peak, independent of annular diameter. Conclusions Patient-specific 3DE-based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral annular geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal geometry. PMID:24090576

Pouch, Alison M.; Vergnat, Mathieu; McGarvey, Jeremy R.; Ferrari, Giovanni; Jackson, Benjamin M.; Sehgal, Chandra M.; Yushkevich, Paul A.; Gorman, Robert C.; Gorman, Joseph H.

2014-01-01

356

Cross-sectional survey on minimally invasive mitral valve surgery  

PubMed Central

Background Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS. Methods Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed. Results The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees. Conclusions These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs. PMID:24349974

Borger, Michael; Byrne, John G.; Chitwood, W. Randolph; Cohn, Lawrence; Galloway, Aubrey; Garbade, Jens; Glauber, Mattia; Greco, Ernesto; Hargrove, Clark W.; Holzhey, David M.; Krakor, Ralf; Loulmet, Didier; Mishra, Yugal; Modi, Paul; Murphy, Douglas; Nifong, L. Wiley; Okamoto, Kazuma; Seeburger, Joerg; Tian, David H.; Vollroth, Marcel; Yan, Tristan D.

2013-01-01

357

Clinical Use of a New Mitral Disc Valve  

PubMed Central

A disc valve of new design was used successfully for the replacement of the mitral valve in patients with rheumatic mitral valve disease. This valve would appear to have the following advantages over the mitral ball valve prosthesis: • Lower left atrial pressure after replacement. • Elimination of the hazard of left ventricular outflow tract obstruction with mitral valve replacement. • Decreased incidence of thromboembolization. • Abolition of possibility of ventricular septal irritation. Despite the better outlook for this valve compared with the ball valve for mitral valve substitution, the mitral valve should always be repaired whenever feasible. Repair is possible in the majority of patients. ImagesFigure 1. PMID:6039183

Kay, Jerome Harold; Tsuji, Harold K.; Redington, John V.; Kawashima, Yasunaru; Kagawa, Yuzuru; Yamada, Takashi; Caponegro, Peter; Mendez, Adolfo

1967-01-01

358

Prosthetic Mitral Valve Leaflet Escape  

PubMed Central

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

2013-01-01

359

Tricuspid Valve Regurgitation after Orthotopic Heart Transplantation: Prevalence and Etiology  

PubMed Central

Background. Tricuspid valve regurgitation (TR) after orthotopic heart transplantation (OHT) is common. The aims of this study were to determine the prevalence of TR after OHT, to examine the correlation between its development and various variables, and to determine its outcomes. Methods. All 163?OHT patients who were followed up between 1988 and 2009 for a minimal period of 12 months were divided into those with no TR/mild TR and those with at least mild-moderate TR, as assessed by doppler echocardiography. These groups were compared regarding preoperative hemodynamic variables, surgical technique employed, number of endomyocardial biopsies, number of acute cellular rejections, incidence of graft vasculopathy, and clinical outcomes. Results. At the end of the followup (average 8.2 years) significant TR was evident in 14.1% of the patients. The development of late TR was found by univariate, but not multivariate, analysis to be significantly correlated with the biatrial surgical technique (P < 0.01) and the presence of graft vasculopathy (P < 0.001). TR development was found to be correlated with the need for tricuspid valve surgery but not with an increased mortality. Conclusions. The development of TR after OHT may be related to the biatrial anastomosis technique and to graft vasculopathy. PMID:23097690

Berger, Yaniv; Har Zahav, Yedael; Kassif, Yigal; Kogan, Alexander; Kuperstein, Rafael; Freimark, Dov; Lavee, Jacob

2012-01-01

360

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

361

[Aortic valve replacement for rheumatoid aortic valve regurgitation].  

PubMed

Valve replacement for aortic regurgitation in patient with rheumatoid arthritis was rare in Japan. We report a successful case in which aortic regurgitation necessitated aortic valve replacement. A 62-year-old woman was admitted for shortness of breath, chest pain and progressive edema. She had been treated for rheumatoid arthritis for more than ten years using steroids. The aortic valve was successfully replaced by a prosthetic mechanical valve. The histopathological examination of the excised aortic valve demonstrated rheumatic nodules in the right- and non-coronary cusp. It was supported that these changes caused shrinkage of cusp and resulted in aortic regurgitation. This patient was discharged on the 20th postoperative day. There was no evidence of detachment of the prosthetic valve. PMID:7474590

Uwabe, K; Tsuchiya, K; Hosaka, S; Morishita, A; Iida, Y; Oyama, T

1995-09-01

362

Quadricuspid aortic valve with aortic regurgitation: a rare echocardiographic finding  

PubMed Central

We report on a middle-aged woman treated for chronic hepatitis C virus infection with pegylated interferon. Auscultation revealed a diastolic murmur and the peripheral signs of aortic regurgitation. She had shortness of breath on moderate exertion for the past 4?months, which she attributed to her liver disease. Echocardiogram showed a quadricuspid aortic valve with severe aortic regurgitation. She was referred to a cardiothoracic surgeon for aortic valve replacement (AVR). However, she decided against AVR despite detailed counselling, and opted for medical treatment. PMID:23349171

Tai, Javed Majid; Laghari, Abid Hussain; Gill, Cyrus Tariq

2013-01-01

363

'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

2014-07-11

364

Predictive factors of left atrial spontaneous echo contrast in patients with rheumatic mitral valve stenosis: a retrospective study of 159 patients  

PubMed Central

Background Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. The presence of spontaneous echo contrast in the left atrium and left atrial appendage has been reported to be an independent predictor of thrombo-embolic risk in patients with mitral stenosis. The objective of this study was to retrospectively investigate various clinical and echocardiographic variables to predict the spontaneous echo contrast in these patients. Methodology This is a bicentric retrospective study which includes 159 cases of symptomatic mitral stenosis from January 2011 to June 2012. All of the patients had transthoracic and transesophageal echocardiography. Patients who had significant mitral regurgitation (> Grade I), significant aortic valve disease, previous mitral valvulotomy and anticoagulation or antiplatelet therapy were excluded from the study. Our study population was divided into two groups based on the presence (Group I) or absence (Group II) of spontaneous echo contrast. Result Left atrial spontaneous contrast was present in 34.6% of cases. Patients in this group have more frequent atrial fibrillation (P = 0.001), larger left atrial area (P = 0.027) and diameter (P=0.023), smaller mitral valve area (P = 0.025), and higher mean transmitral diastolic gradient (p = 0.003) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean age (p = 0.38), duration of symptoms (p = 0.4) and left ventricular ejection fraction (p = 0.7) between patients with and without spontaneous echo contrast. On multivariate analysis, only mitral valve area and transmitral diastolic gradient (OR: 18.753, 1.21, CI [1,838-191,332], [1,064-1,376], p: 0.013, 0.004, respectively) were found to be independently associated to the presence of spontaneous echo contrast. Conclusion Patients with severe rheumatic mitral stenosis in atrial fibrillation or sinus rhythm have a higher risk of developing spontaneous echo contrast. These patients might benefit from prophylactic anticoagulation. The long-term outcomes can be ascertained in a study over a longer period and with periodic follow-up. PMID:24995039

2014-01-01

365

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

366

Repeated mitral valve replacement in the growing child with congenital mitral valve disease.  

PubMed

The successful second-replacement of mitral valve prostheses in two children, age 5 and 9 years, is reported. In one, a parachute mitral valve deformity was first corrected at the age of 10 months by the small-size 00 Starr-Edwards prosthesis. The second child had mitral valve disease caused by Marfan's syndrome 1; the valve was initially replaced at the age of 3 years by a size 0 Starr-Edwards prosthesis. For both patients, in the period between the two interventions, the left ventricle had grown in size and the mitral anulus was not a limiting factor in the insertion of a larger prosthesis of the Björk-Shiley type. Follow-up periods of 1 and 6 years, respectively, confirm excellent clinical results. Problems concerning valve replacements in pediatric patients are discussed. PMID:7366244

Nudelman, I; Schachner, A; Levy, M J

1980-05-01

367

Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study  

PubMed Central

Background and aim of the study Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR). Methods A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters. Results Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9% p <0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 62%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter. Conclusion The mitral annulus undergoes significant geometric changes immediately after AVR Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve. PMID:23409347

Mahmood, Feroze; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Chen, Tzong-Huei; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal

2014-01-01

368

Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging.  

PubMed

Velocity-encoded cine-magnetic resonance imaging (VEC-MRI) is a new method for quantitation of blood flow with the potential to measure high-velocity jets across stenotic valves. The objective of this study was to evaluate the ability of VEC-MRI to measure transmitral velocity in patients with mitral stenosis. Sixteen patients with known mitral stenosis were studied. A 1.5 Tesla superconducting magnet was used to obtain velocity-encoded images in the left ventricular short-axis plane. Images were obtained throughout the cardiac cycle at 3 consecutive slices beginning proximal to the mitral coaptation point. To determine the optimal slice thickness for MRI imaging, both 10 mm and 5 mm thicknesses were used. Echocardiography including continuous-wave Doppler was performed on every patient within 2 hours of MRI imaging. Peak velocity was determined for both VEC-MRI and Doppler-echo images. Two observers independently measured the VEC-MRI mitral inflow velocities. Of the 16 patients, imaged data were incomplete in only 1 study, and all images were adequate for analysis. Strong correlations were found for measurements of mitral valve gradient for both 10 mm (peak r = 0.89, mean r = 0.84) and 5 mm (peak r = 0.82, mean r = 0.95) slice thicknesses. Measurements of peak velocity with VEC-MRI (10 mm) agreed well with Doppler: mean 1.46 m/s, mean of differences (Doppler MRI) 0.38 m/s, standard deviation of differences 0.2 m/s. These findings suggest that VEC-MRI can noninvasively determine the severity of mitral stenosis. PMID:7856529

Heidenreich, P A; Steffens, J; Fujita, N; O'Sullivan, M; Caputo, G R; Foster, E; Higgins, C B

1995-02-15

369

Mitral valve replacement: randomized trial of St. Jude and Medtronic Hall prostheses  

Microsoft Academic Search

Background. This study was designed to better define the merits of the bileaflet and tilting-disc valves.Methods. We prospectively randomized 156 patients (mean age, 59 years) to receive either the St. Jude (n = 80) or the Medtronic Hall (n = 76) mitral valve prosthesis between September 1986 and December 1997. The two groups were not significantly different with respect to

Andrew C Fiore; Hendrick B Barner; Marc T Swartz; Lawrence R McBride; Arthur J Labovitz; Kathy J Vaca; Jan St. Vrain; Gary L Grunkemeier; George C Kaiser

1998-01-01

370

Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency  

Microsoft Academic Search

Background—Results of conservative surgery are well established in degenerative mitral valve (MV) insufficiency. However, there are controversies in rheumatic disease. This study is the evaluation of one center for rheumatic MV insufficiency based on a functional approach. Methods and Results—From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier.

Sylvain Chauvaud; Jean-François Fuzellier; Alain Berrebi; Alain Deloche; Jean-Noël Fabiani; Alain Carpentier

2001-01-01

371

The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome  

Microsoft Academic Search

Objective: The ‘double-orifice’ (DO) technique has been recently proposed as an additional option in mitral valve repair (MVR). However, little is known regarding the long-term postoperative outcome and the predictors of DO results. Therefore, the aim of this study was to evaluate our clinical series and to identify prognostic factors of DO repair. Methods: From 1992, 75 patients underwent DO

Roberto Lorusso; Valentino Borghetti; Pasquale Totaro; Giovanni Parrinello; Giuseppe Coletti; Gaetano Minzioni

2001-01-01

372

A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approachq  

Microsoft Academic Search

Objective: We describe an original radiofrequency ablation technique to treat chronic atrial fibrillation in patients undergoing mitral valve surgery. Most of the procedure is carried out epicardially, in order to avoid an undue increase of surgical time and trauma. Methods: The ablations are performed using a temperature-controlled multipolar radiofrequency catheter. Two encircling lesions around the ostia of the right and

Stefano Benussi; Carlo Pappone; Simona Nascimbene; Giuseppe Oreto; Alessandro Caldarola; Pier Luigi Stefano; Valter Casati; Ottavio Alfieri

373

Extraction of high-quality host DNA from feces and regurgitated seeds: a useful tool for vertebrate ecological studies.  

PubMed

DNA extraction methods for genotyping non-invasive samples have led to great advances in molecular research for ecological studies, and have been particularly useful for analyzing threatened species. However, scarce amounts of fragmented DNA and the presence of Taq polymerase inhibitors in non-invasive samples are potential problems for subsequent PCR amplifications. In this study we describe a novel technique for extracting DNA from alimentary tract cells found on external surfaces of feces and regurgitated seeds. The presence of contaminants and inhibitors is minimized and samples are preserved intact for use in other ecological research (e.g. trophic studies). The amplification efficiency and purity of the extracted DNA from feces were significantly higher than in commonly used extraction procedures. Moreover, DNA of two bird species was identified from seeds expelled by regurgitation. Therefore, this method may be suitable for future ecological studies of birds, and other vertebrate groups. PMID:19746259

Marrero, Patricia; Fregel, Rosa; Cabrera, Vicente M; Nogales, Manuel

2009-01-01

374

Mitral valve replacement on a beating heart.  

PubMed

We report the case of a patient who needed mitral valve replacement but was at a high risk of myocardial injury with the conventional technique (cardioplegic arrest on cardiopulmonary bypass). Valve replacement was carried out on a beating heart on cardiopulmonary bypass by perfusing the heart continuously with oxygenated noncardioplegic normothermic blood via the coronary sinus. PMID:14686670

Bedi, Harinder S; Singh, Raman P; Goel, Vipin; Lal, Purshottam

2003-01-01

375

Double mitral valve orifice in atrioventricular defects  

Microsoft Academic Search

Eleven patients with double mitral valve orifice and atrioventricular defects were studied, and the diagnosis proven by open heart surgery. The correct preoperative diagnosis was suggested by a characteristic angiographic appearance of the medial border of the left ventricle. M-mode echocardiography may show the two orifices which are better seen on two dimensional echocardiography. Two operative deaths occurred in patients

C Warnes; J Somerville

1983-01-01

376

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

377

Mitral valve replacement with ball valve prostheses  

PubMed Central

Our experience with ball valve replacement of the mitral valve during the past decade is presented in terms that allow comparison with other techniques. The use of such prostheses is characterized by ease of implantation, with an overall operative mortality of 11 per cent for isolated mitral replacement and 13 per cent for multiple valve replacement. The operative mortality for isolated mitral valve replacement during 1969 and thus far in 1970 has been nil. The late mortality was 13 per cent for isolated mitral replacement and 20 per cent for multiple valve replacement. Forty-three per cent of the total late deaths were clearly unrelated to the prosthetic device itself. The overall incidence of late infection and leak is less than 1 per cent and the immediate haemodynamic benefit is not altered by loss of structural integrity of the prosthesis. The most serious problem after mitral valve replacement with the ball valve prosthesis is that of thromboembolic complications. While thrombotic stenosis of the prosthesis is a rarity, embolic episodes, usually cerebral in type, have been noted in 63 per cent of the patients surviving mitral valve replacement with the earliest model ball valve from August 1960 to February 1966. Improvements in valve design have resulted in a remarkable decrease in this incidence as examined by actuarial techniques and taking into account the duration of follow-up. The extension of the cloth sewing margins to the orifice of the valve while maintaining a metallic orifice and metallic cage (Model 6120) resulted in a drop of the thromboembolic rate to 17 per cent from April 1965 to April 1969. The development of the totally cloth-covered prosthesis has further improved these results, with only one thromboembolic complication after isolated mitral valve replacement with the Model 6310 valve in a series of 66 consecutive patients. In clinical practice this has resulted in the avoidance of the use of anticoagulant therapy in patients in whom for a variety of reasons this carries an increased hazard. With further follow-up it may be possible to discontinue the routine use of anticoagulants. Images PMID:5572646

Starr, Albert

1971-01-01

378

Percutaneous Mitral Valve Repair with the Edge-to-Edge Technique: Case Series of First Iranian Experience  

PubMed Central

Mitral regurgitation (MR) is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System (Abbot Laboratories, Abbot Park, IL, USA) is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future. PMID:25561971

Kassaian, Seyed Ebrahim; Karbassi, Arsha; Sahebjam, Mohammad; Aghajani, Hassan; Amin, Ahmad; Ahmadbeigi, Niloufar; Abbasi, Kyomars; Salehiomran, Abbas; Poorhosseini, Hamidreza; Salarifar, Mojtaba

2014-01-01

379

Transaortic approach for the Alfieri stitch  

Microsoft Academic Search

The management of associated mitral regurgitation in patients undergoing cardiac surgery is controversial. A simple, reliable, and fast repair is advantageous, especially in critically ill patients. We describe a simple method of transaortic edge-to-edge repair in patients with associated mitral regurgitation undergoing aortic valve surgery.

Göran Källner; Jan van der Linden; Leonidas Hadjinikolaou; Dan Lindblom

2001-01-01

380

Transaortic approach for the Alfieri stitch.  

PubMed

The management of associated mitral regurgitation in patients undergoing cardiac surgery is controversial. A simple, reliable, and fast repair is advantageous, especially in critically ill patients. We describe a simple method of transaortic edge-to-edge repair in patients with associated mitral regurgitation undergoing aortic valve surgery. PMID:11216794

Källner, G; van der Linden, J; Hadjinikolaou, L; Lindblom, D

2001-01-01

381

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

PubMed

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

Boronyak, Steven M; Merryman, W David

2012-09-01

382

Abnormal regurgitation in three cows caused by intrathoracic perioesophageal lesions  

PubMed Central

Background Three Brown Swiss cows with abnormal regurgitation because of a perioesophageal disorder are described. Case presentation The cows were ill and had poor appetite, salivation and regurgitation of poorly-chewed feed. Collection of rumen juice was successful in one cow, and in another, the tube could be advanced to the level of the 7th intercostal space, and in the third, only saliva could be collected. In one cow, oesophagoscopy revealed a discoloured 10-cm mucosal area with fibrin deposits. Thoracic radiographs were normal. The cows were euthanased and examined postmortem. Cow 1 had a large perioesophageal abscess containing feed material at the level of the thoracic inlet, believed to be the result of a healed oesophageal injury. Cow 2 had an abscess between the oesophagus and trachea 25 cm caudal to the epiglottis with the same presumed aetiology as in cow 1. Cow 3 had a mediastinal carcinoma that enclosed and constricted the oesophagus. Conclusions Abnormal regurgitation in cattle is usually the result of an oesophageal disorder. Causes of oesophageal disorders vary widely and their identification can be difficult. PMID:24629042

2014-01-01

383

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

384

Aortic valve repair with autologous pericardium for traumatic aortic valve regurgitation  

PubMed Central

We present a case of successful aortic valve repair for traumatic aortic valve regurgitation. A 26-year-old male who had a history of motor-cycle accident months prior to admission, was referred to our hospital for surgical treatment of severe aortic valve regurgitation. Intraoperative inspection revealed a tear in noncoronary cusp, with otherwise preserved valvular anatomy. Aortic valvuloplasty was successfully performed with closure using an autologous pericardium patch. Intraoperative transesophageal echocardiogram confirmed absence of residual regurgitation. PMID:24282768

Takakura, Hiromitsu; Hachiya, Takashi; Onoguchi, Katsuhisa

2013-01-01

385

Heterotopic transcatheter tricuspid valve implantation: first-in-man application of a novel approach to tricuspid regurgitation  

PubMed Central

Aims Transcatheter treatment of heart valve disease is well established today. However, for the treatment of tricuspid regurgitation (TR), no effective catheter-based approach is available. Herein, we report the first human case description of transcatheter treatment of severe TR in a 79-year-old patient with venous congestion and associated non-cardiac diseases. In this patient, surgical treatment had been declined and pharmacological therapy had been ineffective. After ex vivo and animal studies, the treatment of TR was performed by percutaneous caval valve implantation. Methods and results In a transcatheter approach through the right femoral vein, a custom-made self-expanding heart valve was implanted into the inferior vena cava (IVC). The device was anchored in the IVC at the cavoatrial junction with the level of the valve aligned immediately above the hepatic inflow and protruding into the right atrium. After deployment, excellent valve function was observed resulting in a marked reduction in caval pressure and an abolition of the ventricular wave in the IVC. Sequential echocardiographic exams over a follow-up period of 8 weeks confirmed continuous device function without paravalvular leakage or remaining venous regurgitation. The patient experienced improved physical capacity and was able to resume off-bed activities. There was no recurrence of right heart failure during follow-up and a partial reduction of ascites. The patient was discharged from hospital into a rehabilitation programme. Conclusion Transcatheter treatment of severe TR by caval valve implantation is feasible resulting in an immediate abolition of IVC regurgitation and mid-term clinical improvement. Thus, in selected non-surgical patients, caval valve implantation may become a therapeutic option to treat venous regurgitation and improve associated non-cardiac diseases. Further confirmatory experience with longer follow-up is required to evaluate the long-term clinical benefit of the procedure as well as potential deleterious effects. PMID:21300731

Lauten, Alexander; Ferrari, Markus; Hekmat, Khosro; Pfeifer, Ruediger; Dannberg, Gudrun; Ragoschke-Schumm, Andreas; Figulla, Hans R.

2011-01-01

386

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

387

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

NASA Astrophysics Data System (ADS)

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

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

2009-02-01

388

New indexes for assessing aortic regurgitation with two-dimensional Doppler echocardiographic measurement of the regurgitant aortic valvular area.  

PubMed

Direct examination of the aortic orifice at the level of the aortic valves (aortic valvular orifice area, AVOA) in the short-axis plane was performed with a 3 MHz two-dimensional pulsed Doppler echocardiographic apparatus. The AVOA was mapped with the Doppler gate to detect or rule out the presence of a regurgitant aortic valvular area (RAVA) established by recording of abnormal diastolic Doppler signals on a "yes or no" basis. A group of 12 normal subjects and 83 patients, including 40 patients with aortic regurgitation proven by aortography, were investigated with this procedure. In the 38 patients with aortic regurgitation diagnosed by Doppler echocardiography (diagnostic sensitivity 95%, specificity 100%), planimetric measurements of the RAVA and AVOA were performed with calculation of two indexes: the RAVA/square meter of body surface area and the RAVA/AVOA ratio. These indexes correlated well with independently performed angiographic grading on a three-point scale (r = .87 for the RAVA, .88 for the RAVA/AVOA; p less than .001), with highest significance of differences in mean values among each grade of severity found for the RAVA/AVOA (p less than .001). In addition, Doppler echocardiography identified the anatomic valvular site of the lesion, and we confirmed the site during surgery. PMID:6616800

Veyrat, C; Lessana, A; Abitbol, G; Ameur, A; Benaim, R; Kalmanson, D

1983-11-01

389

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

390

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

PubMed Central

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

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

2012-01-01

391

Left ventricular outflow tract obstruction due to anomalous mitral valve: successful mitral valve replacement in a four month old infant.  

PubMed Central

A four month old infant was investigated for heart failure was found to have mitral incompetence and severe subvalvar aortic stenosis. The left ventricular outflow tract obstruction was found to be due to an anatomically anomalous mitral valve. The obstruction could only be relieved by removal of the mitral valve and its replacement with a St Jude's prosthesis. Two years after operation the child is fit and active. There have been no difficulties with anticoagulant treatment. Images Fig 1 Fig 2 PMID:3768218

Morais, P; Westaby, S; Hallidie-Smith, K A

1986-01-01

392

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

PubMed

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

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

2015-01-01

393

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

394

Infective mitral valve endocarditis after transapical aortic valve implantation  

PubMed Central

An 80-year old patient underwent a transapical aortic valve implantation. On the 28th postoperative day, the patient developed acute mitral valve endocarditis. Initially, the patient was unsuccessfully treated conservatively. After 71 days, the patient was operated on with mitral valve replacement. In this report, we discuss the potentially growing problem of complications related to transcatheter valve implantation. PMID:23223669

Hirnle, Grzegorz; Holzhey, David; Borger, Michael; Mohr, Friedrich-Wilhelm

2013-01-01

395

Echocardiography in Transcatheter Aortic Valve Implantation and Mitral Valve Clip  

PubMed Central

Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair. PMID:23019387

Luo, Huai

2012-01-01

396

Recent Developments and Evolving Techniques of Mitral Valve Reconstruction  

Microsoft Academic Search

Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly, operation is

Frank C Spencer; Aubrey C Galloway; Eugene A Grossi; Greg H Ribakove; Julie Delianides; F. Gregory Baumann; Stephen B Colvin

1998-01-01

397

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

398

Robotic mitral valve surgery—current status and future directions  

PubMed Central

Robotic mitral valve surgery is the most common robotic cardiac procedure performed today. Benefits include smaller, less invasive incisions resulting in less pain, shorter length of hospital stay, improved cosmesis, quicker return to preoperative level of functional activity, and decreased blood transfusion requirements. The history and evolution of robotic mitral valve surgery is detailed in th