Sample records for mitral valve calcification

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

    PubMed Central

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

    1985-01-01

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

  2. Prevalence of calcification of the mitral valve annulus in patients undergoing surgical repair of mitral valve prolapse.

    PubMed

    Fusini, Laura; Ghulam Ali, Sarah; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Maffessanti, Francesco; Celeste, Fabrizio; Guglielmo, Marco; Cefalù, Claudia; Alamanni, Francesco; Zanobini, Marco; Pepi, Mauro

    2014-06-01

    Factors correlating to mitral annulus calcification (MAC) include risk factors predisposing to atherosclerosis. In patients with mitral valve (MV) prolapse (MVP), other anatomic or mechanical factors have been supposed to facilitate MAC. The aims of this study were, in patients with MVP undergoing MV repair, (1) to describe the prevalence and characteristics of MAC, (2) to correlate MAC with clinical risk factors, coronary involvement, and aortic valve disease, and (3) to describe prevalence, site, and extension of MAC in fibroelastic deficiency (FED) versus Barlow's disease (BD) and correlate MAC to surgical outcomes (repair vs replacement). In 410 consecutive patients with MVP suitable for surgical MV repair, detailed clinical and echocardiographic data were collected to characterize MAC in BD and FED. MAC was found in 99 patients (24%). Age, female gender, coronary artery disease, and cardiovascular risk factors were correlated with MAC. MAC was equally distributed in FED and BD groups despite patients with FED being older with more cardiovascular risk factors. The most common localization of MAC was annular involvement adjacent to P2 (75%), P1 (31%), and P3 (35%). The presence of MAC affected surgical outcomes in both groups (8% patients with MAC underwent replacement after a first attempt of repair vs 3% without MAC). MAC is a common finding in patients undergoing MV repair, and several clinical characteristics correlate with MAC either in FED or BD. In conclusion, despite very high percentage of repairability, MAC influences surgical outcomes and very detailed echo evaluation is advocated. PMID:24837266

  3. Mitral Valve Prolapse

    MedlinePLUS

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

  4. Mitral Valve Prolapse

    MedlinePLUS

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

  5. Mitral valve prolapse

    MedlinePLUS

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

  6. Low Magnesium Levels and FGF-23 Dysregulation Predict Mitral Valve Calcification as well as Intima Media Thickness in Predialysis Diabetic Patients

    PubMed Central

    Jerónimo, Teresa; Fragoso, André; Silva, Claudia; Guilherme, Patrícia; Santos, Nélio; Faísca, Marília; Neves, Pedro

    2015-01-01

    Background. Mitral valve calcification and intima media thickness (IMT) are common complications of chronic kidney disease (CKD) implicated with high cardiovascular mortality. Objective. To investigate the implication of magnesium and fibroblast growth factor-23 (FGF-23) levels with mitral valve calcification and IMT in CKD diabetic patients. Methods. Observational, prospective study involving 150 diabetic patients with mild to moderate CKD, divided according to Wilkins Score. Carotid-echodoppler and transthoracic echocardiography were used to assess calcification. Statistical tests used to establish comparisons between groups, to identify risk factors, and to establish cut-off points for prediction of mitral valve calcification. Results. FGF-23 values continually increased with higher values for both IMT and calcification whereas the opposite trend was observed for magnesium. FGF-23 and magnesium were found to independently predict mitral valve calcification and IMT (P < 0.05). Using Kaplan-Meier analysis, the number of deaths was higher in patients with lower magnesium levels and poorer Wilkins score. The mean cut-off value for FGF-23 was 117?RU/mL and for magnesium 1.7?mg/dL. Conclusions. Hypomagnesemia and high FGF-23 levels are independent predictors of mitral valve calcification and IMT and are risk factors for cardiovascular mortality in this population. They might be used as diagnostic/therapeutic targets in order to better manage the high cardiovascular risk in CKD patients.

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

    Microsoft Academic Search

    A S Sadee; A E Becker

    1991-01-01

    To investigate the mechanism that increases the orifice area of the mitral valve during balloon dilatation 43 surgically excised intact rheumatic mitral valves were studied. The main pathological features were (a) fibrosis of mitral valve leaflets and commissures (10 valves); (b) fibrosis with calcification of one commissure (eight anterolateral, seven posteromedial); (c) fibrosis with calcification of both commissures (seven valves);

  8. Mitral Valve Prolapse

    MedlinePLUS

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

  9. Mitral Valve Prolapse

    MedlinePLUS

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

  10. Mitral Valve Prolapse

    MedlinePLUS

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

  11. 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 ...

  12. Mitral Valve Prolapse

    PubMed Central

    Rosser, Walter W.

    1992-01-01

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

  13. Mitral valve surgery - open

    MedlinePLUS

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

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

    ClinicalTrials.gov

    2014-08-08

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

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

    PubMed Central

    Sawazaki, Masaru; Tomari, Shiro; Izawa, Naoto

    2012-01-01

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

  16. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation

    Microsoft Academic Search

    G T Wilkins; A E Weyman; V M Abascal; P C Block; I F Palacios

    1988-01-01

    Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral

  17. Mitral valve surgery - minimally invasive

    MedlinePLUS

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

  18. Mitral Valve Prolapse (For Parents)

    MedlinePLUS

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

  19. Mechanics of the mitral valve

    PubMed Central

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

    2013-01-01

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

  20. How Is Mitral Valve Prolapse Diagnosed?

    MedlinePLUS

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

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

    PubMed

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

    2014-10-01

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

  2. Tophaceous pseudogout of the mitral valve

    Microsoft Academic Search

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

    1998-01-01

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

  3. Minimally invasive mitral valve surgery: the subxiphoid approach

    Microsoft Academic Search

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

    1999-01-01

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

  4. Leakage test during mitral valve repair.

    PubMed

    Watanabe, Taiju; Arai, Hirokuni

    2014-11-01

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

  5. Transjugular approach in valve-in-valve transcatheter mitral valve replacement: direct route to the valve.

    PubMed

    Kaneko, Tsuyoshi; Swain, JaBaris D; Loberman, Dan; Welt, Frederick G P; Davidson, Michael J; Eisenhauer, Andrew C

    2014-06-01

    With the recent emergence of transcatheter valve replacement, high-risk cases of structural valve deterioration after mitral bioprosthesis can be treated with valve-in-valve transcatheter mitral valve replacement (TMVR). The transapical approach has become the principal access for TMVR, but we report an alternative direct access for TMVR--transjugular transseptal route--in an 81-year-old woman with a degenerated mitral bioprosthesis. PMID:24882333

  6. Unique mitral valve mass: Think beyond vegetation.

    PubMed

    Farhoud, Mahmoud; Bakdash, Husam

    2014-10-01

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

  7. Independence of mitral valve prolapse and neurosis

    Microsoft Academic Search

    A J Hickey; G Andrews; D E Wilcken

    1983-01-01

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

  8. Prevalence of Mitral Valve Prolapse in Hypertension

    PubMed Central

    Holgado, Gemelia M.; Prakash, Ravi

    1987-01-01

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

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

    Microsoft Academic Search

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

    1999-01-01

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

  10. Association between congenitally quadricuspid aortic valve and mitral valve prolapse

    PubMed Central

    George, Betsy Ann; O'Hayre, Tayler Ann

    2013-01-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  11. Association between congenitally quadricuspid aortic valve and mitral valve prolapse.

    PubMed

    George, Betsy Ann; O'Hayre, Tayler Ann; Schussler, Jeffrey M

    2013-07-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  12. Prevalence of mitral valve prolapse and congenital bicuspid aortic valves in black and white patients undergoing cardiac valve operations.

    PubMed

    Novaro, Gian M; Houghtaling, Penny L; Gillinov, A Marc; Blackstone, Eugene H; Asher, Craig R

    2013-03-15

    The risk factors for aortic and mitral valve diseases that require surgical repair such as congenital bicuspid aortic valve (BAV) and mitral valve prolapse include acquired clinical factors and genetic influences. Whether race affects the prevalence of certain valvular diseases has not been sufficiently investigated. Through the Cleveland Clinic's Cardiovascular Information Registry, we evaluated the data from 40,419 patients who had undergone aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting from 1993 to 2007. Of these patients, 38,366 were white and 2,053 were black. The prospective evaluation of valvular disease was coded, identifying the etiology and morphology by echocardiographic, surgical, and pathologic inspection. At baseline, compared to white patients, the black patients were younger, more often women, had a greater body mass index, and a greater prevalence of hypertension, diabetes, tobacco use, and renal disease. The prevalence of congenital BAV and mitral valve prolapse was considerably lower in blacks than in whites (9% vs 25%, p <0.001, and 27% vs 52%, p <0.001, respectively), as was the presence of calcific aortic stenosis (14% vs 28%; p <0.001), pathologically determined aortic valve calcium (50% vs 67%; p <0.001), and mitral valve chordal rupture (13% vs 31%; p <0.001). In conclusion, in the present large surgical series, the valve etiologies and morphology differed among blacks and whites. Despite an adverse cardiovascular risk profile, blacks had a significantly lower prevalence of valvular calcium and degeneration than did the whites and a lower prevalence of congenital BAV and mitral valve prolapse. Our findings offer insight into the influence of race on the development of mitral valve disease and congenital BAV. PMID:23276473

  13. Genetic mechanisms of mitral valve prolapse

    Microsoft Academic Search

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

    2008-01-01

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

  14. Durability of mitral valve repair for degenerative disease

    Microsoft Academic Search

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

    1998-01-01

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

  15. Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

    PubMed Central

    Mo?e?ska, Olga; Sypu?a, S?awomir; Celi?ska-Spoder, Ma?gorzata; Walecki, Jerzy; Kosior, Dariusz A.

    2014-01-01

    Summary Background Caseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction. Case Report 76-year old obese (BMI 32 kg/m2), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment. Conclusions Although caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis. PMID:24791181

  16. Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

    PubMed Central

    Kalmanson, D; Veyrat, C; Bernier, A; Witchitz, S; Chiche, P

    1976-01-01

    In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification. PMID:1259828

  17. Mitral valve prolapse in the general population

    Microsoft Academic Search

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

    2002-01-01

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

  18. Blood cyst of the mitral valve.

    PubMed

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

    2012-01-01

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

  19. Marfan syndrome and mitral valve prolapse

    PubMed Central

    Weyman, Arthur E.; Scherrer-Crosbie, Marielle

    2004-01-01

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

  20. Atrial Vectorcardiogram in Mitral Valve Disease

    Microsoft Academic Search

    G. E. Burch; T. D. Giles

    1973-01-01

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

  1. Mitral valve prolapse and occult aortic coarctation.

    PubMed Central

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

    1990-01-01

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

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

    PubMed

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

    2014-10-01

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

  3. Stentless mitral valve replacement using the quattro valve.

    PubMed

    Walther, T; Walther, C; Falk, V; Krüger, M; Dagge, A; Diegeler, A; Autschbach, R; Mohr, F W

    1999-10-01

    This study analyzed early clinical results after stentless mitral valve (Quadrileaflet Mitral Valve (QMV)/Quattro) implantation. A total of 28 patients have received a Quattro valve since August 1997. Patient age was 69+/-8 years; the underlying disease was mitral incompetence (14) and stenosis (13). Preoperative New York Heart Association functional class was 3.2+/-0.4 and cardiac index was 1.8+/-0.6. Mean cross-clamp duration was 58+/-19 minutes. Twenty patients received a 28-mm prosthesis, and eight patients received a 30-mm prosthesis. Four patients had myocardial revascularization, two had tricuspid valve repair, and six had radiofrequency ablation therapy to restore sinus rhythm. Mortality (1) was nonvalve related. Reoperation was necessary in two patients for posterior paravalvular leakage (1) and for functional stenosis (1). Echocardiography showed satisfactory hemodynamic function. By stentless mitral valve implantation the annuloventricular continuity is preserved to stabilize left ventricular function. The Quattro valve resembles native mitral valve function and is well suited for mitral valve replacement. PMID:10660190

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

    Microsoft Academic Search

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

    2000-01-01

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

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

    PubMed

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

    2015-07-01

    The aim of this study was to assess the association between mitral annular calcium (MAC) and flail mitral leaflets in a cohort of patients with degenerative mitral valve disease. A retrospective study was conducted of consecutive patients with degenerative mitral valve disease who underwent echocardiography at Rabin Medical Center from 2003 to 2012. Special focus was attended to the presence and grade of MAC and characterization of valve pathology (myxomatous vs nonmyxomatous, prolapse vs flail). Patients were excluded if they had undergone previous mitral valve surgery and/or had infective endocarditis. Multivariate logistic regressions were used to control for confounders. The study included 1,912 patients (60.8% men, mean age 63.8 ± 17.4 years) divided into 3 groups: 1,627 (86%) without MAC, 183 (10%) with either mild or moderate MAC, and 94 (5%) with severe MAC. The presence of flail leaflet was 27%, 30%, and 46% in these groups, respectively (p <0.001). After adjustment for age, gender, and co-morbidities, the odd ratio for flail mitral leaflet with severe MAC versus no MAC was 1.76 (95% confidence interval 1.10 to 2.83, p = 0.019). In conclusion, this study demonstrates that degenerative mitral valve disease with severe MAC is significantly associated with flail mitral leaflet. PMID:25966825

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

    PubMed

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

    2014-06-01

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

  7. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

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

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

    Microsoft Academic Search

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

    2001-01-01

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

  9. Mitral Valve Prolapse in Young Patients.

    ERIC Educational Resources Information Center

    McFaul, Richard C.

    1987-01-01

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

  10. Calcified left atrial myxoma with floppy mitral valve

    Microsoft Academic Search

    G P Sharratt; M L Grover; J L Monro

    1979-01-01

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

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

    PubMed

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

    2008-07-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    E-print Network

    Pekkan, Kerem

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

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

    PubMed

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

    2015-05-01

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

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

    Microsoft Academic Search

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

    2004-01-01

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

  16. Outcome of atrial fibrillation after mitral valve repair

    Microsoft Academic Search

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

    1997-01-01

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

  17. Modelisation mathematique realiste de la valve mitrale Sabine Paeme

    E-print Network

    Wolper, Pierre

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    2015-03-01

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

  20. Robotically assisted minimally invasive mitral valve surgery

    PubMed Central

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

    2013-01-01

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

  1. Natural history of mitral valve prolapse

    Microsoft Academic Search

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

    1995-01-01

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

  2. A large cardiac mass: diagnosis of caseous mitral annular calcification and determining optimum management strategy.

    PubMed

    Shapera, Emanuel A; Karimi, Afshin; Castellanos, Luis R

    2014-01-01

    A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a 2.0 × 2.3?cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient's presentation, risk factors, and overall clinical circumstances. PMID:25028589

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

    PubMed

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

    2015-07-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-01-01

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

  6. Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population.

    PubMed

    Willemink, Martin J; Takx, Richard A P; Išgum, Ivana; de Koning, Harry J; Oudkerk, Matthijs; Mali, Willem P Th M; Budde, Ricardo P J; Leiner, Tim; Vliegenthart, Rozemarijn; de Jong, Pim A

    2015-08-01

    To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95 % confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0 %) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0 % (n = 59) or 12.9 % (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95 % CI, 1.09-1.84) and 2.74 (95 % CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95 % CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events. PMID:25962863

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

    PubMed Central

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

    2008-01-01

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

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

    Microsoft Academic Search

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

    1990-01-01

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

  9. [Immune state in athletes with mitral valve prolapse].

    PubMed

    Maslennikova, O M; Reznichenko, T A; Firsakova, V Iu

    2013-01-01

    The authors evaluated immune state in 541 professional athletes. The athletes with vitral valve prolapse (132 subjects) appeared to have immune changes - lower immunoglobulines levels, general leucocytes count, if compared to the athletes without mitral valve prolapse. PMID:24340766

  10. Successful thrombolytic treatment of prosthetic mitral valve thrombosis

    PubMed Central

    Gazi, Emine; Altun, Burak; Temiz, Ahmet; Colkesen, Yucel

    2013-01-01

    Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 47-year-old woman who had undergone coronary artery bypass graft and mitral valve replacement operation 9?months ago. A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transoesophageal echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred. PMID:23749862

  11. Living with Mitral Valve Prolapse

    MedlinePLUS

    ... Clinical Trials Links Related Topics Arrhythmia Endocarditis Heart Valve Disease How the Heart Works Marfan Syndrome Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  12. Port-access mitral valve replacement in dogs

    Microsoft Academic Search

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

    1996-01-01

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

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

    Microsoft Academic Search

    A J Hickey; D E Wilcken

    1986-01-01

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

  14. Mitral valve prolapse in hyperthyroidism of two different origins

    Microsoft Academic Search

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

    1985-01-01

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

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

    PubMed

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

    2015-04-01

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

  16. Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

    PubMed Central

    Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-01-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

  17. Ochronotic involvement of the aortic and mitral valves in a 72-year-old man.

    PubMed

    Atalay, Atakan; Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-02-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

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

    PubMed Central

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

    1985-01-01

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

  19. Triglycidylamine Cross-linking Combined with Ethanol Inhibits Bioprosthetic Heart Valve Calcification

    PubMed Central

    Connolly, Jeanne M.; Bakay, Marina A.; Alferiev, Ivan S.; Gorman, Robert C.; Gorman, Joseph H.; Kruth, Howard S.; Ashworth, Paul E.; Kutty, Jaishankar K.; Schoen, Frederick J.; Bianco, Richard W.; Levy, Robert J.

    2012-01-01

    Background One of the most important factors responsible for the calcific failure of bioprosthetic heart valves is glutaraldehyde cross-linking. Ethanol (EtOH) incubation after glutaraldehyde cross-linking has previously been reported to confer anti-calcification efficacy for bioprostheses. The present studies investigated the anticalcification efficacy in vivo of the novel cross-linking agent, triglycidyl amine (TGA), with or without EtOH incubation, in comparison to glutaraldehyde. Methods TGA cross-linking (+/? EtOH) was used to prepare porcine aortic valves for both rat subdermal implants and sheep mitral valve replacements, for comparisons with glutaraldehyde-fixed controls. Thermal denaturation temperature (Ts), an index of cross-linking, cholesterol extraction, and hydrodynamic properties were quantified. Explant endpoints included quantitative and morphologic assessment of calcification. Results Ts after TGA were intermediate between unfixed and glutaraldehyde-fixed. EtOH incubation resulted in almost complete extraction of cholesterol from TGA or glutaraldehyde-fixed cusps. Rat subdermal explants (90days) demonstrated that TGA-EtOH resulted in a significantly greater level of inhibition of calcification than other conditions. Thus, TGA-ethanol stent mounted porcine aortic valve bioprostheses were fabricated for comparisons with glutaraldehyde-pretreated controls. In hydrodynamic studies, TGA-EtOH bioprostheses had lower pressure gradients than glutaraldehyde-fixed. TGA-ethanol bioprostheses used as mitral valve replacements in juvenile sheep (150 days) demonstrated significantly lower calcium levels in both explanted porcine aortic cusp and aortic wall samples compared to glutaraldehyde-fixed controls. However, TGA-EtOH sheep explants also demonstrated isolated calcific nodules and intracuspal hematomas. Conclusions TGA-EtOH pretreatment of porcine aortic valves confers significant calcification resistance in both rat subdermal and sheep circulatory implants, but with associated structural instability. PMID:21871270

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

    Microsoft Academic Search

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

    1995-01-01

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

  1. Towards new therapies for calcific aortic valve disease

    Microsoft Academic Search

    P. W. Riem Vis

    2011-01-01

    Calcific aortic valve disease (CAVD) is characterized by progressive calcification of the aortic valve cusps. The end-stage (stenosis), can lead to heart failure and death. Approximately 2-3% of adults over 65 years of age are thought to suffer from valve stenosis, requiring aortic valve replacement. This amounts to a total number of approximately 300,000 aortic valve replacements worldwide and this

  2. Mitral Valve Prolapse and the Association with Cutaneous Mucin Infiltration

    PubMed Central

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

    2013-01-01

    Mitral valve prolapse is the most common disorder of the cardiac valves in people in the United States. It can present as both primary and secondary disorders, and when associated with myxomatous changes in the skin, the term cardiocutaneous mucinosis can be used to describe this entity. Patients with mitral valve prolapse may have cutaneous findings on histological analysis that may indicate its severity and complication rate. PMID:23710268

  3. Trilogy Pericardial Valve: Hemodynamic Performance and Calcification in Adolescent Sheep

    Microsoft Academic Search

    Willem Flameng; Bart Meuris; Crystal Cunanan; Erik Verbeken; Paul Herijgers; Marie-Christine Herregods

    2010-01-01

    Background. We assessed the hemodynamic perfor- mance and calcification potential of a new design o f bovine pericardial valve, the Trilogy valve (Arbor Surgi - cal Technologies Inc, Irvine, CA). We compared this new valve with the Perimount valve (Edwards Lifesciences , Irvine, CA) in a randomized prospective study in adoles - cent sheep . Methods. Nine Trilogy valves (size

  4. Transapical transcatheter valve-in-valve replacement for deteriorated mitral valve bioprosthesis without radio-opaque indicators: the "invisible" mitral valve bioprosthesis.

    PubMed

    Rossi, Marco Luciano; Barbaro, Cristina; Pagnotta, Paolo; Cappai, Antioco; Ornaghi, Diego; Belli, Guido; Presbitero, Patrizia

    2015-02-01

    In view of the high number of bioprosthetic valves implanted during the past 30 years, an increasing number of patients are coming to medical attention because of degenerated bioprostheses. Transcatheter aortic valve-in-valve implantation has been described as a less invasive alternative to re-operation to treat severe structural valve deterioration. As far as degenerated mitral valve bioprostheses are concerned, transcatheter transapical mitral valve-in-valve replacement (TMVR) has been less commonly performed, but may also become a viable alternative to re-do replacement surgery. We describe treatment of a degenerated bioprosthetic mitral valve, characterised by complete absence of any radio-opaque landmarks making the TMVR procedure very challenging. PMID:25456504

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

    PubMed Central

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

    1991-01-01

    This case study describes a 9-year-old-girl presenting with symptoms of anxiety and depression who was found to have mitral valve prolapse syndrome. The relationship of mitral valve prolapse and anxiety and depression has been studied and a review of the literature is presented. The family history of heart and psychiatric problems is explored. The importance of the bio-psycho-social approach is stressed as well as the suggestion that mitral valve prolapse be included as part of the differential diagnosis for anxiety. PMID:2049370

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

    PubMed

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

    2015-01-01

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

  7. Dermatoglyphs in children with mitral valve prolapse.

    PubMed Central

    Tay, J S; Yip, W C; Yap, H K; Lee, B W; Wong, H B; Chay, S O

    1985-01-01

    The dermatoglyphs of 50 Singapore school children with mitral valve prolapse (MVP) were studied, with special reference to the frequency of digital arches. The MVP was diagnosed clinically and substantiated by two dimensional echocardiography. In the study there were 35 Chinese and 15 Malay children, with ages ranging from 6 to 19 years. Four Chinese children had one or more arches on the digits but none of the Malay children was found to have arches. It was shown that the frequency of arches on the digits was not significantly higher than that among 50 controls (who were shown not to have MVP on two dimensional echocardiography) or when compared with the frequency of arches among the Chinese and Malay population in Singapore (2.0% and 2.9% respectively). No other dermatoglyphic abnormalities (including atd angle) were found. PMID:3989829

  8. Mitral valve replacement with Alvarez prosthesis: long-term results

    PubMed Central

    Mashhour, Y. A. S.; Garcia, J. B.; Ionescu, M.; Wooler, G. H.

    1969-01-01

    The high mortality and morbidity that follow insertion of the Alvarez valve in the mitral position, and particularly the thrombo-embolic complications, stopped us from using it clinically in the Leeds General Infirmary. Images PMID:5810369

  9. “Adjustable” Artificial Chordal Replacement for Repair of Mitral Valve Prolapse

    Microsoft Academic Search

    J. Scott Rankin; Ricardo E. Orozco; Tracey L. Rodgers; David D. Alfery; Donald D. Glower

    2006-01-01

    Achieving a stable repair of mitral valve prolapse can be difficult in complex pathologies, and a 5% to 20% late reoperation rate exists with leaflet resection and recon- struction. During an 8-year period, prolapse was man- aged uniformly with \\

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

    PubMed Central

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

    2000-01-01

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

  11. Minimally Invasive Port-Access Mitral Valve Surgery

    Microsoft Academic Search

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

    1998-01-01

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

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

    PubMed

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

    2014-09-01

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

  13. Evaluation of mitral valve replacement anchoring in a phantom

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

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

    PubMed

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

    2010-10-01

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

  15. Calcification characteristics of porcine stentless valves in juvenile sheep1

    Microsoft Academic Search

    Paul Herijgers; Shigeyuki Ozakia; Eric Verbeken; Alfons Van Lommelb; Rozalia Racz; Miroslaw Zietkiewicz; Bartlomiej Perek; Willem Flamenga

    Objective: To compare calcification characteristics of two porcine stentless valves (Toronto SPV and Freestyle) with different designs, fixation and antimineralization techniques using a juvenile sheep model of valve implantation inside the circulation. Methods: The stentless valves (n = 2 ? 6) were implanted in juvenile sheep in the pulmonary artery as an interposition, while the circulation was maintained with a

  16. The myxomatous mitral valve and sudden death.

    PubMed

    Chesler, E; King, R A; Edwards, J E

    1983-03-01

    The clincopathologic features of 14 cases of sudden death attributable to dysrhythmias associated with the myxomatous mitral valve are described. The patients were 14-59 years old (mean 27 +/- 11 years). Eleven were female and three male. Of the seven ECGs available, none showed prolongation of the QT interval, but two showed repolarization abnormalities. The material was classified according to the degree of prolapse in the pathologic specimen. When obvious prolapse was found, the expected auscultatory findings had been documented. In three cases there was minimal prolapse, casting some doubt on the hypothesis that traction on the papillary muscles or diastolic dumping of the leaflets may be implicated in the pathogenesis of the dysrhythmias. In one of the cases with minimal prolapse there was a strong family history of sudden death. Endocardial friction lesions were present in 11 cases, including two of the three with minimal prolapse. In five cases there was a thrombotic lesion in the angle between the posterior leaflet and the left atrial wall containing fibrin and platelets. These abnormalities may be important in the pathogenesis of the ventricular dysrhythmias. PMID:6821906

  17. Electrocardiographic Changes in Mitral Valve Prolapse Syndrome

    PubMed Central

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

    2014-01-01

    Introduction: Mitral valve prolapse syndrome (MVP) is the most common valvular abnormalityin the young and is correlated with increased frequency of cardiac dysrhythmias and sudden death.The aim of this study was to compare frequency of “early repolarization” in electrocardiogram(ECG) between MVP patients and healthy adults. Methods: In this cross-sectional study, we compared ECG presentations of early repolarizationincluding notch in descending arm of QRS and J-point and/or ST segment changes in 100 patientswith MVP with 100 healthy individuals. MVP patients were referred to cardiology clinic withsymptoms of palpitation, chest pain or anxiety. Results: The mean age in patients with MVP was significantly less than healthy subjects (29.5 ±9.3 years versus 31.0 ± 6.9 years in control group, P= 0.1967). We detected early repolarizationas a prevalent sign in ECG of patients which was a notch in descending arm of QRS and/or STsegment or J-point elevation seen in 74% of patients ( 51% in inferior leads and 23% in I and aVLleads) , whilst the same findings were seen in 8 men (8%) in control group (P= 0.0001). Conclusion: Early repolarization in ECG presented as a notch in descending arm of QRS and/or ST segment or J-point elevation is more frequent in in young patients with MVP syndrome. PMID:24753827

  18. Association between neutrophil-lymphocyte ratio and mitral annular calcification.

    PubMed

    Varol, Ercan; Aksoy, Fatih; Ozaydin, Mehmet; Erdogan, Dogan; Dogan, Abdullah

    2014-09-01

    Mitral annular calcification (MAC) is closely related to cardiovascular disorders including coronary artery disease, atherosclerosis, heart failure, and stroke. The clinical risk factors for cardiovascular diseases, including age, obesity, hypertension, hyperlipidemia, and diabetes mellitus, are the same for MAC and atherosclerosis. The aim of this study was to assess the neutrophil-lymphocyte ratio (NLR), an inflammatory marker, in patients with MAC. The study group consisted of 117 patients with MAC. Age and sex-matched control group was composed of 38 patients who were admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured hematological indices in patients and control individuals. NLR ratio was significantly higher in patients with MAC than in control individuals (3.3 ± 1.8 vs. 1.6 ± 0.4, respectively; P < 0.001), and NLR ratio was positively correlated with MAC (P < 0.001, r = 0.58). Red cell distribution width was also significantly higher in patients with MAC than in control individuals (16.2 ± 3.3 vs. 13.4 ± 0.9%, respectively; P < 0.001). We have shown that NLR was significantly elevated in patients with MAC and it was correlated with MAC. PMID:24561537

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

    Microsoft Academic Search

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

    1998-01-01

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

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

    Microsoft Academic Search

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

    2002-01-01

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

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

    E-print Network

    Ayache, Nicholas

    Using Real-Time Three-Dimensional Ultrasound to Characterize Mitral Valve Motion Paul M. Novotnya results aim to fully characterize the four-dimensional (3D + time) movement of the mitral valve for better understanding of its behavior prior to surgical interventions, such as mitral valve repair. A behavior model

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

    E-print Network

    Luo, Xiaoyu

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

  3. Fast Interactive Simulations of Mitral Valve Repair Neil A. Tenenholtz, Peter E. Hammer, Robert D. Howe

    E-print Network

    Fast Interactive Simulations of Mitral Valve Repair Neil A. Tenenholtz, Peter E. Hammer, Robert D. Howe Keywords: Surgical simulation, human-computer interaction, haptics, mitral valve, cardiac surgery. I. Problem Solved A healthy mitral valve ensures the one-way flow of oxygenated blood from the left

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

    Microsoft Academic Search

    Roland Fasol; Katja Mahdjoobian

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

  5. Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse

    Microsoft Academic Search

    Kaan Kulan; Baki Komsuo?lu; Cemal Tuncer; Cansel Kulan

    1996-01-01

    The present study was designed to detect the arrhythmogenic effect of mitral valve prolapse, and the relationship between QT, QT dispersion and ventricular arrhythmias in subjects with mitral valve prolapse. Sixty-four mitral valve prolapse subjects (24 men and 40 women, mean age 27 ± 6), and 80 healthy control subjects (32 men and 48 women, mean age 28 ± 7)

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

    Microsoft Academic Search

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

    1995-01-01

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

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

    Microsoft Academic Search

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

    2001-01-01

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

  8. Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

    PubMed Central

    Doolub, Gemina

    2015-01-01

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

  9. Mitral Valve Mechanics Following Posterior Leaflet Patch Augmentation

    PubMed Central

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

    2013-01-01

    Background and aim of the study Attention towards the optimization of mitral valve repair methods is increasing. Patch augmentation is one strategy used to treat functional ischemic mitral regurgitation (FIMR). The study aim was to investigate the force balance changes in specific chordae tendineae emanating from the posterior papillary muscle in a FIMR-simulated valve, following posterior leaflet patch augmentation. Methods Mitral valves were obtained from 12 pigs (body weight 80 kg). An in vitro test set-up simulating the left ventricle was used to hold the valves. The left ventricular pressure was regulated with water to simulate different static pressures during valve closure. A standardized oval pericardial patch (17 × 29 mm) was introduced into the posterior leaflet from mid P2 to the end of the P3 scallop. Dedicated miniature transducers were used to record the forces exerted on the chordae tendineae. Data were acquired before and after 12 mm posterior and 5 mm apical posterior papillary muscle displacement to simulate the effect from one of the main contributors of FIMR, before and after patch augmentation. Results The effect of displacing the posterior papillary muscle induced tethering on the intermediate chordae tendineae to the posterior leaflet, and resulted in a 39.8% force increase (p = 0.014). Posterior leaflet patch augmentation of the FIMR valve induced a 31.1% force decrease (p = 0.007). There was no difference in force between the healthy and the repaired valve simulations (p = 0.773). Conclusion Posterior leaflet patch augmentation significantly reduced the forces exerted on the intermediate chordae tendineae from the posterior papillary muscle following FIMR simulation. As changes in chordal tension lead to a redistribution of the total stress exerted on the valve, patch augmentation may have an adverse long-term influence on mitral valve function and remodeling. PMID:23610985

  10. Review Article The aortic valve microenvironment and its role in calcific aortic

    E-print Network

    Simmons, Craig A.

    Review Article The aortic valve microenvironment and its role in calcific aortic valve disease 21 November 2010; accepted 1 December 2010 Abstract In calcific aortic valve disease, fibrotic and calcific lesions form focally in the fibrosa layer of the valve leaflets. Layer

  11. Beating heart mitral valve repair with integrated ultrasound imaging

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John T.; Peters, Terry M.

    2015-03-01

    Beating heart valve therapies rely extensively on image guidance to treat patients who would be considered inoperable with conventional surgery. Mitral valve repair techniques including the MitrClip, NeoChord, and emerging transcatheter mitral valve replacement techniques rely on transesophageal echocardiography for guidance. These images are often difficult to interpret as the tool will cause shadowing artifacts that occlude tissue near the target site. Here, we integrate ultrasound imaging directly into the NeoChord device. This provides an unobstructed imaging plane that can visualize the valve lea ets as they are engaged by the device and can aid in achieving both a proper bite and spacing between the neochordae implants. A proof of concept user study in a phantom environment is performed to provide a proof of concept for this device.

  12. State of the mitral valve in rabbits with hypokinesia

    NASA Technical Reports Server (NTRS)

    Strelkovska, V. Y.

    1979-01-01

    In hypokinesia, edema of all the layers of the mitral value was observed, which resulted in morphological changes of the cellular and noncellular components. An increase in ratio of elastic and collagenic fibers in the value was also observed along with and changes in their structural and staining properties. The observed changes can limit valve mobility and can result in manifestations of cardiac valve insufficiency, which is found clinically.

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

    E-print Network

    Developing a Training Tool for Intraoperative Mitral Valve Analysis Neil A. Tenenholtz, Robert D@seas.harvard.edu INTRODUCTION The mitral valve is one of the four valves of the human heart. Serving as a passive check valve transparency. To produce such a fast simulation, a mass-spring approximation of a finite element model

  14. Surgical phantom for off-pump mitral valve replacement

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John; Guiraudon, Gerard M.; Jones, Doug L.; Campbell, Gordon; Peters, Terry M.

    2011-03-01

    Off-pump, intracardiac, beating heart surgery has the potential to improve patient outcomes by eliminating the need for cardiopulmonary bypass and aortic cross clamping but it requires extensive image guidance as well as the development of specialized instrumentation. Previously, developments in image guidance and instrumentation were validated on either a static phantom or in vivo through porcine models. This paper describes the design and development of a surgical phantom for simulating off-pump mitral valve replacement inside the closed beating heart. The phantom allows surgical access to the mitral annulus while mimicking the pressure inside the beating heart. An image guidance system using tracked ultrasound, magnetic instrument tracking and preoperative models previously developed for off-pump mitral valve replacement is applied to the phantom. Pressure measurements and ultrasound images confirm the phantom closely mimics conditions inside the beating heart.

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

    PubMed

    Idir, M; Deville, C; Roudaut, R

    2000-04-01

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

  16. Dynamic modelling of chorded mitral valves inside left ventricle

    E-print Network

    Luo, Xiaoyu

    model. This model allows us to investigate the influences of the flow vortex generated by the LV motion and swirls around in a clockwise fashion, forming a main clockwise vortex. This vortex persists through. Yin M, Luo X Y, Wang T J & Watton P , Effects of Flow Vortex on a Chorded Mitral Valve in the Left

  17. Endocarditis of the mitral valve posteromedial papillary muscle.

    PubMed

    Moorjani, Narain; Saad, Rasheed; Gallagher, Patrick; Livesey, Steven

    2014-03-01

    A 36-year-old intravenous drug abuser presented with an aortic root abscess and partial rupture of the posteromedial papillary muscle. Following aortic and mitral valve replacement, histological and microbiological analysis of the papillary muscle demonstrated methicillin-sensitive Staphylococcus aureus infection. PMID:24152175

  18. Fibrillin and other matrix proteins in mitral valve prolapse syndrome

    Microsoft Academic Search

    Joseph F Nasuti; Paul J Zhang; Michael D Feldman; Terri Pasha; Jasvir S Khurana; Joseph H Gorman; Robert C Gorman; Jagat Narula; Navneet Narula

    2004-01-01

    BackgroundUnlike myxomatous degeneration in Marfan syndrome, which has been reported to result from a mutation in the gene that codes for the extracellular structural protein fibrillin, no specific molecular abnormality has been documented to be the underlying cause of myxomatous degeneration in mitral valve prolapse syndrome (MVPS). The present study examined the distribution of fibrillin and other extracellular matrix proteins

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

    PubMed Central

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

    1987-01-01

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

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

    Microsoft Academic Search

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

    1995-01-01

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

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

    Microsoft Academic Search

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

    2002-01-01

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

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

    PubMed

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

    2003-01-01

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

  3. Percutaneous mitral heart valve repair--MitraClip.

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-08-01

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

  5. Review of mitral valve insufficiency: repair or replacement

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-03-01

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

  7. On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair

    E-print Network

    On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair Neil A repair of the mitral valve is a difficult procedure that is often avoided in favor of less effective valve replacement because of the associated technical challenges facing non-expert surgeons

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

    NASA Astrophysics Data System (ADS)

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

    2012-06-01

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

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

    PubMed

    Quader, Nishath; Rigolin, Vera H

    2014-01-01

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

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

    PubMed

    Kern, M J; Aguirre, F

    1992-08-01

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

  11. Kangaroo vs. porcine aortic valves: calcification potential after glutaraldehyde fixation.

    PubMed

    Narine, K; Chéry, Cyrille C; Goetghebeur, Els; Forsyth, R; Claeys, E; Cornelissen, Maria; Moens, L; Van Nooten, G

    2005-01-01

    The aim of this study was to evaluate and compare the calcification potential of kangaroo and porcine aortic valves after glutaraldehyde fixation at both low (0.6%) and high (2.0%) concentrations of glutaraldehyde in the rat subcutaneous model. To our knowledge this is the first report comparing the time-related, progressive calcification of these two species in the rat subcutaneous model. Twenty-two Sprague-Dawley rats were each implanted with two aortic valve leaflets (porcine and kangaroo) after fixation in 0.6% glutaraldehyde and two aortic valve leaflets (porcine and kangaroo) after fixation in 2% glutaraldehyde respectively. Animals were sacrificed after 24 h and thereafter weekly for up to 10 weeks after implantation. Calcium content was determined using inductively coupled plasma-mass spectrometry and confirmed histologically. Mean calcium content per milligram of tissue (dry weight) treated with 0.6 and 2% glutaraldehyde was 116.2 and 110.4 microg/mg tissue for kangaroo and 95.0 and 106.8 microg/mg tissue for porcine valves. Calcium content increased significantly over time (8.8 microg/mg tissue per week) and was not significantly different between groups. Regression analysis of calcification over time showed no significant difference in calcification of valves treated with 0.6 or 2% glutaraldehyde within and between the two species. Using the subcutaneous model, we did not detect a difference in calcification potential between kangaroo and porcine aortic valves treated with either high or low concentrations of glutaraldehyde. PMID:16088178

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

    PubMed

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

    2007-01-01

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

  13. Radiofrequency ablation of atrial fibrillation during mitral valve surgery

    Microsoft Academic Search

    David C. Kress; Jasbir Sra; David Krum; Anil Goel; Jennifer Campbell; Jeff Fox

    2002-01-01

    Twenty-three patients underwent endocardial radiofrequency ablation of atrial fibrillation (AF) during mitral valve procedures with a previously described left atrial lesion pattern. A temperature-controlled 7-coil surgical probe delivered 60-second lesions at 80°C. The left atrial appendage was oversewn after ablation. Ages ranged from 28 to 88 years. Nineteen patients had chronic AF that was present for over 1 year in

  14. Bilateral retinal artery occlusion due to mitral valve prolapse.

    PubMed Central

    van Rhee, F.; Blecher, T. E.; DeLepeleire, K. A.; Galloway, N. R.

    1991-01-01

    We report a case of bilateral retinal artery occlusion due to mitral valve prolapse. Most patients with retinal ischaemia in whom it is found have not been previously known to have it. Since it is a common condition it would seem essential that it be included in the differential diagnosis of amaurosis fugax and retinal artery occlusion if future ischaemic events are to be prevented. All patients with retinal ischaemia should have a full cardiovascular examination supplemented by echocardiography. Images PMID:1854701

  15. Heart rate variability of children with mitral valve prolapse

    Microsoft Academic Search

    Lin Han; Ting Fei Ho; William CL Yip; Kit Yee Chan

    2000-01-01

    Studies have indicated that adult patients with mitral valve prolapse (MVP) may have autonomic dysfunction. The purpose of this study was to evaluate heart rate variability (HRV) in children with MVP. Sixty-seven children with MVP (ages 6 to 18 years; 30 boys and 37 girls) were consecutively studied and subdivided into those with or without symptoms. Thirty-seven normal age-matched children

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

    PubMed

    Mahmood, Feroze; Matyal, Robina

    2015-07-01

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

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

    PubMed

    Desai, Heena M; Amonkar, Gayathri P

    2015-01-01

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

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

    PubMed Central

    Hickey, A J; Wilcken, D E

    1986-01-01

    The prevalence of mitral valve prolapse was determined in two independent populations (6887 consecutive adults and children referred for echocardiography during a three year period and 206 non-referred first degree relatives of 65 patients with mitral valve prolapse). In the 118 adults with echocardiographic evidence of prolapse those aged greater than or equal to 50 years were significantly more likely to have pansystolic murmurs and increased echocardiographic dimensions than those aged less than 50 years; and patients with complications of mitral valve prolapse were significantly older than those without. In the population referred for echocardiography and in the non-referred relatives there was a significant increase in prevalence in the two decades after adolescence (20-39 years) compared with that in the first two decades. The data suggest that prolapse principally becomes manifest in late adolescence when the growth spurt is complete and that thereafter the severity of prolapse increases with age in an important subset of patients. The latter findings accord with the predictions of the response to injury hypothesis for the pathogenesis of progressive changes. PMID:3718797

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

    PubMed Central

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

    2014-01-01

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

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

    Microsoft Academic Search

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

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

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

    PubMed Central

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

    1975-01-01

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

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

    PubMed Central

    2011-01-01

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

  3. Hemodynamics and Mechanobiology of Aortic Valve Inflammation and Calcification

    PubMed Central

    Balachandran, Kartik; Sucosky, Philippe; Yoganathan, Ajit P.

    2011-01-01

    Cardiac valves function in a mechanically complex environment, opening and closing close to a billion times during the average human lifetime, experiencing transvalvular pressures and pulsatile and oscillatory shear stresses, as well as bending and axial stress. Although valves were originally thought to be passive pieces of tissue, recent evidence points to an intimate interplay between the hemodynamic environment and biological response of the valve. Several decades of study have been devoted to understanding these varied mechanical stimuli and how they might induce valve pathology. Here, we review efforts taken in understanding the valvular response to its mechanical milieu and key insights gained from in vitro and ex vivo whole-tissue studies in the mechanobiology of aortic valve remodeling, inflammation, and calcification. PMID:21760982

  4. How Is Mitral Valve Prolapse Treated?

    MedlinePLUS

    ... Clinical Trials Links Related Topics Arrhythmia Endocarditis Heart Valve Disease How the Heart Works Marfan Syndrome Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

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

    PubMed

    Boudoulas, Konstantinos Dean; Boudoulas, Harisios

    2013-01-01

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

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

    PubMed

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

    2014-02-01

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

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

    PubMed Central

    Kang, Jessie; Das, Bijon

    2015-01-01

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

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

    PubMed

    Kang, Jessie; Das, Bijon

    2015-05-01

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

  9. 1302. P6.51. Using Real-Time Three-Dimensional Ultrasound To Characterize Mitral Valve Motion , M. LINGURARU

    E-print Network

    1302. P6.51. Using Real-Time Three-Dimensional Ultrasound To Characterize Mitral Valve Motion P results aim to fully characterize the four-dimensional (3D + time) movement of the mitral valve for better understanding of its behavior prior to surgical interventions, such as mitral valve repair. A behavior model

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

    E-print Network

    Wong, Kenneth K.Y.

    Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based, The Chinese University of Hong Kong, Hong Kong ABSTRACT Mitral valve repair is one of the most prevalent operations for various mitral valve conditions. Echocardiography, being famous for its low-cost, non

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

    Microsoft Academic Search

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

    1999-01-01

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

  12. Traumatic mitral valve avulsion from the annulus fibrosis producing acute left heart failure in a dog

    PubMed Central

    2004-01-01

    Abstract Traumatic detachment of the mitral valve from the annulus fibrosis occurred in a dog following blunt chest trauma. Euthanasia was elected approximately 7 months posttrauma due to refractory, chronic left heart failure. This is the first reported case of traumatic mitral valve rupture in a dog. PMID:15510686

  13. The "loop with anchor" technique to repair mitral valve prolapse.

    PubMed

    Isoda, Susumu; Osako, Motohiko; Kimura, Tamizo; Mashiko, Yuji; Yamanaka, Nozomu; Nakamura, Shingo; Maehara, Tadaaki

    2012-01-01

    The current surgical technique of using an artificial chord (composed of expanded polytetrafluoroethylene [ePTFE] sutures) to repair mitral prolapse is technically difficult to perform. Slippery knot tying and the difficulty of changing the chordae length after the hydrostatic test are frustrating problems. The loop technique solves the problem of slippery knot tying but not the problem of changing the chordae length. Our "loop with anchor" technique consists of the following elements: construction of an anchor at the papillary muscle; determining the loop length; tying the loop to the anchor; suturing the loop to the mitral valve; the hydrostatic test; and re-suturing or changing the loop, if needed. Adjustments can be made for the entire procedure or for a portion of the procedure. PMID:22156285

  14. Innate and Adaptive Immunity in Calcific Aortic Valve Disease

    PubMed Central

    Mathieu, Patrick; Bouchareb, Rihab

    2015-01-01

    Calcific aortic valve disease (CAVD) is the most common heart valve disorder. CAVD is a chronic process characterized by a pathologic mineralization of valve leaflets. Ectopic mineralization of the aortic valve involves complex relationships with immunity. Studies have highlighted that both innate and adaptive immunity play a role in the development of CAVD. In this regard, accumulating evidence indicates that fibrocalcific remodelling of the aortic valve is associated with activation of the NF-?B pathway. The expression of TNF-? and IL-6 is increased in human mineralized aortic valves and promotes an osteogenic program as well as the mineralization of valve interstitial cells (VICs), the main cellular component of the aortic valve. Different factors, including oxidized lipid species, activate the innate immune response through the Toll-like receptors. Moreover, VICs express 5-lipoxygenase and therefore produce leukotrienes, which may amplify the inflammatory response in the aortic valve. More recently, studies have emphasized that an adaptive immune response is triggered during CAVD. Herein, we are reviewing the link between the immune response and the development of CAVD and we have tried, whenever possible, to keep a translational approach.

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

    PubMed

    Thomas, Michael J; Bach, David S

    2012-07-01

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

  16. Orthostatic hypotension, catecholamines, and alpha-adrenergic receptors in mitral valve prolapse.

    PubMed Central

    Schatz, I. J.; Ramanathan, S.; Villagomez, R.; MacLean, C.

    1990-01-01

    The reported association of mitral valve prolapse with autonomic dysfunction and neuroendocrine abnormalities is derived from studies of patients selected because of symptoms or specifically referred for investigation. To determine whether such associations occur in nonreferred and unselected women with mitral valve prolapse, we measured blood pressure, heart rate, and norepinephrine response to standing in 13 volunteers with mitral valve prolapse and in 11 control subjects. Platelet alpha-adrenergic receptor quantity and affinity on standing also were determined in all persons. No significant differences were found between the groups in any of these measurements. Although small subsets of women with mitral valve prolapse may indeed have associated neuroendocrine epiphenomena and autonomic dysfunction, it is probably incorrect to generalize these findings to the vast spectrum of those with mitral valve prolapse. PMID:2155518

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

    SciTech Connect

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

    2007-08-29

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

  18. A Computational Model of Aging and Calcification in the Aortic Heart Valve

    E-print Network

    Mofrad, Mohammad R. K.

    A Computational Model of Aging and Calcification in the Aortic Heart Valve Eli J. Weinberg1 of America Abstract The aortic heart valve undergoes geometric and mechanical changes over time. The cusps of a normal, healthy valve thicken and become less extensible over time. In the disease calcific aortic

  19. Morphological and chemical study of pathological deposits in human aortic and mitral valve stenosis: a biomineralogical contribution.

    PubMed

    Cottignoli, Valentina; Cavarretta, Elena; Salvador, Loris; Valfré, Carlo; Maras, Adriana

    2015-01-01

    Aim of this study was to investigate heart valve calcification process by different biomineralogical techniques to provide morphological and chemical features of the ectopic deposit extracted from patients with severe mitral and aortic valve stenosis, to better evaluate this pathological process. Polarized light microscopy and scanning electron microscopy analyses brought to light the presence of nodular and massive mineralization forms characterized by different levels of calcification, as well as the presence of submicrometric calcified globular cluster, micrometric cavities containing disorganized tissue structures, and submillimeter pockets formed by organic fibers very similar to amyloid formations. Electron microprobe analyses showed variable concentrations of Ca and P within each deposit and the highest content of Ca and P within calcified tricuspid aortic valves, while powder X-ray diffraction analyses indicated in the nanometer range the dimension of the pathological bioapatite crystals. These findings indicated the presence of highly heterogeneous deposits within heart valve tissues and suggested a progressive maturation process with continuous changes in the composition of the valvular tissue, similar to the multistep formation process of bone tissue. Moreover the micrometric cavities represent structural stages of the valve tissue that immediately precedes the formation of heavily mineralized deposits such as bone-like nodules. PMID:25685595

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

    PubMed Central

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

    2014-01-01

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

  1. The Heterogeneous Biomechanics and Mechanobiology of the Mitral Valve: Implications for Tissue Engineering

    Microsoft Academic Search

    K. Jane Grande-Allen; Jun Liao

    2011-01-01

    There are compelling reasons to develop a tissue-engineered mitral valve, but this endeavor has not received the same attention\\u000a as tissue engineering strategies for the semilunar valves. Challenges in regenerating a mitral valve include recapitulating\\u000a the complex heterogeneity in terms of anatomy (differently sized leaflets, numerous chordae), extracellular matrix composition,\\u000a biomechanical behavior, valvular interstitial cell and endothelial cell phenotypes, and

  2. Mitral valve prolapse and the association with cutaneous mucin infiltration: ("cardiocutaneous mucinosis").

    PubMed

    Farooq, Uzma; Choudhary, Sonal; McLeod, Michael P; Torchia, Daniele; Romanelli, Paolo

    2013-05-01

    Mitral valve prolapse is the most common disorder of the cardiac valves in people in the United States. It can present as both primary and secondary disorders, and when associated with myxomatous changes in the skin, the term cardiocutaneous mucinosis can be used to describe this entity. Patients with mitral valve prolapse may have cutaneous findings on histological analysis that may indicate its severity and complication rate. PMID:23710268

  3. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study

    PubMed Central

    Kalra, Philip A.; Hunter, John; Menoyo, José; Stankus, Nicole

    2015-01-01

    Background: This multicenter international cross-sectional observational study characterized vascular and valvular calcification burden and correlations with pulse pressure, diabetes, hypertension, and cardiovascular diseases in prevalent hemodialysis patients. Methods: We enrolled 275 consecutive adults with end-stage renal disease on maintenance hemodialysis for ?3 months. Coprimary endpoints were prevalences of: (1) echocardiographic calcification in mitral valve, aortic valve or mitral annulus; (2) aortoiliac tree vascular calcifications by plain lateral lumbar X-ray. Correlations among calcification sites and with demographics and comorbidities were determined. Pulse pressures were determined. Results: Subjects’ mean?±?standard deviation (SD) age was 56?±?15.9 years; mean (SD) dialysis duration was 4.5?±?4.3 years. Overall, 100% of echocardiographically imaged patients (n?=?243) had calcification in aortic valve, mitral valve, or mitral annulus; 77.8% of X-rayed patients (n?=?248) had abdominal aortic calcification. Radiographic abdominal aortic calcification score correlated significantly with calcification of aortic valve (p?mitral annulus (p?=?0.0001) but not mitral valve. Aortic valve, mitral valve, and mitral annulus calcification correlated significantly among themselves (p?valve calcification was significantly more prevalent in patients aged ?65 years than <65 years, men than women, and Whites than African Americans. Pulse pressure correlated significantly with vascular calcification score (p?=?0.0049) but not with valvular calcification at any site. Conclusions: Vascular and valvular calcification are highly prevalent in the hemodialysis population. Peripheral vascular calcification correlates significantly with elevated pulse pressure and can be assessed easily using lateral lumbar X-ray. Further studies investigating the interaction between pulse pressure and development or progression of vascular calcification are of interest. PMID:25984289

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

    PubMed Central

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

    2011-01-01

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

  7. On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair

    PubMed Central

    Tenenholtz, Neil A.; Hammer, Peter E.; Schneider, Robert J.; Vasilyev, Nikolay V.; Howe, Robert D.

    2011-01-01

    Surgical repair of the mitral valve is a difficult procedure that is often avoided in favor of less effective valve replacement because of the associated technical challenges facing non-expert surgeons. In the interest of increasing the rate of valve repair, an accurate, interactive surgical simulator for mitral valve repair was developed. With a haptic interface, users can interact with a mechanical model during simulation to aid in the development of a surgical plan and then virtually implement the procedure to assess its efficacy. Sub-millimeter accuracy was achieved in a validation study, and the system was successfully used by a cardiac surgeon to repair three virtual pathological valves. PMID:24511427

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

    PubMed Central

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

    2013-01-01

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

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

    Microsoft Academic Search

    Toshinosuke Akutsu; Ryota Imai; Jun Saito; Tomoyuki Suzuki

    2008-01-01

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

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

    Microsoft Academic Search

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

    2007-01-01

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

  11. Surgery for congenital mitral valve disease in the first year of life

    Microsoft Academic Search

    Miguel Sousa Uva; Lorenzo Galletti; François Lacour Gayet; Dominique Piot; A. Serraf; Jacqueline Bruniaux; Juan Comas; R. Roussin; A. Touchot; Jean Paul Binet; Claude Planché

    1995-01-01

    Between 1980 and 1993, 20 patients less than 1 year of age underwent operations for congenital mitral valve disease. Ten patients had congenital mitral incompetence and 10 had congenital mitral stenosis. Mean age was 6.6 ± 3.4 months and mean weight was 5.6 ± 1.5 kg. Atrioventricular canal defects, univentricular heart, class III\\/IV hypoplastic left heart syndrome, discordant atrioventricular and

  12. Warfarin Causes Rapid Calcification of the Elastic Lamellae in Rat Arteries and Heart Valves

    E-print Network

    Price, Paul A.

    Warfarin Causes Rapid Calcification of the Elastic Lamellae in Rat Arteries and Heart Valves Paul A of the elastic lamellae in the media of major arteries and in aortic heart valves in the rat. Aortic, and 5 weeks of treatment. By 5 weeks, the highly focal calcification of major arteries could be seen

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

    PubMed

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

    2009-06-01

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

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

    Microsoft Academic Search

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

    2001-01-01

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

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

    Microsoft Academic Search

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

    2010-01-01

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

  16. Adult women with mitral valve prolapse are more flexible

    PubMed Central

    Araujo, C; Chaves, C

    2005-01-01

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

  17. Myxomatous mitral valve disease in dogs: Does size matter?

    PubMed Central

    Parker, Heidi G.; Kilroy-Glynn, Paul

    2012-01-01

    Myxomatous mitral valve disease (MMVD) is the most commonly diagnosed cardiovascular disease in the dog accounting for more than 70% of all cardiovascular disease in dogs. As are most canine diseases with genetic underpinnings, risk of MMVD is greatly increased in a subset of breeds. What is uncommon is that the vast majority of the breeds at elevated risk for MMVD are small or toy breeds with average adult weights under 9 kg. These breeds appear to have little in common other than their diminutive size. In the following review we propose a number of mechanisms by which relatively unrelated small breeds may have developed a predisposition for chronic valvular disorders. Although factors such as age are key in the expression of MMVD, taking a comprehensive look at the commonalities, as well as the differences, between the susceptible breeds may assist in finding the causal variants responsible for MMVD and translating them to improved treatments for both dogs and humans. PMID:22356836

  18. Myxomatous mitral valve disease in dogs: does size matter?

    PubMed

    Parker, Heidi G; Kilroy-Glynn, Paul

    2012-03-01

    Myxomatous mitral valve disease (MMVD) is the most commonly diagnosed cardiovascular disease in the dog accounting for more than 70% of all cardiovascular disease in dogs. As are most canine diseases with genetic underpinnings, risk of MMVD is greatly increased in a subset of breeds. What is uncommon is that the vast majority of the breeds at elevated risk for MMVD are small or toy breeds with average adult weights under 9 kg. These breeds appear to have little in common other than their diminutive size. In the following review we propose a number of mechanisms by which relatively unrelated small breeds may have developed a predisposition for chronic valvular disorders. Although factors such as age are key in the expression of MMVD, taking a comprehensive look at the commonalities, as well as the differences, between the susceptible breeds may assist in finding the causal variants responsible for MMVD and translating them to improved treatments for both dogs and humans. PMID:22356836

  19. Epidemiology of symptomatic mitral valve prolapse in black patients.

    PubMed Central

    Zua, M. S.; Dziegielewski, S. F.

    1995-01-01

    This study analyzed the charts of 743 black patients who visited the emergency rom of a Nashville Hospital with symptoms of chest pain, palpitation, or fatigue. One hundred sixty-five met the criteria for the diagnosis of mitral valve prolapse (MVP). Epidemiologic factors of symptomatic MVP in blacks (ie, symptoms reported based on age and sex) were examined to determine whether there are significant differences in the prevalence of symptomatic MVP with relation to black males and females. Similarities were found in the patterns of the ages of both males and females and the symptoms that were reported. No significant differences were found between black males and females, which does not support previous findings. PMID:7752279

  20. Prevalence of mitral valve prolapse in keratoconus patients.

    PubMed Central

    Sharif, K W; Casey, T A; Coltart, J

    1992-01-01

    Fifty patients with advanced degrees of keratoconus, requiring corneal transplantation, were screened for mitral valve prolapse by two dimensional echocardiography. The overall prevalence of 58% was found to be statistically higher than the prevalence of 7% found in a group of age and sex-matched controls. It was also found to be higher than the previously reported prevalence of 38% in a group of keratoconus patients with similar age and sex match to our series. The findings of our study in conjunction with the histopathological and biochemical similarities between the two conditions strongly suggest that they may be different manifestations of similar defects in collagen metabolism. Images Figure 1. Figure 2. PMID:1404188

  1. Echocardiographic assessment of left ventricular geometry and the mitral valve apparatus in cats with hypertrophic cardiomyopathy

    Microsoft Academic Search

    Karsten Schober; Amanda Todd

    2010-01-01

    ObjectivesThis retrospective study addressed the general hypothesis that abnormalities of the mitral valve apparatus are common in cats with idiopathic hypertrophic cardiomyopathy (HCM) and contribute to dynamic obstruction of the left ventricular outflow tract (LVOT).

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

    PubMed Central

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

    2013-01-01

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

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

    Microsoft Academic Search

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

    1997-01-01

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

  4. [Sudden death as presentation form of papillary fibroelastoma of mitral valve].

    PubMed

    Sánchez Rodríguez, A; Jiménez Moragas, J M; Marín Gurrea, M; Ravina Sanz, J; Sánchez Heredia, A

    2000-05-01

    We describe the case of a 35-year-old male, who presented with sudden death, secondary to anterior miocardial infarction due to embolism. Echocardiography, transthoracic and transesophageal, revealed a tumor in the anterior mitral leaflet. Tumor, histopathologically an papillary fibroelastoma, was excised and the mitral valve was replaced with a mechanical prosthetic valve. We revised the current literature on intracardiac papillary fibroelastoma. PMID:10859828

  5. Systematic review of robotic minimally invasive mitral valve surgery

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2012-06-01

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

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

    PubMed Central

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

    2005-01-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Naqvi, T Z

    2007-04-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2013-10-01

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

  14. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair

    PubMed Central

    Spampinato, Ricardo A.; Borger, Michael A.; Strotdrees, Elfriede; Mohr, Friedrich W.

    2013-01-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  15. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair.

    PubMed

    Spampinato, Ricardo A; Borger, Michael A; Strotdrees, Elfriede; Mohr, Friedrich W

    2013-03-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  16. Operative risks of the maze procedure associated with mitral valve surgery

    Microsoft Academic Search

    J. Q. Melo; J. P. Neves; L. M. Abecasis; P. Adragão; R. Ribeiras; R. Seabra-Gomes

    1997-01-01

    Twelve patients were operated on for mitral valve disease with concomitant chronic atrial fibrillation. Valve repair was performed in five patients and replacement in seven. Maze I and maze III procedures were applied in eight and four patients, respectively, and are compared. There was a regular rhythm in all maze I patients with a constant junctional rhythm in three and

  17. Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure

    Microsoft Academic Search

    Néstor Sandoval; Victor M. Velasco; Hernando Orjuela; Victor Caicedo; Hernando Santos; Fernando Rosas; Juan R. Correa; Iván Melgarejo; Carlos A. Morillo

    1996-01-01

    Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has

  18. Genetic segregation analysis of familial mitral valve prolapse shows no linkage to fibrillar collagen genes

    Microsoft Academic Search

    P Wordsworth; D Ogilvie; F Akhras; G Jackson; B Sykes

    1989-01-01

    Three pedigrees were identified in which mitral valve prolapse seemed to be inherited as a mendelian autosomal dominant trait. The segregation of the genes encoding the major fibrillar collagens present in valve tissue, collagens I and III, was analysed by use of restriction enzyme site variants as genetic markers. In one pedigree there was discordance between the segregation of the

  19. Inhibition of Calcification of Bioprosthetic Heart Valves by Local Controlled-Release Diphosphonate

    NASA Astrophysics Data System (ADS)

    Levy, Robert J.; Wolfrum, Jacqueline; Schoen, Frederick J.; Hawley, Marguerite A.; Lund, Sally Anne; Langer, Robert

    1985-04-01

    Bioprostheses fabricated from porcine aortic valves are widely used to replace diseased heart valves. Calcification is the principal cause of the clinical failure of these devices. In the present study, inhibition of the calcification of bioprosthetic heart valve cusps implanted subcutaneously in rats was achieved through the adjacent implantation of controlled-release matrices containing the anticalcification agent ethanehydroxydiphosphonate dispersed in a copolymer of ethylene-vinyl acetate. Prevention of calcification was virtually complete, without the adverse effects of retarded bone and somatic growth that accompany systemic administration of ethanehydroxydiphosphonate.

  20. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome.

    PubMed Central

    Handler, C E; Child, A; Light, N D; Dorrance, D E

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the continuous wave Doppler ultrasound technique. Ten (67%) patients had mitral valve prolapse shown by auscultatory signs or echocardiography or both--a prevalence at least three times greater than that in the general adult population. It is concluded that if the abnormality of collagen biosynthesis found in skin biopsy samples in these patients is also present in their mitral valve tissue this may predispose them to prolapse of the valve. Images PMID:3902069

  1. Cardiac transgenic matrix metalloproteinase-2 expression induces myxomatous valve degeneration: a potential model of mitral valve prolapse disease

    PubMed Central

    Mahimkar, Rajeev; Nguyen, Anita; Mann, Michael; Yeh, Che-Chung; Zhu, Bo-Qing; Karliner, Joel S.; Lovett, David H.

    2012-01-01

    Introduction Myxomatous mitral valve “degeneration” with prolapse (MVP) is the most frequent form of nonischemic mitral valve disease. In myxomatous valves, interstitial cells express extracellular matrix-degrading enzymes and it has been postulated that matrix metalloproteinases (MMPs) contribute to these changes. Methods We generated mice with cardiac-specific expression of constitutively active MMP-2 under the control of the ?-myosin heavy chain promoter. Results These mice are normal at 4–6 months of age; at 12–14 months the mitral valves and chordae tendineae exhibit severe myxomatous change with echocardiographic MVP. Myxomatous change was also evident to a lesser extent in the aortic valves. Myxomatous changes were heterogeneous and limited to the left side of the heart with major disorganization of collagen bundles within the lamina fibrosa. Alcian blue/PAS-stained valves revealed massive accumulation of acidic glycosoaminoglycans within the lamina spongiosa, consistent with valvular interstitial cell differentiation to a chondrocytic phenotype. Cells with the histologic features of hypertrophied chondrocytes were found within the chordae tendineae and the tips of the mitral papillary muscles. Conclusion This report demonstrates that increased activity of a single enzyme, MMP-2, within a transgenic context reproduces many of the features of the human MVP syndrome. The cardiac-specific MMP-2 transgenic mouse potentially provides a unique experimental platform for the evaluation of nonsurgical therapies based on the underlying pathophysiology of this disease. Published by Elsevier Inc. PMID:18835790

  2. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts.

    PubMed

    Ostrovsky, Yury; Spirydonau, Siarhei; Shchatsinka, Mikalai; Shket, Aliaksandr

    2015-05-01

    Surgical treatment of infective and prosthetic endocarditis using allografts gives good results. Aortic allograft implantation is a common technique, while tricuspid valve replacement with a mitral allograft is very rare. Multiple valve disease in case of infective endocarditis is a surgical challenge as such patients are usually in a grave condition and results of surgical treatment are often unsatisfactory. In this article we describe a clinical case of successful surgical treatment in a patient with active infective endocarditis of aortic and tricuspid valve, complicated by an aortic-right ventricular fistula. The aortic valve and ascending aorta were replaced with a cryopreserved aortic allograft; the tricuspid valve was replaced with a cryopreserved mitral allograft. PMID:25697982

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

    PubMed Central

    2015-01-01

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

  4. Computational Mitral Valve Evaluation and Potential Clinical Applications.

    PubMed

    Chandran, Krishnan B; Kim, Hyunggun

    2015-06-01

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

  5. Postoperative coronary artery spasm after mitral valve replacement?

    PubMed Central

    Pragliola, Claudio; Gaudino, Mario; Farina, Piero; Massetti, Massimo

    2015-01-01

    Introduction Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease Presentation of case We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. Discussion A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. Conclusion This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery PMID:25680533

  6. Increased prevalence of mitral valve prolapse in patients with migraine.

    PubMed Central

    Spence, J D; Wong, D G; Melendez, L J; Nichol, P M; Brown, J D

    1984-01-01

    Patients with classic migraine (69 women and 31 men) selected randomly from a practice list of over 1000 were matched for age, sex and neighbourhood with 100 people who did not have headache problems, and both groups underwent M-mode and two-dimensional echocardiography and clinical examination by cardiologists blinded to the subjects' clinical status. The mean ages were 34.9 +/- 11.3 years for the migraine group and 33.1 +/- 9.9 years for the control group. Definite and possible mitral valve prolapse (MVP), diagnosed according to predefined echocardiographic criteria, were found about twice as often in the migraine group as in the control group (in 15 v. 7 and 16 v. 8 patients respectively); the echocardiograms were definitely normal in 69 migraine patients and 85 controls (chi 2 = 8.39, p less than 0.025). Altogether 25% of the migraine group and 11% of the control group had evidence of MVP from a combination of the echocardiographic and auscultatory findings (chi 2 = 5.72, p less than 0.025). The odds ratio was 2.7, with 95% confidence limits of 1.17 and 6.29. The association between migraine and MVP has implications for the understanding of platelet abnormalities and episodes of cerebral ischemia occurring in both these conditions. PMID:6498701

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

    PubMed Central

    2010-01-01

    Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results. PMID:20331896

  8. Reproducibility of Electron-Beam CT Measures of Aortic Valve Calcification

    Microsoft Academic Search

    Matthew J. Budoff; Songshou Mao; Junichiro Takasu; David M. Shavelle; Xue-Qiao Zhao; Kevin D. O'Brien

    2002-01-01

    Rationale and ObjectivesThe authors performed this study to establish the interscan, interobserver, and intraobserver reproducibility of aortic valve calcification (AVC) measurements obtained with electron-beam computed tomography (CT).

  9. Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular septum in mitral valve prolapse

    Microsoft Academic Search

    Allen P. Burke; Andrew Farb; Anita Tang; John Smialek; Renu Virmani

    1997-01-01

    The mechanism of sudden cardiac death in patients with mitral valve prolapse is poorly understood. Twenty-four hearts from patients with mitral valve prolapse who suddenly died (mean age 34 ± 8 years) and 16 trauma control hearts (mean age 30 ± 7 years) were histologically studied. Dysplasia of the atrioventricular nodal artery was present in 18 of 24 hearts with

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

    Microsoft Academic Search

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

    2006-01-01

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

  11. Mitral Valve Surgery in a Patient with Spinal Progressive Muscular Atrophy: Report of a Case

    Microsoft Academic Search

    Yoshiyuki Takami; Hiroshi Ina; Akihiro Terasawa; Masahide Nakao

    2003-01-01

    We describe our experience in treating a 69-year-old man with spinal progressive muscular atrophy (SPMA), who underwent a\\u000a mitral valve replacement. He was admitted for dyspnea, and surgery was indicated for severe mitral insufficiency associated\\u000a with inferior myocardial infarction. He had been aware of muscle weakness and received a diagnosis of SPMA 18 years previously.\\u000a Worsening muscle atrophy had led

  12. Mitral replacement: clinical experience with a ball-valve prosthesis. Twenty-five years later.

    PubMed Central

    Cobanoglu, A; Grunkemeier, G L; Aru, G M; McKinley, C L; Starr, A

    1985-01-01

    The purpose of this report is to review the results of mitral valve replacement since a first report in the Annals of Surgery in 1961, in order to determine the relative importance of new valve designs versus other surgical variables. The continued use of the silastic ball valve in its 1966 configuration (Model 6120), by providing a comparative data base for other new prosthetic valves, allows this analysis. For a valid comparison with the tilting disc (Bjork-Shiley) and the porcine (Hancock and Carpentier-Edwards) valves, only results with the silastic ball valves implanted during comparable time frames should be used. (Formula: see text) Thus, there are no significant differences in the results obtained with the silastic ball valve in time frames comparable to other contemporary valves introduced in the early 1970s. Improved results, therefore, must be non-prosthetic valve related. Images FIG. 1. FIG. 2. FIG. 3. PMID:4037910

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

    PubMed

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

    1982-11-01

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

  14. [Chest pain with ischemic electrocardiographic changes: mitral valve prolapse in pediatrics. Case report].

    PubMed

    Matamala-Morillo, Miguel Ángel; Rodríguez-González, Moisés; Segado-Arenas, Antonio

    2015-01-01

    Chest pain is rare and usually benign in pediatrics. Cardiac etiology is even rarer. However, it is a symptom associated with ischemic heart disease and it imposes great social alarm, even in health care workers. Therefore, it is necessary to know the most common causes of this symptom in children, as well as serious diseases that can cause it, which require prompt medical attention. We report a case of chest pain associated with ischemic electrocardiographic changes in a patient with mitral valve prolapse and MASS phenotype (mitral valve prolapse, aortic root enlargement, and skeletal and skin alterations), we review the mitral valve prolapse and stress the importance of knowing it in the pediatric setting. PMID:25622171

  15. Progressive aortic valve calcification: three-dimensional visualization and biomechanical analysis.

    PubMed

    Halevi, Rotem; Hamdan, Ashraf; Marom, Gil; Mega, Mor; Raanani, Ehud; Haj-Ali, Rami

    2015-02-01

    Calcific aortic valve disease (CAVD) is a progressive pathology characterized by calcification mainly within the cusps of the aortic valve (AV). As CAVD advances, the blood flow and associated hemodynamics are severely altered, thus influencing the mechanical performance of the AV. This study proposes a new method, termed reverse calcification technique (RCT) capable of re-creating the different calcification growth stages. The RCT is based on three-dimensional (3D) spatial computed tomography (CT) distributions of the calcification density from patient-specific scans. By repeatedly subtracting the calcification voxels with the lowest Hounsfield unit (HU), only high calcification density volume is presented. RCT posits that this volume re-creation represents earlier calcification stages and may help identify CAVD initiation sites. The technique has been applied to scans from 12 patients (36 cusps) with severe aortic stenosis who underwent CT before transcatheter aortic valve implantation (TAVI). Four typical calcification geometries and growth patterns were identified. Finite elements (FE) analysis was applied to compare healthy AV structural response with two selected CAVD-RCT configurations. The orifice area decreased from 2.9cm(2) for the healthy valve to 1.4cm(2) for the moderate stenosis case. Local maximum strain magnitude of 0.24 was found on the edges of the calcification compared to 0.17 in the healthy AV, suggesting a direct relation between strain concentration and calcification geometries. The RCT may help predict CAVD progression in patients at early stages of the disease. The RCT allows a realistic FE mechanical simulation and performance of calcified AVs. PMID:25553668

  16. Left ventricular function and mitral valve opening in massive pulmonary embolism.

    PubMed Central

    Bullock, R E; Hall, R J

    1982-01-01

    M-mode echocardiograms are demonstrated from a patient with subacute massive pulmonary embolism before and after thrombolytic treatment and clinical recovery. Severely impaired left ventricular contraction returned to normal. A reversible reduction in mitral valve opening velocity was also seen and was thought to be in part the result of diminished left atrial filling. This hypothesis was tested experimentally; mitral valve opening velocity was measured in normal subjects and found to be significantly reduced when pulmonary blood flow was impeded during the Valsalva manoeuvre. Images PMID:7126394

  17. The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis

    PubMed Central

    Ortlepp, J; Hoffmann, R; Ohme, F; Lauscher, J; Bleckmann, F; Hanrath, P

    2001-01-01

    OBJECTIVE—To test the hypothesis that vitamin D receptor polymorphism is associated with calcific aortic valve stenosis.?DESIGN—The distribution of one polymorphism of the vitamin D receptor (BsmI B/b) was examined in 100 consecutive patients with calcific valvar aortic stenosis and compared with a control group of 100 patients (paired match for age, sex, and the presence of coronary artery disease from a total of 630 patients without calcified aortic valves). Polymerase chain reaction and restriction fragment length polymorphism were used to determine genotypes.?RESULTS—There was a significant difference in vitamin D receptor allele and genotype frequencies between the two groups. The allele B had a higher prevalence in patients with calcific aortic stenosis (B = 0.56, b = 0.44) than in the control cohort (B = 0.40, b = 0.60) (p = 0.001).?CONCLUSIONS—There is a significant association of vitamin D receptor polymorphism with calcific aortic valve stenosis. The B allele of the vitamin D receptor is more common in patients with calcific aortic valve stenosis. It now needs to be evaluated whether other genes that control calcium homeostasis are involved in the pathogenesis of this disorder.???Keywords: vitamin D receptor; calcific aortic stenosis; aortic valve; genetic polymorphism PMID:11359741

  18. Mitral valve anatomy and function: new insights from three-dimensional echocardiography.

    PubMed

    Muraru, Denisa; Cattarina, Maria; Boccalini, Francesca; Dal Lin, Carlo; Peluso, Diletta; Zoppellaro, Giacomo; Bellu, Roberto; Sarais, Cristiano; Xhyheri, Borejda; Iliceto, Sabino; Badano, Luigi P

    2013-02-01

    Integrating volumetric rendering with motion in real-time, three-dimensional (3D) echocardiography is the most suitable imaging technique for assessing heart valves. Today, the rapidly advancing 3D technology allows us to perform a virtual 'dissection' of the heart intra vitam and to discover unprecedented, realistic views of cardiac valves in just a few minutes. The mitral valve is the cardiac structure easiest to visualize by transthoracic or transoesophageal approach. Three-dimensional echocardiography is able to display the non-planar valve leaflets and annulus, the complex subvalvular apparatus and their spatial relationships with the surrounding structures. The complementary use of 3D colour flow adds data about valve integrity and allows the quantitation of valvular diseases. Accumulating evidence suggests that 3D echocardiography is emerging as the reference technique to assess mitral valve morphology and function and guide valvular procedures of mounting complexity. The purpose of this review is to provide an update on the current clinical applications of 3D echocardiography for assessing mitral valves and to stress the incremental benefits of 3D echocardiography over conventional two-dimensional echocardiography. PMID:23275024

  19. Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals

    PubMed Central

    Lange, David C.; Glidden, David; Secemsky, Eric A.; Ordovas, Karen; Deeks, Steven G.; Martin, Jeffrey N.; Bolger, Ann F.; Hsue, Priscilla Y.

    2015-01-01

    Background HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals. Methods and Results We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell’s C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all). Conclusion In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death. PMID:26132465

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

    PubMed Central

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

    2013-01-01

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

  1. Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi

    Microsoft Academic Search

    Yaron Shapira; Itzhak Herz; Mordehay Vaturi; Avital Porter; Yehuda Adler; Yochai Birnbaum; Boris Strasberg; Samuel Sclarovsky; Alex Sagie

    2000-01-01

    OBJECTIVESWe sought to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves in the absence of high-risk thrombi.BACKGROUNDCurrent recommendations for the thrombolytic treatment of stuck prosthetic mitral valves are partially based on older valve models and inclusion of patients in whom high-risk thrombi were either ignored or not sought for. The feasibility and safety of

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

    PubMed

    Sprouse, C; Mukherjee, R; Burlina, P

    2013-11-01

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

  3. Computer-enhanced mitral valve surgery: toward a total endoscopic procedure.

    PubMed

    Falk, V; Autschbach, R; Krakor, R; Walther, T; Diegeler, A; Onnasch, J F; Chitwood, W R; Mohr, F W

    1999-07-01

    The aim of the study was to develop a computer-enhanced, video-assisted approach for mitral valve repair as a potential step toward a complete endoscopic procedure. In 10 patients with nonischemic mitral valve insufficiency, computer-enhanced telemetric mitral valve repair using the Intuitive surgical telemanipulation system was performed. A femorofemoral bypass was initiated using Port-Access (Heartport, Redwood City, CA) cannulation. A small minithoracotomy was made in the right 4th intercostal space, and a custom-made rib retractor was placed. The pericardium was opened manually, and four traction stay sutures were placed to enhance exposure. After endoaortic balloon clamping, the left atrium was opened and stabilized. The end-effectors were placed in the left atrium through two ports (3rd ICS and 6th ICS, midaxillary line). A 30 degrees three-dimensional (3D)-videoscope angled up was placed through the incision. Mitral valve repair was then performed remotely from the surgical console. This included inspection of the valve, leaflet resection, leaflet repair, and ring implantation. After completion of the repair and testing of the valve, the end effectors were withdrawn, and the left atrium was closed manually using standard endoscopic instruments (Heartport). In all but 1 patient, successful repair, including quadrangular resection, chordal shortening, Whooler-plasty, and Alfieri-plasty, could be accomplished using the computer-enhanced telemanipulation system. A partial ring was implanted in 6 patients and a complete ring was implanted in 3 patients, respectively. Time for surgery, CPB, and clamp time were 170 to 330 minutes (median, 185 minutes), 140 to 220 minutes (median, 149 minutes), and 78 to 133 minutes (median, 94 minutes), respectively. In one patient, intraoperative transesophageal echocardiography (TEE) showed insufficient repair, a second surgery was performed via an enlarged left thoracotomy. One patient with recurrent mitral insufficiency had to have a second surgery on postoperative day 3 for a torn-out ring. Median time of hospitalization was 8 days. At 3 months follow-up (completed in 7 patients), all patients had improved clinically. Computer-enhanced mitral valve repair is feasible and can be performed with good functional results. The telemanipulation system offers the potential for true endoscopic mitral valve repair. However, surgical time is prolonged, and a learning curve has to be overcome. PMID:10451255

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

    NASA Astrophysics Data System (ADS)

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

    2012-03-01

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

  5. Vertical left ventricular angulation assessed by thallium 201 myocardial perfusion imaging in patients with mitral valve prolapse

    SciTech Connect

    Arora, R.R.; Horowitz, S.F.; Machac, J.; Goldman, M.E.

    1986-01-01

    Mitral valve prolapse has been associated with septal to aortic root angle abnormalities determined by echocardiography. Thallium 201 imaging in the anterior view permits visualization of the left ventricular long axis. In the present study, the vertical angle was defined as the angle formed by the long axis of the left ventricle and a horizontal line. The vertical angle was determined in 25 patients who had 201 TL stress testing and M-mode echocardiography. Group I (11 patients) had mitral valve prolapse and group II (14 patients) did not have mitral valve prolapse. The vertical angle and ultrasound were read blinded to each other. Height, weight, and body surface area were compared for the two groups, and receiver operator curve analysis performed. Vertical angle measured by TL 201 was significantly more vertical in patients with mitral valve prolapse. Receiver operator curve analysis showed that an angle of greater than 30 degrees successfully identified 9/11 patients with mitral valve prolapse, with a sensitivity of 82% and a specificity of 79%. There were no significant differences in height, weight, or body surface area between the two groups. Thus, patients with mitral valve prolapse have more vertically positioned hearts than patients without mitral valve prolapse, independent of body habitus. The different appearance of a vertically oriented heart may contribute to false-positive readings of TL 201 images.

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

    PubMed

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

    1989-11-01

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

  7. Aberrant right ventricular branch of right coronary artery with mitral valve prolapse

    PubMed Central

    Arinc, Huseyin; Gunduz, Huseyin; Tamer, Ali; Ozhan, Hakan; Akdemir, Ramazan; Ozkokeli, Mehmet; Uyan, Cihangir

    2004-01-01

    A 37-year-old man presented with a three-week history of chest pain. Transthoracic echocardiography demonstrated a mitral valve prolapse and mild mitral insufficiency. Coronary angiography showed normal left main, circumflex, left anterior descending and right coronary arteries; however, the right ventricular branch of the right coronary artery had a separate ostium. Concomitant congenital heart abnormalities have been observed with coronary artery anomalies. Primary congenital coronary and valvular anomalies may have genetic heredity. In the present case, mitral valve prolapse was accompanied by a right ventricular coronary artery origin anomaly which, to the best of our knowledge, is the first report in the literature in which both anomalies presented together. PMID:19641717

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

    PubMed Central

    2012-01-01

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

  9. In Vivo Dynamic Deformation of the Mitral Valve Annulus

    PubMed Central

    Eckert, Chad E.; Zubiate, Brett; Vergnat, Mathieu; Gorman, Joseph H.; Gorman, Robert C.; Sacks, Michael S.

    2010-01-01

    Though mitral valve (MV) repair surgical procedures have increased in the United States [Gammie, J. S., et al. Ann. Thorac. Surg. 87(5):1431–1437, 2009; Nowicki, E. R., et al. Am. Heart J. 145(6):1058–1062, 2003], studies suggest that altering MV stress states may have an effect on tissue homeostasis, which could impact the long-term outcome [Accola, K. D., et al. Ann. Thorac. Surg. 79(4):1276–1283, 2005; Fasol, R., et al. Ann. Thorac. Surg. 77(6):1985–1988, 2004; Flameng, W., P. Herijgers, and K. Bogaerts. Circulation 107(12):1609–1613, 2003; Gillinov, A. M., et al. Ann. Thorac. Surg. 69(3):717–721, 2000]. Improved computational modeling that incorporates structural and geometrical data as well as cellular components has the potential to predict such changes; however, the absence of important boundary condition information limits current efforts. In this study, novel high definition in vivo annular kinematic data collected from surgically implanted sonocrystals in sheep was fit to a contiguous 3D spline based on quintic-order hermite shape functions with C2 continuity. From the interpolated displacements, the annular axial strain and strain rate, bending, and twist along the entire annulus were calculated over the cardiac cycle. Axial strain was shown to be regionally and temporally variant with minimum and maximum values of ?10 and 4%, respectively, observed. Similarly, regionally and temporally variant strain rate values, up to 100%/s contraction and 120%/s elongation, were observed. Both annular bend and twist data showed little deviation from unity with limited regional variations, indicating that most of the energy for deformation was associated with annular axial strain. The regionally and temporally variant strain/strain rate behavior of the annulus are related to the varied fibrous-muscle structure and contractile behavior of the annulus and surrounding ventricular structures, although specific details are still unavailable. With the high resolution shape and displacement information described in this work, high fidelity boundary conditions can be prescribed in future MV finite element models, leading to new insights into MV function and strategies for repair. PMID:19585241

  10. Lack of association between mitral valve prolapse and history of rheumatic fever

    Microsoft Academic Search

    Alfredo Zuppiroli; Mary J. Roman; Michael O'Grady; Richard B. Devereux

    1996-01-01

    To determine whether rheumatic fever is associated with mitral valve prolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The prevalence of a history of rheumatic fever by modified Jones criteria was determined in 92 probands and 112 affected relatives or spouses with M-mode and two-dimensional echocardiographic findings of MVP, accompanied in

  11. Surface Strains in the Anterior Leaflet of the Functioning Mitral Valve

    Microsoft Academic Search

    M. S. Sacks; Z. He; Lotte Baijens; S. Wanant; P. Shah; H. Sugimoto; A. P. Yoganathan

    2002-01-01

    The mitral valve (MV) is a complex anatomical structure whose function involves a delicate force balance and synchronized function of each of its components. Elucidation of the role of each component and their interactions is critical to improving our understanding of MV function, and to form the basis for rational surgical repair. In the present study, we present the first

  12. Homozygous Factor X Deficiency Associated with Familial Hypercholesterolemia, Mitral Valve Prolapse, and Hypertrophic Cardiomyopathy

    Microsoft Academic Search

    Alton Onat

    1994-01-01

    The family investigated showed the presence of multiple genetic disorders among their members. The presumable defective genes were related to coagulation factor X, familial hypercholesterolemia, mitral valve prolapse, and hypertrophic cardiomyopathy. The parents were offspring of two siblings, and their children comprised a nonidentical twin. While the proband demonstrated factor X deficiency, obstructive hypertrophic cardiomyopathy, and primary hypercholesterolemia, her parents

  13. Surveillance of human mitral valve cells by autochthonous lymphocytes, in vitro.

    PubMed

    Algard, F T; Van Netten, J P; Montessori, G A; Tan, W C

    1980-12-01

    Analysis of a time-lapse film of cultured human mitral valve endothelium containing autochthonous lymphocytes reveals details of a pattern of interaction suggesting a previously undescribed type of cellular surveillance. Highly mobile lymphocytes rapidly approach individual endothelial cells, slowly circumnavigate the nuclear region, and rapidly move away to repeat this behavior on adjacent cells during the 1-month culture period. PMID:7216236

  14. Mitral valve prolapse and joint hypermobility: evidence for a systemic connective tissue abnormality?

    Microsoft Academic Search

    D Pitcher; R Grahame

    1982-01-01

    Clinical evidence for an abnormally of extracardiac connective tissue was sought in 21 patients with idiopathic mitral valve prolapse and was compared to that in 21 matched controls. The incidence of rheumatic and orthopaedic complaints and the prevalence of hypermobile joints, Marfanoid habitus, and skeletal deformity were compared in the 2 groups. Skin thickness and elasticity were measured, and the

  15. Mitral Valve Prolapse and Panic Disorder: A Review of their Relationship

    Microsoft Academic Search

    JURGEN MARGRAF; ANKE EHLERS; WALTON T. ROTH

    There has been considerable speculation about a possible relationship between panic disorder and mitral valve prolapse syndrome (MVP), although empirical results have been highly in- consistent. Some studies report low frequencies of 0-8%, others high frequencies of 24-35% \\

  16. Angiotensin II type 1 receptor gene polymorphism and mitral valve prolapse syndrome

    Microsoft Academic Search

    Tamás Szombathy; Lívia Jánoskúti; Csaba Szalai; Albert Császár; Miklós Miklósi; Zsuzsa Mészáros; Pál Kempler; Zoltán László; Tamás Fenyvesi; László Romics

    2000-01-01

    Background Mitral valve prolapse syndrome (MVPS), a term applied to patients who have a variety of symptoms, has been associated with autonomic or neuroendocrine dysfunction. Recent evidence suggests that effects of angiotensin II mediated by the angiotensin II type 1 (AT1) receptor are involved in modulation of cardiovascular autonomic control in human beings. Association of a genetic polymorphism (A-C1166) of

  17. Neuroendocrine changes in Dachshunds with mitral valve prolapse examined under different study conditions

    Microsoft Academic Search

    H. D PEDERSEN; L. H OLSEN; T MOW; N. J CHRISTENSEN

    1999-01-01

    Neuroendocrine changes associated with canine mitral valve prolapse (MVP) were studied in 159 Dachshunds older than two years. In study 1, 102 dogs were sampled without controlling diet or fasting period. In good accordance with human findings, theMVPseverity correlated positively with plasma renin activity and tended to correlate negatively with plasma aldosterone. These findings were not attributable to any coexistent

  18. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome

    Microsoft Academic Search

    C E Handler; A Child; N D Light; D E Dorrance

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the

  19. MITRAL VALVE PROLAPSE SYNDROME AND ITS ASSOCIATION WITH ANXIETY AND PANIC STATES

    PubMed Central

    Chatterjee, S.B.; John, M.J.

    1982-01-01

    SUMMARY Mitral Valve Prolapse Syndrome is one of the most frequent cardiac valvular abnormalities in general population. Mostly the patients remain asymptomatic but a few may suffer from hyperadrenergic panic states, similar to anxiety attacks. In psychiatric practice, a number of physicians have come across this finding during the recent past. Present article deals with two such case illustrations. PMID:21965948

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2015-07-21

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

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

    PubMed

    Adams, John; O'Rourke, Malachy J

    2015-07-01

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

  3. Increased dietary intake of vitamin A promotes aortic valve calcification in vivo

    PubMed Central

    Huk, Danielle J.; Hammond, Harriet L.; Kegechika, Hiroyuki; Lincoln, Joy

    2013-01-01

    Objective Calcific aortic valve disease (CAVD) is a major public health problem with no effective treatment available other than surgery. We previously showed that mature heart valves calcify in response to retinoic acid (RA) treatment through downregulation of the SRY-transcription factor Sox9. In this study, we investigated the effects of excess vitamin A and its metabolite RA on heart valve structure and function in vivo, and examined the molecular mechanisms of RA signaling during the calcification process in vitro. Methods and Results Using a combination of approaches, we defined CAVD pathogenesis in mice fed 200 IU/g and 20 IU/g of retinyl palmitate for 12 months at molecular, cellular and functional levels. We show that mice fed excess vitamin A develop aortic valve stenosis and leaflet calcification associated with increased expression of osteogenic genes and decreased expression of cartilaginous markers. Using a pharmacological approach, we show that RA-mediated Sox9 repression and calcification is regulated by classical RA signaling and requires both RAR and RXR receptors. Conclusions Our studies demonstrate that excess vitamin A dietary intake promotes heart valve calcification in vivo. Therefore suggesting that hypervitaminosis A could serve as a new risk factor of CAVD in the human population. PMID:23202364

  4. NOTCH1 regulates matrix gla protein and calcification gene networks in human valve endothelium.

    PubMed

    White, Mark P; Theodoris, Christina V; Liu, Lei; Collins, William J; Blue, Kathleen W; Lee, Joon Ho; Meng, Xianzhong; Robbins, Robert C; Ivey, Kathryn N; Srivastava, Deepak

    2015-07-01

    Valvular and vascular calcification are common causes of cardiovascular morbidity and mortality. Developing effective treatments requires understanding the molecular underpinnings of these processes. Shear stress is thought to play a role in inhibiting calcification. Furthermore, NOTCH1 regulates vascular and valvular endothelium, and human mutations in NOTCH1 can cause calcific aortic valve disease. Here, we determined the genome-wide impact of altering shear stress and NOTCH signaling on human aortic valve endothelium. mRNA-sequencing of primary human aortic valve endothelial cells (HAVECs) with or without knockdown of NOTCH1, in the presence or absence of shear stress, revealed NOTCH1-dependency of the atherosclerosis-related gene connexin 40 (GJA5), and numerous repressors of endochondral ossification. Among these, matrix gla protein (MGP) is highly expressed in aortic valve and vasculature, and inhibits soft tissue calcification by sequestering bone morphogenetic proteins (BMPs). Altering NOTCH1 levels affected MGP mRNA and protein in HAVECs. Furthermore, shear stress activated NOTCH signaling and MGP in a NOTCH1-dependent manner. NOTCH1 positively regulated endothelial MGP in vivo through specific binding motifs upstream of MGP. Our studies suggest that shear stress activates NOTCH1 in primary human aortic valve endothelial cells leading to downregulation of osteoblast-like gene networks that play a role in tissue calcification. PMID:25871831

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

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

    PubMed Central

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

    2013-01-01

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

  7. Study of in vitro mitral valve filling flow.

    PubMed

    Drost, Timothy; Zimmer, Tiffany; Kim, Hyoung-Bum; Shandas, Robin; Hertzberg, Jean

    2004-01-01

    Diastolic function is a good indicator of overall cardiac health. This study is in support of a non-invasive technique to measure diastolic function. Interpretation of mitral flow, and early diagnosis of normality or dysfunction, can be enhanced by improved understanding of the fluid dynamics. A simple in-vitro model of mitral flow is being used to illustrate vortex dynamics associated with diastolic inflow. A range of tailored mitral flow waveforms are being developed to mimic normal velocity profiles. Laser Doppler velocimetry (LDV) is being used to measure the flow speed. By combining flow visualization, particle image velocimetry and LDV, vortex ring signatures including size, circulation, and propagation speed are being examined as possible metrics for diastolic dysfunction. The detection of these signatures in the downstream flow will be compared to clinical waveforms derived from Doppler ultrasound. PMID:15133983

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  10. Robotic resection of dual accessory mitral valve tissue in an adult patient.

    PubMed

    Yamaguchi, Shojiro; Ishikawa, Norihiko; Tomita, Shigeyuki; Ohtake, Hiroshi; Kiuchi, Ryuta; Nishida, Yuji; Muramatsu, Kenichi; Watanabe, Go

    2014-09-01

    The presence of isolated accessory mitral valve tissue (AMVT) is extremely rare in adults. We successfully performed robot-assisted resection of dual AMVT that was attached to the papillary muscle and anterior mitral leaflet. Echocardiography was invaluable for identifying the most suitable approach. The short-axis view on echocardiography revealed the precise location where the AMVT was attached. The robotic operation enabled fine visualization; we clearly observed the AMVT and removed its entire extra structure. The patient recovered well and was discharged 3 days after the operation. To the best of our knowledge, this is the first report of successful robotic AMVT resection. PMID:25193197

  11. P-wave signal-averaged electrocardiogram in patients with idiopathic mitral valve prolapse syndrome and supraventricular arrhythmias

    Microsoft Academic Search

    Waldemar Banasiak; Iwona Pajak; Piotr Ponikowski; Wieslaw Lacheta; Krzysztof Wiech; Massimo Piepoli; Czeslaw Telichowski

    1995-01-01

    The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 ± 9 years) were prospectively studied. P-wave triggered SAECG was recorded

  12. Evaluation of obstructive characteristics of mitral disc valve implants with ultrasound doppler techniques.

    PubMed

    Holen, J; Nitter-Hauge, S

    1977-01-01

    Ten adult patients with mitral disc valve implants have been examined on the catheterization table. Non-invasive ultrasound Doppler data, pulmonary artery wedge pressure and left ventricular pressure were recorded simultaneously. The cardiac output was determined with the direct Fick method. The effective valve area was taken as a measure of the flow obstruction in the disc valve implants. This area was calculated from the ultrasound data and the cardiac output as well as from the manometric data and the cardiac output. The resulting two sets of areas demonstrated a linear correlation coefficient of 0.86. The effective valve areas calculated from the ultrasound data were reasonable when compared with the results of in vitro studies of disc valve performance and demonstrated good agreement with the findings of other investigators. PMID:561517

  13. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis First Human Case Description

    Microsoft Academic Search

    Alain Cribier; Helene Eltchaninoff; Assaf Bash; Nicolas Borenstein; Christophe Tron; Fabrice Bauer; Genevieve Derumeaux; Frederic Anselme; François Laborde; Martin B. Leon

    Background—The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was developed. After ex vivo testing and animal implantation studies, the first human implantation was performed in a 57-year-old man with calcific aortic stenosis, cardiogenic shock, subacute

  14. Mitral valve prolapse in 3-year-old healthy Cavalier King Charles Spaniels. An echocardiographic study.

    PubMed Central

    Pedersen, H D; Kristensen, B O; Lorentzen, K A; Koch, J; Jensen, A L; Flagstad, A

    1995-01-01

    Clinical studies have shown that Cavalier King Charles Spaniels (CKCS) have a high prevalence of mitral valvular insufficiency (MVI). Echocardiography has the potential to disclose early valvular changes, and the present prospective study was designed to investigate the occurrence of mitral valve prolapse (MVP) in young CKCS without heart murmurs, and to correlate the degree of MVP with the clinical status of the dogs by including CKCS with MVI as well. The study was based on blinded evaluations of echocardiographic recordings of mitral valves from 34 CKCS and 30 control dogs. Thirteen (87%) of 15 three-year-old CKCS without heart murmurs had MVP (2 total and 11 partial), as compared with 1 (7%) of 15 three-year-old normal Beagle dogs (P < 0.0001), and none of 15 three-year-old normal Medium Size Poodles (P < 0.0001). Of 19 CKCS with MVI, MVP was found in 84% of the entire group and in 100% of dogs with pulmonary congestion or edema. The occurrence of total MVP tended to be higher in the group with MVI (47%, 9/19), when compared with the younger CKCS without heart murmurs (13%, 2/15, P = 0.06). MVP was positively associated with excessive heart rate variability (P = 0.003). The radius of curvature of the anterior mitral valve leaflet in systole was significantly reduced in dogs with MVP when compared with those without (P < 0.0001). In conclusion, this study shows that CKCS at an early age have a high occurrence of MVP. This suggests: 1) A genetic predisposition of CKCS to MVP; and 2) That MVP is a pathogenetic factor in the development of mitral valvular insufficiency. Follow up studies may add further support to these proposals, and clarify whether echocardiography may be an aid in selecting CKCS for future breeding. Images Fig. 1. PMID:8548691

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

    PubMed Central

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

    2012-01-01

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

  16. Stress myocardial imaging in patients with mitral valve prolapse: evidence of a perfusion abnormality

    SciTech Connect

    Butman, S.; Chandraratna, P.A.; Milne, N.; Olson, H.; Lyons, K.; Aronow, W.S.

    1982-01-01

    Twenty-four patients with mitral valve prolapse underwent cardiac catheterization, exercise testing, and exercise /sup 201/T1 scintigraphy. Of 10 patients with coronary artery disease, six had abnormal scintigrams. Two of these six had exercise-induced reversible defects, two had defects that persisted during redistribution, and two had both reversible and persistent defects. Of 14 patients with normal coronary arteries, five had negative scintigrams. Of the remaining nine patients, two had exercise-induced defects, and seven (50%) had defects involving the inferior or posterior wall that persisted during redistribution. Possible mechanisms for this latter finding are discussed. In contrast to previous reports, exercise /sup 201/T1 scintigraphy was not entirely successful in identifying patients with coronary artery disease in our patients with mitral valve prolapse.

  17. Left ventricular non-noncompaction: the mitral valve prolapse of the 21st century?

    PubMed

    Captur, Gabriella; Flett, Andrew S; Jacoby, Daniel L; Moon, James C

    2013-03-20

    A spongiform epidemic is upon us - myocardial trabeculae are everywhere as left ventricular noncompaction (LVNC) ingratiates itself into modern day cardiology. Current understanding of the condition is evolving but remains incomplete, and brings to mind the chronicles of another great cardiac story: mitral valve prolapse. Anecdote suggests that many individuals with prominent trabeculae may be being falsely labelled with a disease - LVNC - using poor echocardiographic and cardiovascular magnetic resonance criteria. Until we have robust diagnostic criteria, aetiology, clinicopathological significance and prognosis, the risk of casualties from ascertainment bias will remain. We should look to history and learn from past mistakes - specifically from the mitral valve prolapse story to show the way forward for LVNC. Meanwhile, clinicians (and patients) should be wary, bearing in mind the possibility that they might be seeing LVNNC - left ventricular non-noncompaction. PMID:22658573

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

    PubMed

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

    2012-02-01

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

  19. Left ventricular noncompaction complicated by mitral valve prolapse: report of a case.

    PubMed

    Igarashi, Takashi; Takase, Shinya; Satokawa, Hirono; Wakamatsu, Hiroki; Kurosawa, Hiroyuki; Yokoyama, Hitoshi

    2013-07-01

    A 31-year-old male was diagnosed with congestive heart failure due to left ventricular noncompaction and coarctation of the aorta by echocardiography and computed tomography. He also developed mitral valve prolapse of the posteromedial commissural leaflet due to rupture of chordae tendineae. Segmental leaflet resection was performed with ring annuloplasty. Aorto-bifemoral bypass was carried out simultaneously to attenuate the ventricular afterload. His postoperative course was uneventful. PMID:22847676

  20. Characterization of mitral valve prolapse with cardiac computed tomography: comparison to echocardiographic and intraoperative findings.

    PubMed

    Ghosh, Nina; Al-Shehri, Haliah; Chan, Kwan; Mesana, Thierry; Chan, Vincent; Chen, Li; Yam, Yeung; Chow, Benjamin J W

    2012-04-01

    A single imaging modality that can accurately assess both coronary anatomy and mitral valve (MV) anatomy prior to surgery may be desirable. We sought to determine the diagnostic accuracy of cardiac computed tomography (CT) to detect and characterize mitral valve prolapse (MVP) compared to echocardiography. Consecutive patients referred for 'single-source' cardiac CT for investigation prior to non-coronary cardiac sugery were identified. MV anatomy was assessed for MVP and results were compared to echocardiography and to intra-operative visual assessment of the MV. Comparison between the three modalities was performed at the per-patient, per-leaflet and per-scallop levels. A total of 67 consecutive patients that were referred for Cardiac CT prior to non-coronary cardiac surgery and were prospectively recruited into a Cardiac CT registry. Of these, 65 patients underwent cardiac surgery. 63 patients had echocardiography and 32 patients had intra-operative visual assessment of the mitral valve. Compared to echocardiography, cardiac CT had excellent sensitivity (92.6%) and specificity (97.1%) for the detection of any MVP, but had poor sensitivity (68.5%) for the detection of individual prolapsing scallop. Compared to intra-operative visual assessment of the prolapsing scallop, both cardiac CT and echocardiography had low sensitivity (58.1 and 78.1%, respectively). Cardiac CT was able to identify patients with MVP but had difficulty identifying the prolapsed scallops compared to echocardiography. Single-source CT may not be ready for characterization of individual mitral valve scallops. PMID:21604082

  1. Ventricular fibrillation in a patient with unsuspected mitral valve prolapse and a prolonged QT interval

    Microsoft Academic Search

    R. B. Forbes; G. H. Morton

    1979-01-01

    Summary  Mitral valve prolapse is a common cardiac abnormality associated with arrhythmias and sudden death. In most instances it can\\u000a be diagnosed on the basis of physical findings. Those patients who are symptomatic or who display electrocardiographic abnormalities\\u000a appear to be most susceptible to arrhythmias and, therefore, may be at increased risk for anaesthesia. Because the syndrome\\u000a is relatively common and

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

    PubMed Central

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

    2015-01-01

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

  3. Calcification

    MedlinePLUS

    Calcification is a process in which calcium builds up in body tissue, causing the tissue to harden. ... with how these blood vessels and organs work. Calcifications can usually be seen on x-rays . A ...

  4. Well-functioning double-orifice mitral valve in a young adult.

    PubMed

    Karas, Spilios; Barbetseas, John; Lambrou, Spyros; Parissis, John; Metzikof, Demetrios; Toutouzas, Pavlos

    2003-01-01

    We report the case of a rare congenital anomaly, a double-orifice mitral valve, in a 23-year-old woman who was asymptomatic and had no history of heart disease. Transthoracic and multiplane transesophageal echocardiography revealed 2 functionally normal orifices of equal size, the least frequent anatomic presentation of this anomaly. We prescribed antibiotic prophylaxis because of the concomitant presence of a mildly stenotic bicuspid aortic valve and recommended annual follow-up examinations to monitor both lesions for possible progression. PMID:12594805

  5. Genetic segregation analysis of familial mitral valve prolapse shows no linkage to fibrillar collagen genes.

    PubMed Central

    Wordsworth, P; Ogilvie, D; Akhras, F; Jackson, G; Sykes, B

    1989-01-01

    Three pedigrees were identified in which mitral valve prolapse seemed to be inherited as a mendelian autosomal dominant trait. The segregation of the genes encoding the major fibrillar collagens present in valve tissue, collagens I and III, was analysed by use of restriction enzyme site variants as genetic markers. In one pedigree there was discordance between the segregation of the disease and markers for all three collagen genes. In another, there was discordance between the disease and markers for both collagen I loci. This is evidence against the disease being generally the result of mutations of the genes encoding the major fibrillar collagens. PMID:2930669

  6. Transapical mitral valved stent implantation: computed tomographic evaluation of different prototype designs.

    PubMed

    Pokorny, Saskia; Heinig, Alin; Hettich, Holger; Bähr, Telse; Marczynski-Bühlow, Martin; Morlock, Michael M; Sattler, Benjamin; Schöttler, Jan; Lutter, Georg

    2014-08-30

    Aims: The evaluation of in vivo shaping of mitral valved stent prototypes using cardiac computed tomography (CT) was the focus of this study. Methods and results: Twelve pigs received a self-expanding mitral valved stent, composed of an atrial element connected to a tubular ventricular body at a modified angle (45°, 90°, 110°) resulting in three designs. Cardiac CT was performed three weeks after implantation, with focus placed on stent design-related parameters: possible left ventricular outflow tract obstruction and stent shaping. CT was successfully conducted in 11/12 animals showing correct stent position within the mitral annulus and no obstruction of the left ventricular outflow tract in 9/11 animals. Minor radial deformations of the stent body were detected. At the atrioventricular junction, deformations of the stent structure were observed in all cases. Stents with a 45° angle exhibited the greatest deflection (?56.4°±14.5°). Conclusions: The effectiveness of cardiac computed tomography in the development process of valved stents to provide essential information and quantitative data about the in vivo stent geometry was demonstrated. The in vivo mechanical deformations of the stent were quantified, identifying critical design areas: a larger preset angle leads to less deflection and improved alignment and hence reduces the mechanical load. PMID:25169591

  7. Management of ventricular arrhythmias associated with mitral valve prolapse by combined alpha and beta blockade.

    PubMed Central

    Butrous, G. S.; Maltz, M. B.; O'Keefe, J.; Banim, S. O.; Camm, A. J.

    1986-01-01

    Ventricular arrhythmias are common in patients with mitral valve prolapse. Ten patients with echocardiographically confirmed mitral valve prolapse and documented ventricular arrhythmias were included in this study. The aim was to assess the value of combined alpha- and beta-blockade (labetalol) compared with beta-blockade alone (propranolol) in the management of ventricular arrhythmias in these patients. The study was performed using physiological stress, such as the Valsalva manoeuvre, isometric exercise and treadmill exercise, to initiate ventricular arrhythmias before and after intravenous propranolol or labetalol and to document arrhythmias during 24 hour electrocardiography before and after oral medication. Labetalol and propranolol decreased the heart rate and blood pressure response to these manoeuvres to a similar extent but labetalol was more effective in the control of the ventricular arrhythmias. These findings suggest that alpha adrenergic receptors may play a role in the pathogenesis of the ventricular arrhythmias in mitral valve prolapse syndrome and that labetalol offers an alternative treatment for the management of this condition. PMID:3714619

  8. Autonomic dysregulation as a novel underlying cause of mitral valve prolapse: A hypothesis

    PubMed Central

    Hu, Xiang; Zhao, Qiang

    2011-01-01

    Summary Mitral valve prolapse is a common valvular abnormality that is caused by myxomatous degeneration, characterized macroscopically by leaflet thickening and redundancy accompanied with histologically marked proliferation of the spongiosa and mucopolysaccharide acid replacement of leaflet collagen in the prolapse leaflets. Nevertheless, the discrepant natural history and various concomitant syndromes cannot be explained completely by the current genetic autosomal dominant inheritance theory. In addition, autonomic dysregulation has been commonly reported in mitral valve prolapse, but has never been indicated as a major underlying cause. This article attempts to interpret the occurrence of primary pathology and progression in mitral valve prolapse on a common basis of improper autonomic tone. The imbalanced background of autonomic nervous firing leads to disharmonized synthetic/catabolism balance in the extracellular matrix, disrupted transition in the interstitial cellular component and invalided anti-inflammatory pathway in the endothelium, which trigger and accelerate the progression of this condition. Such a hypothesis not only unifies the seemingly disparate syndromes and valvular disorder, but also has implications for future biopharmaceutical and mechanical treatment. PMID:21873953

  9. Automated auscultation : using acoustic features to diagnose mitral valve prolapse

    E-print Network

    Jung, Marcia Yeojin, 1982-

    2004-01-01

    During annual physical examinations, a primary-care physician listens to the heart using a stethoscope to assess the condition of the heart muscle and valves. This process, termed cardiac auscultation, is the primary means ...

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

    PubMed

    Sack, Stefan; Kahlert, Philipp; Erbel, Raimund

    2009-01-01

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

  11. In vitro assessment of a combined radiofrequency ablation and cryo-anchoring catheter for treatment of mitral valve prolapse.

    PubMed

    Boronyak, Steven M; Merryman, W David

    2014-03-21

    Percutaneous approaches to mitral valve repair are an attractive alternative to surgical repair or replacement. Radiofrequency ablation has the potential to approximate surgical leaflet resection by using resistive heating to reduce leaflet size, and cryogenic temperatures on a percutaneous catheter can potentially be used to reversibly adhere to moving mitral valve leaflets for reliable application of radiofrequency energy. We tested a combined cryo-anchoring and radiofrequency ablation catheter using excised porcine mitral valves placed in a left heart flow loop capable of reproducing physiologic pressure and flow waveforms. Transmitral flow and pressure were monitored during the cryo-anchoring procedure and compared to baseline flow conditions, and the extent of radiofrequency energy delivery to the mitral valve was assessed post-treatment. Long term durability of radiofrequency ablation treatment was assessed using statically treated leaflets placed in a stretch bioreactor for four weeks. Transmitral flow and pressure waveforms were largely unaltered during cryo-anchoring. Parameter fitting to mechanical data from leaflets treated with radiofrequency ablation and cryo-anchoring revealed significant mechanical differences from untreated leaflets, demonstrating successful ablation of mitral valves in a hemodynamic environment. Picrosirius red staining showed clear differences in morphology and collagen birefringence between treated and untreated leaflets. The durability study indicated that statically treated leaflets did not significantly change size or mechanics over four weeks. A cryo-anchoring and radiofrequency ablation catheter can adhere to and ablate mitral valve leaflets in a physiologic hemodynamic environment, providing a possible percutaneous alternative to surgical leaflet resection of mitral valve tissue. PMID:24495753

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

    PubMed

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

    2015-04-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2012-11-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  17. The Expanding Role of Mitral Valve Repair in Triple Valve Operations: Contemporary North American Outcomes in 8,021 Patients

    PubMed Central

    Suri, Rakesh M.; Thourani, Vinod H.; Englum, Brian R.; Rankin, J. Scott; Badhwar, Vinay; Svensson, Lars G.; Ailawadi, Gorav; Mack, Michael J.; He, Max; Brennan, J. Matthew; Schaff, Hartzell V.; Gammie, James S.

    2015-01-01

    Background Although the operative risk of multivalve operations has historically been high, current outcomes are poorly understood. We sought to evaluate factors influencing contemporary results of triple-valve operations using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods Among patients undergoing combined mitral, aortic, and tricuspid valve (triple- valve) operations between 1993 and 2011, aortic valve repair patients were excluded and those having aortic valve replacement were analyzed according to whether they underwent repair vs replacement of the mitral valve (MV) and tricuspid valve (TV). Temporal trends in operative death and clinical outcomes were examined using unadjusted and adjusted analyses. Results A total of 8,021 triple-valve patients were studied. The median (25th percentile, 75th percentile) age was 67 years (59, 77 years), 4,809 (60%) were women, 4,488 (56%) had New York Heart Association class III to IV symptoms, and the mean (25th percentile, 75th percentile) ejection fraction was 50% (40%, 60%). MV repair was performed in 2,728 (34%) patients overall and increased over time from 13% (1993 to 1997) to 41% (2008 to 2011). TV repair was performed in 7,512 (94%) patients overall and increased over time from 86% (1993 to 1997) to 96% (2008 to 2011). Unadjusted operative mortality decreased from 17% in 1993 to 9% in 2011. Adjusted odds ratios (95% confidence intervals) of operative mortality were lower in those having MV repair (0.72 [0.61 to 0.85]), TV repair (0.64 [0.50 to 0.83]), and MV D TV repair (0.46 [0.34 to 0.63]) compared with those having replacements. Unadjusted and adjusted odds of stroke were similar between groups and not significant for all. Conclusions This large series demonstrates that surgical results of triple-valve operations have continued to improve during the past 18 years. MV and TV repair were associated with improvements in early survival. Although further study is required to understand late outcomes, these data suggest that broader efforts to perform MV repair instead of replacement in this high-risk patient population appear warranted. PMID:24680034

  18. Acquired Left Atrial-to-Right Ventricular Shunt with Mitral Valve Incompetence

    PubMed Central

    Mohapatra, Srikant; Minhas, Harpreet Singh; Virmani, Sanjula; Mishra, Bana Bihari; Mukherjee, Kaushik; Banerjee, Amit

    2009-01-01

    Acquired left ventricular-to-right atrial communication is encountered periodically. This condition is chiefly attributable to surgical mishaps, trauma, endocarditis, or endomyocardial biopsy. In a few instances, a Gerbode-like defect develops after the repair of an atrioventricular septal defect. Our search of the worldwide medical literature revealed just 1 report of a “mirror” occurrence of a Gerbode-like defect: a shunt between the left atrium and the right ventricle. Herein, we present the case of a 22-year-old woman who had severe mitral valve incompetence accompanying an acquired shunt between the left atrium and the right ventricle—a late sequela of the earlier repair of an atrioventricular septal defect. After surgical correction of the shunt and the associated mitral incompetence, the patient experienced a good outcome. Echocardiographic and intraoperative findings are presented, along with a plausible explanation for the mechanism and presentation of the condition in our patient. To our knowledge, this is only the 2nd report of an acquired shunt between the left atrium and the right ventricle, and the 1st such case to be accompanied by severe mitral valve incompetence. PMID:19436792

  19. SMAD4 mutation segregating in a family with juvenile polyposis, aortopathy, and mitral valve dysfunction.

    PubMed

    Andrabi, Sara; Bekheirnia, Mir Reza; Robbins-Furman, Patricia; Lewis, Richard Alan; Prior, Thomas W; Potocki, Lorraine

    2011-05-01

    Juvenile polyposis syndrome (JPS) is caused by heterozygous mutations in either SMAD4 or BMPR1A. Individuals with JPS due to mutations in SMAD4 are at greater risk to manifest signs of hereditary hemorrhagic telangiectasia (HHT). HHT is caused by either mutations in SMAD4 or other genes that modulate transforming growth factor-beta (TGF?) signaling. Additional genes in the TGF? network include FBN1, TGFBR1, and TGFBR2, mutations of which cause either Marfan syndrome (MFS) or Loeys-Dietz syndrome (LDS), respectively. As SMAD4, FBN1, and TGFBR1/2 map to different regions of the genome, disorders associated with mutations in these genes are not expected to co-segregate in a family. We report an individual whose family history was positive for aortopathy, mitral valve dysfunction, and JPS. Mutation analysis of SMAD4 implicates this gene for these phenotypes in this family. Although SMAD4 is among several genes in the TGF? network, and although prior single case reports have described large vessel aneurysms in HHT, this is the first description of aortic and mitral disease presenting with JPS. This observation suggests that, in addition to HHT, individuals with SMAD4 mutations may be at risk for aortic dilation and mitral valve dysfunction. We emphasize the importance of comprehensive review of the medical history prior to molecular testing, especially in an asymptomatic patient. PMID:21465659

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

    Microsoft Academic Search

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

    2001-01-01

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

  1. Genetic evidence that mutations in the COL1A1, COL1A2, COL3A1, or COL5A2 collagen genes are not responsible for mitral valve prolapse

    Microsoft Academic Search

    A M Henney; P Tsipouras; R C Schwartz; A H Child; R B Devereux; G J Leech

    1989-01-01

    DNA markers were used to assess the segregation of genes encoding the collagen types that predominate in the mitral valve (types I, III, and V) in two family pedigrees that are phenotypically different but showed dominantly inherited mitral valve prolapse. The inheritance of these markers was compared with the segregation of the phenotype for mitral valve prolapse in both families.

  2. Heart valve calcification and calcium x phosphorus product in hemodialysis patients: Analysis of optimum values for its prevention

    Microsoft Academic Search

    Margarita Rufino; Sagrario García; Alejandro Jiménez; Alejandra Alvarez; Rosa Miquel; Patricia Delgado; Domingo Marrero; Armando Torres; Daniel Hernández; Victor Lorenzo; Margarita Rufino Hernández

    2003-01-01

    Heart valve calcification and calcium x phosphorus product in hemodialysis patients: Analysis of optimum values for its prevention.BackgroundPrevalence of valve calcification (VC) in end-stage renal disease (ESRD) patients is high and information regarding modifiable predictors is scarce. Our aim was to determine the prevalence of VC in our maintenance hemodialysis (HD) population, and the optimal Ca x P value that

  3. Giant left atrial myxoma mimicking severe mitral valve stenosis and severe pulmonary hypertension.

    PubMed

    Mouine, Najat N; Asfalou, Ilyass I; Raissouni, Maha M; Benyass, Aatif A; Zbir, El Mehdi E

    2013-01-01

    Myxoma is the most common primary tumor of the heart and can arise in any of the cardiac chambers. This paper reports A 50 -year-old woman without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. Transthoracic echocardiogram showed a giant left atrial myxoma mobile confined to the left atrium in systole, in diastole the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery with good outcome. PMID:23601991

  4. Giant left atrial myxoma mimicking severe mitral valve stenosis and severe pulmonary hypertension

    PubMed Central

    2013-01-01

    Myxoma is the most common primary tumor of the heart and can arise in any of the cardiac chambers. This paper reports A 50 -year-old woman without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. Transthoracic echocardiogram showed a giant left atrial myxoma mobile confined to the left atrium in systole, in diastole the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery with good outcome. PMID:23601991

  5. Primary Cardiac Synovial Sarcoma Originating from the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

    PubMed

    Veshti, Altin; Prifti, Edvin Mihal; Ikonomi, Majlinda

    2015-01-01

    An 11-year-old boy was admitted due to different episodes of syncope and convulsion. Echocardiogram revealed a mass of 2 × 4 cm originating from the mitral subvalvular apparatus and more precisely from the antero-lateral papillary muscle, protruding in the left ventricle outflow tract causing intermittent obstruction. The patient underwent surgical excision of the left sided mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At 6 months after the operation a small mass in the left ventricle of 1 × 1 cm was detected. The patient underwent reoperation consisting in radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was a cardiac synovial sarcoma. At 1 year after surgery the patient is doing well. PMID:26115156

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

    PubMed

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

    2015-02-01

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

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

    PubMed

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

    2014-01-01

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

  8. Staphylococcus lugdunensis Endocarditis Complicated by Embolism in an 18-Year-Old Woman with Mitral Valve Prolapse.

    PubMed

    Pecoraro, Rosaria; Tuttolomondo, Antonino; Parrinello, Gaspare; Pinto, Antonio; Licata, Giuseppe

    2013-01-01

    Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS). It is a major cause of prosthetic valve endocarditis; mitral valve prolapse (MVP) has emerged as a prominent predisposing structural cardiac abnormality. We describe a case of Staphylococcus lugdunensis endocarditis in an 18-year-old woman with preexisting mitral valve prolapse complaining of fever, a one-month history of continuous-remittent fever (T(max) 38.6°C). The transthoracic echocardiogram revealed large vegetation on the anterior mitral valve leaflet flopping from the atrial side to the ventricular side. Five sets of blood cultures were positive for coagulase-negative staphylococci. During hospitalization, after two weeks of antibiotic therapy, the patient complained of sudden pain in her right leg associated with numbness. Lower limb arterial Doppler ultrasound showed an arterial thrombosis of right common iliac artery. Transfemoral iliac embolectomy was promptly performed and on septic embolus S. lugdunensis with the same antibiotic sensitivity and the same MIC values was again isolated. Our patient underwent cardiac surgery: triangular resection of the A2 with removal of infected tissue including vegetation. Our case is an example of infective endocarditis by S. lugdunensis on native mitral valve in a young woman of 18 with anamnesis valve prolapse. PMID:23424690

  9. Staphylococcus lugdunensis Endocarditis Complicated by Embolism in an 18-Year-Old Woman with Mitral Valve Prolapse

    PubMed Central

    Pecoraro, Rosaria; Tuttolomondo, Antonino; Parrinello, Gaspare; Pinto, Antonio; Licata, Giuseppe

    2013-01-01

    Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS). It is a major cause of prosthetic valve endocarditis; mitral valve prolapse (MVP) has emerged as a prominent predisposing structural cardiac abnormality. We describe a case of Staphylococcus lugdunensis endocarditis in an 18-year-old woman with preexisting mitral valve prolapse complaining of fever, a one-month history of continuous-remittent fever (Tmax 38.6°C). The transthoracic echocardiogram revealed large vegetation on the anterior mitral valve leaflet flopping from the atrial side to the ventricular side. Five sets of blood cultures were positive for coagulase-negative staphylococci. During hospitalization, after two weeks of antibiotic therapy, the patient complained of sudden pain in her right leg associated with numbness. Lower limb arterial Doppler ultrasound showed an arterial thrombosis of right common iliac artery. Transfemoral iliac embolectomy was promptly performed and on septic embolus S. lugdunensis with the same antibiotic sensitivity and the same MIC values was again isolated. Our patient underwent cardiac surgery: triangular resection of the A2 with removal of infected tissue including vegetation. Our case is an example of infective endocarditis by S. lugdunensis on native mitral valve in a young woman of 18 with anamnesis valve prolapse. PMID:23424690

  10. Cardiac Hemodynamics in the Pathogenesis of Congenital Heart Disease and Aortic Valve Calcification

    NASA Astrophysics Data System (ADS)

    Nigam, Vishal

    2011-11-01

    An improved understanding of the roles of hemodynamic forces play in cardiac development and the pathogenesis of cardiac disease will have significant scientific and clinical impact. I will focus on the role of fluid dynamics in congenital heart disease and aortic valve calcification. Congenital heart defects are the most common form of birth defect. Aortic valve calcification/stenosis is the third leading cause of adult heart disease and the most common form of acquired valvular disease in developed countries. Given the high incidence of these diseases and their associated morbidity and mortality, the potential translational impact of an improved understanding of cardiac hemodynamic forces is very large. Division of Pediatric Cardiology, Rady Children's Hospital, San Diego

  11. Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature

    PubMed Central

    2013-01-01

    Mitral valve reoperation, through a median sternotomy, for a patient with patent coronary bypass grafts is technically challenging and carries higher postoperative morbidity and mortality than a primary operation. We present a case of mitral valve repair using a beating heart technique under normothermic cardiopulmonary bypass that was performed 3 years after a coronary artery bypass operation. A limited (10 cm) right thoracotomy was made and cardiopulmonary bypass was conducted using the ascending aortic and femoral venous cannulation. The left atrium was opened while beating was maintained. Triangular resection of the prolapsed portion of the posterior leaflet and ring annuloplasty were performed. Completeness of the repair was verified by direct visualization under beating condition and transesophageal echocardiogram. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizes risks of bleeding, graft injury and myocardial damage. PMID:24128131

  12. Screening of TGFBR1, TGFBR2, and FLNA in familial mitral valve prolapse.

    PubMed

    Aalberts, Jan J J; van Tintelen, J Peter; Oomen, Toon; Bergman, Jorieke E H; Halley, Dicky J J; Jongbloed, Jan D H; Suurmeijer, Albert J H; van den Berg, Maarten P

    2014-01-01

    So far only mutations in the filamin A gene (FLNA) have been identified as causing familial mitral valve prolapse (MVP). Previous studies have linked dysregulation of the transforming growth factor beta (TGF-?) cytokine family to MVP. We investigated whether mutations in the TGF-? receptors genes type I (TGFBR1) and II (TGFBR2) underlie isolated familial MVP cases. Eight families with isolated familial MVP were evaluated clinically and genetically. Ventricular arrhythmias were present in five of the eight families and sudden cardiac death occurred in six patients. Tissue obtained during mitral valve surgery or autopsy was available for histological examination in six cases; all demonstrated myxomatous degeneration. A previously described FLNA missense mutation (p.G288R) was identified in one large family, but no mutations were discovered in TGFBR1 or TGFBR2. An FLNA missense mutation was identified in one family but we found no TGFBR1 or TGFBR2 mutations. Our results suggest that TGFBR1 and TGFBR2 mutations do not play a major role in isolated myxomatous valve dystrophy. Screening for FLNA mutations is recommended in familial myxomatous valvular dystrophy, particularly if X-linked inheritance is suspected. PMID:24243761

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

    PubMed

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

    2015-05-15

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

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (< or =5%) patients. Obstructive coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  15. Cerebral Protection During Mitral Valve Repair in a Patient With Moyamoya Syndrome.

    PubMed

    Okamoto, Kazuma; Arai, Shingo; Hirabayashi, Noriyuki; Morita, Masanori; Kudo, Mikihiko; Yozu, Ryohei; Shimizu, Hideyuki

    2015-06-01

    In patients with moyamoya syndrome requiring heart surgery, the brain blood flow during the low perfusion state under cardiopulmonary bypass is a concern. We report on a successful mitral valve repair and tricuspid repair in a patient with moyamoya syndrome, performed using an integrated cerebral protection strategy with cerebral oxygen saturation monitoring, intraaortic balloon pumping, and cardiopulmonary bypass perfusion at a relatively high pressure. An integrated approach with a thorough discussion among cardiac surgeons, anesthesiologists, and perfusionists was invaluable to protect brain perfusion in a patient with moyamoya syndrome. PMID:26046880

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

    PubMed

    Reif, T H; Huffstutler, M C

    1985-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2001-10-01

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

  18. [The oxidative modifications of lipoproteins in male youths with primary mitral valve prolapse].

    PubMed

    Mikashinovich, Z I; Chepurnenko, S A

    2012-10-01

    The sampling of 137 male youths with primary mitral valve prolapse underwent the analysis of content of lipoproteins, malonic dialdehyde and modified lipoproteins depending on conditions of adaptive reserves of organism. The decrease of adaptive reserves of organism documented by higher content of oxidized lipoproteins up to 2.84 times (p < 0.05) and malonic dialdehyde up to 1.85 times as compared with control group (p < 0.05). The reliable difference between lipidogram data in patients with high and lower adaptive reserves was not established. PMID:23265049

  19. Spindle cell sarcoma of the mitral valve: an unusual cause of acute coronary syndrome in a child.

    PubMed

    Martens, Thomas; Vandekerckhove, Kristof; François, Katrien; Bove, Thierry

    2014-10-01

    We present an unusual case of acute myocardial infarction by embolic obstruction of both the left anterior descending and right coronary arteries in a 14-year-old girl. Echocardiography showed mobile lesions on the mitral valve and into the left ventricular outflow tract with poor left ventricular function, eventually suggesting endocarditis. Successful surgery comprised mitral valve plasty after complete resection of the tumoral lesion, in association with coronary artery embolectomy. Histologic examination revealed a malignant spindle cell sarcoma treated with adjuvant chemotherapy. We emphasize here the differential diagnosis of acute coronary syndrome in children by a rare cardiac tumor. PMID:25282213

  20. Mitral valve dysplasia characterized by isolated cleft of the anterior leaflet resulting in fixed left ventricular outflow tract obstruction.

    PubMed

    Otoni, Cristiane; Abbott, Jonathan A

    2012-03-01

    A 7-month-old, sexually intact male English toy spaniel weighing 4 kg was referred for evaluation of a subclinical cardiac murmur. Echocardiography disclosed fixed left ventricular outflow tract obstruction that was caused by attachment of a cleft anterior mitral valve leaflet to the interventricular septum. Neither atrial nor ventricular septal defects were detected. Fixed obstruction of the left ventricular outflow tract by a malformed mitral valve is rare in human beings and has not been previously reported in the dog. PMID:22377653

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

    PubMed

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

    2015-06-01

    Latent TGFB-binding protein 3 (LTBP3) is known to increase bio-availability of TGFB. A homozygous mutation in this gene has previously been associated with oligodontia and short stature in a single family. We report on two sisters with homozygous truncating mutations in LTBP3. In addition to oligodontia and short stature, both sisters have mitral valve prolapse, suggesting a link between truncating LTBP3 mutations and mitral valve disease mediated through the TGFB pathway. © 2015 Wiley Periodicals, Inc. PMID:25899461

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

    PubMed Central

    2009-01-01

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

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2003-01-01

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

  5. Obstructed bi-leaflet prosthetic mitral valve imaging with real-time three-dimensional transesophageal echocardiography.

    PubMed

    Shimbo, Mai; Watanabe, Hiroyuki; Kimura, Shunsuke; Terada, Mai; Iino, Takako; Iino, Kenji; Ito, Hiroshi

    2015-01-01

    Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. PMID:24796869

  6. Cardiac Tamponade following Mitral Valve Replacement for Active Infective Endocarditis with Ring Abscess.

    PubMed

    Ranjan, R; Lawrence, T

    2015-01-01

    Periannular extension and abscess formation are rare but deadly complications of infective endocarditis (IE) with high mortality. Multimodality cardiac imaging, invasive and noninvasive, is needed to accurately define the extent of the disease. Debridement, reconstruction, and valve replacement, often performed in an emergent setting, remain the treatment of choice. Here we present a case of severe IE in a 29-year-old intravenous drug user who after undergoing debridement of the abscess, annular reconstruction, and mitral valve replacement (MVR) presented with recurrence of shortness of breath and pedal edema. Transthoracic echocardiogram (TTE) showed a 6.2 × 5.5?cm cavity, posterior to and communicating with the left ventricle through a 3?cm wide fistulous opening, in proximity of the reconstructed mitral annulus. The patient underwent a redo MVR with patch closure of the fistulous opening, with good clinical outcome. This case highlights the classic TTE findings and the necessity for close follow-up in the perioperative period in patients undergoing surgery for periannular extension of infection. A cardiac magnetic resonance imaging can be considered, preoperatively, in such cases to identify the extent of myocardial involvement and surgical planning. PMID:25688306

  7. Reverse ?-wave as a possible sign in electrocardiography to diagnose mitral valve prolapse

    PubMed Central

    2011-01-01

    Background Mitral valve prolapse (MVP) is defined as superior displacement of the mitral valve leaflets more than 2 mm into the left atrium during systole. Easier and cheaper assessment of this common disease is a priority in cardiac health care facilities. Presentation of the hypothesis In this study I addressed electrocardiographic presentation in 300 patients with MVP compared with 100 healthy individuals. I faced a novel finding in electrocardiogram (ECG) examination of these patients. It was a notch (reverse ?-wave) in descending arm of QRS observed in 79% (237/300) of patients, consisting of 58% (174/300) in inferior leads and 21% (63/300) in I and aVL leads. The notch was identified only in 6 men in control group. Testing the hypothesis Considering the relatively higher prevalence of disease, a population-based diagnostic clinical trial study is appropriate to test the hypothesis. Implications of the hypothesis The hypothesis on diagnostic value of reverse ?-wave in MVP may help in decreasing the rate of unnessessary echocardiography in some patients. PMID:21266072

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

    PubMed Central

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-01-01

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

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

    PubMed

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-06-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2004-10-01

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

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

    PubMed

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

    1981-01-01

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

  13. Outcomes of Nonpledgeted Horizontal Mattress Suture Technique for Mitral Valve Replacement

    PubMed Central

    Kim, Gun Jik; Lee, Jong Tae; Lee, Young Ok; Cho, Joon Young; Oh, Tak-Hyuk

    2014-01-01

    Background Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. Methods We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. Results In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. Conclusion We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL. PMID:25551070

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

    Microsoft Academic Search

    Fumitaka Isobe; Yasunaru Kawashima

    1998-01-01

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

  15. Association between angiotensin I-converting enzyme gene insertion\\/deletion polymorphism and mitral valve prolapse syndrome

    Microsoft Academic Search

    Hsiang-Tai Chou; Yng-Tay Chen; Yi-Ru Shi; Fuu-Jen Tsai

    2003-01-01

    Background Some studies have reported that patients with mitral valve prolapse syndrome (MVPS) also have a disorder in the autonomic or neuroendocrine function, which can cause a host of related symptoms. A potential role of the renin-angiotensin system in the pathogenesis of MVPS has been addressed. However, the role of angiotensin I-converting enzyme (ACE) genetic variant in MVPS has not

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

    Microsoft Academic Search

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

    1995-01-01

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

  17. Anthropometric and physiologic correlates of mitral valve prolapse in a biethnic cohort of young adults: The CARDIA study

    Microsoft Academic Search

    John M. Flack; John H. Kvasnicka; Julius M. Gardin; Samuel S. Gidding; Teri A. Manolio; David R. Jacobs

    1999-01-01

    Objective To describe the epidemiology of echocardiographic mitral valve prolapse (MVP) and its anthropometric, physiologic, and psychobehavioral correlates with a cross-sectional analysis at 4 urban clinical centers. Patients A biethnic, community-based sample of 4136 young (aged 23 to 35 years) adult participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who had echocardiograms during their third examination

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

    Microsoft Academic Search

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

    2009-01-01

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

  19. Percutaneous Mitral Valve Dilatation: Single Balloon versus Double Balloon - A Finite Element Study

    SciTech Connect

    Schievano, Silvia; Kunzelman, Karyn; Nicosia, Mark; Cochran, R. P.; Einstein, Daniel R.; Khambadkone, Sachin; Bonheoffer, Philipp

    2009-01-01

    Background: Percutaneous mitral valve (MV) dilatation is performed with either a single balloon (SB) or double balloon (DB) technique. The aim of this study was to compare the two balloon system results using the finite element (FE) method. Methods and Results: An established FE model of the MV was modified by fusing the MV leaflet edges at commissure level to simulate a stenotic valve (orifice area=180mm2). A FE model of a 30mm SB (low-pressure, elastomeric balloon) and an 18mm DB system (high-pressure, non-elastic balloon) was created. Both SB and DB simulations resulted in splitting of the commissures and subsequent stenosis dilatation (final MV area=610mm2 and 560mm2 respectively). Stresses induced by the two balloon systems varied across the valve. At the end of inflation, SB showed higher stresses in the central part of the leaflets and at the commissures compared to DB simulation, which demonstrated a more uniform stress distribution. The higher stresses in the SB analysis were due to the mismatch of the round balloon shape with the oval mitral orifice. The commissural split was not easily accomplished with the SB due to its high compliance. The high pressure applied to the DB guaranteed the commissural split even when high forces were required to break the commissure welds. Conclusions: The FE model demonstrated that MV dilatation can be accomplished by both SB and DB techniques. However, the DB method resulted in higher probability of splitting of the fused commissures and less damage caused to the MV leaflets by overstretching.

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

    PubMed Central

    Tieleman, R. G.; Crijns, H. J.; Wiesfeld, A. C.; Posma, J.; Hamer, H. P.; Lie, K. I.

    1995-01-01

    BACKGROUND--The mechanism responsible for the reported high incidence of ventricular arrhythmias in mitral valve prolapse is not clear. Electrocardiographic studies show an increased occurrence of repolarisation abnormalities on the 12 lead surface electrocardiogram, indicating regional differences in ventricular recovery. The purpose of this study was to investigate whether dispersion of refractoriness was an arrhythmogenic mechanism. METHODS--QT dispersion was measured in 32 patients with echocardiographically documented mitral valve prolapse and ventricular arrhythmias on 24 hour Holter recordings. QT dispersion was defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface electrocardiogram. QT dispersion corrected for heart rate was calculated by Bazett's formula. The results were compared with the data from 32 matched controls without a history of cardiac disease. Patients taking drugs that influence the QT interval and patients with a QRS duration > 120 ms were excluded. RESULTS--QT dispersion was greater in patients with mitral valve prolapse than in matched controls (60 (20) v 39 (11 ms) respectively, P < or = 0.001) as was corrected QT (64 (20 ms) v 43 (12 ms) respectively, P < or = 0.001). There was no significant difference in minimum or maximum QT intervals between the two groups. CONCLUSIONS--QT dispersion on the 12 lead surface electrocardiogram was greater in patients with mitral valve prolapse with ventricular arrhythmias than in normal controls, but the maximum QT interval was not increased. The results accord with the hypothesis that regional shortening and lengthening of repolarisation times in patients with mitral valve prolapse may account for the increased dispersion of refractoriness. PMID:7888258

  1. Differential activation of valvulogenic, chondrogenic, and osteogenic pathways in mouse models of myxomatous and calcific aortic valve disease.

    PubMed

    Cheek, Jonathan D; Wirrig, Elaine E; Alfieri, Christina M; James, Jeanne F; Yutzey, Katherine E

    2012-03-01

    Studies of human diseased aortic valves have demonstrated increased expression of genetic markers of valve progenitors and osteogenic differentiation associated with pathogenesis. Three potential mouse models of valve disease were examined for cellular pathology, morphology, and induction of valvulogenic, chondrogenic, and osteogenic markers. Osteogenesis imperfecta murine (Oim) mice, with a mutation in Col1a2, have distal leaflet thickening and increased proteoglycan composition characteristic of myxomatous valve disease. Periostin null mice also exhibit dysregulation of the ECM with thickening in the aortic midvalve region, but do not have an overall increase in valve leaflet surface area. Klotho null mice are a model for premature aging and exhibit calcific nodules in the aortic valve hinge-region, but do not exhibit leaflet thickening, ECM disorganization, or inflammation. Oim/oim mice have increased expression of valve progenitor markers Twist1, Col2a1, Mmp13, Sox9 and Hapln1, in addition to increased Col10a1 and Asporin expression, consistent with increased proteoglycan composition. Periostin null aortic valves exhibit relatively normal gene expression with slightly increased expression of Mmp13 and Hapln1. In contrast, Klotho null aortic valves have increased expression of Runx2, consistent with the calcified phenotype, in addition to increased expression of Sox9, Col10a1, and osteopontin. Together these studies demonstrate that oim/oim mice exhibit histological and molecular characteristics of myxomatous valve disease and Klotho null mice are a new model for calcific aortic valve disease. PMID:22248532

  2. Echocardiographic integrated backscatter for detecting progression and regression of aortic valve calcifications in rats

    PubMed Central

    2013-01-01

    Background Calcification is an independent predictor of mortality in calcific aortic valve disease (CAVD). The aim of this study was to evaluate the use of non-invasive, non-ionizing echocardiographic calibrated integrated backscatter (cIB) for monitoring progression and subsequent regression of aortic valvular calcifications in a rat model of reversible renal failure with CAVD, compared to histology. Methods 28 male Wistar rats were prospectively followed during 21 weeks. Group 1 (N=14) was fed with a 0.5% adenine diet for 9 weeks to induce renal failure and CAVD. Group 2 (N=14) received a standard diet. At week 9, six animals of each group were killed. The remaining animals of group 1 (N=8) and group 2 (N=8) were kept on a standard diet for an additional 12 weeks. cIB of the aortic valve was calculated at baseline, 9 and 21 weeks, followed by measurement of the calcified area (Ca Area) on histology. Results At week 9, cIB values and Ca Area of the aortic valve were significantly increased in the adenine-fed rats compared to baseline and controls. After 12 weeks of adenine diet cessation, cIB values and Ca Area of group 1 decreased compared to week 9, while there was no longer a significant difference compared to age-matched controls of group 2. Conclusions cIB is a non-invasive tool allowing quantitative monitoring of CAVD progression and regression in a rat model of reversible renal failure, as validated by comparison with histology. This technique might become useful for assessing CAVD during targeted therapy. PMID:23351880

  3. Fluoroscopy-guided thrombolysis of mechanical mitral valve thrombosis in a young female with antiphospholipid antibody syndrome.

    PubMed

    Ikram, Sohail; Pant, Sadip; Hussain, Zeeshan; Brown, Lorrel

    2015-01-01

    Prosthetic valve thrombosis (PVT) is a rare but potentially fatal complication of mechanical valve prosthesis. The differential diagnoses for prosthetic valve obstruction includes pannus formation, prosthetic valve dehiscence, prosthetic valve endocarditis, chordae entrapment, patient-prosthesis mismatch and primary device failure. Establishing a diagnosis requires an understanding of prosthetic valve haemodynamics and careful correlation of clinical and imaging findings. Definitive therapy must be individualised based on various patient-specific factors. We present a case of mechanical mitral PVT in a young woman with antiphospholipid antibody syndrome, and outline the diagnostic and therapeutic approach utilised for successful treatment. The success and complication rates of various therapeutic strategies are also discussed, and highlight the need for individualised decision-making rather than a one-size-fits-all approach to PVT. PMID:25953214

  4. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse.

    PubMed

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Massoni, Alberto; Natali, Benedetta Maria; Focardi, Marta; Tacchini, Damiana; Geyer, Alessia; Curci, Valeria; Di Tommaso, Cristina; Lisi, Gianfranco; Maccherini, Massimo; Chiavarelli, Mario; Massetti, Massimo; Tanganelli, Piero; Mondillo, Sergio

    2013-02-15

    In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling. PMID:23211360

  5. An augmented reality environment for image-guidance of off-pump mitral valve implantation

    NASA Astrophysics Data System (ADS)

    Linte, Christian; Wiles, Andrew D.; Hill, Nick; Moore, John; Wedlake, Chris; Guiraudon, Gerard; Jones, Doug; Bainbridge, Daniel; Peters, Terry M.

    2007-03-01

    Clinical research has been rapidly evolving towards the development of less invasive surgical procedures. We recently embarked on a project to improve intracardiac beating heart interventions. Our novel approach employs new surgical technologies and support from image-guidance via pre-operative and intra-operative imaging (i.e. two-dimensional echocardiography) to substitute for direct vision. Our goal was to develop a versatile system that allowed for safe cardiac port access, and provide sufficient image-guidance with the aid of a virtual reality environment to substitute for the absence of direct vision, while delivering quality therapy to the target. Specific targets included the repair and replacement of heart valves and the repair of septal defects. The ultimate objective was to duplicate the success rate of conventional open-heart surgery, but to do so via a small incision, and to evaluate the efficacy of the procedure as it is performed. This paper describes the software and hardware components, along with the methodology for performing mitral valve replacement as one example of this approach, using ultrasound and virtual tool models to position and fasten the valve in place.

  6. Balloon dilatation of the mitral valve by a single bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter

    Microsoft Academic Search

    J Patel; S Vythilingum; A S Mitha

    1990-01-01

    The efficacy of balloon dilatation of the mitral valve by a bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter (single catheter technique) was assessed in 53 patients (mean age 28) with mitral stenosis, most of whom were women. The procedure was unsuccessful in three patients. After balloon dilatation the left atrial pressure decreased from 22 mm

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

    PubMed Central

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

    2010-01-01

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

  8. Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

    E-print Network

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

    2008-04-23

    Abstract Background Techniques to preserve the sub-valvular apparatus in order to reduce morbidity and mortality following mitral valve replacement have been frequently reported. However, it is uncertain what impact sub-valvular apparatus...

  9. Is robotic mitral valve surgery more expensive than its conventional counterpart?

    PubMed

    Canale, Leonardo Secchin; Colafranceschi, Alexandre Siciliano

    2015-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If amortization is taken into consideration, robotic cases are considerably more expensive. PMID:25757475

  10. In vivo quantification of the apical fixation forces of different mitral valved stent designs in the beating heart.

    PubMed

    Pokorny, S; Huenges, K; Engel, A; Gross, J; Frank, D; Morlock, M M; Cremer, J; Lutter, G

    2015-05-01

    The aim of this study was the quantification of the apical fixation forces of mitral valved stents for the first time. A test set-up was developed to measure the forces acting on the apical fixation of mitral valved stents. Twenty pigs received a self-expanding valved stent in the mitral position via a transapical approach in an off-pump procedure. Following stent deployment in the beating heart, the apical fixation forces were recorded following a standardized protocol and normalized. The apical fixation force of two different valved stent designs (AP: sole apical fixation, n = 10; SA: additional sub-annular fixation, n = 10) was compared to quantify the impact of the design change. Force measurement was successfully conducted in 18 of 20 animals (design AP: n = 10; design SA: n = 8). Evaluation showed higher mean forces and amplitude in the group with sole apical fixation (p = 0.046; Table 1). The impact of the additional sub-annular fixation was shown by a significant reduction of the force acting upon the apex of the heart. Quantification of these in vivo forces provides important information about the impact of different stent designs and might provide an objective parameter for stent performance evaluation in clinical application. PMID:25352439

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  12. Advances in catheter ablation: atrial fibrillation ablation in patients with mitral mechanical prosthetic valve.

    PubMed

    Santangeli, Pasquale; Di Biase, Luigi; Bai, Rong; Horton, Rodney; Burkhardt, J David; Sanchez, Javier; Price, Justin; Natale, Andrea

    2012-11-01

    Atrial fibrillation (AF) is common in patients with mitral valve replacement (MVR). Treatment of AF in these subjects is challenging, as the arrhythmia is often refractory to antiarrhythmic drug therapy. Radiofrequency catheter ablation (RFCA) is usually avoided or delayed in patients with MVR due to the higher perceived risks and difficulty of left atrial catheter manipulation in the presence of a mechanical valve. Over the last few years, several investigators have reported the feasibility and safety of RFCA of AF in patients with MVR. Five case-control studies have evaluated the feasibility and safety of RFCA of AF or perimitral flutter (PMFL) in patients with MVR. Overall, a total of 178 patients with MVR have been included (21 undergoing ablation of only PMFL), and have been compared with a matched control group of 285 patients. Total procedural duration (weighted mean difference [WMD] = +24.5 min, 95% confidence interval [CI] +10.2 min to +38.8 min, P = 0.001), and fluoroscopy time (WMD = +13.5 min, 95% CI +3.7 min to +23.4 min, P = 0.007) were longer in the MVR group. After a mean follow-up of 11.5 ± 8.6 months, 64 (36%) patients in the MVR group experienced recurrence of AF/PMFL, as compared to 73 (26%) patients in the control group, accounting for a trend toward an increased rate of recurrences in patients with MVR (odds ratio [OR] = 1.66, 95% CI 0.99 to 2.78, P = 0.053). Periprocedural complications occurred in 10 (5.6%) patients in the MVR group, and in 8 (2.8%) patients in the control group (OR = 2.01, 95% CI 0.56 to 7.15, P = 0.28). In conclusion, a quantitative analysis of the available evidence supports a trend toward a worse arrhythmia-free survival and a higher absolute rate of periprocedural complications in patients with MVR undergoing RFCA of AF or PMFL, as compared to a matched control group without mitral valve disease. These data would encourage the adoption of RFCA of AF in MVR patients mostly by more experienced Institutions. PMID:23003204

  13. The Prevalence of Hypomagnesaemia in Pediatric Patients with Mitral Valve Prolapse Syndrome and the Effect of Mg Therapy

    PubMed Central

    Amoozgar, Hamid; Rafizadeh, Hashem; Ajami, Gholamhossein; Borzoee, Mohammad

    2012-01-01

    Background A paucity of data exists regarding the prevalence and relationship of hypomagnesaemia with clinical symptoms of mitral valve prolapse (MVP) in pediatric patients. Objective In this study we evaluated the prevalence of magnesium (Mg) deficiency in pediatric patients with MVP syndrome and attempted to clarify the effect of Mg therapy on alleviating their symptoms. Methods The present study was conducted from April 2010 to January 2012, and included 230 patients (90 males and 140 females) with symptoms of mitral valve prolapse and mean age of 11.6±3.66. Serum magnesium (Mg) level less than 1.5 mg/dl was defined as hypomagnesaemia. Patients with 2 mm leaflet displacement and maximum leaflet thickness of 5 mm in echocardiography were considered to have classic MVP, while those with leaflet thickness less than 5 mm were considered as non-classic MVP. Patients with hypomagnesaemia were orally treated with 4.5 mg/kg/day Mg chloride for 5 weeks followed by re-evaluation of symptoms of chest pain, palpitation, fatigue and dyspnea. Results Hypomagnesaemia was found in 19 (8.2 %) of 230 patients with mitral valve prolapse. The re-evaluation of patients with Hypomagnesaemia after 5 weeks of Mg therapy, showed statistically significant relief of chest pain (P=0.01). However, no significant changes was detected in regard to palpitation (P=0.06), fatigue (P= 0.5) and dyspnea (P=0.99). Conclusion This study revealed that the prevalence of hypomagnesaemia in pediatric patients with mitral valve prolapse is relatively low compared to adults, but treatment with oral Mg in patient with hypomagnesaemia decreases chest pain. PMID:24757600

  14. Coenzyme Q 10 and key enzyme activities in papillary muscle related to left ventricle function in mitral valve disease

    Microsoft Academic Search

    Jan Karlsson; Christer Sylvén; Eva Jansson; Kazumasa Muratsu; Karl Folkers

    1988-01-01

    Coenzyme Q10 (CoQ10) was studied in papillary muscle from 18 patients (52–67 years, 2 females) subjected to open heart surgery due to mitral valve disease. In addition the enzyme activities of lactate dehydrogenase (LD) with its five isozymes, citrate synthase (CS) and mitochondrial CK (CK-MIT) were determined. Myocardial function was assessed by means of left ventricle (LV) angiography. CoQ10 averaged

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

    Microsoft Academic Search

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

    1989-01-01

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

  16. Prenatal ultrasonographic diagnosis of generalized arterial calcification of infancy.

    PubMed

    Corbacioglu Esmer, Aytul; Kalelioglu, Ibrahim; Omeroglu, Rukiye Eker; Kayserili, Hulya; Gulluoglu, Mine; Has, Recep; Yuksel, At?l

    2015-01-01

    A healthy 19-year-old nulliparous pregnant woman was referred to our clinic because of fetal pericardial effusion and ascites. The sonographic examination performed at 28 weeks' gestation revealed scalp edema, severe skin edema, bilateral hydrocele, ascites, and pleural and pericardial effusion. Fetal echocardiographic examination showed that both ventricles were dilated with severely depressed contractility. The aortic annulus, ascending aorta, aortic arch, descending aorta, common iliac arteries, main pulmonary artery, tricuspid valve, and mitral chordae tendinae were hyperechogenic. Right ventricular outflow tract was narrow with decreased blood flow. There was tricuspid and mitral valve regurgitation and tricuspid valve stenosis. On the basis of these findings, we made the diagnosis of generalized arterial calcification, which is characterized by extensive calcification of internal elastic lamina and intimal proliferation of medium-sized and large arteries. This diagnosis was confirmed histologically after the termination of pregnancy. PMID:24420383

  17. On the presence of affine fibril and fiber kinematics in the mitral valve anterior leaflet.

    PubMed

    Lee, Chung-Hao; Zhang, Will; Liao, Jun; Carruthers, Christopher A; Sacks, Jacob I; Sacks, Michael S

    2015-04-21

    In this study, we evaluated the hypothesis that the constituent fibers follow an affine deformation kinematic model for planar collagenous tissues. Results from two experimental datasets were utilized, taken at two scales (nanometer and micrometer), using mitral valve anterior leaflet (MVAL) tissues as the representative tissue. We simulated MVAL collagen fiber network as an ensemble of undulated fibers under a generalized two-dimensional deformation state, by representing the collagen fibrils based on a planar sinusoidally shaped geometric model. The proposed approach accounted for collagen fibril amplitude, crimp period, and rotation with applied macroscopic tissue-level deformation. When compared to the small angle x-ray scattering measurements, the model fit the data well, with an r(2) = 0.976. This important finding suggests that, at the homogenized tissue-level scale of ?1 mm, the collagen fiber network in the MVAL deforms according to an affine kinematics model. Moreover, with respect to understanding its function, affine kinematics suggests that the constituent fibers are largely noninteracting and deform in accordance with the bulk tissue. It also suggests that the collagen fibrils are tightly bounded and deform as a single fiber-level unit. This greatly simplifies the modeling efforts at the tissue and organ levels, because affine kinematics allows a straightforward connection between the macroscopic and local fiber strains. It also suggests that the collagen and elastin fiber networks act independently of each other, with the collagen and elastin forming long fiber networks that allow for free rotations. Such freedom of rotation can greatly facilitate the observed high degree of mechanical anisotropy in the MVAL and other heart valves, which is essential to heart valve function. These apparently novel findings support modeling efforts directed toward improving our fundamental understanding of tissue biomechanics in healthy and diseased conditions. PMID:25902446

  18. Biology of mitral valve prolapse: the harvest is big, but the workers are few.

    PubMed

    Loardi, Claudia; Alamanni, Francesco; Trezzi, Matteo; Kassem, Samer; Cavallotti, Laura; Tremoli, Elena; Pacini, Davide; Parolari, Alessandro

    2011-09-01

    Mitral valve prolapse (MVP) represents a common degenerative disease, often requiring surgery. If untreated, MVP with considerable valve incompetence can lead to cardiovascular and systemic complications causing substantial morbidity and mortality. In contrast with the wide knowledge concerning clinical and physiological features, currently available data regarding its molecular bases are very limited. We review current knowledge concerning MVP biological mechanisms, focusing on specific aspects of haemostasis, platelet function, oxidative stress, extracellular matrix remodeling and genomics. In particular, available evidence supports the role played by tissue remodeling processes in determining MVP onset and progression. Moreover, even if a consistent although controversial perturbation of haemostatic system and alterations of the oxidative stress equilibrium have been proposed to influence disease development, it is unknown whether these changes precede or follow MVP occurrence. Consequently, the complete knowledge of all the biochemical pathways involved are far from complete. In addition, changes in the regulation pattern of adrenergic and renin-angiotensin-aldosterone systems have been described in MVP syndrome, a condition characterized by the association of MVP with other peculiar neurological and general symptoms, but it is unknown whether these abnormalities are shared by "traditional" MVP. In conclusion, MVP is probably a multi-factorial process, and many aspects still need to be clarified. As surgery can only correct the damaged valve but not the underlying mechanisms, a more complete knowledge of the involved molecular pathways is necessary, as it may allow the discovery of targeted therapeutic strategies aimed at modifying or slackening MVP natural course in the early phases. PMID:21168228

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

    PubMed

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

    2014-01-01

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

  20. Matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) and transforming growth factor-? (TGF-?) in advanced canine myxomatous mitral valve disease.

    PubMed

    Moesgaard, S G; Aupperle, H; Rajamäki, M M; Falk, T; Rasmussen, C E; Zois, N E; Olsen, L H

    2014-12-01

    This study investigated mitral valve and myocardial protein and gene expression of matrix metalloproteinases (MMPs), their tissue inhibitors (TIMPs) and transforming growth factor-? (TGF-?) and plasma MMP and TGF-? concentrations in age-matched dog groups euthanized due to either advanced myxomatous mitral valve disease (MMVD) or other reasons. Furthermore, echocardiographic data and lumen/area ratio were correlated with tissue and plasma levels of MMPs, TIMPs and TGF-?s. Mitral valve and myocardial gene expression of MMP2, MMP14, TGF-?1 and TGF-?2 were increased and plasma MMP9 was decreased in advanced MMVD dogs. Myocardial gene expression of TIMP2 and TIMP3 were increased in advanced MMVD. All affected markers correlated to echocardiographic parameters. Significantly narrowed lumen/area ratio was associated with increased myocardial expression of MMP2, MMP14, TIMP2 and TIMP3. No differences in tissue protein expression were recorded. MMP2, MMP14, TIMP2, TIMP3, TGF-?1 and TGF-?2 appear to play a local role in the development of advanced MMVD. PMID:25458505

  1. Integration of a biomechanical simulation for mitral valve reconstruction into a knowledge-based surgery assistance system

    NASA Astrophysics Data System (ADS)

    Schoch, Nicolai; Engelhardt, Sandy; Zimmermann, Norbert; Speidel, Stefanie; De Simone, Raffaele; Wolf, Ivo; Heuveline, Vincent

    2015-03-01

    A mitral valve reconstruction (MVR) is a complex operation in which the functionality of incompetent mitral valves is re-established by applying surgical techniques. This work deals with predictive biomechanical simulations of operation scenarios for an MVR, and the simulation's integration into a knowledge-based surgery assistance system. We present a framework for the definition of the corresponding surgical workflow, which combines semantically enriched surgical expert knowledge with a biomechanical simulation. Using an ontology, 'surgical rules' which describe decision and assessment criteria for surgical decision-making are represented in a knowledge base. Through reasoning these 'rules' can then be applied on patient-specific data in order to be converted into boundary conditions for the biomechanical soft tissue simulation, which is based on the Finite Elements Method (FEM). The simulation, which is implemented in the open-source C++ FEM software HiFlow3, is controlled via the Medical Simulation Markup Language (MSML), and makes use of High Performance Computing (HPC) methods to cope with real-time requirements in surgery. The simulation results are presented to surgeons to assess the quality of the virtual reconstruction and the consequential remedial effects on the mitral valve and its functionality. The whole setup has the potential to support the intraoperative decision-making process during MVR where the surgeon usually has to make fundamental decision under time pressure.

  2. Juvenile idiopathic arthritis, mitral valve prolapse and a familial variant involving the integrin-binding fragment of FBN1.

    PubMed

    Wilson, Brian T; Jensen, Sacha A; McAnulty, Ciaron P; Brennan, Paul; Handford, Penny A

    2013-08-01

    Mutations in Fibrillin 1 (FBN1) are associated with Marfan syndrome and in some instances with the MASS phenotype (myopia, mitral valve prolapse, borderline non-progressive aortic root dilatation, skeletal features, and striae). Potential confusion over diagnosis and management in patients with borderline features has been addressed through the revised Ghent nosology, which emphasizes the importance of aortic root dilatation and ectopia lentis as features of Marfan syndrome. The overlapping and more common mitral valve prolapse syndrome is precluded by ectopia lentis or aortic dilatation. Among these clinically related conditions, there is no compelling evidence that genotype predicts phenotype, with the exception of neonatal Marfan syndrome, mutations in which cluster within FBN1 exons 24-32. Recent reports also link two very different phenotypes to changes in FBN1. Heterozygous mutations in transforming growth factor ?-binding protein-like domain 5 (TB5) can cause acromicric or geleophysic dysplasias-and mutations in the TB4 domain, which contains an integrin binding RGD loop, have been found in congenital scleroderma/stiff skin syndrome. We report on a variant in an evolutionarily conserved residue that stabilizes the integrin binding fragment of FBN1, associated with juvenile idiopathic arthritis, mitral valve prolapse or apparently normal phenotype in different family members. PMID:23794388

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

    PubMed

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

    2015-07-21

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

  4. Usefulness of novel hematologic inflammatory parameters to predict prosthetic mitral valve thrombosis.

    PubMed

    Gürsoy, Ozan Mustafa; Karakoyun, Süleyman; Kalçik, Macit; Gökdeniz, Tayyar; Yesin, Mahmut; Gündüz, Sabahattin; Astarcio?lu, Mehmet Ali; Ozkan, Mehmet

    2014-03-01

    Prosthetic valve thrombosis (PVT) is a life-threatening complication. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding valvular disease are lacking. The study population included patients with mitral PVT (n = 152) versus control subjects (n = 164) with functional mitral prosthesis. Transesophageal echocardiography was performed to diagnose PVT. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil and platelet levels did not differ between the groups (4.9 ± 2.0 vs 4.7 ± 1.5, p = 0.84 and 254.8 ± 89.7 vs 241.5 ± 62.8 p = 0.36, respectively), but lymphocyte levels were significantly lower in patients with PVT than the controls (1.8 ± 0.7 vs 2.2 ± 0.6, p <0.001). NLR, PLR, and CRP levels were significantly higher in patients with PVT than in controls (3.2 ± 2.1 vs 2.2 ± 0.8, p <0.001; 163 ± 77.5 vs 114.9 ± 37.3, p <0.001; and 1.97 ± 3.02 vs 1.02 ± 1.22, p = 0.01, respectively). A positive correlation was observed between NLR and PLR (r = 528, p <0.001). NLR level of >2.23, measured on admission, yielded an area under the curve value of 0.659 (95% confidence interval 0.582 to 0.736, sensitivity 66%, specificity 60%, p <0.001) and PLR level of >117.78 yielded an area under the curve value of 0.707 (95% confidence interval 0.636 to 0.777, sensitivity 70%, specificity 58%, p <0.001). Multivariate analysis showed that increased PLR and inadequate anticoagulation were independent predictors of thrombosis in patients with PVT. In conclusion, patients with PVT had increased NLR, PLR, and CRP levels compared with subjects with normofunctional prosthesis, and increased PLR was an independent predictor of mitral PVT. PMID:24411287

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

    Microsoft Academic Search

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

    2003-01-01

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

  6. Correlation between conjunctival and corneal calcification and cardiovascular calcification in patients undergoing maintenance hemodialysis.

    PubMed

    Sun, Wenxue; Sun, Mei; Zhang, Minghui; Liu, Yi; Lin, Xiaomin; Zhao, Sisi; Ma, Lulu

    2015-04-01

    The purpose of this study was to investigate the correlation of conjunctival and corneal calcification (CCC) with cardiovascular calcification in patients undergoing maintenance hemodialysis (MHD). A total of 122 patients undergoing MHD in our hospital were included in this study. Conjunctival and corneal calcification was examined by slit lamp and graded. Abdominal aortic calcification (AAC), aortic valve calcification (AVC), and mitral valve calcification (MVC) were determined by X-ray or ultrasound. The correlation of CCC with AAC, AVC, and MVC was analyzed. Biochemical, hematological, and cardiovascular data were compared between patients with different severity of CCC or AAC. Mitral valve calcification was significantly associated with AAC in our patients. Conjunctival and corneal calcification positively correlated with AAC. We also found that patients with severe CCC exhibited significantly higher levels of serum calcium, phosphate, product of calcium and phosphate, serum copper, cystatin, intact parathyroid hormone, and vitamin D than patients with mild CCC. In addition to significantly increased levels of serum calcium, product of calcium and phosphate, serum copper, and cystatin, patients with severe AAC also had higher high-sensitivity C-reactive protein level and greater left ventricular posterior wall thickness and left ventricular end-diastolic interventricular septum thickness than patients with mild AAC. Our results suggest that patients undergoing MHD with severe CCC or AAC have high degree of mineral metabolism disorder, inflammation, and cardiovascular function disorder. The strong correlation between CCC and AAC indicates that CCC score might be used as an indirect indicator to predict cardiovascular risks in patients undergoing MHD. PMID:25377787

  7. Triglycidylamine Crosslinking of Porcine Aortic Valve Cusps or Bovine Pericardium Results in Improved Biocompatibility, Biomechanics, and Calcification Resistance

    PubMed Central

    Connolly, Jeanne M.; Alferiev, Ivan; Clark-Gruel, Jocelyn N.; Eidelman, Naomi; Sacks, Michael; Palmatory, Elizabeth; Kronsteiner, Allyson; DeFelice, Suzanne; Xu, Jie; Ohri, Rachit; Narula, Navneet; Vyavahare, Narendra; Levy, Robert J.

    2005-01-01

    We investigated a novel polyepoxide crosslinker that was hypothesized to confer both material stabilization and calcification resistance when used to prepare bioprosthetic heart valves. Triglycidylamine (TGA) was synthesized via reacting epichlorhydrin and NH3. TGA was used to crosslink porcine aortic cusps, bovine pericardium, and type I collagen. Control materials were crosslinked with glutaraldehyde (Glut). TGA-pretreated materials had shrink temperatures comparable to Glut fixation. However, TGA crosslinking conferred significantly greater collagenase resistance than Glut pretreatment, and significantly improved biomechanical compliance. Sheep aortic valve interstitial cells grown on TGA-pretreated collagen did not calcify, whereas sheep aortic valve interstitial cells grown on control substrates calcified extensively. Rat subdermal implants (porcine aortic cusps/bovine pericardium) pretreated with TGA demonstrated significantly less calcification than Glut pretreated implants. Investigations of extracellular matrix proteins associated with calcification, matrix metalloproteinases (MMPs) 2 and 9, tenascin-C, and osteopontin, revealed that MMP-9 and tenascin-C demonstrated reduced expression both in vitro and in vivo with TGA crosslinking compared to controls, whereas osteopontin and MMP-2 expression were not affected. TGA pretreatment of heterograft biomaterials results in improved stability compared to Glut, confers biomechanical properties superior to Glut crosslinking, and demonstrates significant calcification resistance. PMID:15631995

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

    PubMed

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

    2014-02-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2014-03-15

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

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

    PubMed

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

    2014-01-01

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

  12. Expression Profiling of Circulating MicroRNAs in Canine Myxomatous Mitral Valve Disease

    PubMed Central

    Li, Qinghong; Freeman, Lisa M.; Rush, John E.; Laflamme, Dorothy P.

    2015-01-01

    MicroRNAs (miRNAs) are small non-coding RNAs that have shown promise as noninvasive biomarkers in cardiac disease. This study was undertaken to investigate the miRNA expression profile in dogs with myxomatous mitral valve disease (MMVD). 277 miRNAs were quantified using RT-qPCR from six normal dogs (American College of Veterinary Internal Medicine Stage A), six dogs with MMVD mild to moderate cardiac enlargement (ACVIM Stage B1/B2) and six dogs with MMVD and congestive heart failure (ACVIM Stage C/D). Eleven miRNAs were differentially expressed (False Discovery Rate < 0.05). Dogs in Stage B1/B2 or C/D had four upregulated miRNAs, including three cfa-let-7/cfa-miR-98 family members, while seven others were downregulated, compared to Stage A. Expression of six of the 11 miRNAs also were significantly different between dogs in Stage C/D and those in Stage B1/B2. The expression changes were greater as disease severity increased. These miRNAs may be candidates for novel biomarkers and may provide insights into genetic regulatory pathways in canine MMVD. PMID:26101868

  13. Impaired Corneal Biomechanical Properties and the Prevalence of Keratoconus in Mitral Valve Prolapse

    PubMed Central

    Kalkan Akcay, Emine; Akcay, Murat; Uysal, Betul Seher; Kosekahya, Pinar; Aslan, Abdullah Nabi; Caglayan, Mehtap; Koseoglu, Cemal; Yulek, Fatma

    2014-01-01

    Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery. PMID:24864193

  14. Predictive model for the detection of pulmonary hypertension in dogs with myxomatous mitral valve disease

    PubMed Central

    MIKAWA, Shoma; MIYAGAWA, Yuichi; TODA, Noriko; TOMINAGA, Yoshinori; TAKEMURA, Naoyuki

    2014-01-01

    Pulmonary hypertension (PH) often occurs due to a left heart disease, such as myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs requires expertise in echocardiography: however, the examination for PH is difficult to perform in a clinical setting. Thus, simple and reliable methods are required for the diagnosis of PH in dogs. The purpose of this study was to develop models using multiple logistic regression analysis to detect PH due to left heart disease in dogs with MMVD without echocardiography. The medical records of dogs with MMVD were retrospectively reviewed, and 81 dogs were included in this study and classified into PH and non-PH groups. Bivariate analysis was performed to compare all parameters between the groups, and variables with P values of <0.25 in bivariate analysis were included in multiple logistic regression analysis to develop models for the detection of PH. In multiple logistic regression analysis, the model included a vertebral heart scale short axis of >5.2 v, and a length of sternal contact of >3.3 v was considered suitable for the detection of PH. The predictive accuracy of this model (85.9%) was judged statistically adequate, and therefore, this model may be useful to screen for PH due to left heart disease in dogs with MMVD without echocardiography. PMID:25319513

  15. Anxiety and mood disorder in young males with mitral valve prolapse

    PubMed Central

    Lung, For-Wey; Cheng, Chih-Tao; Chang, Wei-To; Shu, Bih-Ching

    2008-01-01

    Objective This study explored the prevalence of panic disorder and other psychiatric disorders in young Han Chinese males with mitral valve prolapse (MVP). With the factors of age, sex, and ethnicity controlled, the specific role of MVP in panic disorder was analyzed. Methods Subjects with chest pain aged between 18 and 25 years were assessed with the echocardiograph for MVP and the Chinese version of the Mini-International Neuropsychiatric Interview for panic disorder (n = 39). Results Of the 39 participants, 35.9% met the diagnosis of anxiety disorder, 46.2% met at least one criterion of anxiety disorder, and 23.1% met the diagnostic criteria of major depressive disorder. There was no statistically significant difference in the prevalence of panic disorder between one of the (8.3%) MVP patients, and two (7.4%) control participants. Conclusions There is a high prevalence of psychiatric disorder, including anxiety disorder and major depressive disorder, in those who report pain symptoms, so that diagnosis and treatment of these patients is of great importance. In addition, individuals with MVP did not have an increased risk for panic disorder. Whether MVP may be a modifier or mediating factor for panic disorder needs to be further assessed in a larger scale study. PMID:21197339

  16. Evaluation of Papillary Muscle Function Using Cardiovascular Magnetic Resonance Imaging in Mitral Valve Prolapse

    PubMed Central

    Han, Yuchi; Peters, Dana C.; Kissinger, Kraig V.; Goddu, Beth; Yeon, Susan B.; Manning, Warren J.; Nezafat, Reza

    2010-01-01

    Abnormal traction and excursion of the papillary muscle (PM) can be observed in patients with mitral valve prolapse (MVP), which may adversely affect the electrophysiological stability of the underlying myocardium. Cardiovascular magnetic resonance (CMR) techniques can directly measure the excursion and velocity of PM tips during ventricular systole. In addition, high resolution late gadolinium enhancement (LGE)-CMR allows for visualization of underlying potentially arrhythmogenic PM fibrosis substrate. We prospectively studied 16 MVP and 9 healthy adult subjects with PC-CMR and cine-CMR to assess PM velocity and excursion. LGE-CMR was performed in 13 (81%) MVP subjects. Peak PM systolic velocity and maximum PM excursion were significantly increased in MVP subjects (12 ± 5 cm/s vs. 5 ± 2 cm/s and 15 ± 5 mm vs. 2 ± 3 mm, both p < 0.001). Definite PM LGE was found in 6 (46%) patients, but did not correlate with PM velocity or excursion. In conclusion, functional CMR imaging demonstrated increased peak PM systolic velocity and excursion distance in MVP patients. These parameters, however, did not relate to underlying PM fibrosis. PMID:20599010

  17. Impaired corneal biomechanical properties and the prevalence of keratoconus in mitral valve prolapse.

    PubMed

    Kalkan Akcay, Emine; Akcay, Murat; Uysal, Betul Seher; Kosekahya, Pinar; Aslan, Abdullah Nabi; Caglayan, Mehtap; Koseoglu, Cemal; Yulek, Fatma; Cagil, Nurullah

    2014-01-01

    Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery. PMID:24864193

  18. Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities

    SciTech Connect

    Tebbe, U.; Schicha, H.; Neumann, P.; Voth, E.; Emrich, D.; Neuhaus, K.L.; Kreuzer, H.

    1985-06-01

    Patients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). The authors performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ventriculography (/sup 99m/technetium), and perfusion scintigrams (/sup 201/thallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams. A significant correlation in pathological results was found only between exercise ECG and both radionuclide ventriculography and pulmonary arterial pressure measurements. Because of the high prevalence of false-positive perfusion scintigrams in patients with typical or atypical chest pain, the use of exercise /sup 201/Tl imaging as a screening method to separate patients with MVP from those with CAD will not be appropriate. The variability of cardiac abnormalities in our patients with MVP and angiographically normal coronary arteries suggests that the MVP syndrome may represent a variable combination of metabolic, ischemic, or myopathic disorders.

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2009-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

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

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

    PubMed

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

    2013-02-15

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

  3. Does the Association Between Mitral Valve Prolapse and Panic Disorder Really Exist?

    PubMed Central

    Filho, Alaor Santos; Maciel, Benedito C.; Martín-Santos, Rocío; Romano, Minna M. D.; Crippa, José Alexandre

    2008-01-01

    Objective: Although the possible relationship between panic disorder and mitral valve prolapse (MVP) attracted considerable research interest in the 1980s and 1990s, the reported prevalence of MVP in these patients has been inconsistent and widely variable. Clinical and epidemiologic studies have produced controversial data on possible association or definite causal relationship between these 2 entities. The primary objective of the present review was to summarize the current state of knowledge on the association between panic disorder and MVP, including the influence of diagnostic criteria for MVP on the controversial results. Data Sources: We searched MEDLINE, LILACS, and EMBASE databases using the keywords panic and mitral. Inclusion criteria were articles concerning the reciprocal association of MVP and panic disorder, published from the earliest dates available through December 2006. Study Selection: All relevant articles published in English, Spanish, or Portuguese and reporting original data related to the association of MVP and panic disorder were included. Forty articles fulfilling the criteria for inclusion in this review were identified. Data Synthesis: Even though the reported prevalence of MVP in panic disorder varied from 0% to 57%, a significant association between the 2 disorders was documented in 17 of the 40 studies. Such inconsistent results were due to sampling biases in case or control groups, widely different diagnostic criteria for MVP, and lack of reliability of MVP diagnosis. None of the reviewed studies used the current state-of-the-art diagnostic criteria for MVP to evaluate the volunteers. Apparently, the more elaborate the study methodology, the lower the chance to observe a significant relationship between these 2 conditions. Conclusions: Published results are insufficient to definitely establish or to exclude an association between MVP and panic disorder. If any relationship does actually exist, it could be said to be infrequent and mainly occur in subjects with minor variants of MVP. To clarify this intriguing issue, future studies should mainly focus on the observed methodological biases and particularly should use the current criteria for MVP as the standard for evaluation. PMID:18311420

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

    PubMed

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

    2012-05-01

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

  5. Elucidating the Molecular-Level Events in Valvular Interstitial Cell Calcification to Improve the Design of Tissue-Engineered Heart Valves

    NASA Astrophysics Data System (ADS)

    Gu, Xiaoxiao

    Calcification is the leading cause of native and bioprosthetic heart valve failure, yet its etiology and progression remain poorly understood. Total valve replacement, which is both invasive and accompanied by numerous shortcomings, is commonly performed to replace stenotic valves, but there are currently no medical agents that are FDA-approved for the prevention of aortic valve disease progression. Tissue engineering offers an attractive alternative to current valve replacement options. Thus, there is a pressing need to: (1) better understand the progression of valve calcification, (2) develop more options for prevention and treatment of valve calcification, and (3) define the properties of appropriate scaffold environments that will support the growth of engineered valve tissue. In this thesis, we describe our plan to bring together these goals in cardiovascular medicine: we aim to identify differences between calcifying and non-calcifying valve cultures and then use this information to discover potential calcification inhibitors and define biomaterial environments that can be used to support either healthy or diseased valvular interstitial cell function.

  6. MECHANISMS OF THE IN VIVO INHIBITION OF CALCIFICATION OF BIOPROSTHETIC PORCINE AORTIC VALVE CUSPS AND AORTIC WALL WITH TRIGLYCIDYLAMINE/MERCAPTO BISPHOSPHONATE

    PubMed Central

    Rapoport, H. Scott; Connolly, Jeanne M.; Fulmer, James; Dai, Ning; Murti, Brandon H.; Gorman, Robert C.; Gorman, Joseph H.; Alferiev, Ivan; Levy, Robert J.

    2007-01-01

    Heart valve replacements fabricated from glutaraldehyde (Glut)-crosslinked heterograft materials, porcine aortic valves or bovine pericardium, have been widely used in cardiac surgery to treat heart valve disease. However, these bioprosthetic heart valves often fail in long-term clinical implants due to pathologic calcification of the bioprosthetic leaflets, and for stentless porcine aortic valve bioprostheses, bioprosthetic aortic wall calcification also typically occurs. Previous use of the epoxide-based crosslinker, Triglycidyl amine (TGA), on cardiac bioprosthetic valve materials demonstrated superior biocompatibility, mechanics, and calcification resistance for porcine aortic valve cusps (but not porcine aortic wall) and bovine pericardium, versus Glut-prepared controls. However, TGA preparation did not completely prevent long-term calcification of cusps or pericardium. Herein we report further mechanistic investigations of an added therapeutic component to this system, 2-Mercaptoethylidene-1,1-bisphosphonic acid (MABP), a custom synthesized thiol bisphosphonate, which has previously been shown in a preliminary report to prevent bioprosthetic heterograft biomaterial calcification when used in combination with initial TGA crosslinking for 7 days. In the present studies we have further investigated the effectiveness of MABP in experiments that examined: 1) The use of MABP after optimal TGA crosslinking, in order to avoid any competitive interference of MABP-reactions with TGA during crosslinking; 2) Furthermore, recognizing the importance of alkaline phosphatase in the formation of dystrophic calcific nodules, we have investigated the hypothesis that the mechanism by which MABP primarily functions is through the reduction of alkaline phosphatase activity. Results from cell-free model systems, cell culture studies, and rat subcutaneous implants, show that materials functionalized with MABP after TGA crosslinking have reduced alkaline phosphatase activity, and in vivo have no significant calcification in long term implant studies. It is concluded that bioprosthetic heart valves prepared in this fashion are compelling alternatives for Glut-prepared bioprostheses. PMID:17027944

  7. Calcified Rheumatic Valve Neoangiogenesis Is Associated With Vascular Endothelial Growth Factor Expression and Osteoblast-Like Bone Formation

    PubMed Central

    Rajamannan, Nalini M.; Nealis, Thomas B.; Subramaniam, Malayannan; Pandya, Sanjay; Stock, Stuart R.; Ignatiev, Constatine I.; Sebo, Thomas J.; Rosengart, Todd K.; Edwards, William D.; McCarthy, Patrick M.; Bonow, Robert O.; Spelsberg, Thomas C.

    2014-01-01

    Background Rheumatic heart disease is the most common cause of valvular disease in developing countries. Despite the high prevalence of this disease, the cellular mechanisms are not well known. We hypothesized that rheumatic valve calcification is associated with an osteoblast bone formation and neoangiogenesis. Methods and Results To test this hypothesis, we examined human rheumatic valves replaced at surgery (n=23), normal human valves (n=20) removed at cardiac transplantation, and degenerative mitral valve leaflets removed during surgical valve repair (n=15). Microcomputed tomography was used to assess mineralization fronts to reconstruct the extents of mineralization. Immunohistochemistry was used to localize osteopontin protein, ?-actin, osteocalcin, vascular endothelial growth factor, von Willebrand factor, and CD68 (human macrophage). Microcomputed tomography demonstrated complex calcification developing within the heavily calcified rheumatic valves, not in the degenerative mitral valves and control valves. Immunohistochemistry localized osteopontin and osteocalcin to areas of smooth muscle cells within microvessels and proliferating myofibroblasts. Vascular endothelial growth factor was present in areas of inflammation and colocalized with the CD68 stain primarily in the calcified rheumatic valves. Alizarin red, osteopontin, and osteocalcin protein expression was upregulated in the calcified rheumatic valves and was present at low levels in the degenerative mitral valves. Conclusions These findings support the concept that rheumatic valve calcification is not a random passive process but a regulated, inflammatory cellular process associated with the expression of osteoblast markers and neoangiogenesis. PMID:15956138

  8. Carnitine Deficiency as the Possible Etiology of Idiopathic Mitral Valve Prolapse

    PubMed Central

    Trivellato, Mario; De Palo, Elio; Gatti, Rosalba; Parenti, Anna; Piazza, Mario

    1984-01-01

    Idiopathic mitral valve prolapse (IMVP) is a very common cardiac abnormality that may be linked to carnitine deficit (inadequate nutritional intake or absorption). One patient with IMVP and related symptoms that were resistant to drug therapy was fully studied. Free plasma carnitine and 24-hour free urine carnitine were measured twice, 10 days apart, after an overnight fast. Findings: Free plasma carnitine 23 and 28 ?M/L (our laboratory N=38±2 ?M/L); free urine C 25 and 44 ?M/24 hr (N=255±66 ?M/24 hr); FFA 0.88 mEq/L, Duncombe method (N=0.09-0.60); LDL 42% (N = 44-65); cholesterol 161 mg/dl (N = 180-280); triglycerides 84 mg/dl (N = 50-172); SGOT 79 MU/ml (N = up to 40); SGPT 147 MU/ml (N = up to 40); OCT 11.2 MU/ml (N = up to 10.0); aldolase 11.5 MU/ml (N = up to 3.1, Bruns method). Deltoid biopsy: light microscopy showed the presence of optically empty vacuoles; electron microscopy showed lipid droplets near the subsarcolemma area and intermyofibrillar spaces. The mitochondria contained electron dense granules. The electromyogram was also abnormal. In a random sample of four patients with IMVP and related classic symptoms, we have found low levels of plasma and/or urinary carnitine in each case. This study may be the first step towards L-carnitine therapy for what has previously appeared to be idiopathic cardiomyopathy. Images PMID:15226877

  9. Repair of left atrioventricular disruption after mitral valve replacement using extracorporeal life support system for effective ventricular unloading.

    PubMed

    Sodian, Ralf; Schmauss, Daniel; Hagl, Christian; Juchem, Gerd

    2015-06-01

    Atrioventricular (AV) disruption is a rare but fatal complication after prosthetic mitral valve replacement. Surgical management is controversial and ranges from epicardial tissue sealing to open repair using autologous or xenogenic patch techniques to autotransplantation of the heart. We report the successful repair of an AV disruption Type I using an extracorporeal life support (ECLS) system for effective ventricular unloading followed by epicardial patch closure. The surgical management of AV disruption benefits from the use of ECLS, as it allows effective decompression of the heart without requiring full heparinization. PMID:25079773

  10. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

    Microsoft Academic Search

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

    2008-01-01

    OBJECTIVES: We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR). BACKGROUND: Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one

  11. [Clinical significance of mitral valve insufficiency detected by Doppler echocardiography in acute myocardial infarction].

    PubMed

    Kraska, T; Liszewska-Pfejfer, D; Dziduszko-Fedorko, E; Jakubowska-Najnigier, M; Opolski, G; Stanis?awska-Nielepkiewicz, J; Stawicki, S; Zawadzka-By?ko, M

    1990-10-01

    Doppler echocardiography revealed in the third week of the recent myocardial infarction a pattern of mitral insufficiency in 27 (36%) of the 75 patients studied. Mitral insufficiency was usually associated with the more severe clinical course of myocardial infarction, with more frequent supraventricular and ventricular arrhythmias, heart failure, and with more extensive infarction area, as compared with the patients without mitral failure. A decreased contractibility of the left ventricle wall (especially in patients with anterior myocardial infarction accompanied by mitral insufficiency and enlargement ventricular dimension) may suggest its role in the development of mitral insufficiency in myocardial infarction. The results show the need of Doppler echocardiography in recent myocardial infarction to detect patients with an increased risk. PMID:2080111

  12. Left Ventricular Vortex Under Mitral Valve Edge-to-Edge Repair

    PubMed Central

    Hu, Yingying; Shi, Liang; Parameswaran, Siva; Smirnov, Sergey; He, Zhaoming

    2011-01-01

    Mitral valve (MV) edge-to-edge repair (ETER) changes MV geometry by approximation of MV leaflets, and impacts left ventricle (LV) filling fluid mechanics. The purpose of this study was to investigate LV vortex with MV ETER during diastole. A computational MV–LV model was developed with MV ETER at the central free edges of the anterior and posterior leaflets. It was supposed that LV would elongate apically during diastole. The elongation deformation was controlled by the intraventricular flow rate. MV leaflets were modeled as a semi-prolate sphere with two symmetrical circular orifices and fixed at the maximum valve opening. MV chordae were neglected. FLUENT was used to simulate blood flow through the MV and in the LV. MV ETER generated two jets deflected laterally toward the LV wall in rapid LV filling. The jets impinged the LV wall obliquely and moved apically along the LV wall. Jet energy was primarily lost near the impingement. The jet from each MV orifice was surrounded by a vortex ring. The two vortex rings dissipated at the end of diastole. The total energy loss increased inversely with the MV orifice area. The atrio-ventricular pressure gradient was adverse near the end of diastole and possibly in diastasis. Reduction of the total orifice area led to more increment in the transmitral pressure drop than in the transmitral velocity. In conclusion, during diastole, two deflected jets from the MV under ETER impinged the LV wall. Major energy loss occurred around the jet impingement. Two vortex rings dissipated at the end of diastole with little storage of inflow energy for blood ejection in the following process of systole. MV ETER increased energy loss and lowered LV filling efficiency. The maintaining of a larger orifice area after ETER might not significantly increase energy loss in the LV during diastole and the transmitral pressure drop. The adverse pressure gradient from the atrium to the LV might be the mechanism of MV closure in the late diastole. PMID:21666755

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

    PubMed

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

    2013-01-01

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

  14. Alpha-smooth muscle actin and serotonin receptors 2A and 2B in dogs with myxomatous mitral valve disease.

    PubMed

    Cremer, S E; Moesgaard, S G; Rasmussen, C E; Zois, N E; Falk, T; Reimann, M J; Cirera, S; Aupperle, H; Oyama, M A; Olsen, L H

    2015-06-01

    Canine Myxomatous mitral valve disease (MMVD) is an age-related disease. Serotonin (5-HT) is implicated in the pathogenesis as locally-produced or platelet-derived. Involvement of the 5-HT2A receptor (R) and 5-HT2BR in the induction of myxomatous-mediating valvular myofibroblasts (MF) has been suggested. In an age-matched population of dogs with non-clinical and clinical MMVD, the objectives were to investigate (1) gene expression of 5-HT2AR and 5-HT2BR, (2) protein expression and spatial relationship of 5-HT2AR, 5-HT2BR and MF in the mitral valve (MV) and the cardiac anterior papillary muscle (AP) and (3) serum 5-HT concentrations. Gene expression of 5-HT2BR was significantly higher in MV and AP among dogs with clinical MMVD. This was not found for 5-HT2BR protein expression, though association of 5-HT2BR with myxomatous pathology and co-localization of 5-HT2BR and MF in MV and AP support a functional relationship, perhaps perpetuation of clinical MMVD. 5-HT2AR-expression and serum 5-HT showed no differences between groups. PMID:25843893

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

    PubMed

    Boronyak, Steven M; Merryman, W David

    2012-09-01

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

  16. Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

    PubMed Central

    de Campos, Nelson Leonardo Kerdahi Leite

    2014-01-01

    Introduction Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. Objective To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. Methods We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. Results The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. Conclusion Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature. PMID:24896164

  17. Changes of Serum ?-Endorphin by Programmed Exercise Training Are Correlated with Improvement of Clinical Symptoms and Quality of Life in Female Mitral Valve Prolapse Syndrome

    Microsoft Academic Search

    Huei-Fong Hung; Pai-Feng Kao; Yu-Shuang Lin; Feng-Chia Chen; Fu-Chean Chen; Jen-Chen Tsai; Paul Chan

    2007-01-01

    Background: Mitral valve prolapse (MVP) is a common entity in female population. Although this is a minor disease, it may cause annoying symptoms that impair quality of life (QOL), and no established therapy for this problem. The aim of this study isto examine whether programmed exercise training by treadmill in female MVP syndrome would improve clinical symptoms and QOL. Methods:

  18. 35th Annual Meeting — American College of Angiology Orlando, Florida — October, 1988 Symposium ProceedingsNeurologic Aspects of Mitral Valve Prolapse

    Microsoft Academic Search

    Albert F. Heck

    1989-01-01

    Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications

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

    PubMed

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

    1991-09-01

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

  20. The Leaflex™ Catheter System - a viable treatment option alongside valve replacement? Preclinical feasibility of a novel device designed for fracturing aortic valve calcification.

    PubMed

    Jonas, Michael; Rozenman, Yoseph; Moshkovitz, Yaron; Hamdan, Ashraf; Kislev, Yael; Tirosh, Nitzan; Sax, Sharon; Trumer, Dror; Golan, Erez; Raanani, Ehud

    2014-11-25

    Aims: To demonstrate the feasibility of the Leaflex™ Catheter System, a novel percutaneous device for fracturing valve calcification using mechanical impact in order to regain leaflet mobility. Methods and results: Radiographic analysis of calcium patterns in 90 ex vivo human aortic valve leaflets demonstrated that 82% of leaflets had a typical "bridge" or "half-bridge" pattern, which formed the basis for the catheter design. The therapeutic effect was quantified in 13 leaflets showing a reduction of 49±16% in leaflet resistance to folding after treatment. A pulsatile flow simulator was then used with 11 ex vivo valves demonstrating an increase in aortic valve area of 35±12%. Using gross pathology and histology on fresh calcified leaflets, we then verified that mechanical impacts do not entail excessive risk of embolisation. In vivo safety and usability were then confirmed in the ovine model. Conclusions: We demonstrated preclinically that it is feasible to improve valve function using the Leaflex™ technology. Once demonstrated clinically, such an approach may have an important role as preparation for or bridging to TAVI, as destination treatment for patients where TAVI is clinically or economically questionable and, in the future, maybe even as a means to slow disease progression in asymptomatic patients. PMID:25420790

  1. Genetic Associations with Valvular Calcification and Aortic Stenosis

    PubMed Central

    Thanassoulis, George; Campbell, Catherine Y.; Owens, David S.; Smith, J. Gustav; Smith, Albert V.; Peloso, Gina M.; Kerr, Kathleen F.; Pechlivanis, Sonali; Budoff, Matthew J.; Harris, Tamara B.; Malhotra, Rajeev; O’Brien, Kevin D.; Kamstrup, Pia R.; Nordestgaard, Børge G.; Tybjaerg-Hansen, Anne; Allison, Matthew A.; Aspelund, Thor; Criqui, Michael H.; Heckbert, Susan R.; Hwang, Shih-Jen; Liu, Yongmei; Sjogren, Marketa; van der Pals, Jesper; Kälsch, Hagen; Mühleisen, Thomas W.; Nöthen, Markus M.; Cupples, L. Adrienne; Caslake, Muriel; Di Angelantonio, Emanuele; Danesh, John; Rotter, Jerome I.; Sigurdsson, Sigurdur; Wong, Quenna; Erbel, Raimund; Kathiresan, Sekar; Melander, Olle; Gudnason, Vilmundur; O’Donnell, Christopher J.; Post, Wendy S.

    2013-01-01

    BACKGROUND Limited information is available regarding genetic contributions to valvular calcification, which is an important precursor of clinical valve disease. METHODS We determined genomewide associations with the presence of aorticvalve calcification (among 6942 participants) and mitral annular calcification (among 3795 participants), as detected by computed tomographic (CT) scanning; the study population for this analysis included persons of white European ancestry from three cohorts participating in the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (discovery population). Findings were replicated in independent cohorts of persons with either CT-detected valvular calcification or clinical aortic stenosis. RESULTS One SNP in the lipoprotein(a) (LPA) locus (rs10455872) reached genomewide significance for the presence of aorticvalve calcification (odds ratio per allele, 2.05; P = 9.0×10?10), a finding that was replicated in additional white European, African-American, and Hispanic-American cohorts (P<0.05 for all comparisons). Genetically determined Lp(a) levels, as predicted by LPA genotype, were also associated with aorticvalve calcification, supporting a causal role for Lp(a). In prospective analyses, LPA genotype was associated with incident aortic stenosis (hazard ratio per allele, 1.68; 95% confidence interval [CI], 1.32 to 2.15) and aortic-valve replacement (hazard ratio, 1.54; 95% CI, 1.05 to 2.27) in a large Swedish cohort; the association with incident aortic stenosis was also replicated in an independent Danish cohort. Two SNPs (rs17659543 and rs13415097) near the proinflammatory gene IL1F9 achieved genomewide significance for mitral annular calcification (P = 1.5×10?8 and P = 1.8×10?8, respectively), but the findings were not replicated consistently. CONCLUSIONS Genetic variation in the LPA locus, mediated by Lp(a) levels, is associated with aorticvalve calcification across multiple ethnic groups and with incident clinical aortic stenosis. (Funded by the National Heart, Lung, and Blood Institute and others.) PMID:23388002

  2. The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet

    SciTech Connect

    Liao,J.; Yang, L.; Grashow, J.; Sacks, M.

    2007-01-01

    We have recently demonstrated that the mitral valve anterior leaflet (MVAL) exhibited minimal hysteresis, no strain rate sensitivity, stress relaxation but not creep (Grashow et al., 2006, Ann Biomed Eng., 34(2), pp. 315-325; Grashow et al., 2006, Ann Biomed. Eng., 34(10), pp. 1509-1518). However, the underlying structural basis for this unique quasi-elastic mechanical behavior is presently unknown. As collagen is the major structural component of the MVAL, we investigated the relation between collagen fibril kinematics (rotation and stretch) and tissue-level mechanical properties in the MVAL under biaxial loading using small angle X-ray scattering. A novel device was developed and utilized to perform simultaneous measurements of tissue level forces and strain under a planar biaxial loading state. Collagen fibril D-period strain ({epsilon}{sub D}) and the fibrillar angular distribution were measured under equibiaxial tension, creep, and stress relaxation to a peak tension of 90 N/m. Results indicated that, under equibiaxial tension, collagen fibril straining did not initiate until the end of the nonlinear region of the tissue-level stress-strain curve. At higher tissue tension levels, {epsilon}{sub D} increased linearly with increasing tension. Changes in the angular distribution of the collagen fibrils mainly occurred in the tissue toe region. Using {epsilon}{sub D}, the tangent modulus of collagen fibrils was estimated to be 95.5{+-}25.5 MPa, which was {approx}27 times higher than the tissue tensile tangent modulus of 3.58{+-}1.83 MPa. In creep tests performed at 90 N/m equibiaxial tension for 60 min, both tissue strain and D remained constant with no observable changes over the test length. In contrast, in stress relaxation tests performed for 90 min {epsilon}{sub D} was found to rapidly decrease in the first 10 min followed by a slower decay rate for the remainder of the test. Using a single exponential model, the time constant for the reduction in collagen fibril strain was 8.3 min, which was smaller than the tissue-level stress relaxation time constants of 22.0 and 16.9 min in the circumferential and radial directions, respectively. Moreover, there was no change in the fibril angular distribution under both creep and stress relaxation over the test period. Our results suggest that (1) the MVAL collagen fibrils do not exhibit intrinsic viscoelastic behavior, (2) tissue relaxation results from the removal of stress from the fibrils, possibly by a slipping mechanism modulated by noncollagenous components (e.g. proteoglycans), and (3) the lack of creep but the occurrence of stress relaxation suggests a 'load-locking' behavior under maintained loading conditions. These unique mechanical characteristics are likely necessary for normal valvular function.

  3. ST-Segment Depression in Hyperventilation Indicates a False Positive Exercise Test in Patients with Mitral Valve Prolapse

    PubMed Central

    Michaelides, Andreas P.; Liakos, Charalampos I.; Antoniades, Charalambos; Tsiachris, Dimitrios L.; Soulis, Dimitrios; Dilaveris, Polichronis E.; Tsioufis, Konstantinos P.; Stefanadis, Christodoulos I.

    2010-01-01

    Objectives. Mitral valve prolapse (MVP) is a known cause for false positive exercise test (ET). The purpose of this study was to establish additional electrocardiographic criteria to distinguish the false positive exercise results in patients with MVP. Methods. We studied 218 consecutive patients (53 ± 6 years, 103 males) with MVP (according to echocardiographic study), and positive treadmill ET was performed due to multiple cardiovascular risk factors or angina-like symptoms. A coronary angiography was performed to detect coronary artery disease (CAD). Results. From 218 patients, 90 (group A) presented with normal coronary arteries according to the angiography (false positive ET) while the rest 128 (group B) presented with CAD. ST-segment depression in hyperventilation phase was present in 54 patients of group A (60%) while only in 14 patients of group B (11%), P < .05. Conclusions. Presence of ST-segment depression in hyperventilation phase favors a false positive ET in patients with MVP. PMID:21113438

  4. Genetic evidence that mutations in the COL1A1, COL1A2, COL3A1, or COL5A2 collagen genes are not responsible for mitral valve prolapse.

    PubMed Central

    Henney, A M; Tsipouras, P; Schwartz, R C; Child, A H; Devereux, R B; Leech, G J

    1989-01-01

    DNA markers were used to assess the segregation of genes encoding the collagen types that predominate in the mitral valve (types I, III, and V) in two family pedigrees that are phenotypically different but showed dominantly inherited mitral valve prolapse. The inheritance of these markers was compared with the segregation of the phenotype for mitral valve prolapse in both families. In one family it was shown that the COL1A1, COL1A2, COL3A1, and COL5A2 genes segregated independently of the phenotype; in the other family the results for COL1A1, COL1A2, and COL5A2 were similar but analysis at the COL3A1 locus was not possible. These data indicate that in these families mitral valve prolapse does not arise from a defect in one of these collagen genes. PMID:2930668

  5. Early Results of Posterior Leaflet Folding Plasty for Mitral Valve Reconstruction

    Microsoft Academic Search

    Eugene A. Grossi; Aubrey C. Galloway; Klaus Kallenbach; Jeffrey S. Miller; Rick Esposito; Daniel S. Schwartz; Stephen B. Colvin

    1998-01-01

    Background. Standard reconstruction for posterior mitral leaflet (PML) disease is quadrangular resection and annular plication; when the PML is excessively high, a sliding plasty is used. We have developed an alternative technique, a posterior leaflet folding plasty. It is performed by folding down the cut vertical edges of the PML. The central height of the PML is reduced, leaflet coaptation

  6. Internal carotid artery occlusion in a young female with mitral valve prolapse.

    PubMed Central

    Saadah, M. A.; Shakir, R. A.; Rudwan, M. A.; Khan, N.

    1986-01-01

    A healthy 28 year old housewife presented with sudden right hemiplegia and aphasia. No predisposing factors could be ascertained apart from posterior cusp mitral value prolapse on two dimensional echocardiography. Extensive investigations confirmed the presence of cerebral infarction and persistent occlusion of the left internal carotid artery near its origin. Images Figure 1 Figure 2 PMID:3658849

  7. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval.

    PubMed

    Yontar, Osman Can; Karaagac, Kemal; Tenekecioglu, Erhan; Tutuncu, Ahmet; Demir, Mehmet; Melek, Mehmet

    2014-01-01

    Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP. PMID:25232403

  8. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval

    PubMed Central

    Yontar, Osman Can; Karaagac, Kemal; Tenekecioglu, Erhan; Tutuncu, Ahmet; Demir, Mehmet; Melek, Mehmet

    2014-01-01

    Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP. PMID:25232403

  9. Limitations of Doppler ultrasound in the assessment of the function of prosthetic mitral valves

    Microsoft Academic Search

    J Chambers; G Jackson; D Jewitt

    1990-01-01

    Pressure half time has been assumed to be a relatively flow-independent measure of orifice area, but it may also be influenced by atrial and ventricular factors. Pressure half time and peak left ventricular inflow velocity were measured by continuous wave Doppler ultrasound in 164 patients with normally functioning Carpentier-Edwards, Björk-Shiley, and Starr-Edwards mitral prostheses. Pressure half time was shorter in

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

    PubMed

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

    2014-01-01

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

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

    Microsoft Academic Search

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

    2011-01-01

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

  12. Echocardiographic assessment of ischemic mitral regurgitation.

    PubMed

    Dudzinski, David M; Hung, Judy

    2014-01-01

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

  13. The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement

    PubMed Central

    2014-01-01

    Background Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0–2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. Methods One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n?=?34), INR <2.0; group 2 (n?=?49), INR 2.0–2.5; and group 3 (n?=?52), INR >2.5. Results A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P?=?0.036). Conclusions This study showed that a target INRs of 2.0–2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR. PMID:24885719

  14. Three-dimensional echocardiographic and surgical findings in mitral mechanical valve dysfunction.

    PubMed

    Scandura, Salvatore; Cammalleri, Valeria; Caggegi, Anna; Castello, Aldo; Ronsivalle, Giuseppe; Dipasqua, Fabio; Arcidiacono, Antonio Andrea; Indelicato, Antonino; Mignosa, Carmelo; Tamburino, Corrado

    2013-04-01

    Periodic echocardiographic evaluation of valve function is recommended in all patients with prosthetic valves. Usually trans-thoracic echocardiography (TTE) is satisfactory to assess prosthetic function. Nevertheless when the TTE is suboptimal or in case of strong clinical doubt of prosthetic valve dysfunction, trans-esophageal echocardiography (TEE) remains the gold standard of imaging. Recent advancements in echocardiography, with the three-dimensional (3D) reconstruction, provide an incremental diagnostic value as compared to two-dimensional TEE. In addition, 3D-TEE gives unique views that add extra morphological and anatomical information, providing a very accurate presurgical evaluation. PMID:22801073

  15. Collapse and massive pulmonary edema secondary to thrombosis of a mitral mechanical heart valve prosthesis during low-molecular weight heparin therapy.

    PubMed

    Idir, M; Madonna, F; Roudaut, R

    1999-05-01

    Mechanical heart valves (MHV) are particularly exposed to thrombosis if anticoagulation becomes ineffective. Thromboembolic complications may be avoided by oral anticoagulation with vitamin K antagonists or derivatives of unfractionated heparin. A few cases of low-molecular weight heparin (LMWH) as sole anticoagulant in patients with MHV have been published, though with contradictory results. We report a case of a massive thrombosis of a St. Jude Medical mitral valve after the patient had been treated for one month with calcium nadroparin (Fraxiparine). PMID:10399665

  16. Perspectives of the person with mitral valve prolapse syndrome: a study of self-care needs derived from a health deviation.

    PubMed

    Utz, S W; Whitmire, V M; Grass, S

    1993-01-01

    Epidemiological studies in the United States indicate that 5% of the population or nearly 7 million people have Mitral Valve Prolapse. This incidence has also been confirmed by British physicians. Approximately half of these persons seek medical care for treatment of symptoms. Persons with symptoms are often said to have "Mitral Valve Prolapse Syndrome." The purpose of this study was to describe experiences and self-care needs of persons diagnosed with Mitral Valve Prolapse Syndrome (MVPS). In Phase I of the study, medical records of 124 subjects were reviewed to identify the medical experience and typical symptoms associated with MVPS. In Phase II, 20 subjects with typical symptoms were interviewed using a semi-structured questionnaire based on health deviation self-care requisites developed by Orem. Results of this pilot study indicate that interviewed subjects with MVPS frequently had unresolved health concerns and were seeking help. Nursing assistance may therefore be needed to help such clients understand this health deviation, to make decisions regarding appropriate actions, and to accomplish self-care actions. PMID:8372086

  17. Losartan Inhibits Endothelial-to-Mesenchymal Transformation in Mitral Valve Endothelial Cells by Blocking Transforming Growth Factor-?-induced Phosphorylation of ERK

    PubMed Central

    Wylie-Sears, Jill; Levine, Robert; Bischoff, Joyce

    2014-01-01

    Adult cardiac valve endothelial cells (VEC) undergo endothelial to mesenchymal transformation (EndMT) in response to transforming growth factor-? (TGF?). EndMT has been proposed as a mechanism to replenish interstitial cells that reside within the leaflets and further, as an adaptive response that increases the size of mitral valve leaflets after myocardial infarction. To better understand valvular EndMT, we investigated TGF?-induced signaling in mitral VEC, and carotid artery endothelial cells (CAEC) as a control. Expression of EndMT target genes ?-smooth muscle actin (?-SMA), Snai1, Slug, and MMP-2 were used to monitor EndMT. We show that TGF?-induced EndMT increases phosphorylation of ERK (p-ERK), and this is blocked by Losartan, an FDA-approved antagonist of the angiotensin II type 1 receptor (AT1), that is known to indirectly inhibit phosphorylation of ERK (p-ERK). Blocking TGF-?-induced p-ERK directly with the MEK1/2 inhibitor RDEA119 was sufficient to prevent EndMT. In mitral VECs, TGF? had only modest effects on phosphorylation of the canonical TGF-? signaling mediator mothers against decapentaplegic homolog 3 (SMAD3). These results indicate a predominance of the non-canonical p-ERK pathway in TGF?-mediated EndMT in mitral VECs. AT1 and angiotensin II type 2 (AT2) were detected in mitral VEC, and high concentrations of angiotensin II (AngII) stimulated EndMT, which was blocked by Losartan. The ability of Losartan or MEK1/2 inhibitors to block EndMT suggests these drugs may be useful in manipulating EndMT to prevent excessive growth and fibrosis that occurs in the leaflets after myocardial infarction. PMID:24632204

  18. Mapping of a First Locus for Autosomal Dominant Myxomatous Mitral-Valve Prolapse to Chromosome 16p11.2-p12.1

    PubMed Central

    Disse, Sandra; Abergel, Eric; Berrebi, Alain; Houot, Anne-Marie; Le Heuzey, Jean-Yves; Diebold, Benoît; Guize, Louis; Carpentier, Alain; Corvol, Pierre; Jeunemaitre, Xavier

    1999-01-01

    Summary Myxomatous mitral-valve prolapse (MMVP), also called Barlow disease, is a common cardiac abnormality and affects up to 5% of the population. It is characterized by an excess of tissue that leads to billowing of the mitral leaflets, sometimes complicated by prolapse. Typical histological findings include myxomatous degeneration and degradation of collagen and elastin. Previous reports have proposed an autosomal dominant inheritance of the trait, with age- and sex-dependent expression. By systematic echocardiographic screening of the first-degree relatives of 17 patients who underwent mitral-valve repair, we have identified four pedigrees showing such an inheritance. Genomewide linkage analysis of the most informative pedigree (24 individuals, three generations) showed a significant linkage for markers mapping to chromosome 16p, with a two-point maximum LOD score for D16S3068 (Zmax=3.30 at ?=0). Linkage to D16S3068 was confirmed in a second family (Zmax=2.02 at ?=0) but was excluded for the two remaining families, thus demonstrating the genetic heterogeneity of the disease. Multipoint linkage analysis performed, with nine additional markers, on the two families with linkage gave maximum multipoint LOD scores of 5.45 and 5.68 for D16S3133, according to a conservative and a stringent model, respectively. Haplotype analysis defined a 5-cM minimal MMVP-1 locus between D16S3068 (16p11.2) and D16S420 (16p12.1) and a 34-cM maximal interval between D16S404 and D16S3068 when recombination events were taken into account only in affected individuals. The identification of this locus represents a first step toward a new molecular classification of mitral-valve prolapse. PMID:10521289

  19. Model based Estimation of Aortic and Mitral valves Opening and Closing Timings in Developing Human Fetuses.

    PubMed

    Marzbanrad, Faezeh; Kimura, Yoshitaka; Endo, Miyuki; Oshio, Sayaka; Funamoto, Kiyoe; Sato, Naoaki; Palaniswami, Marimuthu; Khandoker, Ahsan

    2014-10-16

    Electromechanical coupling of the fetal heart can be evaluated non-invasively using Doppler Ultrasound (DUS) signal and fetal electrocardiography (fECG). In this study, an efficient model is proposed using K-means clustering and hybrid SVM-HMM modeling techniques. Opening and closing of the cardiac valves were detected from peaks in the high frequency component of the DUS signal decomposed by wavelet analysis. It was previously proposed to automatically identify the valve motion by hybrid Support Vector Machine- Hidden Markov Model (SVM-HMM) [1] based on the amplitude and timing of the peaks. However, in the present study, six patterns were identified for the DUS components which were actually variable on a beat to beat basis and found to be different for the early gestation (16- 32 weeks), compared to the late gestation fetuses (36-41 weeks). The amplitude of the peaks linked to the valve motion was different across the six patterns and this affected the precision of valve motion identification by the previous hybrid SVM-HMM method. Therefore in the present study, clustering of the DUS components based on K-means was proposed and the hybrid SVM-HMM was trained for each cluster separately. The valve motion events were consequently identified more efficiently by beat-to-beat attribution of the DUS component peaks. Applying this method, more than 98.6% of valve motion events were beatto- beat identified with average precision and recall of 83.4% and 84.2% respectively. It was an improvement compared to the hybrid method without clustering with average precision and recall of 79.0% and 79.8%. Therefore, this model would be useful for reliable screening of fetal wellbeing. PMID:25343774

  20. A case of aortic and mitral valve involvement in granulomatosis with polyangiitis.

    PubMed

    Espitia, Olivier; Droy, Laure; Pattier, Sabine; Naudin, Frédérique; Mugniot, Antoine; Cavailles, Arnaud; Hamidou, Mohamed; Bruneval, Patrick; Agard, Christian; Toquet, Claire

    2014-01-01

    Granulomatosis with polyangiitis (GPA) (Wegener's) is a necrotizing systemic vasculitis of the small-sized blood vessels, affecting kidneys, lungs, upper respiratory tract and skin. Cardiac valvular involvement is an uncommon manifestation of GPA. We report the case of a 60-year-old woman with arthritis and lung nodules due to GPA without antineutrophil cytoplasmic antibodies (ANCA) at time of diagnosis. Remission was obtained with cyclophosphamide and corticosteroid. Azathioprine was then prescribed for 2years. Four years later, she developed severe inflammatory aortic and mitral valvular involvement characterized by GPA typical histopathological valvular lesions. Search for ANCA was positive at this time (anti-myeloperoxidase). Cardiac valvular involvement is a rare and potentially fatal complication of GPA and may misleadingly suggest infectious endocarditis. A review of literature revealed few cases of histologically well-documented cardiac valvular involvement in GPA. Pathologists should be aware of valvular heart diseases in GPA, which usually comprise valvular necrotic lesions without any microbial agents. PMID:25194969

  1. Distinct mitral valve proteomic profiles in rheumatic heart disease and myxomatous degeneration.

    PubMed

    Martins, Carlo de Oliveira; Santos, Keity Souza; Ferreira, Frederico Moraes; Teixeira, Priscila Camillo; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Ma; Sampaio, Roney Orismar; Spina, Guilherme S; Kalil, Jorge; Guilherme, Luiza; Cunha-Neto, Edecio

    2014-01-01

    Rheumatic heart disease (RHD) affects heart-valve tissue and is the most serious consequence of group A Streptococcus infection. Myxomatous degeneration (MXD) is the most frequent valvopathy in the western world. In the present work, key protein expression alterations in the heart-valve tissue of RHD and MXD patients were identified and characterized, with controls from cadaveric organ donors. Proteins were separated by two-dimensional (2D)-electrophoresis and identified by mass spectrometry. We found 17 differentially expressed protein spots, as compared to control samples. We observed an increased expression of ASAP-2 in the RHD patients' valves, while collagen-VI, haptoglobin-related protein, prolargin, and cartilage oligomeric protein showed reduced expression. Valve tissue of MXD patients, on the other hand, presented lower expression of annexin-A1 and A2, septin-2, SOD (Cu/Zn), and transgelin. Tissue samples from both valvopathies displayed higher expression of apolipoprotein-A1. Biglycan was downexpressed in both diseases. Vimentin and lumican showed higher expression in RHD and lower in MXD. These results suggest that key pathogenetic mechanisms are intrinsically distinct in RHD and MXD. PMID:25232280

  2. Effect of Gender on Results of Percutaneous Edge-to-Edge Mitral Valve Repair With MitraClip System.

    PubMed

    Estévez-Loureiro, Rodrigo; Settergren, Magnus; Winter, Reidar; Jacobsen, Per; Dall'Ara, Gianni; Sondergaard, Lars; Cheung, Gary; Pighi, Michele; Ghione, Matteo; Ihlemann, Nikolaj; Moat, Neil E; Price, Susanna; Streit Rosenberg, Tine; Di Mario, Carlo; Franzen, Olaf

    2015-07-15

    Knowledge regarding gender-specific results of percutaneous edge-to-edge mitral valve repair is scarce. The aim of this study was to investigate gender differences in outcomes in a cohort of patients treated with MitraClip implantation. A multicenter registry of 173 patients treated with MitraClip prostheses from 2009 to 2012 at 3 experienced centers was performed. One hundred nine patients (63%) were men. Men were younger (mean age 73 ± 10 vs 79 ± 9 years, p = 0.001) and had a higher prevalence of previous coronary bypass graft surgery (34% vs 13%, p = 0.002), previous myocardial infarction (46% vs 20%, p = 0.001), and diabetes mellitus (26% vs 11%, p = 0.020). There were no differences regarding New York Heart Association (NYHA) functional class before the intervention (NYHA class III or IV in 95% of men vs 97% of women, p = 0.472) or the cause of mitral regurgitation (MR) (functional in 58% of men vs 48% of women, p = 0.233). Men exhibited significantly larger ventricles (mean indexed left ventricular end-systolic diameter 2.4 ± 0.8 vs 2.0 ± 1.6 cm/m(2), p = 0.002, and mean indexed left ventricular end-diastolic volume 92.7 ± 46.1 vs 59.9 ± 24.6 ml/m(2), p <0.001). At 1 month, there were no differences between groups in the reduction of MR or NYHA functional class (MR grade ?2+ in 98.2% of men vs 96.8% of women, p = 0.586, and NYHA class ?II in 78.3% of men vs 77% of women, p = 0.851). At 6 months, results were maintained (MR grade ?2+ in 89.5% of men vs 96.8% of women, p = 0.414, and NYHA class ?II in 73.1% of men vs 74.2% of women, p = 0.912). After a mean follow-up period of 16.1 ± 11.1 months, no difference was found between groups in the incidence of death or admission for heart failure (log-rank p = 0.798). In conclusion, MitraClip implantation seems to be an equally safe and effective treatment of MR in men and women. PMID:25960377

  3. Limitations of Doppler ultrasound in the assessment of the function of prosthetic mitral valves.

    PubMed Central

    Chambers, J; Jackson, G; Jewitt, D

    1990-01-01

    Pressure half time has been assumed to be a relatively flow-independent measure of orifice area, but it may also be influenced by atrial and ventricular factors. Pressure half time and peak left ventricular inflow velocity were measured by continuous wave Doppler ultrasound in 164 patients with normally functioning Carpentier-Edwards, Björk-Shiley, and Starr-Edwards mitral prostheses. Pressure half time was shorter in the Björk-Shiley than in the other value types and peak transmitral velocity was highest in the Starr-Edwards prostheses. These differences, however, were partly explained by coexistent differences in transmitral flow. Filling time accounted for 19% and stroke volume for 15% of the variance in pressure half time compared with only 5.6% for prosthetic design and 0.4% for annulus diameter when each of these variables was considered alone. The design of the prosthesis explained 18% of the variance in peak transmitral velocity, while cardiac output and annulus diameter did not contribute significantly. With Doppler ultrasound it is impossible to define reliable normal ranges for prosthetic function independently of atrial and ventricular function. Formulas for orifice area based on peak transmitral velocity and flow seem more likely to reflect the behaviour of normally functioning prostheses than those based on pressure half time. Images PMID:2183860

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

    PubMed Central

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

    2014-01-01

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

  5. Aortic Valve

    MedlinePLUS

    ... disease requiring surgery is called " senile aortic calcification ," meaning that the valve has worn out with age. ... valve of the left side of the heart, meaning that it opens during systole (when the ventricle ...

  6. Minimally invasive mitral valve surgery through right mini-thoracotomy: recommendations for good exposure, stable cardiopulmonary bypass, and secure myocardial protection.

    PubMed

    Ito, Toshiaki

    2015-07-01

    An apparent advantage of minimally invasive mitral surgery through right mini-thoracotomy is cosmetic appearance. Possible advantages of this procedure are a shorter ventilation time, shorter hospital stay, and less blood transfusion. With regard to hard endpoints, such as operative mortality, freedom from reoperation, or cardiac death, this method is reportedly equivalent, but not superior, to the standard median sternotomy technique. However, perfusion-related complications (e.g., stroke, vascular damage, and limb ischemia) tend to occur more frequently in minimally invasive technique than with the standard technique. In addition, valve repair through a small thoracotomy is technically demanding. Therefore, screening out patients who are not appropriate for performing minimally invasive surgery is the first step. Vascular disease and inadequate anatomy can be evaluated with contrast-enhanced computed tomography. Peripheral cannulation should be carefully performed, using transesophageal echocardiography guidance. Preoperative detailed planning of the valve repair process is desirable because every step is time-consuming in minimally invasive surgery. Three-dimensional echocardiography is a powerful tool for this purpose. For satisfactory exposure and detailed observation of the valve, a special left atrial retractor and high-definition endoscope are useful. Valve repair can be performed in minimally invasive surgery as long as cardiopulmonary bypass is stable and bloodless exposure of the valve is obtained. PMID:25840800

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

  8. Comparison of the Ventricle Muscle Proteome between Patients with Rheumatic Heart Disease and Controls with Mitral Valve Prolapse: HSP 60 May Be a Specific Protein in RHD

    PubMed Central

    Zheng, Dawei; Xu, Limin; Sun, Lebo; Feng, Qiang; Wang, Zishan; Shao, Guofeng; Ni, Yiming

    2014-01-01

    Objective. Rheumatic heart disease (RHD) is a serious autoimmune heart disease. The present study was aimed at identifying the differentially expressed proteins between patients with RHD and controls with mitral valve prolapse. Methods. Nine patients with RHD and nine controls with mitral valve prolapsed were enrolled for this study. Two-dimensional difference in-gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) were performed. Results. A total of 39 protein spots with differential expressions were identified between the two groups (P < 0.05, Average Ratio > 1.2 or Average Ratio < ?1.2) and four upregulated proteins (including heat shock protein 60 (HSP 60), desmin, PDZ and LIM domain protein 1, and proteasome subunit alpha type-1) and three downregulated proteins (including tropomyosin alpha-1 chain, malate dehydrogenase, and chaperone activity of bc1 complex homolog) were determined. Conclusion. These seven proteins, especially HSP 60, may serve as potential biomarkers for the diagnosis of RHD and provide evidence to explain the mechanisms of this complex disease in the future. PMID:24738046

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

    Microsoft Academic Search

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

    2009-01-01

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

  10. Ex Vivo Evidence for the Contribution of Hemodynamic Shear Stress Abnormalities to the Early Pathogenesis of Calcific Bicuspid Aortic Valve Disease

    PubMed Central

    Sun, Ling; Chandra, Santanu; Sucosky, Philippe

    2012-01-01

    The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is frequently associated with calcific aortic valve disease (CAVD). The most prevalent type-I morphology, which results from left-/right-coronary cusp fusion, generates different hemodynamics than a tricuspid aortic valve (TAV). While valvular calcification has been linked to genetic and atherogenic predispositions, hemodynamic abnormalities are increasingly pointed as potential pathogenic contributors. In particular, the wall shear stress (WSS) produced by blood flow on the leaflets regulates homeostasis in the TAV. In contrast, WSS alterations cause valve dysfunction and disease. While such observations support the existence of synergies between valvular hemodynamics and biology, the role played by BAV WSS in valvular calcification remains unknown. The objective of this study was to isolate the acute effects of native BAV WSS abnormalities on CAVD pathogenesis. Porcine aortic valve leaflets were subjected ex vivo to the native WSS experienced by TAV and type-I BAV leaflets for 48 hours. Immunostaining, immunoblotting and zymography were performed to characterize endothelial activation, pro-inflammatory paracrine signaling, extracellular matrix remodeling and markers involved in valvular interstitial cell activation and osteogenesis. While TAV and non-coronary BAV leaflet WSS essentially maintained valvular homeostasis, fused BAV leaflet WSS promoted fibrosa endothelial activation, paracrine signaling (2.4-fold and 3.7-fold increase in BMP-4 and TGF-?1, respectively, relative to fresh controls), catabolic enzyme secretion (6.3-fold, 16.8-fold, 11.7-fold, 16.7-fold and 5.5-fold increase in MMP-2, MMP-9, cathepsin L, cathepsin S and TIMP-2, respectively) and activity (1.7-fold and 2.4-fold increase in MMP-2 and MMP-9 activity, respectively), and bone matrix synthesis (5-fold increase in osteocalcin). In contrast, BAV WSS did not significantly affect ?-SMA and Runx2 expressions and TIMP/MMP ratio. This study demonstrates the key role played by BAV hemodynamic abnormalities in CAVD pathogenesis and suggests the dependence of BAV vulnerability to calcification on the local degree of WSS abnormality. PMID:23119099

  11. National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999–2010

    PubMed Central

    Dodson, John A.; Wang, Yun; Murugiah, Karthik; Dharmarajan, Kumar; Cooper, Zack; Hashim, Sabet; Nuti, Sudhakar V.; Spatz, Erica; Desai, Nihar; Krumholz, Harlan M.

    2015-01-01

    Background Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals. Methods We included 100% of Medicare Fee-for-Service patients ?65 years of age who underwent MVS between 1999–2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race). Results The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999–2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65–74: 47.4% to 44.4%; 75–84: 51.4% to 49.2%, ?85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18). Conclusions Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks. PMID:26147225

  12. Improved success rate of the maze procedure in mitral valve disease by new criteria for patients’ selection 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

    Junjiro Kobayashi; Yoshio Kosakai; Kiyoharu Nakano; Yoshikado Sasako; Kiyoyuki Eishi; Fumio Yamamoto

    1998-01-01

    Objective: We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively.

  13. Mitral Valve Repair Surgery

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  14. Quantification of stenotic mitral valve area and diagnostic accuracy of mitral stenosis by dual-source computed tomography in patients with atrial fibrillation: comparison with cardiovascular magnetic resonance and transthoracic echocardiography.

    PubMed

    Kim, Song Soo; Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Kim, Jun Suk; Hwang, Hweung Kon; Lee, Jae-Hwan

    2015-06-01

    This study aimed to evaluate the utility of dual-source computed tomography (DSCT) for quantification of the mitral valve area (MVA) in patients with atrial fibrillation (AF) and mitral stenosis (MS) and to compare the results of DSCT with those of cardiovascular magnetic resonance (CMR) and transthoracic echocardiography (TTE). One hundred-two patients with AF and MS who had undergone electrocardiography-gated DSCT, TTE and CMR prior to operation were retrospectively enrolled. The MVA was planimetrically determined by DSCT, CMR, and TTE, as well as by Doppler TTE using the pressure half-time method (TTE-PHT). Agreement, relationship between measurements, and the highest accuracy were evaluated using Bland-Altman, Pearson correlation, and receiver operating characteristic analyses. The MVA on DSCT (mean, 1.27 ± 0.27 cm(2)) was significantly larger than that on CMR (1.15 ± 0.28 cm(2), P < 0.05), TTE-planimetry and TTE-PHT (1.16 ± 0.28 and 1.07 ± 0.30 cm(2), respectively; P < 0.05). TTE-planimetry had better correlation with planimetry on DSCT and CMR (r = 0.65 and 0.67, respectively; P < 0.05) than TTE-PHT (r = 0.51 and 0.55, respectively; P < 0.05). Using an MVA of 1.0 cm(2) on TTE-planimetry and TTE-PHT as the reference, the optimal thresholds for detecting severe MS on DSCT was 1.19 cm(2). The planimetry of the MVA measured by DSCT may be a reliable, alternative method for the quantification of MS in patients with AF. PMID:25011534

  15. Surgical treatment of functional ischemic mitral regurgitation.

    PubMed

    Jensen, Henrik

    2015-03-01

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

  16. Flow Induced Turbulent Stress Accumulation Study of the Differently Designed Bi-leaflet Mitral Valves Using Dynamic PIV System

    Microsoft Academic Search

    T. Akutsu; X. D. Cao

    \\u000a Long duration of high fluid stresses on the blood component are considered influential to the cause of hemolysis, thromboembolic\\u000a complications, and platelet activation. This experimental study was conducted to analyze the accumulated turbulent stresses\\u000a generated by the differently designed prosthetic heart valves using Dynamic PIV system. Four bi-leaflet valves, the St. Jude\\u000a Medical (SJM) and the On-X (OX) valves with

  17. Flow Induced Turbulent Stress Accumulation in Differently Designed Contemporary Bi-leaflet Mitral valves: Dynamic PIV Study

    Microsoft Academic Search

    T. Akutsu; X. D. Cao

    Fluid stresses and duration of it on the blood component are considered influential to the cause of hemolysis, thromboembolic\\u000a complications, and platelet activation. This experimental study was conducted to analyze the accumulated turbulent stresses\\u000a generated by the differently designed prosthetic heart valves using Dynamic PIV system. Four bi-leaflet valves, the St. Jude\\u000a Medical (SJM) and the On-X (OX) valves with

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

    PubMed

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

    2001-04-01

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

  19. Calcification and cellularity in human aortic heart valve tissue determine the differentiation of bone-marrow-derived cells

    Microsoft Academic Search

    Hannu-Ville Leskelä; Jari Satta; Jani Oiva; Heidi Eriksen; Risteli Juha; Paula Korkiamäki; Kaisa K. Ivaska; Ylermi Soini; Petri Lehenkari

    2006-01-01

    Human bone-marrow-derived mesenchymal stem cells (MSC) are responsible the remodeling of human tissue. However, damaged aortic valves are lack the ability to regenerate which is an active cell-mediated process. Diseased aortic valve remodeling has similarities even to bone formation. In this study, the prerequisites for cultured MSCs to undergo osteoblastic differentiation on aortic valves were explored. An ex vivo model

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

    PubMed Central

    Kossaify, Antoine; Akiki, Vanessa

    2014-01-01

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

  1. Potential Inherited Causes of Recurrent Prosthetic Mitral Valve Thrombosis in a Pregnant Patient Suffering from Recurrent Miscarriage

    PubMed Central

    Gursoy, M. Ozan; Karakoyun, Suleyman; Yesin, Mahmut; Astarcioglu, Mehmet Ali; Ozkan, Mehmet

    2014-01-01

    An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagulation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient in the present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwent a thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prosthetic valve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C and heterozygous mutations of ?-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphisms may be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss. PMID:25089140

  2. Percutaneous intervention for mitral regurgitation.

    PubMed

    Sarraf, Mohammad; Feldman, Ted

    2015-04-01

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

  3. Interactions between TGF?1 and cyclic strain in modulation of myofibroblastic differentiation of canine mitral valve interstitial cells in 3D culture

    PubMed Central

    Waxman, Andrew S.; Kornreich, Bruce G.; Gould, Russell A.; Moïse, N. Sydney; Butcher, Jonathan T.

    2012-01-01

    Objectives The mechanisms of myxomatous valve degeneration (MVD) are poorly understood. Transforming growth factor-beta1 (TGF?1) induces myofibroblastic activation in mitral valve interstitial cells (MVIC) in static 2D culture, but the roles of more physiological 3D matrix and cyclic mechanical strain are unclear. In this paper, we test the hypothesis that cyclic strain and TGF?1 interact to modify MVIC phenotype in 3D culture. Animals, Materials and Methods MVIC were isolated from dogs with and without MVD and cultured for 7 days in type 1 collagen hydrogels with and without 5 ng/ml TGF?1. MVIC with MVD were subjected to 15% cyclic equibiaxial strain with static cultures serving as controls. Myofibroblastic phenotype was assessed via 3D matrix compaction, cell morphology, and expression of myofibroblastic (TGF?3, alpha-smooth muscle actin - ?SMA) and fibroblastic (vimentin) markers. Results Exogenous TGF?1 increased matrix compaction by canine MVIC with and without MVD, which correlated with increased cell spreading and elongation. TGF?1 increased ?SMA and TGF?3 gene expression, but not vimentin expression, in 15% cyclically stretched MVIC. Conversely, 15% cyclic strain significantly increased vimentin protein and gene expression, but not ?SMA or TGF?3. 15% cyclic strain however was unable to counteract the effects of TGF?1 stimulation on MVIC. Conclusions These results suggest that TGF?1 induces myofibroblastic differentiation (MVD phenotype) of canine MVIC in 3D culture, while 15% cyclic strain promotes a more fibroblastic phenotype. Mechanical and biochemical interactions likely regulate MVIC phenotype with dose dependence. 3D culture systems can systematically investigate these phenomena and identify their underlying molecular mechanisms. PMID:22386586

  4. Calcification of Vascular Smooth Muscle Cell Cultures Inhibition by Osteopontin

    Microsoft Academic Search

    Takeo Wada; Marc D. McKee; Susie Steitz; Cecilia M. Giachelli

    2010-01-01

    Calcification of vascular tissue is a common complication in aging, atherosclerosis, diabetes, renal failure, aortic stenosis, and prosthetic valve replacement. Osteopontin is a noncollagenous adhesive protein routinely found at sites of dystrophic calcification and synthesized at high levels by macrophages in calcified aortic valves and atherosclerotic plaques. In the present study, we have characterized the calcification of bovine aortic smooth

  5. Anterior leaflet augmentation for ischemic mitral regurgitation

    Microsoft Academic Search

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

    2004-01-01

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

  6. Modified commissural patch repair in a child with active mitral endocarditis.

    PubMed

    Ishimaru, Kazuhiko; Nishigaki, Kyoichi; Kanaya, Tomomitsu; Araki, Kanta; Shibata, Toshihiko

    2014-05-19

    A 9-year-old patient with massive destruction of the mitral apparatus caused by active infective endocarditis underwent mitral valve plasty using a modified commissural autologous pericardial patch repair. This procedure is a clinically relevant and feasible technique for pediatric patients with active mitral valve endocarditis. PMID:24842454

  7. Morphometric investigations in mitral stenosis using two dimensional echocardiography

    Microsoft Academic Search

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

    1982-01-01

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

  8. Options for Heart Valve Replacement

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  9. Surgical Treatment of Moderate Ischemic Mitral Regurgitation

    PubMed Central

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

    2015-01-01

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

  10. Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

    PubMed Central

    Bradley, Elisa A.; Novak, Eric L.; Rasalingam, Ravi; Cedars, Ari M.; Ewald, Gregory A.; Silvestry, Scott C.; Joseph, Susan M.

    2014-01-01

    Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e? and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e? in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD. PMID:24955040

  11. Plasma and serum serotonin concentrations and surface-bound platelet serotonin expression in Cavalier King Charles Spaniels with myxomatous mitral valve disease.

    PubMed

    Cremer, Signe E; Kristensen, Annemarie T; Reimann, Maria J; Eriksen, Nynne B; Petersen, Stine F; Marschner, Clara B; Tarnow, Inge; Oyama, Mark A; Olsen, Lisbeth H

    2015-06-01

    OBJECTIVE To investigate serum and plasma serotonin concentrations, percentage of serotonin-positive platelets, level of surface-bound platelet serotonin expression (mean fluorescence intensity [MFI]), and platelet activation (CD62 expression) in platelet-rich plasma from Cavalier King Charles Spaniels with myxomatous mitral valve disease (MMVD). ANIMALS Healthy dogs (n = 15) and dogs with mild MMVD (18), moderate-severe MMVD (19), or severe MMVD with congestive heart failure (CHF; 10). PROCEDURES Blood samples were collected from each dog. Serum and plasma serotonin concentrations were measured with an ELISA, and surface-bound platelet serotonin expression and platelet activation were determined by flow cytometry. RESULTS Dogs with mild MMVD had higher median serum (746 ng/mL) and plasma (33.3 ng/mL) serotonin concentrations, compared with MMVD-affected dogs with CHF (388 ng/mL and 9.9 ng/mL, respectively), but no other group differences were found. Among disease groups, no differences in surface-bound serotonin expression or platelet activation were found. Thrombocytopenic dogs had lower serum serotonin concentration (482 ng/mL) than nonthrombocytopenic dogs (731 ng/mL). In 26 dogs, a flow cytometry scatterplot subpopulation (FSSP) of platelets was identified; dogs with an FSSP had a higher percentage of serotonin-positive platelets (11.0%), higher level of surface-bound serotonin expression (MFI, 32,068), and higher platelet activation (MFI, 2,363) than did dogs without an FSSP (5.7%, 1,230, and 1,165, respectively). An FSSP was present in 93.8% of thrombocytopenic dogs and in 29.5% of nonthrombocytopenic dogs. CONCLUSIONS AND CLINICAL RELEVANCE A substantive influence of circulating serotonin on MMVD stages prior to CHF development in Cavalier King Charles Spaniels was not supported by the study findings. An FSSP of highly activated platelets with pronounced serotonin binding was strongly associated with thrombocytopenia but not MMVD. PMID:26000599

  12. The Unusual Suspect: Anemia-induced Systolic Anterior Motion of the Mitral Valve and Intraventricular Dynamic Obstruction in a Hyperdynamic Heart as Unexpected Causes of Exertional Dyspnea after Cardiac Surgery

    PubMed Central

    Mun, Jeong-Beom; Oh, Ah-Reum; Park, Hwa-Sun; Park, Chul-Hyun; Park, Kook-Yang

    2013-01-01

    Dynamic left ventricular (LV) outflow tract obstruction is a characteristic feature of hypertrophic cardiomyopathy; however, it can also occur in association with hyperdynamic LV contraction and/or changes in the cardiac loading condition, even in a structurally normal or near-normal heart. Here, we report a case of anemia-induced systolic anterior motion of the mitral valve and the resultant intraventricular obstruction in a patient who underwent coronary artery bypass grafting and suffered from anemia associated with recurrent gastrointestinal bleeding. PMID:24368973

  13. Mitral balloon valvuloplasty.

    PubMed

    Fawzy, Mohamed Eid

    2010-07-01

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

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

    Microsoft Academic Search

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

    2003-01-01

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

  15. Valve

    DOEpatents

    Cho, Nakwon (Knoxville, TN)

    1980-01-01

    A positive acting valve suitable for operation in a corrosive environment is provided. The valve includes a hollow valve body defining an open-ended bore for receiving two, axially aligned, spaced-apart, cylindrical inserts. One insert, designated the seat insert, terminates inside the valve body in an annular face which lies within plane normal to the axis of the two inserts. An elastomeric O-ring seal is disposed in a groove extending about the annular face. The other insert, designated the wedge insert, terminates inside the valve body in at least two surfaces oppositely inclined with respect to each other and with respect to a plane normal to the axis of the two inserts. An elongated reciprocable gate, movable between the two inserts along a path normal to the axis of the two inserts, has a first flat face portion disposed adjacent and parallel to the annular face of the seat insert. The gate has a second face portion opposite to the first face portion provided with at least two oppositely inclined surfaces for mating with respective inclined surfaces of the wedge insert. An opening is provided through the gate which registers with a flow passage through the two inserts when the valve is open. Interaction of the respective inclined surfaces of the gate and wedge insert act to force the first flat face portion of the gate against the O-ring seal in the seat insert at the limits of gate displacement where it reaches its respective fully open and fully closed positions.

  16. Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia

    Microsoft Academic Search

    Mohamed Ben Farhat; Fethi Betbout; Habib Gamra; Faouzi Maatouk; Mokdad Ayari; Ali Cherif; Mourad Jarrar; Habib Boussadia; Sonia Hammami; Iheb Chahbani

    1995-01-01

    Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age ±SD was 33 ± 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral

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

    Microsoft Academic Search

    L Hatle; A Brubakk; A Tromsdal; B Angelsen

    1978-01-01

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

  18. Quantitation of mitral regurgitation.

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

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

    2010-01-01

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

  1. Living with Heart Valve Disease

    MedlinePLUS

    ... Endocarditis Heart Murmur How the Heart Works Mitral Valve Prolapse Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  2. Calcific stenotic jump graft.

    PubMed Central

    Padmakumar, R.; Krishnamoorthy, K. M.; Tharakan, J. A.

    2004-01-01

    A young lady with post-subclavian coarctation and cranial hypertension is discussed. She had a jump graft from left subclavian artery to descending aorta, and presented 18 years later with hypertension, calcification of the graft with a gradient of 40 mmHg across it. In the meantime, she also developed moderate aortic regurgitation on a bicuspid aortic valve. Management strategies including trans-catheter options are discussed. We present our reservations on trans-catheter options in an occluded dacron graft. PMID:16749963

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

    PubMed

    Soofi, Muhammad Adil; Alsamadi, Faisal

    2015-08-01

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

  4. Fluid dynamics of the CarboMedics Kinetic bileaflet prosthetic heart valve 1 Presented at the Ninth Annual Meeting of the European Association for Cardiothoracic Surgery, Paris, France, 24–27 September, 1995. 1

    Microsoft Academic Search

    J. Timothy Baldwin; Andy Campbell; Christopher Luck; William Ogilvie; Joe Sauter

    1997-01-01

    Objective: To compare hydrodynamic characteristics of a new bileaflet heart valve, the CarboMedics® Kinetic™ cardiac valve prosthesis, with those of a St. Jude Medical (SJM) heart valve. Methods: Hydrodynamic characteristics were determined in the mitral and aortic positions of a Vivitro Systems pulse duplicator for size 23 Kinetic aortic valves, size 23 SJM aortic valves, size 29 Kinetic mitral valves

  5. Comparison of three contemporary surgical scores for predicting all-cause mortality of patients undergoing percutaneous mitral valve repair with the MitraClip system (from the multicenter GRASP-IT registry).

    PubMed

    Adamo, Marianna; Capodanno, Davide; Cannata, Stefano; Giannini, Cristina; Laudisa, Maria Luisa; Barbanti, Marco; Curello, Salvatore; Immè, Sebastiano; Maffeo, Diego; Grasso, Carmelo; Bedogni, Francesco; Petronio, Anna Sonia; Ettori, Federica; Tamburino, Corrado

    2015-01-01

    The aim of this study was to explore the adaptability of 3 contemporary surgical scores (Logistic EuroSCORE [LES], EuroSCORE II [ESII], and Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) for prediction of mortality after percutaneous mitral valve repair with the MitraClip system. A total of 304 patients from the multicenter Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly registry (GRASP-IT) were stratified based on LES, ESII, and STS-PROM tertiles and analyzed by different measurements of discrimination, calibration, and global accuracy with focus on 30-day and 1-, 2-, and 3-year mortality. A statistically significant gradient in the distribution of mortality was observed at all time points with ESII, at 2 years with LES, and at 2 and 3 years with STS-PROM. ESII had the best discrimination at 30 days (C-statistic 0.80), which remained acceptable at later follow-up, being significantly superior to that of LES at each time point (p = 0.003 at 30 days, p = 0.005 at 1 year, p = 0.011 at 2 years, and p = 0.029 at 3 years). Compared with STS-PROM, ESII showed better discrimination at 30 days (C-statistic 0.80 vs 0.62, p = 0.023). All scores overpredicted the risk of mortality at 30 days and were miscalibrated at 2 and 3 years. At 1 year, there was a good agreement between the observed and predicted probabilities for ESII and STS-PROM, whereas LES remained overpredictive. ESII showed the best global accuracy at 30 days and 1 year, whereas no notable differences were noted versus LES and STS-PROM at 2 and 3 years. In conclusion, lacking specific tools for risk stratification of patients undergoing MitraClip implantation, ESII holds favorable prognostic characteristics, which makes it a valid surrogate. PMID:25456878

  6. Recellularization of aortic valves in pigs

    Microsoft Academic Search

    Jesper Langhoff Honge; Jonas Funder; Erik Hansen; Pascal Maria Dohmen; Wolfgang Konertz; John Michael Hasenkam

    2011-01-01

    Objectives: Decellularized porcine heart valves treated with deoxycholic acid (DOA) have demonstrated complete recellularization and absence of calcification when implanted into the pulmonary position in sheep. We studied recellularization and calcification in stented DOA-treated heart valves compared with conventional stented glutaraldehyde-treated valves in the aortic position in juvenile pigs 6 months after implantation. Methods: DOA heart valves (n=12) and glutaraldehyde-treated

  7. Mechanisms and Clinical Consequences of Vascular Calcification

    PubMed Central

    Zhu, Dongxing; Mackenzie, Neil C. W.; Farquharson, Colin; MacRae, Vicky E.

    2012-01-01

    Vascular calcification has severe clinical consequences and is considered an accurate predictor of future adverse cardiovascular events, including myocardial infarction and stroke. Previously vascular calcification was thought to be a passive process which involved the deposition of calcium and phosphate in arteries and cardiac valves. However, recent studies have shown that vascular calcification is a highly regulated, cell-mediated process similar to bone formation. In this article, we outline the current understanding of key mechanisms governing vascular calcification and highlight the clinical consequences. By understanding better the molecular pathways and genetic circuitry responsible for the pathological mineralization process novel drug targets may be identified and exploited to combat and reduce the detrimental effects of vascular calcification on human health. PMID:22888324

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

    PubMed

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

    2009-01-01

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

  9. Vascular Calcification

    PubMed Central

    Demer, Linda L.; Tintut, Yin

    2009-01-01

    Summary Clinically, vascular calcification is now accepted as a valuable predictor of coronary heart disease.153 Achieving control over this process requires understanding mechanisms in the context of a tightly controlled regulatory network, with multiple, nested feedback loops and cross talk between organ systems, in the realm of control theory. Thus, treatments for osteoporosis such as calcitriol, estradiol, bisphosphonates, calcium supplements, and intermittent PTH are likely to affect vascular calcification, and, conversely, many treatments for cardiovascular disease such as statins, antioxidants, hormone replacement therapy, angiotensin-converting enzyme inhibitors, fish oils, and calcium channel blockers may affect bone health. As we develop and use treatments for cardiovascular and skeletal diseases, we must give serious consideration to the implications for the organ at the other end of the bone-vascular axis. PMID:11602487

  10. Saving a Life: Heart Valve Replacement

    NSDL National Science Digital Library

    2014-09-18

    Students use their knowledge about how healthy heart valves function to design, construct and implant prototype replacement mitral valves for hypothetical patients' hearts. Building on what they learned in the associated lesson about artificial heart valves, combined with the testing and scoring of their prototype heart valve designs in this activity, students discover the pros and cons of different types of artificial heart valves based on materials, surgery requirements, and lifespan.

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

    PubMed

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

    2009-03-01

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

  12. Bone Formation and Inflammation in Cardiac Valves

    Microsoft Academic Search

    Emile R. Mohler III; Francis Gannon; Carol Reynolds; Robert Zimmerman; Martin G. Keane; Frederick S. Kaplan

    2010-01-01

    Background—For nearly a century, the mechanical failure of calcified heart valves was attributed to a passive degenerative process. Recently, several case reports described bone formation in surgically excised heart valves and suggested an unexpected process of tissue repair. Methods and Results—We studied the prevalence and pathology of heterotopic ossification in 347 surgically excised heart valves (256 aortic, 91 mitral) in

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. Non-invasive assessment by Doppler ultrasound of 155 patients with bioprosthetic valves: a comparison of the Wessex porcine, low profile Ionescu-Shiley, and Hancock pericardial bioprostheses

    Microsoft Academic Search

    I A Simpson; I J Reece; A B Houston; I Hutton; D J Wheatley; S M Cobbe

    1986-01-01

    One hundred and fifty five patients with 167 bioprosthetic valves (68 Wessex porcine, 54 Hancock pericardial, and 45 low profile Ionescu-Shiley pericardial valves) were studied by Doppler ultrasound. Valve gradients were calculated from the mitral and aortic flow velocities by the modified Bernoulli equation. Mean mitral gradients were significantly smaller across the Ionescu-Shiley valves than across the Wessex porcine or

  16. A stepwise aortic clamp procedure to treat porcelain aorta associated with aortic valve stenosis and hemodialysis.

    PubMed

    Isoda, Susumu; Osako, Motohiko; Kimura, Tamizo; Nishimura, Kenji; Yamanaka, Nozomu; Nakamura, Shingo; Maehara, Tadaaki

    2014-01-01

    A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery. PMID:23801177

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

    Microsoft Academic Search

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

    2011-01-01

    The anterior mitral leaflet (AML) is a thin membrane that withstands high left ventricular (LV) pressure pulses 100,000 times per day. The presence of contractile cells determines AML in vivo stiffness and complex geometry. Until recently, mitral valve finite element (FE) models have neglected both of these aspects. In this study we assess their effect on AML strains and stresses,

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

    Omslaer, Brian T; Biederman, Robert W W

    2015-06-01

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

  20. Mechanistic insights into functional mitral regurgitation

    Microsoft Academic Search

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

    2002-01-01

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

  1. Automated coronary artery calcification detection on low-dose chest CT images

    NASA Astrophysics Data System (ADS)

    Xie, Yiting; Cham, Matthew D.; Henschke, Claudia; Yankelevitz, David; Reeves, Anthony P.

    2014-03-01

    Coronary artery calcification (CAC) measurement from low-dose CT images can be used to assess the risk of coronary artery disease. A fully automatic algorithm to detect and measure CAC from low-dose non-contrast, non-ECG-gated chest CT scans is presented. Based on the automatically detected CAC, the Agatston score (AS), mass score and volume score were computed. These were compared with scores obtained manually from standard-dose ECG-gated scans and low-dose un-gated scans of the same patient. The automatic algorithm segments the heart region based on other pre-segmented organs to provide a coronary region mask. The mitral valve and aortic valve calcification is identified and excluded. All remaining voxels greater than 180HU within the mask region are considered as CAC candidates. The heart segmentation algorithm was evaluated on 400 non-contrast cases with both low-dose and regular dose CT scans. By visual inspection, 371 (92.8%) of the segmentations were acceptable. The automated CAC detection algorithm was evaluated on 41 low-dose non-contrast CT scans. Manual markings were performed on both low-dose and standard-dose scans for these cases. Using linear regression, the correlation of the automatic AS with the standard-dose manual scores was 0.86; with the low-dose manual scores the correlation was 0.91. Standard risk categories were also computed. The automated method risk category agreed with manual markings of gated scans for 24 cases while 15 cases were 1 category off. For low-dose scans, the automatic method agreed with 33 cases while 7 cases were 1 category off.

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

    PubMed Central

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

    2013-01-01

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

  3. Cardiac Valve Annulus Manual Segmentation Using Computer Assisted Visual Feedback in Three-Dimensional Image Data

    E-print Network

    Oxford, University of

    Cardiac Valve Annulus Manual Segmentation Using Computer Assisted Visual Feedback in Three is an important tool for the study of valve anatomy and physiology, for the four main valves of the heart (mitral rat hearts, on all four valves. I. INTRODUCTION There are four main cardiac valves in the heart, two

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

    PubMed

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

    2015-01-01

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

  5. Novel mitral clipping technique overcoming extreme atrial dilatation.

    PubMed

    Tiroch, Klaus; Vorpahl, Marc; Seyfarth, Melchior

    2014-10-01

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

  6. Dynamic particle image velocimetry flow analysis of the flow field immediately downstream of bileaflet mechanical mitral prostheses

    Microsoft Academic Search

    Toshinosuke Akutsu; Jun Saito

    2006-01-01

    New dynamic particle image velocimetry (PIV) technology was applied to the study of the flow field associated with prosthetic\\u000a heart valves. Four bileaflet prostheses, the St. Jude Medical (SJM) valve, the On-X valve with straight leaflets, the Jyros\\u000a (JR) valve, and the Edwards MIRA (MIRA) valve with curved leaflets, were tested in the mitral position under pulsatile flow\\u000a conditions to

  7. Pneumococcal endocarditis with extremely rapid valve destruction in a splenectomized host.

    PubMed

    Tanawuttiwat, Tanyanan; Poustinchian, Brian; Treitman, Adam; Zelinger, Allan

    2011-09-01

    A 45-year-old patient presented with fever and pneumococcal bacteremia. Transthoracic echocardiography, performed on the second day of admission, was unremarkable; however, repeat imaging performed only 60 h later showed destruction of posterior mitral valve leaflet with severe mitral regurgitation, and large, newly developed vegetations appearing on the mitral valve and the left ventricular outflow tract (LVOT). The patient underwent successful mitral valve replacement, with debridement of the LVOT vegetation. The findings of the present case illustrate the highly aggressive nature of pneumococcal endocarditis that is uncommonly encountered in the current, penicillin, era. PMID:22066368

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  9. Mitral balloon valvuloplasty

    Microsoft Academic Search

    Mohamed Eid Fawzy

    2010-01-01

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

  10. Algal Calcification and Silification

    E-print Network

    Taylor, Alison

    major producers of calcium carbonate and silica among the world's biota. Calcification involves's CaCO3 is produced in the oceans. Calcification has been widespread among the biota since at least of crystal poisons produced by the biota. Among the algae, calcification can be found in both freshwater

  11. Percutaneous Mitral Annuloplasty for Functional Mitral Regurgitation

    PubMed Central

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

    2014-01-01

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

  12. Noninvasive imaging for assessment of calcification in chronic kidney disease.

    PubMed

    Karohl, Cristina; D'Marco Gascón, Luis; Raggi, Paolo

    2011-10-01

    Vascular calcification is highly prevalent in patients with chronic kidney disease and has a progressive course. Several cardiovascular and uremia-related risk factors, such as abnormalities in mineral metabolism, contribute to the development of vascular calcification, although the pathophysiological mechanisms are still unclear. The presence and extent of vascular calcification is associated with an increased risk of cardiovascular events and mortality. By contrast, patients who do not have calcification seem to have a good prognosis, with minimal or no calcification progression over an extended period of time. A number of noninvasive imaging methods are available to detect vascular calcification and may help clinicians to make therapeutic decisions. Cardiac CT remains the reference standard to detect and quantify coronary artery, aortic and cardiac valve calcification. However, the high cost of equipment, the inability to perform in-office testing and the expertise required limit its use on a routine basis. Other imaging methods, such as planar X-ray, ultrasound and echocardiography, are appropriate alternatives to evaluate vascular and valvular calcification. In this review, we discuss the noninvasive imaging methods most frequently used to assess vascular and valvular calcification, with their advantages and limitations. PMID:21862991

  13. The effect of respiratory static volumes on heart valve sounds

    E-print Network

    Im, Jae Joong

    1988-01-01

    comparatively long, vibrating sound. It is the sound vena cava aorta pulmonary valve left atrium right atrium rtic valve tricuspid valve (AV valve) in s ~ 'L 4 D O a bicuspid valve (AV valve, mitral valve) right ventricle left ventricle Fig I...THE EFFECT OF RESPIRATORY STATIC VOLUMES ON HEART VALVE SOUNDS A Thesis by JAE JOONG IM Submitted to the Graduate College of Texas A&M University in partial fulfillment of the requirement for the degree of MASTER OF SCIENCE May 1988 Major...

  14. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial

    Microsoft Academic Search

    Karl Hammermeister; Gulshan K Sethi; William G Henderson; Frederick L Grover; Charles Oprian; Shahbudin H Rahimtoola

    2000-01-01

    OBJECTIVESThe goal of this study was to compare long-term survival and valve-related complications between bioprosthetic and mechanical heart valves.BACKGROUNDDifferent heart valves may have different patient outcomes.METHODSFive hundred seventy-five patients undergoing single aortic valve replacement (AVR) or mitral valve replacement (MVR) at 13 VA medical centers were randomized to receive a bioprosthetic or mechanical valve.RESULTSBy survival analysis at 15 years, all-cause

  15. What Are the Signs and Symptoms of Heart Valve Disease?

    MedlinePLUS

    ... Endocarditis Heart Murmur How the Heart Works Mitral Valve Prolapse Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  16. Electron beam computed tomography in the evaluation of cardiac calcifications in chronic dialysis patients

    Microsoft Academic Search

    Johann Braun; Manfred Oldendorf; Werner Moshage; Rudolf Heidler; Eberhard Zeitler; Friedrich C. Luft

    1996-01-01

    The purpose of this study was to assess the value of electron beam computed tomography in the detection of cardiac calcifications in coronaries and valves of dialysis patients and to determine the rate at which calcification progresses. Forty-nine chronic hemodialysis patients aged 28 to 74 years were compared with 102 nondialysis patients aged 32 to 73 years with documented or

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

    PubMed Central

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

    2013-01-01

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

  18. Double-valve surgery in Shprintzen-Goldberg syndrome.

    PubMed

    Elmistekawy, Elsayed; Hudson, Christopher C; Williams, Anne; Mesana, Thierry

    2014-09-01

    We describe the challenging case of a 28-year-old Jehovah's Witness patient who presented with symptomatic mitral and tricuspid valve disease and Shprintzen-Goldberg syndrome. This is the first reported double-valve surgery in such a patient who, apart from chest deformity, had a small body size, severe lung disease, difficult airway and vascular access, and to add to the complexity, refused blood and blood product use. The patient underwent a successful mitral valve replacement and tricuspid valve repair through a right thoracotomy. Apart from atrial fibrillation, he had a smooth hospital course and was discharged home on postoperative day 9. PMID:24887819

  19. Foetal hepatic calcification

    Microsoft Academic Search

    N. D. Hawass; M. G. El Badawi; J. A. Fatani; A. Al-Meshari; D. Makanjoula; Y. B. Edress

    1990-01-01

    Thirty-three cases of 1,500 spontaneously-aborted foetuses showed hepatic calcifications. The exact location of these calcifications were confirmed by contrast studies, anatomic dissection, and further histology when necessary. Of them, 18 were calcified hepatic vein thrombi (CHVT), 12 were calcified portal vein thrombi (CPVT), 2 were parenchymal calcifications, and one was mixed. Associated anomalies were high (85% of cases). No significant

  20. Update of transcatheter valve treatment

    PubMed Central

    Liu, Xian-bao; Wang, Jian-an

    2013-01-01

    Transcatheter valve implantation or repair has been a very promising approach for the treatment of valvular heart diseases since transcatheter aortic valve implantation (TAVI) was successfully performed in 2002. Great achievements have been made in this field (especially TAVI and transcatheter mitral valve repair—MitraClip system) in recent years. Evidence from clinical trials or registry studies has proved that transcatheter valve treatment for valvular heart diseases is safe and effective in surgical high-risk or inoperable patients. As the evidence accumulates, transcatheter valve treatment might be an alterative surgery for younger patients with surgically low or intermediate risk valvular heart diseases in the near future. In this paper, the updates on transcatheter valve treatment are reviewed. PMID:23897785

  1. A collagen-glycosaminoglycan co-culture model for heart valve tissue engineering applications

    Microsoft Academic Search

    Thomas C. Flanagan; Brendan Wilkins; Alexander Black; Stefan Jockenhoevel; Terence J. Smith; Abhay S. Pandit

    2006-01-01

    In order to develop efficient design strategies for a tissue-engineered heart valve, in vivo and in vitro models of valvular structure and cellular function require extensive characterisation. Collagen and glycosaminoglycans (GAGs) provide unique functional characteristics to the heart valve structure. In the current study, type I collagen-GAG hydrogels were investigated as biomaterials for the creation of mitral valve tissue.Porcine mitral

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

    PubMed

    Cipriani, Alberto; Mojoli, Marco; Tarantini, Giuseppe

    2015-04-01

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

  3. Aortic Valve

    MedlinePLUS

    ... Replacement of Artificial Valves? Are There Differences Between Mechanical and Biological Replacement Valves? Why is Surgery Necessary? ... are two types of artificial valves or prostheses: mechanical valves and biological valves . Examples of the valves ...

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  5. Pulmonary calcifications: a review

    Microsoft Academic Search

    D. BENDAYAN; Y. BARZIV; M. R. KRAMER

    2000-01-01

    Pulmonary calcification is a common asymptomatic finding, usually discovered on routine chest X-ray or at autopsy.Pulmonary calcifications are caused mainly by two mechanisms: the dystrophic form and the metastatic form (1). Despite the different aetiologies, the pulmonary function and clinical manifestations are quite similar in both forms. We present a review of the clinical and radiology findings of the different

  6. Calcification in atherosclerosis

    Microsoft Academic Search

    Nikolaos Alexopoulos; Paolo Raggi

    2009-01-01

    Coronary calcification has long been known to occur as a part of the atherosclerotic process, although whether it is a marker of plaque stability or instability is still a topic of considerable debate. Coronary calcification is an active process resembling bone formation within the vessel wall and, with the advances in CT technology of the past decade, can be easily

  7. Neomycin prevents enzyme-mediated glycosaminoglycan degradation in bioprosthetic heart valves

    Microsoft Academic Search

    Devanathan Raghavan; Dan T. Simionescu; Naren R. Vyavahare

    2007-01-01

    Bioprosthetic heart valves (BHVs) derived from glutaraldehyde crosslinked porcine aortic valves are frequently used in heart valve replacement surgeries. However, BHVs have limited durability and fail either due to degeneration or calcification. Glycosaminoglycans (GAGs), one of the integral components of heart valve cuspal tissue, are not stabilized by conventional glutaraldehyde crosslinking. Previously we have shown that valvular GAGs could be

  8. Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis and survival

    PubMed Central

    Massy, Ziad A.

    2012-01-01

    Patients with chronic kidney disease (CKD) have a high prevalence of vascular calcification, and cardiovascular disease is the leading cause of death in this population. However, the molecular mechanisms of vascular calcification, which are multifactorial, cell-mediated and dynamic, are not yet fully understood. We need to address ways to improve outcomes in CKD patients, both in terms of vascular calcification and cardiovascular morbidity and mortality—and to these ends, we investigate the role of magnesium. Magnesium’s role in the pathogenesis of vascular calcification has not been extensively studied. Nonetheless, several in vitro and animal studies point towards a protective role of magnesium through multiple molecular mechanisms. Magnesium is a natural calcium antagonist and both human and animal studies have shown that low circulating magnesium levels are associated with vascular calcification. Clinical evidence from observational studies of dialysis patients has shown that low-magnesium levels occur concurrently with mitral annular calcification, peripheral arterial calcification and increased carotid intima–media thickness. Few interventional studies have been performed. Two interventional studies suggest that there may be benefits such as retardation of arterial calcification and/or reductions in carotid intima–media thickness in response to magnesium supplementation in CKD patients, though both studies have limitations. Finally, observational studies have shown that low serum magnesium may be an independent risk factor for premature death in CKD patients, and patients with mildly elevated serum magnesium levels could have a survival advantage over those with lower magnesium levels.

  9. Discriminant analysis of heart valve sounds during respiratory static volume conditions

    E-print Network

    Hatzopoulos, Stavros D.

    1988-01-01

    one way valve, that keeps the blood from flowing back into the atrium during the atrial and ventricular contraction. 2. The two leaf valve between the left atrium and the left ventricle is called the MITRAL valve. 3. The valve between the right.... the onset of the left-ventricular ejection. Closure of the mitral and the tricuspid valves contributes significantly to HVS1 ( Fig. 2), Due to the complexity of the events which are taking place during the ventricular systole, there is a considerable...

  10. A rare case of Neisseria bacilliformis native valve endocarditis.

    PubMed

    Abandeh, Foad I; Balada-Llasat, Joan-Miquel; Pancholi, Preeti; Risaliti, Carleen M; Maher, William E; Bazan, Jose A

    2012-08-01

    Neisseria bacilliformis has most often been associated with infections of the oral cavity and the respiratory tract. We report a case of N. bacilliformis mitral valve endocarditis in a previously healthy adult which required valve replacement, thus confirming the opportunistic nature and pathogenic potential of this novel organism. PMID:22673965

  11. Multiple valve surgery for a patient with presternal oesophageal reconstruction.

    PubMed

    Hamamoto, Masaki; Kobayashi, Taira; Ozawa, Masamichi

    2015-08-01

    A 73-year old woman presented with progressive exertional dyspnoea. Echocardiography revealed severe regurgitation of the aortic, mitral and tricuspid valves, indicating the need for multiple valve surgery. The patient had a past history of oesophageal cancer that had been treated with chemoradiotherapy followed by oesophagectomy with presternal reconstruction using a gastric tube and a pedicled jejunum covered by the rectus abdominal muscle flap. She underwent aortic and mitral valve replacement with prostheses and tricuspid ring annuloplasty through a lower partial median sternotomy to avoid injury to the cervical oesophagus and a pedicled jejunum placed on the sternal manubrium. PMID:26059876

  12. Dynamic particle image velocimetry flow analysis of the flow field immediately downstream of bileaflet mechanical mitral prostheses.

    PubMed

    Akutsu, Toshinosuke; Saito, Jun

    2006-01-01

    New dynamic particle image velocimetry (PIV) technology was applied to the study of the flow field associated with prosthetic heart valves. Four bileaflet prostheses, the St. Jude Medical (SJM) valve, the On-X valve with straight leaflets, the Jyros (JR) valve, and the Edwards MIRA (MIRA) valve with curved leaflets, were tested in the mitral position under pulsatile flow conditions to find the effect of the leaflet shape and overall valve design on the flow field, particularly in terms of the turbulent stress distribution, which may influence hemolysis, platelet activation, and thrombus formation. Comparison of the time-resolved flow fields associated with the opening, accelerating, peak, and closing phases of the diastolic flow revealed the effects of the leaflet shape and overall valve design on the flow field. Anatomically and antianatomically oriented bileaflet valves were also compared in the mitral position to study the effects of the orientation on the downstream flow field. The experimental program used a dynamic PIV system utilizing a high-speed, high-resolution video camera to map the true time-resolved velocity field inside the simulated ventricle. Based on the experimental data, the following general conclusions can be made. High-resolution dynamic PIV can capture true chronological changes in the velocity and turbulence fields. In the vertical measuring plane that passes the centers of both the aortic and mitral valves (A-A section), bileaflet valves show clear and simple circulatory flow patterns when the valve is installed in the antianatomical orientation. The SJM, the On-X, and the MIRA valves maintain a relatively high velocity through the central orifice. The curved leaflets of the JR valve generate higher velocities with a divergent flow during the accelerating and peak flow phases when the valve is installed in the anatomical orientation. In the velocity field directly below the mitral valve and normal to the previous measuring plane (B-B section), where characteristic differences in valve design on the three-dimensional flow should be visible, the symmetrical divergent nature of the flow generated by the two inclined half-disks installed in the antianatomical orientation was evident. The SJM valve, with a central downward flow near the valve, is contrasted with the JR valve, which has a peripherally strong downward circulation with higher turbulent stresses. The On-X valve has a strong central downward flow attributable to its large opening angle and flared inlet shape. The MIRA valve also has a relatively strong downward central flow. The MIRA valve, however, diverts the flow three-dimensionally due to its peripherally curved leaflets. PMID:16998702

  13. Foetal hepatic calcification.

    PubMed

    Hawass, N D; el Badawi, M G; Fatani, J A; al-Meshari, A; Makanjoula, D; Edress, Y B

    1990-01-01

    Thirty-three cases of 1,500 spontaneously-aborted foetuses showed hepatic calcifications. The exact location of these calcifications were confirmed by contrast studies, anatomic dissection, and further histology when necessary. Of them, 18 were calcified hepatic vein thrombi (CHVT), 12 were calcified portal vein thrombi (CPVT), 2 were parenchymal calcifications, and one was mixed. Associated anomalies were high (85% of cases). No significant difference was found between the type and percentage of anomalies of those with CHVT and those with CPVT. The most common anomalies encountered in all cases were meconium intraluminal calcification (27%), cystic hygroma (18%), and metaphyseal defect (18%). In view of this, it is suggested that a variety of severe foetal illnesses predispose to CHVT and CPVT. At correlation with maternal factors, it was found that the highest incidence was in the third decade. A significant high percentage of mothers (33%) had been on contraceptive pills, and there was interesting inverse relationship of hepatic calcification with gravidity. Practically, it is also hoped that the awareness of the presence of various types of hepatic calcifications will help in their detection prenatally by ultrasound. PMID:2216588

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

    PubMed Central

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

    1991-01-01

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

  15. Minimally immunogenic decellularized porcine valve provides in situ recellularization as a stentless bioprosthetic valve

    Microsoft Academic Search

    Shigemitsu Iwai; Kei Torikai; Chris M. Coppin; Yoshiki Sawa

    2007-01-01

    Currently used bioprosthetic valves have several limitations such as calcification and functional deterioration, and revitalization\\u000a through cellular ingrowth is impossible. To overcome these obstacles, we have developed a minimally immunogenic tissue-engineered\\u000a valve that consists of an unfixed, decellularized porcine valve scaffold capable of being spontaneously revitalized in vivo\\u000a after implantation. Porcine aortic root tissue was decellularized using detergents such as

  16. Surgical experience for prolapse of both atrioventricular valves in a patient with filamin A mutation.

    PubMed

    Hoashi, Takaya; Shiraishi, Isao; Ichikawa, Hajime

    2015-02-01

    A 21-year-old man underwent mitral valve replacement and tricuspid annuloplasty for severe mitral regurgitation and moderate tricuspid regurgitation. Until the operation, he had been treated for hypermobility type Ehlers-Danlos syndrome. Gene examination revealed a mutation in filamin A gene, which is the gene responsible for X-linked myxomatous valvular dystrophy. PMID:24521555

  17. Elec 331 -Blood Pressure Heart Valves

    E-print Network

    Pulfrey, David L.

    Elec 331 - Blood Pressure 1 Heart Valves · Atrio-Ventricular (AV) ­ Bicuspid / Mitral (left - Blood Pressure 2 Phases of the Heart · Systole (Max BP) ­ Ventricle contracted ­ Aorta inflated 331 - Blood Pressure 3 Korotkov Phases / Sounds S D P P Nothing Sharp Swish Faint Nothing 0 1 2-3 4 5

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

    Microsoft Academic Search

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

    2001-01-01

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

  19. Tgf?-Smad and MAPK signaling mediate scleraxis and proteoglycan expression in heart valves.

    PubMed

    Barnette, Damien N; Hulin, Alexia; Ahmed, A S Ishtiaq; Colige, Alain C; Azhar, Mohamad; Lincoln, Joy

    2013-12-01

    Mature heart valves are complex structures consisting of three highly organized extracellular matrix layers primarily composed of collagens, proteoglycans and elastin. Collectively, these diverse matrix components provide all the necessary biomechanical properties for valve function throughout life. In contrast to healthy valves, myxomatous valve disease is the most common cause of mitral valve prolapse in the human population and is characterized by an abnormal abundance of proteoglycans within the valve tri-laminar structure. Despite the clinical significance, the etiology of this phenotype is not known. Scleraxis (Scx) is a basic-helix-loop-helix transcription factor that we previously showed to be required for establishing heart valve structure during remodeling stages of valvulogenesis. In this study, we report that remodeling heart valves from Scx null mice express decreased levels of proteoglycans, particularly chondroitin sulfate proteoglycans (CSPGs), while overexpression in embryonic avian valve precursor cells and adult porcine valve interstitial cells increases CSPGs. Using these systems we further identify that Scx is positively regulated by canonical Tgf?2 signaling during this process and this is attenuated by MAPK activity. Finally, we show that Scx is increased in myxomatous valves from human patients and mouse models, and overexpression in human mitral valve interstitial cells modestly increases proteoglycan expression consistent with myxomatous mitral valve phenotypes. Together, these studies identify an important role for Scx in regulating proteoglycans in embryonic and mature valve cells and suggest that imbalanced regulation could influence myxomatous pathogenesis. PMID:24157418

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

    PubMed Central

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

    2013-01-01

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