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Massive Left Atrial Calcification Associated with Mitral Valve Replacement  

PubMed Central

Calcification of the left atrium can be observed in patients with a long-lasting rheumatic heart disease. However, massive calcification of the atrial wall, so called porcelain or coconut atrium is very rare and has been generally reported only as incidental radiographic findings. We report a case of massive and firm calcifications at the left atrium in patient who underwent mitral valve replacement.

Lee, Won Jae; Son, Chang Woo; Yoon, Jun Cheol; Jo, Hyun Su; Son, Jang Won; Park, Kyu Hwan; Lee, Sang Hee; Shin, Dong Gu; Park, Jong Seon; Kim, Young Jo



Mitral annulus calcification and sudden death.  


Mitral valve annulus calcification is a degenerative cardiac condition often found at autopsy in the elderly. While usually considered incidental to the cause of death, we report two cases where mitral valve annulus calcification with valve stenosis was associated with sudden death. Case 1: a 61-year-old female who had underlying atherosclerosis and hypertension collapsed at home. At autopsy there was marked mitral valve annulus calcification with valve stenosis and cardiomegaly. Case 2: a previously well 74-year-old female collapsed in a toilet. At autopsy there was marked calcification of the mitral valve annulus with valve stenosis. In both cases death was attributed to the effects of the calcified mitral valve annulus. Although such calcification may be unrelated to the terminal lethal mechanism, the association with left atrial enlargement, atrial fibrillation, mitral regurgitation, mitral stenosis, bacterial endocarditis, ischaemic and thromboembolic stroke, myocardial infarction, and arrhythmias, means that it should not be overlooked in the differential diagnosis in cases of sudden and unexpected death. PMID:23622459

Quick, Esther; Byard, Roger W



In vitro comparison of Doppler and catheter-measured pressure gradients in 3D models of mitral valve calcification.  


Mitral annular calcification (MAC) involves calcium deposition in the fibrous annulus supporting the mitral valve (MV). When calcification extends onto the leaflets, valve opening can be restricted. The influence of MAC MV geometry on Doppler gradients is unknown. This study describes a novel methodology to rapid-prototype subject-specific MAC MVs. Replicated valves were used to assess the effects of distorted annular-leaflet geometry on Doppler-derived, transmitral gradients in comparison to direct pressure measurements and to determine if transmitral gradients vary according to measurement location. Three-dimensional echocardiography data sets were selected for two MAC MVs and one healthy MV. These MVs were segmented and rapid prototyped in their middiastolic configuration for in vitro testing. The effects of MV geometry, measurement modality, and measurement location on transmitral pressure gradient were assessed by Doppler and catheter at three locations along the MV's intercommissural axis. When comparing dimensions of the rapid-prototyped valves to the subject echocardiography data sets, mean relative errors ranged from 6.2% to 35%. For the evaluated MVs, Doppler pressure gradients exhibited good agreement with catheter-measured gradients at a variety of flow rates, though with slight systematic overestimation in the recreated MAC valves. For all of the tested MVs, measuring the transmitral pressure gradient at differing valve orifice positions had minimal impact on observed gradients. Upon the testing of additional normal and calcific MVs, these data may contribute to an improved clinical understanding of MAC-related mitral stenosis. Moreover, they provide the ability to statistically evaluate between measurement locations, flow rates, and valve geometries for Doppler-derived pressure gradients. Determining these end points will contribute to greater clinical understanding for the diagnosis MAC patients and understanding the use and application of Doppler echocardiography to estimate transmitral pressure gradients. PMID:23720100

Herrmann, Tarrah A; Siefert, Andrew W; Pressman, Gregg S; Gollin, Hannah R; Touchton, Steven A; Saikrishnan, Neelakantan; Yoganathan, Ajit P



Robotic mitral valve surgery  

Microsoft Academic Search

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

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



[Mitral valve replacement for a severely calcified mitral annulus].  


An 80-year-old woman was referred to our institution because of acute heart failure due to moderate mitral stenosis and severe regurgitation. After medical treatment of heart failure, she underwent mitral valve surgery. Intraoperatively severe calcification of the posterior mitral annulus was revealed. We excised only the anterior mitral leaflet and preserved the posterior mitral leaflet to prevent a fatal complication such as left ventricular rupture, injury of the coronary artery or embolism. Partial resection of the calcified annulus was performed using Ultrasonic Surgical System (SonoSurg), after 2-0 polyester mattress sutures were placed through the anterior and posterior annuli from the left ventricle to the left atrium. Then, mitral valve replacement was performed using a St. Jude Medical mechanical heart valve at the supra-annular position. The postoperative course was uneventful. We concluded that partial resection of a severely calcified posterior mitral annulus by the ultrasonic device was a safe and simple procedure. PMID:24008639

Kuriyama, Mitsuhito; Kioka, Yukio; Tanabe, Atsushi



Robotic mitral valve surgery  

Microsoft Academic Search

Summary  BACKGROUND: Robotic mitral valve surgery has evolved and matured into a safe and reproducible procedure at multiple worldwide\\u000a centers of excellence. METHODS: History of robotic mitral valve repair is reviewed. Current results and recent advances are\\u000a discussed. RESULTS: Multiple trials have demonstrated that surgical outcomes for robotic mitral valve repair meet or exceed\\u000a the results of conventional operations, but long-term

E. J. Lehr; E. Rodriguez; L. W. Nifong; W. R. Chitwood


Mitral Valve Prolapse  


Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of the valve are "floppy" and don't close tightly. Most ... can leak the wrong way through the floppy valve. This can cause Palpitations (feelings that your heart ...


Robotic mitral valve surgery  

Microsoft Academic Search

Currently, cardiac surgery is an evolving field. Not only has there been a technological explosion, but there also is a strong interest in minimally invasive operations. Mitral valve surgery can now be performed with the use of sophisticated robotic systems through small incisions. The patient of today and the future will demand minimally invasive operations. Initial clinical experience with robotic

Alan P. Kypson; W. Randolph Chitwood



Mitral valve replacement with ball valve prostheses  

Microsoft Academic Search

Our experience with ball valve replacement of the mitral valve during the past decade is presented in terms that allow comparison with other techniques. The use of such prostheses is characterized by ease of implantation, with an overall operative mortality of 11 per cent for isolated mitral replacement and 13 per cent for multiple valve replacement. The operative mortality for

Albert Starr



Images in cardiovascular medicine: caseous calcification of the mitral annulus.  


A 78-year-old woman was admitted to our emergency department for subarachnoid hemorrhage. Since a month ago, she was taking warfarin after diagnosis, on transthoracic echocardiogram (TTE), of a suspected large atrial thrombus. The patient, referred to our institution for further investigation, presented asymptomatic; electrocardiogram showed sinus rhythm. TTE revealed an echo dense spherical mass located in the mitral periannular posterior region with moderate mitral regurgitation. Transesophageal echocardiography and cardiac computed tomography confirmed a calcified round mass (2.0 × 2.9 cm) with central areas of echolucency-like liquefaction surrounded by a hyperechogenic structure without systolic flow inside the cavity. The mass was diagnosed as caseous calcification of the mitral annulus (CCMA), a rare finding associated with a benign prognosis, requiring surgery only in the presence of mitral valve dysfunction. The diagnosis of CCMA is, often, misconstrued as thrombus, tumor, or abscess, leading to unnecessary investigations or interventions. Our patient was discharged after discontinuation of warfarin. PMID:23167713

Pugliatti, Pietro; Piccione, Maurizio Cusmà; Ascenti, Giorgio; Germanò, Antonino; Recupero, Antonino; Oreto, Giuseppe; Carerj, Scipione



Robotic mitral valve surgery.  


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

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



Minimally invasive mitral valve surgery  

Microsoft Academic Search

Like many other surgical specialties, cardiac surgery is evolving toward more minimally invasive approaches. Mitral valve\\u000a surgery has been shown to be feasible and safe when performed through smaller incisions or with the aid of robotic manipulation.\\u000a Recent technologic advances allow complex mitral valve reconstruction to be carried out through these small incisions with\\u000a avoidance of a full sternotomy and

Sunil Panwar; Edward G. Soltesz



Mitral annulus calcification — a window to diffuse atherosclerosis of the vascular system  

Microsoft Academic Search

Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenerative process of the fibrous support structure of the mitral valve. It occurs more often in women and the elderly. MAC is associated with known atherosclerotic risk factors such as diabetes mellitus, hypertension and hypercholesterolemia. It is also known that patient with MAC have higher prevalence of left atrial and left ventricular

Yehuda Adler; Noam Fink; David Spector; Itay Wiser; Alex Sagie



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

Microsoft Academic Search

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

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



Transseptal Mitral Valve Replacement after Transcatheter Aortic Valve Implantation  

PubMed Central

We report a case of mitral valve replacement in a patient who had previously undergone transcatheter aortic valve implantation. A transseptal approach was used to avoid displacing the aortic prosthesis. Because of the small mitral annulus, a bioprosthetic aortic valve was used in reverse position for mitral valve replacement. The procedure did not interfere with the existing prosthesis, and a follow-up echocardiogram showed that both prosthetic valves were functioning well. To the best of our knowledge, this is the first report of mitral valve replacement in a patient who had a preceding transcatheter aortic valve implantation. We believe that the transseptal approach is promising for mitral valve replacement in such patients. Moreover, using a bioprosthetic aortic valve in reverse position is an option for mitral valve replacement when the mitral annulus is too small for placement of a standard bioprosthetic mitral valve.

Flannery, Laura D.; Lowery, Robert C.; Sun, Xiumei; Satler, Lowell; Corso, Paul; Pichard, Augusto; Wang, Zuyue



[Early bioprosthetic mitral valve thrombosis].  


We present a case of a 70 year-old woman operated due to severe mitral regurgitation. Early after surgery transthoracic echocardiography revealed the decreased effective orifice area of the implanted bioprosthetic valve and the stenotic features of transvalvular flow. Transesophageal echocardiography (TEE) disclosed a thrombotic cause of heterograft dysfunction. Due to the clinical deterioration and the unclear cause of prosthesis stenosis, the patient was reoperated. Intra-operatively bioprosthetic mitral valve thrombosis was confirmed. Precipitating factors of this rare complication including cardiac device related infective endocarditis (CDRIE) and the diagnostic applicability of TEE in this clinical scenario are discussed. PMID:22427084

Tkaczyszyn, Micha?; Olbrycht, Tomasz; Kustrzycka Kratochwil, Dorota; Sokolski, Mateusz; Sukiennik Kujawa, Ma?gorzata; Skiba, Jacek; Gemel, Marek; Banasiak, Waldemar; Jankowska, Ewa A; Ponikowski, Piotr



Models of aortic valve calcification.  


Aortic valve stenosis is a complex inflammatory process, akin to arterial atherosclerosis, involving lymphocytic infiltrates, macrophages, foam cells, endothelial activation and dysfunction, increased cellularity and extracellular matrix deposition, and lipoprotein accumulation. A clonal population of aortic valve myofibroblasts spontaneously undergoes phenotypic transdifferentiation into osteoblast-like cells and forms calcific nodules in cell culture. Animal models complement these cell culture models by providing in vivo systems in which to study the complex molecular and cellular interactions that cause aortic valve disease in the native hemodynamic and biochemical environment. Whereas some species, such as swine, can develop spontaneous vascular and valvular atherosclerotic lesions, others, such as rabbits and mice, have not been shown to develop lesions naturally and require an inciting factor, such as hypercholesterolemia. In this article, we review the published cell culture and animal models available to study calcific aortic valve disease. PMID:17963676

Guerraty, Marie; Mohler Iii, Emile R



Mitral Valve Prolapse  


... one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a ... ventricle of the heart is enlarged • The heart function gets worse MVP very rarely becomes a highly ...


Mitral Valve Repair Surgery  

MedlinePLUS Videos and Cool Tools

... with the annular dilation, I think, is the principle reason this valve is leaking. So what we’ ... posterior annulus and by virtue of gauging the distance between these sutures, one can eventually, you see, ...


Lambl's excrescences of the mitral valve  

PubMed Central

A young male patient, just recovered from a recent transient ischaemic attack, was operated on for mitral valve insufficiency due to suspected endocarditis. Multiple wear-and-tear lesions were found at the line of closure of the mitral valve, which appeared to be Lambl's excrescences. The valve was replaced. ImagesFigure 1Figure 2

Bruinsma, G.J. Brandon Bravo; Leicher, F.G.



Echocardiography in Transcatheter Aortic Valve Implantation and Mitral Valve Clip  

PubMed Central

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

Luo, Huai



Degenerative mitral valve regurgitation: best practice revolution  

PubMed Central

Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation.

Adams, David H.; Rosenhek, Raphael; Falk, Volkmar



Is mitral valve surgery safe in octogenarians?  

Microsoft Academic Search

Objective: To evaluate the outcomes of mitral valve surgery in octogenarians. Methods: Data were collected prospectively from January 1996 to March 2004 at two surgical centers. Of 1386 consecutive patients with mitral valve surgery, 58 (4.2%) were aged ?80 years. Survival data were analyzed using Cox proportional hazards modeling and Kaplan–Meier actuarial log rank statistics. Results: Octogenarians were similar to

Jayan Nagendran; Colleen Norris; Andrew Maitland; Arvind Koshal; David B. Ross



Clinical Use of a New Mitral Disc Valve  

PubMed Central

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

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



The natural history of aortic valve disease after mitral valve surgery  

Microsoft Academic Search

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

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



Mitral Valve Plasty for Idiopathic Rupture of Mitral Valve Posterior Chordae in Infants.  


Introduction: Idiopathic mitral valve chordal rupture is rare among infants. Once it has occurred, acute heart failure progresses, and emergency surgical repair is necessary in most cases. Our surgical experience with idiopathic mitral valve chordal rupture is reported.Patients and Methods: From September 2008 to May 2012, four infants (3 males, 1 female; median age 5.5 months) underwent mitral valve plasty for severe mitral valve regurgitation due to prolapse of posterior mitral valve leaflet. Patient history, surgical procedure, operation time, mortality, postoperative echocardiography data (mitral valve regurgitation grade: 0-trivial, mild, moderate, severe, transmitral flow: TMF) and pathology were examined.Results: Three cases required emergency surgery; 1 case, elective surgery. Intraoperative findings showed chordal rupture of the P2 segment in 3 cases and P1 + P3 segments in 1 case. Quadrangular resection with annular plication was performed for 1 case. Quadrangular resection with annular plication and the Kay procedure were performed for 3 cases. Mitral valve regurgitation improved from severe to trivial-mild in all cases. Pathological examination showed a myxomatous degenerative change in the mitral valve.Conclusion: Mitral valve plasty was performed for idiopathic mitral valve chordal rupture in infants. The surgical procedures were the same as for adult cases and achieved satisfactory results. PMID:23558223

Yanase, Yohsuke; Ishikawa, Natsuya; Watanabe, Manabu; Kimura, Sachiko; Higami, Tetsuya



Acute thrombosis of bioprosthetic mitral valve  

PubMed Central

We report a case of acute thrombosis of bioprosthetic mitral valve in a 59 year–old Korean female, who underwent a mitral valve replacement with a 25 mm Carpentier - Edwards PERIMOUNT Plus bioprosthesis (Edwards Lifesciences, Inc.; Irvine, CA, USA) and a mini-Maze procedure for correction of mitral stenosis (MS) and atrial fibrillation (AF). On the 10th postoperative day, the patient began to complain of increasing dyspnea and general malaise. Her symptoms worsened and developed into pulmonary edema. Echocardiography revealed a mean diastolic pressure gradient (MDPG) of 10 mmHg across the mitral valve and pressure-half time (PHT) of 166 msec. Due to progressive decompensated heart failure, the patient underwent a repeat sternotomy to replace the bioprosthetic mitral valve. Intraoperatively, we found a thrombosis around the bioprosthetic mitral valve. We excised the bioprosthetic mitral valve and replaced it with a 27 mm ATS mechanical valve (ATS medical, Inc.; Minneapolis, MN, USA). We experienced a rare case that required an early reoperation for a thrombosis of the bioprosthetic valve.



Severe mitral regurgitation in a woman with a double orifice mitral valve  

Microsoft Academic Search

A 64 year old woman with partial atrioventricular canal and double orifice mitral valve presented with severe mitral regurgitation secondary to a torn leaflet. The double orifice regurgitant mitral valve is an unusual finding at operation.

J Kron; R J Standerfer; A Starr



Cardiac Myxoma Originating from the Anterior Mitral Valve Leaflet  

PubMed Central

Primary cardiac tumors are rare and myxoma is the most common tumor among them. Cardiac myxoma usually occurs in the left atrium. Myxoma originating from mitral valve is extremely rare. We report a case of mitral valve myxoma. The tumor originated from the anterior mitral valve leaflet. The tumor was completely removed and replacement of the mitral valve was not done.

Yoon, Jung-Han; Kim, Ji-Hyun; Sung, Young-Jun; Lee, Min-Ho; Cha, Myung-Jin; Kang, Do-Yoon; Kim, Yong-Jin



Marfan syndrome and mitral valve prolapse  

PubMed Central

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.

Weyman, Arthur E.; Scherrer-Crosbie, Marielle



Blood cyst of the mitral valve.  


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

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



Spontaneous host endothelial growth on bioprosthetic valves and its relation to calcification  

Microsoft Academic Search

We studied host endotbelial growth and calcification of bovine pericardial valve prostheses treated with: (A) 0.625% glutaraldehyde + 4% formaldehyde, (B) 99.5% glycerol or (C) 99.5% glycerol + 4% formaldehyde. Twenty- three stentless chordally supported bileaflet pericardial mitral valves with treatments A (n = 6), B (n = 6) or C (n = 11) were implanted in juvenile sheep for

K. Liao; G. Gong; D. Hoffman; E. Seifter; S. M. Factor; E Macaluso; R. W. M. Frater



Mitral Annular Caseous Calcification: A Rare Variant of a Common Echocardiographic Finding Discovered with Advanced Imaging Techniques  

PubMed Central

We present the case of a 90-year-old diabetic male and medically managed three-vessel coronary artery disease with evidence of an oval, nonmobile echo-density located on the posterior mitral valve annulus measuring two centimeters in diameter without significant impingement of the mitral valve on initial screening echocardiogram which was initially thought to be prominent mitral annular calcification which was later confirmed to be a rare case of caseoma as confirmed by both cardiac magnetic resonance (CMR) as well as coronary computed tomographic angiography (CCTA).

Pomeroy, William L.; Markelz, Brian; Steel, Kevin; Slim, Ahmad M.



[TRAMI (Transcatheter Mitral Valve Interventions) register. The German mitral register].  


The transcatheter mitral valve interventions (TRAMI) registry was established in 2010 in order to assess the safety and efficacy of percutaneous mitral valve therapy in Germany and to document baseline characteristics and decision-making in different subgroups of patients. The TRAMI registry is available to all German sites performing percutaneous mitral valve therapy. Follow-up is scheduled at 30 days, 1, 3, and 5 years. In addition, patients can be enrolled retrospectively without predefined times of follow-up. The vast majority of patients enrolled in TRAMI underwent MitraClip® therapy. As of March 2013, a total of 1,064 patients treated with MitraClip® have been enrolled at 21 different German sites. Preliminary results show that patients treated with MitraClip® in Germany were mainly elderly patients with significant comorbidities and high or inacceptable risk of surgery. The majority of patients had secondary mitral regurgitation and a large proportion of patients had reduced left ventricular ejection fraction (LV-EF). Nevertheless, MitraClip® was found to be safe and established risk factors for conventional cardiac mitral valve surgery, such as advanced age (?76 years), female gender, severely reduced LV-EF (<30%) and high logistic EuroScore (?20%) were not predictive for mortality or major complication rates. In contrast, severely reduced renal function was predictive for adverse outcome. The TRAMI registry is the largest real world cohort of patients treated with MitraClip®. As long as randomized studies in this high-risk cohort of patients are lacking, TRAMI provides important information on outcomes after MitraClip® therapy. The data are important for hypothesis generation for randomized trials and TRAMI is an important tool for quality assurance after percutaneous mitral valve therapy in Germany. PMID:23797374

Schillinger, W; Senges, J



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

PubMed Central

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

Wang, Jian-Gang; Ren, Bi-Qiao



Emergency transseptal transcatheter mitral valve-in-valve implantation.  


Aims: We report a case of emergency transcatheter heart valve implantation in a failing mitral bioprosthesis via a transseptal access complicated by the atrial migration of a prosthesis. Methods and results: A 42-year-old woman was referred for stenotic failure of a mitral bioprosthesis. A transapical valve-in-valve implantation was initially planned. However, due to sudden haemodynamic deterioration, an emergency transseptal implantation via a femoral venous access was undertaken. Following cardiac arrest, the procedure was performed with extracorporeal membrane oxygenation (ECMO), and was complicated by the migration of a valve, which was left moving freely in the left atrium. A second valve was successfully implanted in the mitral bioprosthesis. Following initial clinical recovery, there was a sudden recurrence of heart failure due to entrapment of the migrated valve in the implanted valve in a "reverse position", which was dislodged percutaneously in an emergency procedure. The valve later migrated into the left atrial appendage. Immediate outcome was uneventful, but the patient suddenly died six months later. Conclusions: Transseptal transcatheter mitral valve-in-valve implantation is feasible, even in an emergency setting with ECMO. Valve migration in the left atrium may occur and lead to late entrapment in a "reverse position", with significant haemodynamic consequences. PMID:24058080

Fassa, Amir-Ali; Himbert, Dominique; Brochet, Eric; Alkhoder, Soleiman; Al-Attar, Nawwar; Brun, Pierre-Yves; Wolff, Michel; Nataf, Patrick; Vahanian, Alec



Association Between Mitral Annulus Calcification and Carotid Atherosclerotic Disease  

Microsoft Academic Search

Background and Purpose—It has been established that mitral annulus calcification (MAC) is an independent predictor of stroke, though a causative relationship was not proved, and that carotid artery atherosclerotic disease is also associated with stroke. The aim of this study was to determine whether there is an association between the presence of MAC and carotid artery atherosclerotic disease. Methods—Of the

Yehuda Adler; Arnon Koren; Noam Fink; David Tanne; Renato Fusman; Abid Assali; Jakov Yahav; Avigdor Zelikovski; Alex Sagie


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


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

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



Recommended transoesophageal echocardiographic evaluation of mitral valve regurgitation  

PubMed Central

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

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



Stenotrophomonas maltophilia endocarditis of prosthetic mitral valve.  


We present a 78-year-old woman with prosthetic valve endocarditis due to Stenotrophomonas maltophilia (S. maltophilia) 3 years after mitral valve replacement. Administration of sulfamethoxazole-trimethoprim was effective; however, it was discontinued because of side effects, which led to failure of antibiotic therapy. Complications of multiple cerebral infarction and paravalvular abscess developed. Although the prosthetic valve was removed 50 days after admission, she died 4 months after surgery. S. maltophilia has been increasingly being considered as a serious nosocomial pathogen. S. maltophilia endocarditis is rare; however, it should be recognized as a possible life-threatening disease in patients with prosthetic valve. PMID:20720357

Katayama, Takuji; Tsuruya, Yoshio; Ishikawa, Susumu



[Surgical echocardiography of the mitral valve].  


In the western world, the prevalence of mitral regurgitation-particularly that due to degenerative disease-has gradually increased despite a substantial decrease in rheumatic disease. If present, secondary ventricular dysfunction, potentially irreversible when clinically diagnosed, requires close echocardiographic follow-up in order to establish a subclinical diagnosis. Thus, echocardiography has become an essential tool in managing patients with mitral valve regurgitation. As well as assessing parameters of ventricular geometry, in the hands of an expert echocardiography offers systematic documentation of lesion in each segment, which together with the dysfunction type should give an accurate idea of the complexity involved in the valve repair. This is increasingly relevant given the growing number of asymptomatic patients referred for mitral valve surgery. Consequently, the echocardiographic study performed prior to referral is crucial to successful mitral valve repair and cardiologists, cardiac imaging experts, and surgeons should be guided by results when referring patients to specialists with the skills necessary to undertake adequate repair of the lesions found. PMID:22032935

Castillo, Javier G; Solís, Jorge; González-Pinto, Angel; Adams, David H



Mitral Valve Prolapse in Young Patients.  

ERIC Educational Resources Information Center

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

McFaul, Richard C.



Mitral Valve Prolapse in Young Patients.  

ERIC Educational Resources Information Center

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

McFaul, Richard C.



Artificial chordae for pediatric mitral and tricuspid valve repair  

Microsoft Academic Search

Objective: To evaluate pediatric atrioventricular valve repair with artificial chordae. Methods: Between February 2001 and January 2006, artificial chords were used in 21 children with severe mitral or tricuspid valve regurgitation. Patients with AVSD were excluded. Median age was 84 (1–194) months. Five patients had isolated tricuspid valve anomalies, 16 had mitral valve anomalies (associated tricuspid annular dilatation in 4).

Rody Boon; Mark Hazekamp; Gerard Hoohenkerk; Marry Rijlaarsdam; Paul Schoof; Dave Koolbergen; Lourdes Heredia; Robert Dion



Mitral valve repair and replacement in northern New England  

Microsoft Academic Search

BackgroundThe etiology of mitral valvular disease has changed in the last 20 years, and new techniques for the diagnosis and repair of mitral valves have been advanced. A retrospective regional study was conducted to identify changes in patient and disease characteristics and in population-based rates for mitral valve repair and replacement in northern New England.

Edward R Nowicki; Ronald W Weintraub; Nancy J. O Birkmeyer; John H Sanders; Lawrence J Dacey; Stephen J Lahey; Bruce Leavitt; Robert A Clough; Reed D Quinn; Gerald T O’Connor



Mitral valve surgery: when is it appropriate?  


Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 150 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred fifty patients with 4+ MR, left ventricular ejection fractions of 8%-24% (mean, 14%), and New York Heart Association class III or IV symptoms were prospectively studied. All patients underwent mitral valve repair with an undersized, flexible annuloplasty ring. There was one intraoperative death and seven 30-day mortalities. Intraoperative echocardiography revealed no residual MR in the majority of patients and mild to trivial MR in seven patients. There were 27 late deaths; three of these patients had progression of the disease and underwent transplantation. The 1-, 2-, and 5-year actuarial survival rates are 82%, 71%, and 57%, respectively. New York Heart Association class has improved for all patients, from a preoperative mean of 3.2+/-0.2 to 1.8+/-0.4 postoperatively. At 24-month follow-up, all patients showed improvement in ejection fraction, cardiac output, and end-diastolic volumes, along with a reduction in the sphericity index and regurgitant volume. Mitral valve repair with an undersized, flexible annuloplasty ring is a safe and effective approach to correction of MR, even in cardiomyopathy patients. All observed changes contribute to reverse remodeling and the restoration of the normal left ventricular geometric relationship. Mitral reconstruction provides a new first-line management strategy for patients with MR and end-stage heart failure. PMID:12147944

Badhwar, Vinay; Bolling, Steve F


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

PubMed Central

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

Eyal, Allon; Raanani, Ehud; Shapira, Yaron



Mitral valve repair for infective endocarditis  

Microsoft Academic Search

Objective  This study investigated the feasibility of mitral valve (MV) repair in patients with active or healed infective endocarditis\\u000a (IE) with mitral regurgitation and evaluated effects on left ventricular (LV) function and structure.\\u000a \\u000a \\u000a \\u000a Methods  Subjects comprised 19 patients who underwent MV operations for IE between December 2004 and September 2007. MV repair was\\u000a performed for acute IE in 10 of 15 patients

Tadashi Omoto; Masahiro Ohno; Masaomi Fukuzumi; Masaya Ohi; Takahisa Okayama; Noboru Ishikawa; Hitoshi Kasegawa; Takeo Tedoriya



Perforated Mitral Valve Aneurysm in the Posterior Leaflet without Infective Endocarditis  

PubMed Central

Aneurysm of the mitral valve, although uncommon, occurs most commonly in association with infective endocarditis of the aortic valve and true mitral valve aneurysm is a rare cause of mitral regurgitation. We report a case with perforated mitral valve aneurysm in the posterior leaflet without concurrent infective endocarditis initially mistaken diagnosis of cystic mass, which was confirmed at operation with successful mitral valve annuloplasty.

Kim, Dong-Jun; Jun, Hee-Jae; Kim, You-Jeong; Song, Yeo-Jeong; Jhi, Joon-Hyung; Chon, Min-Gu; Kim, Seong-Man; Lee, Hyeon-Gook; Kim, Tae-Ik



Flail mitral and tricuspid valves due to myxomatous disease.  


Myxomatous disease generally affects mitral valve. However, tricuspid valves also can be involved in 20% of the myxomatous mitral valve disease. Valve prolapse, elongation of chordae and chordae rupture are generally seen complications of the myxomatous disease. There are some reports about severe tricuspid regurgitation due to tricuspid valve prolapse and elongated chordae, but no tricuspid and mitral chordae ruptures in the same patient due to myxomatous disease have been reported. In this case tricuspid chordae rupture accompanied to mitral chordae rupture is discussed. PMID:17197244

Emine, Bilen Senkaya; Murat, Akcay; Mehmet, Bilge; Mustafa, Kurt; Gokturk, Ipek



Replacement of an immobile prosthetic mitral valve: a case report.  

PubMed Central

A mechanical prosthetic heart valve can become acutely obstructed despite anticoagulation therapy. This can be a life-threatening complication. We report the case of a 38-year-old woman who survived obstruction of her Sorin prosthetic mitral valve. She was admitted to the hospital because of severe pulmonary edema. On auscultation, mechanical valve sounds were absent. Transthoracic echocardiography showed an immobile mechanical valve. The patient suffered a cardiac arrest while being prepared for surgery, but she underwent successful mitral valve replacement after cardiopulmonary resuscitation. When patients with prosthetic mitral valves present with acute dyspnea, the possibility of an obstructed prosthetic valve must be considered in the differential diagnosis. Images

Mete, A; Turkay, C; Kumbasar, D; Golbasi, I; Sahin, N; Bayezid, O



Replacement of an immobile prosthetic mitral valve: a case report.  


A mechanical prosthetic heart valve can become acutely obstructed despite anticoagulation therapy. This can be a life-threatening complication. We report the case of a 38-year-old woman who survived obstruction of her Sorin prosthetic mitral valve. She was admitted to the hospital because of severe pulmonary edema. On auscultation, mechanical valve sounds were absent. Transthoracic echocardiography showed an immobile mechanical valve. The patient suffered a cardiac arrest while being prepared for surgery, but she underwent successful mitral valve replacement after cardiopulmonary resuscitation. When patients with prosthetic mitral valves present with acute dyspnea, the possibility of an obstructed prosthetic valve must be considered in the differential diagnosis. PMID:10524748

Mete, A; Turkay, C; Kumbasar, D; Gölba?i, I; Sahin, N; Bayezid, O



Mitral valve replacement in dogs using pig aortic valve heterografts  

Microsoft Academic Search

Mitral valve replacement using pig aortic valve heterografts has been performed in 27 dogs, siting the grafts in the `atrial position'. Buffered acid formaldehyde sterilization offered the advantages that it is simple and, by de-naturing the proteins of the graft, may minimize `rejection' phenomena. It may offer some self-sterilizing property to the graft within the host post-operatively. The question whether

David I. Hamilton; Frank Gerbode



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

Microsoft Academic Search

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

H V Huikuri



Acute mitral valve regurgitation due to complete rupture of anterior papillary muscle mimicking mitral valve vegetation.  


We report the successful treatment of a 77-year-old man after a difficult diagnosis of mitral valve regurgitation resulting from complete rupture of the anterior papillary muscle. The patient with cardiogenic shock was an emergency admission. An electrocardiogram showed acute lateral wall myocardial infarction. He had complications of leukocytosis and a high-grade fever. Transesophageal echocardiography seemed to show the appearance of a large area of vegetation attached to the anterior mitral valve leaflet and aortic non-coronary cusp, resulting in severe mitral regurgitation. We performed coronary angiography, which showed complete obstruction of the circumflex coronary artery. We determined that the condition was caused by infective endocarditis. Emergency surgery showed the complete rupture of the anterior papillary muscle, but there was no vegetation. The mitral valve was replaced with a bioprosthetic valve and the circumflex coronary artery was bypassed with a saphenous vein graft. Pathological examination revealed mitral valve to be non-mycotic, and the postoperative course was uneventful. PMID:21587137

Takahashi, Yosuke; Tsutsumi, Yasushi; Monta, Osamu; Kato, Yasuyuki; Kohshi, Keitaro; Sakamoto, Tomohiko; Ohashi, Hirokazu



Mitral Valve Repair for Degenerative Disease: A 20Year Experience  

Microsoft Academic Search

Background. Recent advances in surgical technique allow repair of most mitral valves with degenerative disease. However, few long-term data exist to support the superiority of repair versus prosthetic valve replacement, and repair could be limited by late durability or other problems. This study was designed to compare survival characteristics of mitral valve repair versus prosthetic replacement for degenerative disorders during

Mani A. Daneshmand; Carmelo A. Milano; J. Scott Rankin; Emily F. Honeycutt; Madhav Swaminathan; Linda K. Shaw; Peter K. Smith; Donald D. Glower



Beating-heart Mitral Valve Chordal Replacement  

PubMed Central

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

Laing, Genevieve; Dupont, Pierre E.



Pathology of the formalin-treated heterograft porcine aortic valve in the mitral position  

PubMed Central

The mitral valve was replaced by a pig aortic valve in 33 patients at Groote Schuur Hospital. Eleven of the failed heterograft aortic valves were examined at intervals of from 2 to 32 months after insertion. Fourteen control pig aortic valves were also examined. Electron microscopy was performed on two of the failed heterograft valves and three control pig valves. Failure of the heterograft was due to stretching and deformation of the cusps with resultant valvular incompetence. Stretching of the cusp was a result of reduction in the amount of its collagen content. The elastic tissue appeared little altered. A microscopic layer of fibrin thrombus was present on the surface of 8 of the 11 valves. Only 2 of the 11 valves showed invasion of the graft by immunologically competent cells. No valve showed any sign of infection or calcification. The denatured collagen of the heterograft has a low antigenicity and also, infortunately, a limited durability. Images

Rose, Alan G.



Visualization of mitral valve aneurysm by transesophageal echocardiography.  


This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm. PMID:10149234

Shakudo, M; Eng, A K; Applegate, P M; Bansal, R C; Wong, M; Shah, P M



An alternative approach to difficult mitral valve problems  

Microsoft Academic Search

Mitral valve replacement in the pediatric population has been accomplished with good results in spite of challenges posed by anticoagulation, size, and valve degeneration. Occasionally, problems can be compounded by a small left atrium as in the case of a 14-month-old child weighing 4.4 kg, who presented to us with mitral stenosis (parachute mitral valve) and small left atrium. This

Hema Bhargava; Rohinton K. Balsara



Surgical management of mitral valve infective endocarditis.  


Active mitral valve infective endocarditis is a challenging clinical problem with a high rate of mortality. Surgery is currently performed in more than 40% of patients, and selecting those patients who will benefit from surgical intervention and performing a technically sound operation at the proper time are keys to optimizing outcomes. Moderate-to-severe and severe mitral regurgitation, large, mobile vegetations, paravalvular abscess, embolic events, failure of antibiotic therapy, and infection with a fungal organism are indications for prompt operation. The use of computed tomography imaging is important to determine whether there are noncardiac sources of infection, and transesophageal echocardiography is essential to delineate valvular dysfunction, identify paravalvular abscesses, rule out involvement of other valves, and plan operative therapy. In most cases, surgery should not be delayed because of cerebrovascular emboli. Mitral valve repair is favored over replacement whenever possible, is associated with superior short- and long-term outcomes, and should be possible in most cases. Operative mortality is <10% and 5-year survival is >80%. PMID:22172361

Evans, Charles F; Gammie, James S



Left atrial myxoma associated with mitral valve pathology in pregnancy.  


We report a case of a left atrial myxoma associated with mitral valve regurgitation in a pregnant patient, describing the importance of transoesophageal or transthoracic echocardiography, preoperatively and during the operation, as a useful tool to rule out any associated valvular damage or mitral annular dilatation as an underlying cause of mitral regurgitation. PMID:23557615

Koukis, Ioannis; Velissaris, Theodore; Pandian, Alex


Mitral valve surgery in the patient with left ventricular dysfunction  

Microsoft Academic Search

Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 125 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred twenty-five patients with 4+ MR, left ventricular ejection fractions from 8% to 24% (mean 14%), and

Vinay Badhwar; Steven F. Bolling



Cardiopulmonary exercise testing before and one year after mitral valve repair for severe mitral regurgitation  

Microsoft Academic Search

For the evaluation of efficacy of cardiopulmonary exercise testing, we compared New York Heart Association functional class with peak oxygen consumption rate (VO2peak) in 31 patients with severe mitral regurgitation who underwent mitral valve repair surgery. One year later, the VO2peak values did not show significant improvement; however, the patients who had more than a mild degree of residual mitral

Hyun-Joong Kim; Seok Jin Ahn; Seung Woo Park; Byung Ryul Cho; Jidong Sung; Sun-Hee Hong; Pyo Won Park; Kyung Pyo Hong



Mitral valve surgery for marantic endocarditis and multiple cerebral embolisation.  


Valvular involvement is common in antiphospholipid syndrome (APS) with increased risk of thrombo-embolic events. We report a patient with APS and multiple cerebral infarcts. Echocardiography demonstrated verrucous vegetations of the mitral valve in keeping with marantic endocarditis. The patient underwent successful mitral valve replacement. Post-operative clinical and echocardiographic follow-up showed excellent short term results. PMID:23253884

Moustafa, Sherif; Patton, David J; Balon, Yvonne; Kidd, William T; Alvarez, Nanette



Robotic mitral valve surgery: A United States multicenter trial  

Microsoft Academic Search

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

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



Determination of the pressure required to cause mitral valve failure  

Microsoft Academic Search

A method has been developed for applying water pressure to a closed mitral valve on the side corresponding to the heart's left ventricle. The pressure is increased until fluid flows through the valve, i.e. until it fails. A specific dissection technique has been developed to produce a specimen with two annular rings, mitral annulus and papillary muscle annulus. Since the

D. M. Espino; D. W. L. Hukins; D. E. T. Shepherd; M. A. Watson; K. Buchan



[Mitral valve tissue characterization using acoustic microscopy].  


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

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



MitraClip catheter-based mitral valve repair system.  


The ongoing evolution of transcatheter valve technology is impressive. Mitral valve regurgitation is the most common type of heart valve insufficiency and mitral valve surgery is, next to aortic valve surgery, the second leading valvular surgical procedure in the western world. However, there is a large patient population suffering from mitral valve regurgitation that is currently not treated with heart surgery because of significant morbidity and mortality risks. This large underserved patient population could benefit from a less invasive treatment. The MitraClip system (Abbott Vascular, Menlo Park, CA, USA) is the first commercially available medical technology providing a catheter-based nonsurgical repair alternative for patients suffering from mitral valve regurgitation and has the greatest clinical experience compared with other alternative devices. The device is currently in late-stage clinical trials in the USA and has received the CE mark. PMID:20583881

Jönsson, Anders; Settergren, Magnus



Preoperative Posterior Leaflet Angle Accurately Predicts Outcome After Restrictive Mitral Valve Annuloplasty for Ischemic Mitral Regurgitation  

Microsoft Academic Search

Background—Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty, in which case it is associated with worse clinical outcomes. The goal of the present study was to determine whether persistence of MR and\\/or clinical outcome could be predicted from preoperative analysis of mitral valve configuration. Methods and Results—In 51 consecutive patients undergoing restrictive annuloplasty for ischemic MR, posterior

Julien Magne; Philippe Pibarot; François Dagenais; Zeineb Hachicha; Jean G. Dumesnil; Mario Sénéchal



The outcome and criteria for mitral valve surgery in patients with ischemic mitral regurgitation  

Microsoft Academic Search

Objectives: Mitral valve surgery for the correction of mitral regurgitation (MR) in patients with ischemic heart disease has been associated\\u000a with poor prognosis. The criteria for selecting an appropriate surgical procedure are not clearly defined. The objectives\\u000a of this study were to clarify the criteria for mitral valve manipulation and the outcome in patients with ischemic MR.Methods: Twenty patients with

Atsushi Yamaguchi; Koji Kawahito; Hideo Adachi; Takashi Ino



Mitral valve prolapse in hyperthyroidism of two different origins.  

PubMed Central

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.

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



Early open mitral valve surgery following arterial embolism  

PubMed Central

A report is presented of nine patients who underwent early open mitral valve surgery after arterial embolism had occurred. Five of these patients suffered an early second arterial embolism before their mitral operation, an observation which stresses the risk inherent in delay of mitral valve surgery. The demonstration of atrial thrombi in four illustrates the potential danger of closed valvotomy techniques in such cases. Advanced pathological changes and severe stenosis of the mitral valve were found in all nine patients; valve replacement had to be done in three. All nine patients are alive and well after follow-up from 6 to 42 months. No further thromboembolic events have occurred after mitral valve surgery.

Borman, J. B.; Merin, G; Romanoff, H.; Milwidsky, H.



Inhibitory Role of Notch1 in Calcific Aortic Valve Disease  

PubMed Central

Aortic valve calcification is the most common form of valvular heart disease, but the mechanisms of calcific aortic valve disease (CAVD) are unknown. NOTCH1 mutations are associated with aortic valve malformations and adult-onset calcification in families with inherited disease. The Notch signaling pathway is critical for multiple cell differentiation processes, but its role in the development of CAVD is not well understood. The aim of this study was to investigate the molecular changes that occur with inhibition of Notch signaling in the aortic valve. Notch signaling pathway members are expressed in adult aortic valve cusps, and examination of diseased human aortic valves revealed decreased expression of NOTCH1 in areas of calcium deposition. To identify downstream mediators of Notch1, we examined gene expression changes that occur with chemical inhibition of Notch signaling in rat aortic valve interstitial cells (AVICs). We found significant downregulation of Sox9 along with several cartilage-specific genes that were direct targets of the transcription factor, Sox9. Loss of Sox9 expression has been published to be associated with aortic valve calcification. Utilizing an in vitro porcine aortic valve calcification model system, inhibition of Notch activity resulted in accelerated calcification while stimulation of Notch signaling attenuated the calcific process. Finally, the addition of Sox9 was able to prevent the calcification of porcine AVICs that occurs with Notch inhibition. In conclusion, loss of Notch signaling contributes to aortic valve calcification via a Sox9-dependent mechanism.

Koenig, Sara N.; Nichols, Haley A.; Galindo, Cristi L.; Garner, Harold R.; Merrill, Walter H.; Hinton, Robert B.; Garg, Vidu



Polyurethane heart valves: fatigue failure, calcification, and polyurethane structure.  


Six flexible-leaflet prosthetic heart valves, fabricated from a polyetherurethaneurea (PEUE), underwent long-term fatigue and calcification testing. Three valves exceeded 800 million cycles without failure. Three valves failed at 775, 460, and 544 million cycles, respectively. Calcification was observed with and without associated failure in regions of high strain. Comparison with similar valves fabricated from a polyetherurethane (PEU) suggests that the PEU is likely to fail sooner as a valve leaflet. Localized calcification developed in PEUE leaflets at the primary failure site of PEU leaflets, close to the coaptation region of the three leaflets. The failure mode in PEU valves had the appearance of abrasion wear associated with calcification. High strains in the same area may render the PEUE leaflets vulnerable to calcification. Intrinsic calcification of this type, however, is a long-term phenomenon unlikely to cause early valve failure. Both polymers performed similarly during static in vitro and in vivo calcification testing and demonstrated a much lesser degree of calcification than bioprosthetic types of valve materials. Polyurethane valves can achieve the durabilities required of an implantable prosthetic valve, equaling the fatigue life of currently available bioprosthetic valves. PMID:9086407

Bernacca, G M; Mackay, T G; Wilkinson, R; Wheatley, D J



Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients  

Microsoft Academic Search

Objective: We sought to compare 10-year survival in patients after mitral valve replacement with biologic or mechanical valve prostheses. Methods: Retrospective survival analysis was performed on data from 1139 consecutive patients older than 18 years of age undergoing mitral valve replacement with Carpentier-Edwards (n = 495; Baxter Healthcare Corp, Irvine, Calif) or St Jude Medical (n = 644; St Jude

Ye-Ying Cen; Donald D. Glower; Kevin Landolfo; James E. Lowe; R. Duane Davis; Walter G. Wolfe; Carl Pieper; Bercedis Peterson



Echocardiographic analysis of a malfunctioning Davila-Sierra mitral valve  

PubMed Central

Although the Davila-Sierra mitral valve prosthesis was removed from the market nearly a decade ago, a number of patients still have this valve in place. We recently studied the echocardiographic features of a malfunctioning Davila-Sierra mitral valve prosthesis. Abnormalities that suggested improper functioning of the prosthesis included a markedly delayed poppet opening and an early diastolic hump believed to represent motion of the mitral annulus. Previously described echocardiographic indications of dys-function were not observed in our patient. We report the first known echocardiographic evaluation of a Davila-Sierra prosthesis. Images

Tri, Terry B.; Gregoratos, Gabriel



Mitral valve replacement with aortic heterografts in humans  

PubMed Central

The complications associated with the implantation of prosthetic valves and the experimental attempts to graft the mitral valve are described. Because of the disadvantages connected with the use of artificial valves and as the experimental methods of grafting the mitral valve did not prove satisfactory for clinical use, the authors developed a technique for mitral valve replacement using heterologous aortic valves—reinforced by a semirigid Teflon ring—placed above the mitral annulus inside the atrial cavity. The technique of collecting, preparing, and inserting these grafts is described in detail. Using this method, seven patients with mitral incompetence or mitral disease were operated upon between February and April, 1967. One patient died five weeks after the operation from bacterial endocarditis in a period of severe hospital infection with staphylococcus. The other six patients had a very good clinical result immediately after surgery. At the present time they are symptom-free and have normal heart sounds. Clinical and experimental data are discussed concerning the long-term fate of aortic heterografts in the mitral position. Images

Ionescu, M. I.; Wooler, G. H.; Smith, D. R.; Grimshaw, V. A.



Mitral Valve Repair for Anterior Leaflet Prolapse With Expanded Polytetrafluoroethylene Sutures  

Microsoft Academic Search

Background. This study was a long-term Doppler echo- cardiographic assessment of mitral valve repair for ante- rior mitral leaflet prolapse using expanded polytetrafluo- roethylene sutures. Methods. Between April 1992 and December 2003, we performed mitral valve repair using expanded polytetra- fluoroethylene sutures in 204 patients (mean age, 54.6 years) with severe mitral regurgitation (MR) having an- terior mitral leaflet prolapse.

Hitoshi Kasegawa; Tomoki Shimokawa; Ikuko Shibazaki; Hiroki Hayashi; Toshiya Koyanagi; Takao Ida



[Mitral valve replacement in dextrocardia and situs inversus].  


Cardiac surgery for acquired valvular diseases in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve replacement and tricuspid annuloplasty in a patient with dextrocardia and situs inversus. A 74-year-old man with dextrocardia and situs inversus, who had undergone patch closure of atrial septal defect 25 years before, was referred for surgical treatment of severe mitral and tricuspid valve regurgitation. Preoperative computed tomography( CT) showed dextrocardia, situs inversus, interruption of the inferior vena cava with an azygos vein continuation, and drainage of the hepatic vein into the right atrium. Under redo-median sternotomoy, cardiopulmonary bypass was established by cannulating the ascending aorta, the superior vena cava, the right femoral and the hepatic veins. The surgeon operated from the left side of the operating table, and had an excellent exposure to the mitral and tricuspid valves during the operation. Mitral valve replacement and tricuspid annuloplasty were performed successfully. The postoperative course was uneventful. PMID:22940654

Uchimuro, Tomoya; Fukui, Toshihiro; Matsuyama, Shigefumi; Tabata, Minoru; Takanashi, Shuichirou



Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae  

Microsoft Academic Search

Background. A new technique is suggested for the reconstructive surgical treatment of mitral regurgitation. It involves partial transfer of the tricuspid valve of the patient to the mitral valve, in order to provide chordae to correct anterior leaflet prolapse of the mitral valve, secondary to rupture of the chordae tendineae.Methods. From January 1991 to May 1997, 20 patients with mitral

Francisco Gregori; Celso O Cordeiro; Ulisses A Croti; Sergio S Hayashi; Samuel S da Silva; Thelma E. F Gregori



Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement  

PubMed Central

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

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



Defect in mitochondrial functions in damaged human mitral valve  

Microsoft Academic Search

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

Santosh Shinde; Pawan Kumar; Kaushala Mishra; Neela Patil



Accessory mitral valve as a potential source of cardioembolism.  


An accessory mitral valve (AMV) is considered to arise from abnormal development of endocardial cushion tissue. It is a very rare entity, commonly diagnosed in childhood and associated with symptomatic left ventricular outflow tract (LVOT) obstruction. Here we describe the presence of AMV in a 58-year old patient who presented with a transient ischemic attack. Transesophageal echocardiography visualized a spherical structure attached to the ventricular aspect of the anterior mitral valve leaflet. PMID:17707535

Bär, Harald; Katus, Hugo A; Mereles, Derliz



Minimally Invasive Port-Access Mitral Valve Surgery  

Microsoft Academic Search

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

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



Percutaneous implantation of CoreValve aortic prostheses in patients with a mechanical mitral valve.  


Concerns exist in the field of transcatheter aortic valve implantation regarding the treatment of patients with mechanical mitral valve for possible interference between the percutaneous aortic valve and the mechanical mitral prosthesis. We report our experience with percutaneous aortic valve implantation in 4 patients with severe aortic stenosis, previously operated on for mitral valve replacement with a mechanical prosthesis. All patients underwent uneventful percutaneous retrograde CoreValve implantation (CoreValve Inc, Irvine, CA). No deformation of the nitinol tubing of the prostheses (ie, neither distortion nor malfunction of the mechanical valve in the mitral position) occurred in any of the patients. All patients are alive and asymptomatic at a mean follow-up of 171 days. PMID:19853076

Bruschi, Giuseppe; De Marco, Federico; Oreglia, Jacopo; Colombo, Paola; Fratto, Pasquale; Lullo, Francesca; Paino, Roberto; Frigerio, Maria; Martinelli, Luigi; Klugmann, Silvio



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


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

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



[Prosthetic valve endocarditis associated with paravalvular aortic and mitral abscesses].  


A 63-year-old female, who had undergone aortic and mitral valve replacement 16 years ago, was admitted because of urinary tract infection. The patient developed cerebral hemorrhage. Methicillinresistant Staphylococcus aureus was isolated from her blood culture. Transesophageal echocardiography revealed paravalvular aortic and mitral abscesses, and the diagnosis of prosthetic valve endocarditis was established. A redo double valve replacement was performed. Both paravalvular abscess cavities were debrided and closed with fresh autologous pericardial patches, and mechanical valves were implanted. The patient's postoperative course was uneventful, and she had no sign of recurrent infection 3 years postoperatively. PMID:22374598

Aoki, Takayuki; Nishizawa, Junichiro; Nishio, Hiroomi



Dissection of the atrial wall after mitral valve replacement.  

PubMed Central

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

Lukacs, L; Kassai, I; Lengyel, M



Animal Models of Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD), once thought to be a degenerative disease, is now recognized to be an active pathobiological process, with chronic inflammation emerging as a predominant, and possibly driving, factor. However, many details of the pathobiological mechanisms of CAVD remain to be described, and new approaches to treat CAVD need to be identified. Animal models are emerging as vital tools to this end, facilitated by the advent of new models and improved understanding of the utility of existing models. In this paper, we summarize and critically appraise current small and large animal models of CAVD, discuss the utility of animal models for priority CAVD research areas, and provide recommendations for future animal model studies of CAVD.

Sider, Krista L.; Blaser, Mark C.; Simmons, Craig A.



Calcification characteristics of porcine stentless valves in juvenile sheep1  

Microsoft Academic Search

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

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


[Conduction disorders and sites of calcification of the mitral ring: 2-dimensional echocardiographic study].  


The association between a calcified mitral annulus and impairment of cardiac impulse transmission is well known. However informations on the relations between the site of mitral calcification and conduction disturbance are still scanty. Twenty-nine patients (22 women and 7 men, mean age 64.4 +/- 13.1 years) with M-mode and two-dimensional echocardiographic evidence of mitral annulus calcifications were studied. The "annulus" was subdivided in 4 segments: antero-medial, antero-lateral, postero-medial and postero-lateral. Conduction disturbances were present in 15 patients (51.7%). Atrio-ventricular or intra-ventricular conduction defects were found in 12 out of 15 patients with calcifications of the antero-medial segment and only in 3 of 14 subjects without antero-medial calcifications (P less than .01). The presence of conduction defects therefore seems to be significantly increased when calcium deposition is located near the conduction system. PMID:3743933

Montemurro, D; Ronzani, G; Defilippi, G; Pizzuti, A; Brusca, A



Papillary Fibroelastoma Mimicking Vegetation of the Mitral Valve  

PubMed Central

Although cardiac papillary fibroelastoma is rare, it is the most common primary tumor of cardiac valves. The clinical presentation of these tumors varies from asymptomatic to embolic complications. We report an asymptomatic case of papillary fibroelastoma of mitral valve which was diagnosed by transthoracic echocardiography. The tumor was successfully resected by surgery.

Kim, Su Young; Lee, Dong-Yeol; Lee, Dong Hyun; Cho, Young-Rak; Kim, Moo-Hyun; Kim, Young-Dae; Hong, Sook Hee



Mitral valve-sparing procedures and prosthetic heart valve failure: A case report  

PubMed Central

Prosthetic heart valve dysfunction due to thrombus or pannus formation can be a life-threatening complication. The present report describes a 47-year-old woman who developed valvular cardiomyopathy after chorda-sparing mitral valve replacement, and subsequently underwent heart transplantation for progressive heart failure. The explanted mitral valve prosthesis showed significant thrombus and pannus leading to reduced leaflet mobility and valvular stenosis. The present report illustrates the role of the subvalvular apparatus and pannus in prosthesis dysfunction.

Khan, Nasir A; Butany, Jagdish; Leong, Shaun W; Rao, Vivek; Cusimano, Robert J; Ross, Heather J



Mitral valve surgery in the presence of pulmonary hypertension.  


Mitral valve surgery was performed in 59 patients with severe pulmonary hypertension (average systolic pulmonary artery pressure 77.1 +/- 18.6 mmHg; range 50-115 mmHg) between 1983 and 1990. Thirty-eight patients had been subjected to mitral valve replacement, 16 patients both mitral and aortic valve replacement, and 5 patients had open mitral commissurotomy, with an operative (30 day) mortality of 5.0%. These 3 deaths happened during the early postoperative period. Survivors were followed up for a period ranging from 6 months to 7 years with a mean of 36 months. Four late deaths (7.1%) occurred in patients with valve replacement. Actuarial survival was 93 +/- 3% at 5 years, and 90.7 +/- 4.4% at 7 years. Right ventricular catheterization was performed on 14 patients a mean of 38 months following operation. Systolic pulmonary artery pressure had decreased from a mean of 77.1 +/- 18.6 to 39.7 +/- 14.0 mmHg (p less than 0.001) and 90% of the survivors were in New York Heart Association Class 1 or II compared to 23.7% preoperatively. The clinical and hemodynamic findings in this series suggest that severe pulmonary hypertension is not a contraindication, and pulmonary hypertension decreases significantly after mitral valve surgery. PMID:1593747

Pa?ao?lu, I; Demircin, M; Do?an, R; Ozmen, F; Ersoy, U; Böke, E; Bozer, A Y



Percutaneous transluminal balloon dilatation of the mitral valve in pregnancy.  

PubMed Central

Pregnancy can cause life threatening complications in women with mitral stenosis, and there is a substantial risk of fetal death if valvotomy under cardiopulmonary bypass is required. A patient is described in whom pulmonary oedema developed after delivery of her first child by caesarean section 13 months previously. Subsequent cardiac catheterisation showed severe mitral stenosis (valve area 0.96 cm2, valve gradient 12 mm Hg, pulmonary artery pressure 30/16 mm Hg). Before valvotomy could be performed the patient again became pregnant and presented in pulmonary oedema at twenty two weeks' gestation. Medical treatment was unsuccessful and she underwent percutaneous transluminal balloon dilatation of the mitral valve. This increased the valve area to 1.78 cm2 and reduced the transmitral gradient to 6 mm Hg. The procedure was uncomplicated, and she remained symptom free on no medication. She delivered vaginally at 37 weeks' gestation. Percutaneous transluminal balloon dilatation of the mitral valve is a safe and effective alternative to mitral valvotomy in pregnancy.

Smith, R; Brender, D; McCredie, M



Flail P2 cusp of posterior mitral valve leaflet demonstrated on multi-slice computed tomography.  


We report a case of flail mitral valve in an elderly man. Contrast enhanced images of the left ventricle were compared with transthoracic echocardiography. MSCT during systolic phase accurately identified the flail P2 cusp of posterior mitral valve leaflet. It can be performed non-invasively without requiring sophisticated software. Our case suggests that MSCT may have a role in preoperative assessment of coronary arteries and mitral valve apparatus before mitral valve surgery. PMID:17052789

Wong, Teck Wee; De Larrazabal, Catherine; Boey, H Khim; Lim, Michael C L



Echocardiographic evaluation of congenital mitral valve anomalies in children  

Microsoft Academic Search

Congenital mitral valve anomalies were diagnosed in 65 children, whose ages ranged from newborn to 18 years, using 2-dimensional, color, pulsed-, and continuous-wave Doppler ultrasound. Data were collected over 7.5 years from 13,400 new studies. Data in these patients were compared with those obtained by cardiac catheterization, cardiac surgery, and autopsy. We detected 4 different lesions: (1) congenital mitral stenosis

Anirban Banerjee; Thomas Kohl; Norman H. Silverman



Complications during percutaneous edge-to-edge mitral valve repair.  


Transcatheter edge-to-edge mitral valve repair is an approach for treating mitral regurgitation, which is an alternative for surgery in patients with a high surgical risk. Although the safety and efficacy of the technique have been demonstrated, it is still associated with potentially life-threatening complications. The aim of this paper is to discuss the nature, management, and prevention of the most important procedural complications associated with this procedure. PMID:23797375

Bakker, A L M; Swaans, M J; van der Heyden, J A S; Eefting, F D; Rensing, B J W M; Post, M C



[Anesthetic management for mitral valve replacement in a patient with mitral stenosis and dilated cardiomyopathy].  


A 42-year-old man with dilated cardiomyopathy and rheumatic mitral stenosis underwent mitral valve replacement. Prior intravascular fluid administration and infusion of dopamine and dobutamine stabilized hemodynamics during the induction of anesthesia. High-dose fentanyl at pre-cardiopulmonary bypass period and circulatory assist with milrinone and intraaortic balloon pumping after the bypass enabled us to obtain stable hemodynamics. Preoperative dobutamine stress test provided us the effective information for circulatory management in this patient. PMID:10402817

Kurokawa, S; Fujihara, H; Tobita, T; Fukuda, S; Shimoji, K



Efficacy of a Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Operations  

Microsoft Academic Search

Background. We have devised a simple surgical procedure to be performed on the posterior wall of the left atrium for the treatment of chronic atrial fibrillation (AF) associated with mitral valve disease. The effectiveness of this procedure for serial mitral valve operations was then evaluated. We postulated that chronic AF associated with mitral valve disease could be attributable to a



Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed?  

Microsoft Academic Search

Objective: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms, and impairs quality of life. Arrhythmia surgery for AF shows today very satisfying results and therefore mitral valve surgery with AF surgery appears appealing. This study explores whether combined surgery in view of today's results of mitral valve surgery is indicated. Methods and

Emile R. Jessurun; Norbert M. van Hemel; Johannes C. Kelder; Suzanne Elbers; Aart Brutel de la Rivière; Jo J. A. M. Defauw; Jef M. P. G. Ernst



Prevalence of Mitral Valve Prolapse in Chronic Lymphocytic Thyroiditis and Nongoitrous Hypothyroidism  

Microsoft Academic Search

An increased prevalence of mitral valve prolapse has been found in Graves’ disease and a common autoimmune etiology has been suggested for both disorders. We investigated the prevalence of mitral valve prolapse in 87 patients with autoimmune chronic lymphocytic thyroiditis, 50 patients with nongoitrous hypothyroidism and 111 healthy control subjects. Mitral valve prolapse was found in 16.09% of patients with

A. Brauman; T. Rosenberg; Y. Gilboa; M. Algom; L. Fuchs; Z. Schlesinger



[Heart valve calcification in patients with chronic kidney disease].  


The aim of the study was to identify factors related to heart valve calcification (HVC) and effect of HVC on intracardiac hemodynamics in patients with chronic kidney disease (CKD). 377 CKD patients of the control group and 132 ones treated by hemodialysis (HD) were examined using echocardiography, cardiomonitoring, measurement of the carotid intima-media thickness and mineral bone density, X-ray imaging of calcified abdominal aorta. HVC was diagnosed in 38.9 and 27.3% of the CKD patients on hemodialysis and without it respectively. In both groups, patients with HVC were older than HVC-free ones, more of them had coronary heart disease, cardiac insufficiency, aortic calcinosis, and biochemically identifiable inflammation. In the absence of hemodialysis, patients with HVC had thicker intima-media compex, lower glomerular filtration rate, higher arterial pressure, and increased occurrence of diabetes mellitus. In HVC patients receiving hemodialysis, its duration was longer, blood PTH and calcium levels higher, forearm MOC lower. HVC associated with stenosis of mitral and aortic valves, aortic regurgitation, enlarged left and right atrium, thickened left and right ventricular wall. Multifactor analysis showed that HVC in patients receiving hemodialysis was related to the age, disbalance of phosporus and sodium, and duration of hemodialysis; in its absence, it was related to intima-media thickness and diabetes mellitus. Thus, in patients of the latter group, HVC was in the first place associated with atherosclerosis aggravated by a decrease of glomerular filtration rate and with the presence of diabetes. In patients receiving hemodialysis, HVC correlated with phosporus/sodium disbalance and atherosclerosis. The study revealed negative effect of HVC on intracardiac hemodynamics and for the first time demonstrated decreased MOC in patients with HYC. PMID:19670713

Volkov, M M; Smirnov, A V; Dobronravov, V A; Degtereva, O A; Sheviakova, E V; Panina, I Iu; Trofimenko, I I



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

Microsoft Academic Search

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

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



A new bioprosthesis for aortic and mitral valve replacement: preliminary evaluation of the Tascon valve.  


The Tascon valve, a new porcine bioprosthesis, features a detachable sewing ring designed to facilitate insertion and removal. Between April 1984 and June 1986, we implanted the Tascon valve in 25 patients, 12 of whom underwent aortic valve replacement (AVR), and 13 of whom had mitral valve replacement (MVR). Most of the patients were in NYHA class III or IV. Four MVR patients had had previous mitral valve operations, and three AVR patients required composite graft valved conduits. The valve's screw-locking mechanism worked well in all cases, especially in the AVR cases. There were no hospital deaths, and no significant morbidity or valve-related complications were encountered. One late death occurred 3 months after surgery, owing to causes unrelated to the valve. At the end of the study period, most of the survivors had improved by at least two NYHA functional classes. Postoperative aortic and mitral valve gradients and mitral valve areas, as measured by Doppler methods, were excellent. No significant regurgitation was detected. These favorable results indicate that the Tascon valve is a safe, useful bioprosthesis, with satisfactory hemodynamic characteristics. PMID:15227327

Fernandez, J; Gonzalez-Lavin, L; Maranhao, V; Yang, S S



Mitral valve repair: a clinical and echocardiographic study.  

PubMed Central

OBJECTIVE--To evaluate the clinical and echocardiographic results of mitral valve repair done within an 11 year period. DESIGN--Retrospective review of case notes and clinical and echocardiographic examination of survivors. Analysis was made according to the intention to treat principle. PATIENTS--A consecutive series of 94 patients with mitral valve disease who had mitral reconstruction between 1980 and 1991. INTERVENTIONS--Mitral repair according to the techniques of Carpentier or Duran. MAIN OUTCOME MEASURES--Operative mortality, actuarial survival, rates of freedom from reoperation, thromboembolism, infective endocarditis, clinical state, and echocardiographic findings. RESULTS--There were equal numbers of males and females (mean (range) age 49 (4-74) years). The aetiology of mitral disease was degenerative in 59% and rheumatic in 30% of the patients. Operative mortality was 3%. The 10 year actuarial and valve related survival rates were 67% and 75%. At 10 years, 84% of the patients were free from thromboembolism, 94% free from haemorrhage related to anticoagulation, 88% free from infective endocarditis, and 73% free from reoperation. Of 75 survivors with completed follow up, 96% were in New York Heart Association functional class I or II and 64% were in sinus rhythm. Of 55 survivors who had an echocardiogram at follow up, normal left ventricular end diastolic dimension was shown in 76% and normal left ventricular shortening fraction in 89%. Doppler studies showed no mitral regurgitation in 36%, trivial or mild in 42%, moderate in 14%, and severe in 7% of patients. In stepwise logistic analysis previous myocardial infarction was associated with poor outcome (odds ratio: 13.7, p < 0.05). CONCLUSION--The results are comparable with similar studies and support the value of mitral valve repair. There is reservation about the use of repair for patients with previous myocardial infarction.

Xu, M.; McHaffie, D. J.; Hilless, A. D.



Mitral Valve Mechanics Following Posterior Leaflet Patch Augmentation  

PubMed Central

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.

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



Atrial Fibrillation and Early Clinical Outcomes After Mitral Valve Surgery in Patients with Rheumatic vs. Non-Rheumatic Mitral Stenosis  

PubMed Central

Background: Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. Materials and Methods: We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants’ samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. Results: The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8). Conclusion: We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement.

Mirhosseini, S. J.; Ali-Hassan-Sayegh, Sadegh; Hadadzadeh, Mehdi; Naderi, Nafiseh; Mostafavi Pour Manshadi, S. M. Y.



Hemodynamic and cellular response feedback in calcific aortic valve disease.  


This review highlights aspects of calcific aortic valve disease that encompass the entire range of aortic valve disease progression from initial cellular changes to aortic valve sclerosis and stenosis, which can be initiated by changes in blood flow (hemodynamics) and pressure across the aortic valve. Appropriate hemodynamics is important for normal valve function and maintenance, but pathological blood velocities and pressure can have profound consequences at the macroscopic to microscopic scales. At the macroscopic scale, hemodynamic forces impart shear stresses on the surface of the valve leaflets and cause deformation of the leaflet tissue. As discussed in this review, these macroscale forces are transduced to the microscale, where they influence the functions of the valvular endothelial cells that line the leaflet surface and the valvular interstitial cells that populate the valve extracellular matrix. For example, pathological changes in blood flow-induced shear stress can cause dysfunction, impairing their homeostatic functions, and pathological stretching of valve tissue caused by elevated transvalvular pressure can activate valvular interstitial cells and latent paracrine signaling cytokines (eg, transforming growth factor-?1) to promote maladaptive tissue remodeling. Collectively, these coordinated and complex interactions adversely impact bulk valve tissue properties, feeding back to further deteriorate valve function and propagate valve cell pathological responses. Here, we review the role of hemodynamic forces in calcific aortic valve disease initiation and progression, with focus on cellular responses and how they feed back to exacerbate aortic valve dysfunction. PMID:23833293

Gould, Sarah T; Srigunapalan, Suthan; Simmons, Craig A; Anseth, Kristi S



Doppler echocardiographic study of pulmonary venous flow in mitral stenosis and early after mitral valve replacement.  


The aim of the study was Doppler echocardiographic assessment of the effect of mitral stenosis (MS) on pulmonary venous flow (PVF), and of any changes occurring after mitral valve replacement. Fifty patients with MS (22 in atrial fibrillation (AF)) and 28 healthy subjects (control group) underwent transthoracic echocardiographic evaluation of PVF. Fourteen of the 22 patients in AF were submitted in addition to transesophageal echo study before and after mitral valve replacement. Pulmonary wedge pressure was measured in 18 patients. Patients in sinus rhythm (SR) and more than mild MS showed significantly decreased peak velocity and flow velocity time integral of the systolic forward PVF. This finding was more exaggerated in MS with AF. Concerning diastolic forward PVF, patients in SR showed significantly decreased peak velocity and velocity time integral, irrelevant of the degree of MS, while patients with AF exhibited adequate signs of flow. In all patients duration, deceleration time (D-DT) and pressure half-time (D-PHT) of the diastolic forward PVF were significantly increased. The last two parameters correlated with the corresponding variables of mitral flow and with echocardiographically determined mitral valve area and the D-DT of the pulmonary wedge pressure. Concerning reversed PVF, patients with more than mild MS exhibited significantly increased peak velocity and velocity time integral. After mitral valve replacement, a significant increase of diastolic forward peak velocity and velocity time of the PVF were detected. The duration of diastolic forward peak velocity of PVF, D-DT and D-PHT decreased. The systolic forward phase did not change significntly after the valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7952318

Kranidis, A I; Kostopoulos, K G; Filippatos, G B; Kardaras, F G; Kappos, K G; Koulouris, S N; Fehske, W; Lolas, C T; Anthopoulos, L P



Pulmonary hypertension in mitral valve disease: 56 surgical patients reviewed.  

PubMed Central

A total of 392 patients have undergone prosthetic valve surgery including the mitral valve over a four-year period (1972-76). Of these patients 56 (14%) had a pulmonary artery systolic pressure of 70 mmHg or more during preoperative cardiac catheterisation and the hospital mortality of this group was 5.4%. Similarly, the hospital mortality of the remaining 336 patients with a pulmonary artery pressure below 70 mmHg was 5.4%. The presence of pulmonary hypertension in patients with valve disease including the mitral valve does not therefore indicate that the risk of dying in hospital as a consequence of corrective surgery is increased. The absence of a raised hospital mortality in this recent series may be attributed to improved surgical techniques and materials, while the use of droperidol and pentolinium which may reduce pulmonary vascular resistance as well as systemic resistance during surgery could be contributory.

Manners, J M; Monro, J L; Ross, J K



Early massive thrombosis of a mechanical mitral valve.  

PubMed Central

We report the case of a 74-year-old woman who underwent an elective procedure to replace her mitral valve with a 27-mm CarboMedics bileaflet valve (CarboMedics, Inc.; Austin, Tex) to correct mitral incompetence. Massive thrombosis of the prosthesis was clinically evident on the 6th postoperative day, despite administration of warfarin therapy according to our usual protocol. After an unsuccessful attempt at thrombolysis with recombinant tissue plasminogen activator, the mechanical prosthesis was replaced with a bioprosthesis. The cause of the thrombosis is unknown, but transient suboptimal anticoagulation is assumed to be responsible. Although very early massive valve thrombosis is a rare occurrence, it is a known risk of prosthetic valve implantation. Antiplatelet therapy, in addition to the usual warfarin anticoagulation, can help to prevent it. If thrombosis is diagnosed, it can be managed by thrombolysis or, when thrombolysis is unsuccessful, by reoperation. Transesophageal echocardiography is fundamental in the diagnosis and management of this sequela. Images

Masiello, P; Mastrogiovanni, G; Santoro, G; Iesu, S; Di Benedetto, G



Quantification of mitral valve stenosis by three-dimensional transesophageal echocardiography.  


The aim of this study was the evaluation of the diagnostic potentials of transesophageal 3D- echocardiography in the determination of mitral valve stenosis. 54 patients were investigated by transthoracic and multiplane transesophageal echocardiography. In 41 patients cardiac catheterization was performed. 3D- echocardiographic data acquisition was performed by automatic transducer rotation at 2 degree increments over a span of 180 degrees. The transesophageal probe was linked to an ultrasound unit and to a 3D- workstation capable of ECG- and respiration gated data acquisition, postprocessing and 2D/3D image reconstruction. The mitral valve was visualized in sequential cross-sectional planes out of the 3D data set. The spatial position of the planes was indicated in a reference image. In the cross-sectional plane with the narrowest part of the leaflets the orifice area was measured by planimetry. For topographic information a 3D view down from the top of the left atrium was reconstructed. Measurements were compared to conventional transthoracic planimetry, to Doppler-echocardiographic pressure half time and to invasive data. The mean difference to transthoracic planimetry, pressure half time and to invasive measurements were 0.3 +/- 0.1 cm2, 0.2 +/- 0.1 cm2 and 0.1 +/- 0.1 cm2, respectively. Remarkable differences between the 3D- echocardiographic and the 2D- or Doppler- echocardiographic methods were observed in patients with severe calcification or aortic regurgitation. In 22% of the patients the 3D data set was not of diagnostic quality. New diagnostic information from a 3D view of the mitral valve could be obtained in 69% of the patients. Thus, although image quality is limited, 3D- echocardiography provides new topographic information in mitral valve stenosis. It allows the use of a new quantitative method, by which image plane positioning errors and flow-dependent calculation is avoided. PMID:8993986

Kupferwasser, I; Mohr-Kahaly, S; Menzel, T; Spiecker, M; Dohmen, G; Mayer, E; Oelert, H; Erbel, R; Meyer, J



[Mitral valve insufficiency secondary to endocardial fibrosis associated with distomatosis].  


A new case of assumed parasitic cardiac disease is reported once more; a 67 year old woman with a trematode injection presenting with mitral incompetence and left ventricular failure. Biventricular endomyocardial fibrosis predominating at the apex was diagnosed at angiography and confirmed at surgery. Mitral incompetence was related to retraction of the papillary muscles which were surrounded by fibrosis, the rest of the mitral apparatus being normal. There was no indication for endocardectomy and so, mitral valve replacement alone was performed. There are few previous reports of parasitic cardiac disease: one case of left ventricular endomyocardial fibrosis, one case of biventricular fibroplastic parietal endocarditis and one case of cardiomyopathy. This report emphasises the need for cardiac examination in patients with parasitic diseases. PMID:6800330

Potier, J C; Grollier, G; Le Clerc, A; Mandard, J C; Rousselot, P; Maiza, D; Khayat, A; Verwaerde, J C; Valla, A; Foucault, J P



Minimally Invasive Mitral Valve Surgery: A Systematic Review  

PubMed Central

In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival.

Luca, Fabiana; van Garsse, Leen; Rao, Carmelo Massimiliano; Parise, Orlando; La Meir, Mark; Puntrello, Calogero; Rubino, Gaspare; Carella, Rocco; Lorusso, Roberto; Gensini, Gian Franco; Maessen, Jos G.; Gelsomino, Sandro



Natural History of Mitral Valve Prolapse in Military Aircrew  

Microsoft Academic Search

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

Ori Wand; Alex Prokupetz; Alon Grossman; Amit Assa



Early bioprosthetic mitral valve degeneration due to subchordal apparatus impingement.  


We present a case of early degeneration of a bioprosthesis in the mitral position three years after implantation. Valve explantation revealed complete neo-intima formation and complete fusion of one commissure due to papillary muscle and chordae tendineae embedding in the bioprosthetic leaflets. PMID:23311618

Bianchi, Giacomo; Solinas, Marco; Gilmanov, Daniyar; Glauber, Mattia



Cardiac autotransplantation for aortic and mitral valve replacement in a patient with nephrogenic systemic fibrosis.  


Adequate exposure is a prerequisite for open valve surgery. The mitral valve can rarely be very challenging to expose. We describe a redo double valve replacement in a patient with nephrogenic systemic fibrosis in whom exposure of the mitral valve was achieved with cardiac autotransplantation. PMID:20118047

Panos, Aristotelis; Milas, Fotis; Kalakonas, Spyros; Myers, Patrick O


Mitral valve dimensions and motion in Marfan patients with and without mitral valve prolapse. Comparison to primary mitral valve prolapse and normal subjects.  


To determine mitral valve and extravalvular findings associated with mitral valve prolapse (MVP) in patients with the Marfan syndrome, we compared mitral leaflet and anular dimensions and motion by computerized two-dimensional echocardiography in 53 Marfan patients (28 with M-mode echocardiographic MVP) to those in 48 adults with primary MVP and in 35 normal subjects. Mitral leaflet billowing occurred in 28 of 28 Marfan patients with M-mode MVP versus 24 of 48 with primary MVP (p less than 0.00005), 0 of 25 Marfan patients without M-mode MVP, and 0 of 35 normal subjects (both, p less than 0.0001). Billowing occurred on the first systolic frame in 8 of 28 Marfan-MVP patients, in whom posterior leaflet chordae arose abnormally from the posterior ventricular wall, and in no other subjects. These patients had large mitral valves and normal anular dynamics, whereas the remaining 20 Marfan-MVP patients had increased systolic anular expansion. Marfan-MVP patients were younger than those without MVP (29 +/- 12 vs. 38 +/- 15 years, p less than 0.02) and had lower body mass index (19.8 +/- 2.7 vs. 23.9 +/- 2.9 kg/m2, p less than 0.00005) and systolic blood pressure (120 +/- 20 vs. 133 +/- 20 mm Hg, p less than 0.05), similar to differences between primary MVP and normal subjects in body mass index (21.5 +/- 3.0 vs. 23.9 +/- 4.8 kg/m2, p less than 0.01) and systolic pressure (118 +/- 14 vs. 125 +/- 18 mm Hg, p less than 0.05). Marfan patients with and without MVP had similar arm span, arm span to height ratio, upper to lower segment ratio, and prevalence of ectopia lentis and thoracic bony abnormalities, but arachnodactyly was more frequent in those with MVP (82% and 48%, respectively; p less than 0.02). We conclude that 1) leaflet billowing occurs more uniformly in Marfan patients with MVP than in primary MVP, 2) MVP in Marfan patients may be due to either valve enlargement with distinctively abnormal chordal architecture or abnormal mitral anular distensibility, 3) Marfan patients with MVP have low body weight and systolic blood pressure, similar to primary MVP, and 4) Marfan patients with MVP more commonly have arachnodactyly but otherwise have similar skeletal and anthropometric characteristics to other Marfan patients. PMID:2791251

Pini, R; Roman, M J; Kramer-Fox, R; Devereux, R B



[Mitral valve prolapse. An echocardiographic study of 456 cases].  


The prolapse of the mitral valve is an affection arousing much interest from the clinical and echocardiographical viewpoints. The present paper reports on the analysis of 456 cases (322 women--70% and 134 men--29.39%), suffering from prolapse of the mitral valve, selected out of 15,714 echocardiographic examinations (2.93%). All the patients were examined echocardiographically--Echo) in the M mode and bidimensionally; 256 cases underwent an Echo-Doppler examination, too and in 90 cases the phonocardiogram was also used. 983 cases were diagnosed as clinically suffering from prolapse, confirmed by Echo in 291 cases (29.62%), and in 165 cases the diagnosis was established only clinically. Phonocardiographically, the most frequent were recorded the mesotelesystolic click (40%), followed by click + holosystolic murmur (31.11%), telesystolic murmur (19.70%), holosystolic murmur (6.66%). The prolapse of the mitral valve was evidenced in 394 cases, both by M-Echo and by 2D-Echo; in 28 (6.1%) cases it was evidenced only by M-Echo, and in 34 cases (7.4%) only by 2D-Echo. In 62 cases (13.4%) the prolapse was better evidenced when the patients stood. The most affected was the anterior mitral valve, 203 cases (44.5%). The conclusion was drawn that the prevalence of the prolapse of the mitral valve is of 2.93% according to the Echo examination. A correct diagnosis requires the use of a rigorous examination technique and the observance of the clinical and Echo diagnosis criteria. PMID:1978394

Apetrei, E; Coman, I; Alexandru, D; Danciu, C; Carp, C


Association between mitral annulus calcification and aortic atheroma: a prospective transesophageal echocardiographic study  

Microsoft Academic Search

Background and purpose: Although mitral annulus calcification (MAC) has been reported to be a significant independent predictor of stroke, no causative relationship was proven. It is also known that aortic atheroma (AA), especially those ?5 mm thick and\\/or protruding and\\/or mobile are associated with stroke. This study was designed to determine whether an association exists between MAC and AA. Methods:

Yehuda Adler; Mordehay Vaturi; Noam Fink; David Tanne; Yaron Shapira; Daniel Weisenberg; Noga Sela; Alex Sagie



Kangaroo vs. Porcine Aortic Valves: Calcification Potential after Glutaraldehyde Fixation  

Microsoft Academic Search

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

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



Mitral Valve Function and Chordal Force Distribution Using a Flexible Annulus Model: An In Vitro Study  

Microsoft Academic Search

Since variations in annular motion\\/shape and papillary muscle displacement have been observed in studies of dilated cardiomyopathy and ischemic mitral regurgitation, the objective of this study was to investigate the effects of annular motion\\/flexibility and papillary muscle displacement on chordal force and mitral valve function. Six human mitral valves were studied in a left heart simulator using a flexible annular

Jorge Hernan Jimenez; Dennis Dam Soerensen; Zhaoming He; Jennifer Ritchie; Ajit P. Yoganathan



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

Microsoft Academic Search

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

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



Multiplanar visualization in 3D transthoracic echocardiography for precise delineation of mitral valve pathology.  


A novel multiplanar reformatting (MPR) technique in three-dimensional transthoracic echocardiography (3D TTE) was used to precisely localize the prolapsed lateral segment of posterior mitral valve leaflet in a patient symptomatic with mitral valve prolapse (MVP) and moderate mitral regurgitation (MR) before undergoing mitral valve repair surgery. Transesophageal echocardiography was avoided based on the findings of this new technique by 3D TTE. It was noninvasive, quick, reproducible and reliable. Also, it did not need the time-consuming reconstruction of multiple cardiac images. Mitral valve repair surgery was subsequently performed based on the MPR findings and corroborated the findings from the MPR examination. PMID:18186784

Kuppahally, Suman S; Paloma, Allan; Craig Miller, D; Schnittger, Ingela; Liang, David



Left-sided approach for mitral valve replacement in a case of dextrocardia with situs solitus.  


Mitral valve surgery in dextrocardia is technically challenging due to its anatomical malposition. Minor modifications are required in the surgical technique to counteract the problems during cannulation and exposure of the mitral valve. We report a case of a patient with dextrocardia, situs solitus, rheumatic heart disease, severe mitral regurgitation, moderate pulmonary artery hypertension, and severe left ventricular dysfunction who underwent mitral valve replacement using a two-stage right atrial cannulation with left-sided left atrial atriotomy, with the surgeon standing on the left side of the patient. Our approach for mitral valve surgery in this clinical setting is simple. PMID:23912624

Kikon, Mhonchan; Kazmi, Aamir; Gupta, Anubhav; Grover, Vijay



Isolated non-obstructive accessory mitral valve tissue in an adult mimicking ruptured chordae.  


Accessory mitral valve tissue is commonly associated with other congenital heart diseases and is usually detected in children causing left ventricular outflow tract obstruction. We present an adult patient with isolated non-obstructive accessory mitral valve tissue that was mimicking ruptured chordae of the mitral valve. Accessory mitral valve tissue in adults is very rare and can mimick various causes of left ventricular outflow tract obstruction. This patient represents the first case in literature wherein an unobstructive accessory mitral valve tissue simulated a ruptured chordae. This case illustrates that in patients with suspected mitral valve chordae rupture without any mitral regurgitation, this diagnosis should be considered, which can have therapeutic implications. PMID:23809393

Panduranga, Prashanth; Al-Mukhaini, Mohammed



Mitral valve surgery in the patient with left ventricular dysfunction.  


Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 125 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred twenty-five patients with 4+ MR, left ventricular ejection fractions from 8% to 24% (mean 14%), and New York Heart Association class III or IV symptoms were prospectively studied. All patients underwent mitral valve repair with an undersized flexible annuloplasty ring. There was one intraoperative death and five 30-day mortalities. Intraoperative echocardiography showed mild to trivial MR in seven patients, and no residual MR in the majority of patients. There were 26 late deaths; three of these patients had progression of the disease and underwent transplantation. One- and 2-year actuarial survival has been 80% and 70%, respectively. New York Heart Association class has improved for all the patients from a preoperative mean of 3.2 +/- 0.2 to 1.8 +/- 0.4 postoperatively. At 24-month follow-up, all patients showed an improvement of ejection fraction, cardiac output, and end-diastolic volumes, along with a reduction in sphericity index and regurgitant volume. Mitral valve repair with an undersized flexible annuloplasty ring is a safe and effective approach to correct MR in cardiomyopathy patients. All observed changes contribute to reverse remodeling and the restoration of the normal left ventricular geometric relationship. Mitral reconstruction offers a new treatment strategy for patients with MR and end-stage heart failure. PMID:11988951

Badhwar, Vinay; Bolling, Steven F



Partial cardiac autotransplantation with a concomitant mitral valve, aortic valve replacement and tricuspid plasty.  


We describe a case with left atrial volume reduction of a giant left atrium, treated successfully by partial cardiac autotransplantation, concomitant mitral and aortic valve replacement, and tricuspid valve plasty. We obtained good results at the 1-year follow-up. PMID:23868606

Pan, Jun; Li, Qing-Guo; Li, Jie; Wang, Dong-Jin



Transcatheter Aortic Valve Implantation in Patients With a Mechanical Mitral Valve  

Microsoft Academic Search

Many patients with severe aortic stenosis never undergo surgical treatment for various reasons. Apart from the standard risks, some patients face an additional problem: their carrying of a mechanical mitral valve. In these patients, transcatheter aortic valve implantation is a therapeutic option. The literature contains only few reports of this procedure being performed (usually transapically) in such patients. This paper

Eulogio García; Agustín Albarrán; Jerónimo Heredia-Mantrana; Fernando Guerrero-Pinedo; Julio Rodríguez; Rosana Hernández-Antolín; Juan Tascón; Carlos Macaya



[Severe thrombosis of bioprosthesis mitral valve after dabigatran].  


A 41-year-old female was admitted to our hospital with an unidentified source of fever, dyspnea and dizziness. Transthoracic echocardiography demonstrated severe mitral valve regurgitation, and further examination with transesophageal echocardiography (TEE) revealed a 7 mm vegetation on the anterior mitral leaflet. Blood cultures were negative, and after 45 days of empiric 12 g/day ampicillin-sulbactam therapy, the vegetation was shown to have disappeared. However, due to ongoing severe mitral regurgitation and valve deformity, a prosthetic metallic mitral valve replacement was performed. After the operation, TEE was performed again due to subfebrile fever; however, the valve was normal and blood cultures were negative. Because of the probable relapse risk of infective endocarditis, the preoperative intravenous antibiotherapy was continued for 21 days and then orally for one week. Then, she was placed on follow-up by our outpatient clinic. As her INR was highly unstable during this period and she developed new-onset subfebrile fever, she was hospitalized again, and the TEE demonstrated vegetation. Blood cultures were still negative, and a combination of vancomycin-rifampicin-gentamicin was started. While under that therapy, first stroke and after a few days recurrent trans-ischemic attack developed, and the vegetation was seen to have enlarged. Urgent valve operation was performed with a bioprosthetic mitral valve, and ampicillin-sulbactam therapy was added to her previous antibiotherapy at the suggestion of the Microbiology Department. Oral anticoagulant therapy was planned for three months; however, during the postoperative period, her INR levels were highly unstable and could not be maintained in therapeutic ranges for even two consecutive days. Adjusted dosage of dabigatran to 110 mg/bid according to renal clearance in combination with 150 mg/day aspirin was started. However, valve thrombosis and a massive stroke developed under this therapy. The thrombosis disappeared after continuous heparin infusion, and she was discharged with neurological sequelae on 150 mg/day aspirin 55 days after her last operation. During the follow-up period of four months, no other clinical events occurred. PMID:24104980

Akgüllü, Ca?da?; Ery?lmaz, Ufuk; Kurto?lu, Tünay



How Is Mitral Valve Prolapse Treated?  


... goals of treating MVP include: Preventing infective endocarditis (IE), arrhythmias , and other complications Relieving symptoms Correcting the ... to enter your bloodstream. Antibiotics can help prevent IE, a serious heart valve infection. Discuss with your ...


A forgotten devil; Rupture of mitral valve papillary muscle  

PubMed Central

Summary Background: Papillary muscle rupture is one of the catastrophic mechanical complications following myocardial infarction. Rupture leads to acute mitral valve regurgitation, pulmonary edema, and cardiogenic shock. Survival is dependent on prompt recognition and surgical intervention. Cases Report: We present two cases where acute myocardial infarction was complicated by papillary muscle rupture resulting in severe mitral regurgitation and cardiogenic shock. In both cases rupture occurred within one week of infarction. Both patients did not receive coronary revascularization; one patient presented late after the onset of chest pain, the other patient percutaneous revascularization attempted and was not successful. Both patients suffered an inferior wall infarction. Echocardiogram demonstrated severe mitral regurgitation with a jet directed posteriorly. In both cases rupture of the posteromedial papillary muscle resulted in flail of the anterior mitral valve leaflet, thus serving as a reminder that both the anterior and the posterior leaflets attach to both papillary muscles. Conclusions: While one case had a good outcome, the other reinforces the fact that this is a very serious complication requiring prompt recognition and treatment.

Jain, Sachin Kumar Amruthlal; Larsen, Timothy R.; Darda, Saba; Saba, Souheil; David, Shukri



Clinical Course and Hemodynamic Observations After Supraannular Mitral Valve Replacement in Infants and Children  

Microsoft Academic Search

Objectives. We report the clinical course and unique hemodynamic findings after placement of a supraannular mitral valve prosthesis.Background. Children with symptomatic mitral valve disease whose annulus is too small for the smallest prosthesis are difficult to manage. One option is valve replacement with a prosthesis positioned entirely within the left atrium (LA).Methods. We reviewed 17 patients (median age 10 months)

Ian Adatia; Phillip M Moore; Richard A Jonas; Steven D Colan; James E Lock; John F Keane



Robotic tissue tracking for beating heart mitral valve surgery.  


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

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



Numerical simulation of mechanical mitral heart valve closure.  


A computational fluid dynamic simulation of a mechanical heart valve closing dynamics in the mitral position was performed in order to delineate the fluid induced stresses in the closing phase. The pressure and shear stress fields in the clearance region and near the inflow (atrial) side of the valve were computed during the mitral heart valve closure. Three separate numerical simulations were performed. The atrial chamber pressure was assumed to be zero in all the simulations. The first simulation was steady flow through a closed mitral valve with a ventricular pressure of 100 mm Hg (1.3 kPa). In the second simulation, the leaflet remained in the closed position while the ventricular pressure increased from 0 to 100 mm Hg at a rate of 2000 mm Hg/s (simulating leaflet closure by gravity before the ventricular pressure rise - gravity closure). In the third case, the leaflet motion from the fully open position to the fully closed position was simulated for the same ventricular pressure rise (simulating the normal closure of the mechanical valve). Normal closure (including leaflet motion towards closure, and sudden stop in the closed position) resulted in a relatively large negative pressure transient which was not present in the gravity closure simulation. The wall shear stresses near the housing and the leaflet edge close to the inflow side were around 4000 Pa with normal closure compared to about 725 Pa with gravity closure. The large negative pressure transients and significant increase in wall shear stresses due to the simulation of normal closure of the mechanical valve is consistent with the previously reported increased blood damage during the closing phase. PMID:11556723

Aluri, S; Chandran, K B



Functional mitral regurgitation: from normal to pathological anatomy of mitral valve.  


Mitral valve (MV) is composed of several structures working in synchrony to open during diastole and close in systole within the high-pressure systemic environment. Its morphological features ensure a normal leaflet closure that prevents regurgitation of blood back into the left atrium causing loss of ventricular pressure and forward flow. The complex interactions of the normal MV are reliant on each component playing a complete role for the efficient working of the valve. In this review we firstly discuss the overall MV structure in terms of a complex make up of the annulus, the leaflets, their tendinous cords, and the supporting papillary muscles, and then the anatomical changes of each MV components due to left ventricular geometry and function alterations, underlying functional mitral regurgitation. PMID:22192280

Di Mauro, Michele; Gallina, Sabina; D'Amico, Maria Angela; Izzicupo, Pascal; Lanuti, Paola; Bascelli, Adriana; Di Fonso, Alessia; Bartoloni, Giovanni; Calafiore, Antonio Maria; Di Baldassarre, Angela



Penetrating Trauma to the Mitral Valve and Ventricular Septum  

PubMed Central

Penetrating cardiac trauma is typically life-threatening and often requires urgent surgical intervention. Penetrating injury can cause damage in more than 1 cardiac structure that may be difficult to identify at the initial urgent operation. We describe the case of a young man in whom a perimembranous ventricular septal defect and perforation of the anterior leaflet of the mitral valve were caused by a screwdriver wound.

Topaloglu, Serkan; Aras, Dursun; Cagli, Kerim; Ergun, Kumral; Deveci, Bulent; Demir, Ahmet Duran; Korkmaz, Sule; Sabah, Irfan



Surgical Treatment of Mitral Valve Disease in the Elderly  

Microsoft Academic Search

\\u000a Demographic change presents great challenges to medicine. Especially, heart disease has become more common as people live\\u000a longer. In addition to other age-related physiological changes to the coronary vasculature, mitral valve disease in elderly\\u000a has become center of attention for a rapidly expanding research in this field. The etiology in such population refers to the\\u000a cause of the disease or

Maqsood M. Elahi; Kenton J. Zehr


Mycobacterium fortuitum sternal wound infection following mitral valve replacement  

Microsoft Academic Search

Mycobacterium fortuitum infection of the sternum following cardiac surgery is a rare occurrence.It is usually diagnosed late\\u000a and has a considerable mortality. We present a female patient with mycobacterium fortuitum sternal wound infection following\\u000a mitral valve replacement, who was successfully managed with radical surgical debridement combined with multidrug antibiotics.\\u000a Multidrug antibiotic therapy is essential because of the emergence of resistant

Alpha Mathew Kavunkal; Raju Vijayakumar; Jayavelan Ramkumar; Vijit Koshy Cherian



Prevalence of mitral valve prolapse in primary spontaneous pneumothorax  

Microsoft Academic Search

Summary Background: Mitral valve prolapse (MVP) has been described as a common diagnosis and has been reported in 50% of patients with primary spontaneous pneumothorax (PSP). The purpose of this study was to determine the prevalence of MVP — as diagnosed by 2D-echocardiography criteria — in spontaneous pneumothorax. Method: A case-control study of 24 patients with PSP, and 40 age-matched

Zouheir Ibrahim Bitar; Sherif Ahmed; Amin Elsayed Amin; Khaled Jamal; Mustafa Ridha



Mitral Valve Disease in Marfan Syndrome and Related Disorders  

Microsoft Academic Search

Marfan syndrome (MFS) is a systemic disorder of the connective tissue with pleiotropic manifestations due to heterozygous\\u000a FBN1 mutations and consequent upregulation of TGF? signaling in affected tissues. Myxomatous thickening and elongation of the\\u000a mitral valve (MV) leaflets commonly occur in this condition. Investigation of murine models of this disease has led to improved\\u000a understanding of the mechanisms that underlie

Daniel P. Judge; Rosanne Rouf; Jennifer Habashi; Harry C. Dietz


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

PubMed Central

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

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



A mechanism for the size-related differences in mechanical properties of mitral valve chordae  

Microsoft Academic Search

Understanding the structure\\/function relationship of mitral valve chordae is important to mitral valve repair, chodral transposition and engineering of artificial chordae-like materials. The objectives of this study were to investigate the size-related variations in the mechanical properties of porcine mitral valve chordae, and explain these variations from their intrinsic microstructure. Based on quantification of collagen, water content, fibril crimp, and

J. Liao; I. Vesely



The mitral valve: characterisation by real-time three-dimensional transesophageal echocardiography. Current status.  


The complex anatomy of mitral valve demands precise and sophisticated imaging during any intervention .Transesophageal echocardiography has been the most frequently used modality. With the advent of three-dimensional echocardiography a more comprehensive description of the mitral valve is now possible. This review aims to discuss the framework for imaging the mitral valve by three-dimensional echocardiography; its current status and the limitations of three-dimensional echocardiography in its current platform. PMID:22616339

Pau, Biswajit; Omar, Ashok K



Novel intraoperative evaluation for mitral valve regurgitation: retrograde cardioprotective beating test.  


In mitral valvuloplasty, the saline injection test is commonly employed. However, discrepancies in regurgitation between the naked eye findings during the saline injection test and the postoperative echocardiographical findings are noted. Here, we describe a technique that allows direct transatrial evaluation of the valve in the fully loaded, beating heart without the risks of air embolism. Physiological systolic mitral valve movement is reproduced under aortic cross-clamping. This novel evaluation enables a complete and safe mitral valve repair. PMID:23315958

Tachibana, Kazutoshi; Higami, Tetsuya; Miyaki, Yasuko; Takagi, Nobuyuki



Prolapse of the Mitral Valve: Clinical, Hemodynamic, Angiographic and Echocardiographic Correlations  

Microsoft Academic Search

Among 1,519 patients undergoing diagnostic cardiac catheterization over a 2-year period, angiographically unequivocal mitral valve prolapse was identified in 79 cases (5.2%). Mitral valve prolapse was clinically unsuspected in 30 of these 79 patients. Echocardiographic studies were available in 44 cases, but only 55% of the patients with prolapse of the mitral valve documented by angiography had positive echocardiographic findings.

Abdulmassih S. Iskandrian; Morris N. Kotler; Demetrios Kimbiris; Rafael Levites; Charles E. Bemis; Gary Mintz; Harvey Forman



Hemodynamic effects of dobutamine in patients following mitral valve replacement.  


Mitral valve replacement is frequently complicated by a low cardiac output syndrome and elevated pulmonary arterial pressures. In the present study, we used dobutamine to increase cardiac index and measured the pulmonary hemodynamic effects in 10 patients with increased pulmonary vascular tone following mitral valve replacement. Using increasing doses of dobutamine up to 10, we observed a statistically significant increase in mean cardiac index (from 2.39 +/- .14 liters.min-1.m-2 to 3.52 +/- .33, P less than 0.01) and mean heart rate (from 71.6 +/- 5.2 beats.min-1 to 84.3 +/- 8.1, P less than 0.01). This was associated with stable mean systemic arterial pressures and mean pulmonary arterial pressures. Both mean systemic and pulmonary vascular resistances decreased significantly (from 1210 +/- 99 to 809 +/- 90 [P less than 0.01], and from 195.9 +/- 30.6 to 129.4 +/- 41.2 [P less than 0.01] respectively) with dobutamine. Intrapulmonary shunt flow increased significantly in the five patients studied. Though increases in heart rate and pulmonary shunt flow may limit it use, dobutamine increases cardiac output and decreases pulmonary vascular resistance in patients with increased pulmonary arterial pressure following mitral valve replacement. PMID:2929980

Schwenzer, K J; Miller, E D



[Association of anorexia nervosa and mitral valve prolapse].  


Four cases of anorexia nervosa recently encountered were reported in respect to their cardiovascular manifestations including prolapse of the cardiac valves and other poorly recognized cardiac findings. All four patients, aged 13 to 32 years, were women and had marked emaciation (35 to 44% weight loss of the ideal body weight) with typical hormone abnormalities. Chest radiographs showed a small cardiac shadow, and sinus bradycardia with low voltage was present in their electrocardiograms. One case, 13-year-old, had a mid-systolic click and occasionally a late systolic murmur, and also an abdominal continuous hum. Echocardiography including two-dimensional color flow-mapping disclosed mitral valve prolapse in all, and tricuspid valve prolapse in two. Mild to moderate pericardial effusion was noted in all between the right ventricle and diaphragm, and pericardiocentesis in one case had no effect on the valve movements. No inflammatory changes were observed in the specimen of the pericardium and also of the fluid. An association of mitral valve prolapse and anerexia nervosa was discussed based on the previous studies, but the final conclusion remains unknown. PMID:3681005

Amano, K; Sakamoto, T; Hada, Y; Hasegawa, I; Takahashi, T; Suzuki, J; Takahashi, H



Annular rupture leading to fatal complications in an elderly patient with calcified aortic and mitral annulus undergoing transapical aortic valve implantation.  


This case illustrates the awareness that must be taken of the high morphological risk due to the calcifications of both, the aortic and mitral annulus in elderly patients when performing transapical aortic valve implantation. In an 86-year-old, multimorbid woman (logistic EuroSCORE = 27%) with symptomatic aortic stenosis (annular diameter = 23.4 mm) and severe mitral annular calcification, the implantation of a 26-mm Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve in aortic position was primary successful, with no paravalvular leakage, valve instability, or coronary malperfusion. Second, a persisting transmural bleeding led to hypovolemic shock, which could not be stabilized even after going on cardiopulmonary bypass, and the patient died in the operation room. The autopsy showed a subvalvular ventricular rupture due to a transmural perforation of the calcified fibrotic annulus during valvuloplasty. PMID:23169104

Haldenwang, Peter L; Bechtel, Matthias; Schlömicher, Markus; Lindstaedt, Michael; Strauch, Justus T



Rheumatic mitral valve repair: experience of 221 cases from Central Chest Institute of Thailand.  


Rheumatic heart disease is a major problem in Thailand and this region. Surgical management is still a dilemma and problematic. Current understanding of mitral valve complex and its dynamics in combination with improvement of surgical techniques allow surgeon to repair rheumatic mitral valve disease better. Several innovative approaches have been introduced recently and greatly enhances the success of mitral valve repair in this clinical entity. This case report reviews the authors' current approaches and results in the repair of rheumatic mitral valve at Central Chest Institute of Thailand. PMID:23130475

Chotivatanapong, Taweesak; Lerdsomboon, Piyawat; Sungkahapong, Vibhan



Left atrial reduction and mitral valve replacement in a 5-year-old girl with severe mitral regurgitation and giant left atrium.  


Giant left atrium associated with mitral valve disease has been implicated in the morbidity following mitral valve repair or replacement. Various methods including left atrial plication have been described to reduce the size of left atrium. Herein we describe our technique of left atrial reduction in a 5-year-old girl with severe mitral regurgitation and giant left atrium. She underwent mitral valve replacement and circumferential left atrial reduction with successful outcome. PMID:11526423

Shah, S; Sankar, N M; Cherian, K M


Negative results - Valves Fatal early acute thrombosis of mechanical mitral prosthesis  

Microsoft Academic Search

Objective: To report a rare case of fatal early acute thrombosis of mechanical mitral prosthesis. Methods: A 62-year-old lady, who underwent closed mitral valvotomy for rheumatic heart disease 19 years ago, presented with Canadian Cardiovascular Society Class II angina and New York Heart Association Class III dyspnoea. Investigations including echocardiogram and cardiac catheterisation revealed mixed mitral valve disease. She had

Uday Dandekar; Maninder Kalkat; Christopher Smallpeice



Fenfluramine Disrupts the Mitral Valve Interstitial Cell Response to Serotonin  

PubMed Central

Serotonin (5HT) receptor signaling and 5HT-related agents, such as the anorexogen fenfluramine (Fen), have been associated with heart valve disease. We investigated the hypothesis that Fen may disrupt mitral valve interstitial cell (MVIC) homeostasis through its effects on mitogenesis and extracellular matrix biosynthesis. Normal and myxomatous mitral valves, both human and canine, were harvested, and primary MVIC cultures were established. 5HT caused increased phosphorylation of extracellular signal-related kinase in MVIC; Fen alone did not. However, Fen combined with 5HT increased the level of MVIC extracellular signal-related kinase, when compared with 5HT alone. In addition, MVIC mitogenesis per 3H-thymidine (3HTdR) demonstrated a 5HT dose-dependent increase, with no effect of Fen alone. In contrast, Fen combined with 5HT inhibited the MVIC 3HTdR response when compared with 5HT alone. Furthermore, fluoxetine, a 5HT transporter inhibitor, while having no effect alone, suppressed Fen-5HT 3HTdR inhibition when administered with Fen plus 5HT. Finally, MVIC incorporations of 3H-proline and 3H-glucosamine, measures of extracellular matrix collagen and glycosaminoglycan respectively, were increased with 5HT alone; however, Fen did not affect MVIC glycosaminoglycan or collagen either alone or in combination with 5HT. Taken together, the ratios of 3H-proline or 3H-glycosaminoglycan to 3HTdR in MVIC, normalized to 5HT alone, demonstrated a significant imbalance of extracellular matrix production versus proliferation in MVIC cultures with Fen plus 5HT exposure. This imbalance may explain in part the pathophysiology of Fen-related mitral valve disease.

Connolly, Jeanne M.; Bakay, Marina A.; Fulmer, James T.; Gorman, Robert C.; Gorman, Joseph H.; Oyama, Mark A.; Levy, Robert J.



Successful Mitral Valve Repair in Infective Endocarditis. Case Report and Review of the Data in the Literature  

PubMed Central

ABSTRACT We report a case of mitral valve prolapse associated with infective endocarditis and heart failure, which required surgical intervention. Mitral valve repair was successfully performed and resulted in complete recovery of the patient.




Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy  

PubMed Central

Objective To investigate the value of transoesophageal echocardiography in the assessment of commissural morphology and prediction of outcome after balloon mitral valvotomy (BMV). Design Prospective study. Setting Tertiary cardiac referral centre. Patients 72 consecutive patients (mean age 61.3 years, range 38–89 years) referred for BMV. Interventions Transoesophageal echocardiography was performed immediately before BMV and the mitral commissures were scanned systematically. Anterolateral and posteromedial commissures were scored individually according to whether non?calcified fusion was absent (0), partial (1), or extensive (2). Calcified commissures usually resist splitting and scored 0. Scores for each commissure were combined giving an overall commissure score for each valve of 0–4, higher scores reflecting increased likelihood of commissural splitting. Valve anatomy was also graded by the method of Wilkins et al, which does not include commissural assessment. Main outcome measures Patients were divided into outcome groups: A (good) and B (suboptimal). “Good” was defined as final valve area >?1.5?cm2 with a >?25% increase in area and absence of severe mitral regurgitation judged by echocardiography. Results Valve area increased from a mean (SD) of 1.1 (0.28)?cm2 to 1.8 (0.46)?cm2. Commissure scores were higher in group A than in group B (p?

Sutaria, N; Shaw, T R D; Prendergast, B; Northridge, D



[Calcification of allogenic aortic heart valves].  


The material used for the studies consisted of allogenic aortic valves (AAV) collected from 14 individuals. The necessity of AAV replacement arose from growing circulation insufficiency and AAV dysfunction. The aim the study was the determination of the elemental composition and crystallographic structure of the inorganic deposits in AAV. Moreover, the results of the physicochemical investigations were correlated with clinical data (age of the patient, time between valve replacement surgeries, endomyocarditis, number of infections during last 12 months, arterial hypertension and disturbance of the lipid balance) and with echocardiographic examinations (cusp mineralization and perforation, vegetation, systolic and diastolic dimensions of the left ventricle, maximal and average gradient through allograft valve as well as range of the recoil wave to left ventricle). It was found that mineralization of the AAV cusps was a time-dependent process and took place predominantly at the surface of the cusp. The elemental composition and crystallographic data revealed that the inorganic deposits in AAV were composed of hydroxyapatite crystals. However, the presence of other calcium salts was also found. The development of the mineralization process in AAV does not correlate with endomyocarditis, arterial hypertension and the disturbance of the lipid balance. Probably, endomyocarditis and arterial hypertension induce the pathologic alternations of AAV independently from the mineralization process. The echocardiographic estimations of the pathomorphologic changes of the aortic valve cups are not always consistent with the results of the physicochemical studies. PMID:10085721

Podolec, P; Rokita, E; Cichocki, T; Pfitzner, R; Sadowski, J; Tracz, W; Malinowski, J; Dziatkowiak, A



Cardiac calcification in adult hemodialysis patients  

Microsoft Academic Search

ObjectivesWe sought to determine clinical and laboratory correlates of calcification of the coronary arteries (CAs), aorta and mitral and aortic valves in adult subjects with end-stage renal disease (ESRD) receiving hemodialysis.

Paolo Raggi; Amy Boulay; Scott Chasan-Taber; Naseem Amin; Maureen Dillon; Steven K Burke; Glenn M Chertow



A Braunwald-Cutter valve: a mitral prosthesis at 33 years.  


We present a case of a 76-year-old woman with a Braunwald-Cutter mitral caged-ball valve prosthesis excised after 33 years post implantation due to a paravalvular leak. The valve itself was intact and fully functional. We believe the longevity of this valve was due to the decreased flow velocities and the lower pressure in the mitral valve position. PMID:19135389

Luk, Adriana; Lim, Ki-Dong; Siddiqui, Raheela; Gupta, Shruti; Gilbert, Brian W; Fremes, Stephen E; Butany, Jagdish



Minimally invasive papillary muscle sling placement during mitral valve repair in patients with functional mitral regurgitation.  


BACKGROUND: We evaluated the safety and feasibility of minimally invasive mitral valve repair with papillary muscle sling placement via a right anterior thoracotomy approach in patients with severe functional mitral regurgitation (MR). METHODS: We retrospectively reviewed all minimally invasive mitral valve repairs with papillary muscle sling placement in patients with severe functional MR performed at our institution between October 2011 and September 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed. RESULTS: We identified a total of 19 consecutive patients. There were 12 men (63%); the mean age was 60 ± 13 years. The mean ± SD left ventricular ejection fraction was 23% ± 5.5%, and 4 (21%) of the patients underwent previous coronary artery bypass graft surgery. The median aortic cross-clamp and cardiopulmonary bypass times were 106 (interquartile range [IQR], 76-120) and 163 (IQR, 119-170) minutes, respectively. The median intensive care unit length of stay was 64 (IQR, 43-75) hours, and the median postoperative length of stay was 7 (IQR, 5-7.5) days. Postoperatively, 2 patients developed acute kidney injury. There were no reoperations for bleeding or any cerebrovascular accidents. The 30-day mortality was 0. A follow-up echocardiogram, obtained at a median of 3 (IQR, 1-7.5) months, demonstrated none to trivial MR in all patients. CONCLUSIONS: Minimally invasive mitral repair with papillary muscle sling placement for severe functional MR is safe and effective in the short-term. Long-term data are needed to evaluate the effects on left ventricular remodeling and to assess the durability of the repair. PMID:23545430

Santana, Orlando; Solenkova, Natalia V; Pineda, Andres M; Mihos, Christos G; Lamelas, Joseph



Minimally invasive mitral valve repair using the da Vinci robotic system  

Microsoft Academic Search

BackgroundMinimally invasive mitral valve repair with a shortened hospital stay and quick return to an active lifestyle is the ultimate goal for robotically assisted surgery. We evaluated our da Vinci robotically assisted mitral valve repair experience toward achieving this goal.

Antone J Tatooles; Patroklos S Pappas; Paul J Gordon; Mark S Slaughter



Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery  

Microsoft Academic Search

Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior wall of the left atrium using electrocautery in mitral valve surgery. Methods: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial

Jandir Ferreira; GOMES JÚNIOR; José Carlos; Dorsa Vieira PONTES; Otoni Moreira GOMES; João Jackson DUARTE; Neimar GARDENAL; Amaury Mont' Serrat; Ávila Souza; Ricardo Adala BENFATTI; Guilherme Viotto


Simple Left Atrial Procedure for Chronic Atrial Fibrillation Associated With Mitral Valve Disease  

Microsoft Academic Search

Background. A computerized 48-channel mapping system was used to investigate the characteristics of an atrial epicardial electrogram during chronic atrial fibrillation (AF) in patients with solitary mitral valve disease. We have devised a simple left atrial procedure to eliminate the chronic AF during a mitral valve operation.Methods. Using this mapping system, we performed intraoperative atrial mapping in 11 patients with

Taijiro Sueda; Hideyuki Nagata; Hiroo Shikata; Kazumasa Orihashi; Satoru Morita; Masafumi Sueshiro; Kenji Okada; Yuichiro Matsuura



Clinical, Echocardiographic, and Pathologic Features of Aortic Wall Dehiscence of Porcine Bioprosthetic Valves: A Cause of Rapidly Progressive Mitral Regurgitation and Heart Failure After Bioprosthetic Mitral Valve Replacement  

Microsoft Academic Search

The aim of this study was to define the clinical, echocardiographic, and pathologic correlates of commissural dehiscence of aortic wall from the stent post of the porcine bioprostheses in the mitral position. This form of valve degeneration was found in 5 of 23 explanted mitral bioprostheses. A thickened, separated aortic wall at multiple commissural sites along with other evidence of

Tasneem Z Naqvi; Robert J Siegel; Neil A Buchbinder; Michael C Fishbein



A prospective study of changes in the quality of life of patients following mitral valve repair and replacement  

Microsoft Academic Search

Objective: The primary aim of medical care and surgery for mitral valve disease is to improve the overall functional capacity and health of patients. Aim: To assess whether there was an actual improvement in quality of life (QOL) of patients 3 months following primary mitral valve repair (MRr) or mitral valve replacement (MVR). Methods: Prospective study of 61 consecutive patients

Ira R. A Goldsmith; Gregory Y. H Lip; Ramesh L Patel



Effect of obstructive sleep apnea on mitral valve tenting.  


Obstructive apneas produce high negative intrathoracic pressure that imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no obstructive sleep apnea (OSA; AHI <15) and moderate/severe OSA (AHI ?15). Mitral valve tenting height and area, left ventricular (LV) long and short axes, and LV end-diastolic volume were measured in addition to tissue Doppler parameters. Comparisons of measurements at baseline and follow-up between and within groups were obtained; correlations between absolute changes (?) in echocardiographic parameters were also performed. After a mean follow-up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 to 1.28 ± 0.17 cm, p = 0.001) in moderate/severe OSA as did tenting area (2.30 ± 0.41 to 2.66 ± 0.60 cm(2), p = 0.0002); ?tenting height correlated with ?LV end-diastolic volume (rho 0.43, p = 0.01) and ?tenting area (rho 0.35, p = 0.04). In patients with mild/no OSA there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 to 2.31 ± 0.43 cm(2), p = 0.05). Septal tissue Doppler early diastolic wave decreased (8.04 ± 2.49 to 7.10 ± 1.83 cm/s, p = 0.005) in subjects with moderate/severe OSA but not in in those with mild/no OSA. In conclusion, in patients with moderate/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry. PMID:22264596

Pressman, Gregg S; Figueredo, Vincent M; Romero-Corral, Abel; Murali, Ganesan; Kotler, Morris N



Evaluation of mitral and tricuspid valve velocities in 45 fetuses  

Microsoft Academic Search

Objectives  The study was done to assess the tricuspid and mitral valve velocities in 45 fetuses between 18 and 28 weeks and to compare\\u000a these findings with reported values from literature.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study was conducted on 45 women referred to the clinic for sonography examination. They were between 18 and 28 weeks gestation.\\u000a They had no past history of any medical

Dikshit Sameer




SciTech Connect

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

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



Aortic ring abscess and mitral valve aneurysm in aortic valvular endocarditis: enhanced diagnosis with transesophageal echocardiography.  


Aortic ring abscess and mitral valve aneurysms complicating infective endocarditis have previously been described as surgical or autopsy findings. More recently, transesophageal echocardiography has been shown to be more sensitive than standard transthoracic echocardiography or other imaging modalities in detecting each of these complications. Since aortic ring abscess and mitral valve aneurysms virtually mandate surgical intervention, their early detection may be crucial. This report describes a 35-year-old male with congenitally abnormal aortic valve which became infected and in whom both an aortic ring abscess and mitral valve aneurysm occurred. These findings are discussed and the pertinent literature is reviewed. PMID:7889443

Geiger-Dow, J E; Knight, J L; Sanfilippo, A J



Late Reoperation for Aortic and Mitral Starr-Edwards Ball Valve Prostheses  

Microsoft Academic Search

Starr-Edwards ball valves removed more than 15 years after implantation were retrospectively investigated macroscopically. Eight patients required re-operation. Valve models used in the initial operations were a non-cloth-covered valve in 2 patients and a cloth-covered valve in 6. Two patients had replacement of an aortic ball valve (model 1260 and model 2320) and 6 underwent mitral valve replacement (model 6120

Shigeaki Aoyagi; Shuji Fukunaga; Koichi Arinaga; Yoshinori Yokokura; Hiroko Yokokura; Noriko Egawa


A comparison of the assessment of mitral valve area by continuous wave Doppler and by cross sectional echocardiography.  

PubMed Central

Transmitral pressure half time (PHT) was assessed by continuous wave Doppler in 44 patients with rheumatic mitral valve stenosis (14, pure mitral valve stenosis; 15, combined mitral stenosis and regurgitation; and 15 with associated aortic valve regurgitation). The mitral valve area, derived from transmitral pressure half time by the formula 220/pressure half time, was compared with that estimated by cross sectional echocardiography. The transmitral pressure half time correlated well with the mitral valve area estimated by cross sectional echocardiography. The correlation between pressure half time and the cross sectional echocardiographic mitral valve area was also good for patients with pure mitral stenosis and for those with associated mitral or aortic regurgitation. The regression coefficients in the three groups of patients were significantly different. Nevertheless, a transmitral pressure half time of 175 ms correctly identified 20 of 21 patients with cross sectional echocardiographic mitral valve areas less than 1.5 cm2. There were no false positives. The Doppler formula significantly underestimated the mitral valve area determined by cross sectional echocardiography by 28(9)% in 19 patients with an echocardiographic area greater than 2 cm2 and by 14.8 (8)% in 25 patients with area of less than 2 cm2. In thirteen patients with pure mitral valve stenosis Gorlin's formula was used to calculate the mitral valve area. This was overestimated by cross sectional echocardiography by 0.16 (0.19) cm2 and underestimated by Doppler by 0.13 (0.12) cm2. Continuous wave Doppler underestimated the echocardiographic mitral valve area in patients with mild mitral stenosis. The Doppler formula mitral valve area = 220/pressure half time was more accurate in predicting functional (haemodynamic) than anatomical (echocardiographic) mitral valve area. Images Fig 1

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



Reduction of bronchial responsiveness to methacholine after mitral valve replacement.  


Sixteen patients with mitral valve disease, in whom bronchial hyperresponsiveness to methacholine had been detected shortly before mitral valve replacement (MVR), were reevaluated 35 +/- 1.5 months after MVR. In 9/16 patients there was a significant (greater than 1.5 fold) increase in bronchial provocation dose of methacholine (PD20FEV1) after MVR. In the same patients there was a significant increase in vital capacity (from 69.6 +/- 5 to 75.8 +/- 5.2% of predicted, p less than 0.01), a significant decrease in cardiothoracic ratio and in radiologic score for lung edema (from 64.3 +/- 2.9 to 56 +/- 2.1, p less than 0.01 and from 38 +/- 4.5 to 14.6 +/- 2, p less than 0.001, respectively). In all the patients the increase in PD20FEV1 was not related to any change in spirometric values but it was related to the decrease in cardiothoracic index (r = 0.72, p less than 0.01) and in radiologic score for lung edema (r = 0.61, p less than 0.05) observed after cardiosurgery. PMID:1862255

Rolla, G; Bucca, C; Brussino, L; Costa, P; Morea, M



Characterization of Mitral Valve Anterior Leaflet Perfusion Patterns  

PubMed Central

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

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



[Reoperation for a Starr-Edwards ball valve prosthesis implanted in mitral position 31 years ago].  


The patient is a 61-year-old woman who had undergone mitral valve replacement with the Starr-Edwards cloth-covered ball valve 31 years ago. She had dyspnea on effort 1 month before admission. The echocardiography revealed mitral and tricuspid regurgitation. Re-replacement of the mitral prosthetic valve with an ATS valve and tricuspid annuloplasty were successfully performed without any complication. The cloth wear of the Starr-Edwards ball valve cage was recognized and no thrombus was found at operation. To our knowledge, there has been no such a reoperative case who underwent so long postoperative period after initial implantation of the Starr-Edwards ball valve in Japan. This experience made us realize again the importance of attention to the complications related to a prosthetic valve like a cloth wear during long-term follow-up for the Starr-Edwards ball valve. PMID:12854458

Goshima, M; Shiono, M; Yamamoto, T; Inoue, T; Hata, M; Sezai, A; Niino, T; Nakamura, T; Ye, Z; Negishi, N; Sezai, Y



Video-assisted and robotic mitral valve surgery: Toward an endoscopic surgery  

Microsoft Academic Search

Our group at East Carolina University recently has shown the efficacy of new video-assisted mitral valve surgery. Moreover, we review the evolution and predict the future of endoscopic and robotic-enabling technology for cardiac valve surgery. Herein, a video-assisted mitral valve operation is described and early results are discussed. Cardiopulmonary bypass was established via the femoral vessels, and blood cardioplegic arrest

WR Chitwood



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


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

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



Rapid increase in plasma endothelin concentrations during percutaneous balloon dilatation of the mitral valve in patients with mitral stenosis  

Microsoft Academic Search

OBJECTIVE--To investigate the relation between plasma concentrations of immunoreactive endothelin and haemodynamic variables before and after percutaneous transvenous balloon dilatation of the mitral valve. DESIGN--Prospective study. SETTING--National cardiovascular centre. PATIENTS--25 patients with mitral stenosis and 26 healthy volunteers. MAIN OUTCOME MEASURES--Plasma concentrations of immunoreactive endothelin were measured in the pulmonary artery, left atrium, ascending aorta, and femoral vein before and

O Kinoshita; H Yoshimi; S Nagata; F Ishikura; K Kimura; T Yamabe; K Takagaki; K Miyatake; T Omae



Long-term myocardial recovery after mitral valve replacement in noncompaction cardiomyopathy  

PubMed Central

Isolated noncompaction of the left ventricle is a congenital cardiomyopathy, which has been described recently, with literature limited to case reports and case series. Even though various complications have been reported with noncompaction cardiomyopathy, among them severe mitral regurgitation has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We are reporting a case of an elderly lady with isolated left ventricular noncompaction cardiomyopathy associated with severe mitral regurgitation treated with mitral valve replacement with one and half year of follow up demonstrating significant myocardial recovery.



Long-term myocardial recovery after mitral valve replacement in noncompaction cardiomyopathy.  


Isolated noncompaction of the left ventricle is a congenital cardiomyopathy, which has been described recently, with literature limited to case reports and case series. Even though various complications have been reported with noncompaction cardiomyopathy, among them severe mitral regurgitation has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We are reporting a case of an elderly lady with isolated left ventricular noncompaction cardiomyopathy associated with severe mitral regurgitation treated with mitral valve replacement with one and half year of follow up demonstrating significant myocardial recovery. PMID:21958914

Bhat, Tariq; Costantino, Thomas; Bhat, Hilal; Olkovsky, Yefim; Akhtar, Muhammad; Teli, Sumaya; Culliford, Alfred



Outcomes for Mitral Valve Surgery among Medicare Fee-for-Service Beneficiaries, 1999-2008  

PubMed Central

Background Mitral valve surgery in older adults carries with it substantial morbidity and mortality risks, yet there are a paucity of national surveillance data. Therefore, we sought to determine trends in hospitalization rate, readmission, and mortality among Medicare fee-for-service (FFS) patients undergoing mitral valve surgery. Methods and Results Inpatient Medicare standard analytic files were used to identify 100% of FFS patients aged ?65 years who underwent mitral valve surgery between 1999 and 2008. We constructed a denominator file from Medicare administrative data to report hospitalization rates for mitral valve surgery (total and isolated) per 100,000 beneficiary-years. For isolated mitral valve surgery, 30-day readmission, 30-day mortality, and 1-year mortality outcomes were ascertained through corresponding inpatient and vital status files, and risk-standardized rates were calculated adjusting for age, sex, race, and comorbidities. During 1999–2008, the overall rate of mitral valve surgery per 100K beneficiary-years declined (56/100Kto 51/100K), and the proportion of patients undergoing mitral valve repair (vs. replacement) increased (24.7% to 46.9%, P<0.001). For isolated mitral valve surgery, there were significant declines in risk-adjusted 30-day mortality (8.1% to 4.2%, P<0.001 for trend) and 1-year mortality (15.3% to 9.2%, P=0.003 for trend), and a slight decline in risk-adjusted 30-day readmission (23.0% to 21.0%, P=0.035 for trend) over the study period. Mortality rates decreased in all age, sex, and race subgroups, but remained higher among patients aged ?85 years, women, and nonwhites. Conclusions Between 1999 and 2008, outcomes after isolated mitral valve surgery significantly improved among Medicare FFS patients. Disparities among demographic subgroups indicate potential areas for quality improvement.

Dodson, John A.; Wang, Yun; Desai, Mayur M.; Barreto-Filho, Jose Augusto; Sugeng, Lissa; Hashim, Sabet W.; Krumholz, Harlan M.



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

PubMed Central

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

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



Technique of managing periprosthetic leakage due to mitral prosthetic valve endocarditis: report of a case.  


A patient with multiple leaks caused by active mitral prosthetic valve endocarditis with an annular abscess underwent repeat mitral valve replacement. To secure the new mitral prosthesis, sutures were placed through the healthy interatrial septal wall from right to left at the posteromedial region and then to the new prosthetic valve sewing cuff. In the anterolateral region, sutures were placed through the reconstructed annulus after debridement of the abscess and then reinforced with a pericardial xenograft patch. Postoperatively, the perivalvular leakage stopped and the patient recovered uneventfully. PMID:22695782

Kawada, Noriyasu; Sakamoto, Yoshimasa; Nagahori, Ryuuichi; Yoshitake, Michio; Naganuma, Hirokuni; Inoue, Takahiro; Shinohara, Gen; Hashimoto, Kazuhiro



Familial occurrence of mitral valve prolapse: is this related to the straight back syndrome?  

PubMed Central

Familial prevalence of mitral valve prolapse in a Chinese population was determined in 22 propositi of whom 10 had straight back (group A), three had abnormally high metacarpal index (group B), and nine had neither (group C). Of 71 (32 male and 39 female subjects) first degree relatives screened, mitral valve prolapse was found in 19 (seven male and 12 female subjects) (26.8%). The familial prevalence among groups A, B, and C was 20%, 30%, and 38.5%, respectively. Our study indicates that the familial occurrence of mitral valve prolapse does not depend on its association with the straight back syndrome.

Chen, W W; Chan, F L; Wong, P H; Chow, J S



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


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

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



Pregnancy Outcome after Mechanical Mitral Valve Replacement: A Prospective Study  

PubMed Central

Background: Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. Methods: In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old) were studied. Patients were divided into two groups: group I (n = 43) received Warfarin throughout the pregnancy, while group II (n = 10) received Heparin in the first trimester and then Warfarin until the 36th week. Results: Thirty-two (60.4%) pregnancies resulted in live births, whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal death occurred. In group I, there were 26 (60.5%) live births, one (2.3%) stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live births, one (10%) stillbirth, and 3 (30%) abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7%) of the pregnancies in group I and 50% of those in group II (p value = 0.001) were without complications. There were no congenital malformations in the two groups. Conclusion: Fetal outcome was almost the same between the Warfarin and Heparin regimens. In maternal outcome, the Warfarin regimen is safer than Heparin.

Samiei, Niloufar; Kashfi, Fahimeh; Khamoushi, Amirjamshid; Hosseini, Saeid; Alizadeh Ghavidel, Alireza; Taheripanah, Robabeh; Mirmesdagh, Yalda



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


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

Estevez-Loureiro, R; Franzen, O



A neonate with mitral stenosis due to accessory mitral valve, ventricular septal defect, and patent ductus arteriosus: changes in echocardiographical findings during the neonatal period.  


A female neonate with mitral stenosis due to accessory mitral valve with ventricular septal defect and patent ductus arteriosus is described. She was referred to our hospital because of neonatal asphyxia. Asphyxia was improved by ventilator support, but rapid deterioration of respiration with pulmonary congestion and hemorrhage appeared 8 days after birth. Echocardiography revealed an accessory mitral valve attached to the anterior mitral leaflet with a perimembranous ventricular septal defect and patent ductus arteriosus. Although there were no echocardiographical findings indicating mitral stenosis on admission, the mitral stenosis blood flow patterns were detected by color and pulsed Doppler examination performed on the eighth day after admission. Transaortic resection of accessory mitral valve tissue was performed with patch closure of the ventricular septal defect and ligation of the ductus arteriosus 35 days after birth. After operation, pulmonary congestion and hemorrhage were improved. Postoperative echocardiography showed complete resection of the accessory mitral valve and no mitral insufficiency. We concluded that the combination of the accessory mitral valve and left-to-right shunt due to ventricular septal defect or patent ducturs arteriosus might have led to a critical hemodynamic condition due to relative mitral stenosis in the neonatal period with the decrease in pulmonary vascular resistance. PMID:12541101

Ito, Tadahiko; Okubo, Tadashi



Acenocoumarol and Pregnancy Outcome in a Patient with Mitral Valve Prosthesis: A Case Report  

Microsoft Academic Search

Background: There is considerable controversy concerning the correct management of gravid patients with cardiac valve prostheses. Case Report: We describe the uneventful course of pregnancy and delivery in a pregnant patient with a mechanical heart valve receiving anticoagulation treatment. A 35-year-old primigravida received anticoagulation throughout pregnancy because of mitral valve replacement at the age of 16 due to rheumatic disease.

Konstantinos Stefanidis; Dimitris Papoutsis; George Daskalakis; Dimitris Loutradis; Aris Antsaklis



Minimally Invasive Mitral Valve Surgery: From Port Access to Fully Robotic-Assisted Surgery  

Microsoft Academic Search

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve opera tions through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve

Harry W. Donias; Hratch L. Karamanoukian; Giuseppe DAncona; Eddie L. Hoover



Severe complications following thrombolytic therapy of an acute thrombosis of a prosthetic mitral valve  

Microsoft Academic Search

Thrombosis of prosthetic cardiac valves is a rare but potentially lethal complication. As emergency surgical intervention of thrombotic prosthetic cardiac valves is correlated with high mortality, fibrinolytic therapy has been recently recommended as a therapy with high efficacy and no severe side effects. We report on a patient with thrombosis of a prosthetic mitral valve who developed severe embolic complications

M. M. Hirschl; M. Gwechenberger; M. Zehetgruber; H. Weber



Myxomatous mitral valve disease in dogs: does size matter?  


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

Parker, Heidi G; Kilroy-Glynn, Paul



Epidemiology of symptomatic mitral valve prolapse in black patients.  

PubMed Central

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.

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



Epidemiology of symptomatic mitral valve prolapse in black patients.  


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

Zua, M S; Dziegielewski, S F



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

Microsoft Academic Search

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

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



Genome-wide analysis of mitral valve disease in Cavalier King Charles Spaniels.  


The Cavalier King Charles Spaniel (CKCS) is prone to severe early onset mitral valve disease. In this study, 36 purebred CKCS dogs were evaluated for mitral valve murmur and divided into early and late onset groups. A genome-wide genetic approach was used to assess whether the condition is determined by a small number of genetic factors. There were no regions of highly discrepant homo/heterozygosity in the two groups. Similarly, there was no evidence for loci associated with mitral valve murmur in a genome-wide association study. This analysis suggests that familial occurrence of mitral valve murmur in the CKCS breed is not due to a single major gene effect, indicating that breeding strategies to eliminate the disease cannot be based on genotype information at this time. PMID:22050842

French, Anne T; Ogden, Rob; Eland, Cathlene; Hemani, Gibran; Pong-Wong, Ricardo; Corcoran, Brendan; Summers, Kim M



Midterm results of edge-to-edge mitral valve repair without annuloplasty  

Microsoft Academic Search

ObjectiveEdge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches.

Francesco Maisano; Alessandro Caldarola; Andrea Blasio; Michele De Bonis; Giovanni La Canna; Ottavio Alfieri



Salmonella species group B causing endocarditis of the prosthetic mitral valve.  


The Salmonella species is an extremely rare cause of infective endocarditis. This case report is for Salmonella spp. group B proven by positive multiple blood cultures, and positive intraoperative culture from the vegetation of the mitral valve prosthesis. PMID:19668894

Al-Sherbeeni, Nisreen M



Usefulness of helical computed tomography in detection of mitral annular calcification as a marker of coronary artery disease  

Microsoft Academic Search

BackgroundMitral annulus calcification (MAC) may be a form of atherosclerosis. The goal of the present work was to investigate whether helical CT can determine the presence of MAC and to clarify its possible association with coronary artery disease (CAD) in elderly patients.

Yehuda Adler; Enrique Z. Fisman; Joseph Shemesh; David Tanne; Boaz Hovav; Michael Motro; Ehud Schwammenthal; Alexander Tenenbaum



Minimally invasive mitral valve surgery using three-dimensional video and robotic assistance  

Microsoft Academic Search

Different techniques have been developed for the common goal to minimize surgical trauma for mitral valve surgery. This article focuses on Port-Access (Heartport, Inc, Redwood City, CA) mitral valve replacement or repair (PAMVR) with emphasis on three-dimensional video and robotic assistance. PAMVR was undertaken using a small right anterior minithoracotomy using an endovascular cardiopulmonary bypass (CPB) system. A three-dimensional minicamera

H Reichenspurner; D Boehm; B Reichart



Three-dimensional video and robot-assisted port-access mitral valve operation  

Microsoft Academic Search

Background. In order to minimize surgical trauma, video-assisted mitral valve operation has been started using the Port-Access technique with the addition of a three-dimensional visualization system (Vista Cardiothoracic Systems Inc, Westborough, MA) and a voice-controlled camera-holding robotic arm (Aesop; Computer Motion Inc, Goleta, CA).Methods. Port-Access mitral valve replacement or repair (PAMVR) was undertaken using an endovascular cardiopulmonary bypass (CPB) system.

Hermann Reichenspurner; Dieter H Boehm; Helmut Gulbins; Costas Schulze; Stephen Wildhirt; Armin Welz; Christian Detter; Bruno Reichart



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


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

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



Endovascular Edge-to-Edge Mitral Valve Repair Short-Term Results in a Porcine Model  

Microsoft Academic Search

Background—The edge-to-edge technique is an accepted method for the surgical repair of a regurgitant mitral valve. This study reports the initial use of an endovascular technology that enables a double-orifice edge-to-edge mitral valve repair without cardiopulmonary bypass in an animal model. Methods and Results—Adult pigs (n14) were anesthetized, and left thoracotomy was performed for epicardial echo imaging. Using femoral vein

James I. Fann; Jan Komtebedde; Elyse Foster; Mehmet C. Oz; Thomas J. Fogarty; Ted Feldman; Peter C. Block



Three-Dimensional Asymmetrical Modeling of the Mitral Valve: A Finite Element Study with Dynamic Boundaries  

Microsoft Academic Search

Background and aim of the study: Previous computa- tional studies of the normal mitral valve have been limited because they assumed symmetrical modeling and artificial boundary conditions. The study aim was to model the mitral valve complex asymmetrical- ly with three-dimensional (3-D) dynamic boundaries obtained from in-vivo experimental data. Methods: Distance tracings between ultrasound crys- tals placed in the sheep

Khee Hiang Lim; Joon Hock Yeo; Carlos M. G. Duran



Transjugular and transseptal treatment of a degenerated mitral valve prosthesis with a balloon-expandable biological valve.  


In selected high-risk patients, trans-catheter valve implantation is an emerging therapy for a degenerated bioprosthesis in need of repeated valve replacement. During the last two years, valve-in-valve implantations have mainly been performed in the aortic position and only rarely in the mitral position. Here we describe for the first time the case of a 62 year-old female with severe mitral regurgitation of a degenerated Carpentier Edwards bioprosthesis treated by transjugular, transseptal implantation of a SAPIEN-XT valve. In conclusion this case, together with previous reports, show the feasibility and safety of percutaneous valve-in-valve implantations to treat a degenerated bioprosthesis. PMID:22658887

Schaefer, Ulrich; Frerker, Christian; Busse, Cord; Kuck, Karl-Heinz



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

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.

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



Echo-phonocardiographic features of regurgitant porcine mitral and tricuspid valves presenting with musical murmurs.  


Echophonographic findings of three patients with spontaneous degeneration of porcine tricuspid and mitral valves presenting with musical murmurs are reported. Echocardiography in all these patients revealed systolic or diastolic cusp flutter similar in frequency to the musical murmur on simultaneously recorded phonocardiogram. Porcine tricuspid regurgitation is usually well tolerated and can be followed clinically for many years. However, patients with mitral porcine valves usually become symptomatic or present with congestive heart failure and usually require valve surgery soon after clinical or echo-phonocardiographic findings of valve regurgitation appear. PMID:6829407

Alam, M; Garcia, R; Goldstein, S



[Beating mitral valve surgery in patients with poor left ventricular function].  


Mitral valve surgery is usually performed under the arrested heart condition. However, cardioplegic arrest techniques will inevitably produce some degree of reperfusion injury. We expected that keeping heart beating decrease the reperfusion injury in patients with poor left ventricular function. The present study compared the results of beating heart technique and conventional mitral valve surgery to demonstrate the merit of this technique. Thirty six patients with low left ventricular function[ ejection fraction (EF)?35%] who underwent mitral valve surgery between April 2004 and July 2012 were enrolled in this study. On-pump beating mitral valve surgery were performed in 21 patients (beating group). Fifteen patients underwent conventional mitral valve surgery with cardiac arrest using blood cardioplegia (arrest group). Postoperative cardiac events in the beating group were less than that in the arrest group. However, this difference in both groups was not statistically significant. The visual field of the beating heart was equal to that of conventional surgery, and technical accuracy was not compromised. To decrease postoperative cardiac events, beating-heart mitral valve surgery may be suitable surgical option for patients with poor left ventricular function. PMID:23985399

Kiyama, Hiroshi; Kaki, Nobuaki; Shiomi, Daisuke; Takahashi, Aya; Shimizu, Masatsugu; Shimada, Naohiro



Aortic Valve Calcification on Computed Tomography Predicts the Severity of Aortic Stenosis  

Microsoft Academic Search

AIM: Incidental aortic valve calcification is often detected during computed tomography. The aim was to compare the severity of valvular stenosis and calcification in patients with aortic stenosis.MATERIALS AND METHODS: One hundred and fifty-seven patients aged 68±11 years (range: 34–85) with aortic valve stenosis underwent multislice helical computed tomography and Doppler echocardiography performed by independent, blinded observers. The aortic valve

S. J Cowell; D. E Newby; J Burton; A White; D. B Northridge; N. A Boon; J Reid



Influence of bileaflet prosthetic mitral valve orientation on left ventricular flow—an experimental in vivo magnetic resonance imaging study  

Microsoft Academic Search

Objective: Orientation-related bileaflet mechanical valve flow and velocity studies in the downstream area are limited in mitral valve replacement studies. Methods: In five sheep, ventricular blood flow was visualized prior to the implantation of a mitral Edwards Mira Bileaflet Mechanical Valve Model 9600. The implant orientation was either anatomic, with a 45° rotation, or anti-anatomic, with a 90° rotation. Sheep

H. Mächler; M. Perthel; G. Reiter; U. Reiter; M. Zink; P. Bergmann; A. Waltensdorfer; J. Laas



Long-Term Results After Starr-Edwards Mitral Valve Replacement in Children Aged 5 Years or Younger  

Microsoft Academic Search

Background. Mitral valve replacement with prosthetic valves in infants and children requires consideration of multiple variables. When we examined our late follow- up, the effect of the growth of the patient relative to the size of the prosthesis placed was the most important variable predicting late successful results. We reviewed our experience with mitral valve replacement using the Starr-Edwards ball

Ryuji Higashita; Seiichi Ichikawa; Hiroshi Niinami; Tetsuo Ban; Yuji Suda; Yasuo Takeuchi



Mitral valve regurgitation: accurate blood flow quantification with MRI  

PubMed Central

Background The quantification of transvalvular blood flow through the mitral valve (MV) and regurgitant flow in particular is difficult with echocardiography, which is the method of choice to diagnose patients selected for valve repair or replacement. With magnetic resonance imaging, information on the intraventricular blood flow can be obtained. Several scanning techniques have attempted to assess the regurgitant flow. These techniques either do not directly assess the complete flow through the MV, or they do not measure the flow at the location of the valve. Aim To investigate the accuracy of a novel method using three-directional velocity-encoded MRI to acquire the transvalvular blood flow directly from the intraventricular blood flow field, also representing the regurgitant flow during systole. Methods Ten volunteers without cardiac valvular disease were recruited. The transvalvular MV flow volume was measured with three-directional velocity-encoded MRI (3-dir MV flow). Results The transvalvular flow measurements correlate very well with the flow measured in the aorta (rp=0.92, p<0.01). The small differences (mean -5±7 ml) are insignificant (p=0.06) and demonstrate the high accuracy of the new method. Intra- and inter-observer studies showed non-significant mean differences of 0.9±5.1 ml and 1.3±5.6 ml, respectively, thereby proving the high reproducibility. Conclusion Three-directional velocity-encoded MRI is a patient-friendly and easy-to-use method suitable for quantifying the regurgitant MV flow in clinical practice. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6

Westenberg, J.J.M.; Doornbos, J.; Bax, J.J.; Danilouchkine, M.G.; van der Geest, R.J.; Labadie, G.; Lamb, H.J.; Versteegh, M.I.M.; de Roos, A.; Dion, R.A.E.; Reiber, J.H.C.



Mitral valve repair in patient with absent right superior vena cava in visceroatrial situs solitus  

PubMed Central

We report on a 74-year-old woman with an absence of right superior vena cava in visceroatrial situs solitus who underwent mitral valve plasty for severe mitral regurgitation. Preoperative three-dimensional computed tomography revealed an absent right and persistent left superior vena cava that drained into the right atrium by way of the coronary sinus. Perioperaively, placement of pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were great concern. Obtaining the information about this central venous malformation preoperatively, we performed mitral valve plasty without any difficulties related to this anomaly.



Intraoperative assessment for mitral valve competency in a beating heart under retrograde coronary perfusion.  


Intraoperative assessment of a repaired mitral valve is of paramount importance for reparative mitral surgery. From September 2010 through November 2012, 20 consecutive patients underwent mitral valve plasty for mitral regurgitation. The patients who underwent surgery after June 2012 received assessment of the repair with the heart beating (HB group, n = 10), and the patients who underwent the operation before May 2012 were assessed for the repair only under cardioplegic heart arrest (non-HB group, n = 10). Intermittent cold retrograde blood cardioplegia was used in all patients. In the HB-group, after completion of the procedures, pump blood without a crystalloid additive was delivered into the coronary sinus. The function of the mitral valve was assessed under beating conditions. There were no differences between the two groups in aortic cross clamp time and operation time, although operative and concomitant procedures were slightly more complicated in the HB group than in the non-HB group. Postoperative echocardiography revealed none or mild mitral regurgitation in all the patients in both groups. Reopening of the closed left atrium for additional repair was necessary only in one patient in the HB group and 3 patients in the non-HB group. In conclusion, the method of perfusing the myocardium retrogradely via the coronary sinus with warm blood is safe and effective for assessing the competency of the mitral valve in a beating heart. PMID:23924929

Miyairi, Takeshi; Miura, Sumio; Taketani, Tsuyoshi; Kusuhara, Takayoshi; Lee, Yangsin; Unai, Shinya; Ohno, Takayuki; Fukuda, Sachito; Takamoto, Shinichi



Pathogenesis of mitral valve disease in mucopolysaccharidosis VII dogs.  


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

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



Myocardial deformation and rotational profiles in mitral valve prolapse.  


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

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



Hemodynamics of the mitral valve under edge-to-edge repair: an in vitro steady flow study.  


Edge-to-edge repair (ETER) is a mitral valve repair technique that restores valvular competence by suturing together the free edges of two leaflets. This repair technique alters mitral valve inflow and thus left ventricle hemodynamics during diastole. Our objective was to investigate fluid mechanics immediately downstream of the mitral valve under ETER during diastole. Fresh porcine mitral valves of the annulus size M32 with chordae removed were installed into a steady flow loop simulating a peak diastolic inflow through the mitral valve. Digital particle image velocimetry was used to measure the velocity field immediately downstream of the mitral valve under normal and ETER conditions. First, to study the suture length effect, suture was applied in the central position of the leaflet edge with suture lengths of 3 mm, 6 mm, and 9 mm, respectively. Then, 3 mm suture was set in the central, lateral, and commissural positions of the leaflet edge to study the suture position effect. Flow rate was 15 l/min. Velocity, Reynolds shear stress (RSS), and effective orifice area were assessed. A total of five mitral valves were tested. The normal mitral valve without the ETER had one jet downstream of the valve, but the mitral valve with the central or lateral sutures under the ETER had two jets downstream of the valve with a recirculation region downstream of the suture. The maximum velocity, the maximum RSS in the jets, the pressure drop across the mitral valve, and the jet deflection angle increased with the increase in suture length in the central position. When the suture position effect was investigated with the 3 mm suture, the maximum velocity, the maximum RSS, and the pressure drop across the valve in the central suture position were greater than those of the lateral and the commissural suture positions. The lateral suture demonstrated major and minor jets with the greater maximum velocity and maximum RSS in the major jet. When the suture was in the commissural position, the flow field downstream of the mitral valve was similar to that of the normal mitral valve without the ETER. The effective orifice area was smallest when the suture was applied in the central position as compared with other suture positions. Both suture length and position have an important impact on fluid mechanics downstream of the mitral valve under the ETER in terms of flow pattern, maximum velocity, and RSS distribution. The altered hemodynamics of the mitral valve and thus of the left ventricle by the ETER may change mitral valve and left ventricle function. PMID:19388780

Shi, Liang; He, Zhaoming



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

NASA Astrophysics Data System (ADS)

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.

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



Local serotonin mediates cyclic strain-induced phenotype transformation, matrix degradation, and glycosaminoglycan synthesis in cultured sheep mitral valves.  


This study addressed the following questions: 1) Does cyclic tensile strain induce protein expression patterns consistent with myxomatous degeneration in mitral valves? 2) Does cyclic strain induce local serotonin synthesis in mitral valves? 3) Are cyclic strain-induced myxomatous protein expression patterns in mitral valves dependent on local serotonin? Cultured sheep mitral valve leaflets were subjected to 0, 10, 20, and 30% cyclic strain for 24 and 72 h. Protein levels of activated myofibroblast phenotype markers, ?-smooth muscle actin (?-SMA) and nonmuscle embryonic myosin (SMemb); matrix catabolic enzymes, matrix metalloprotease (MMP) 1 and 13, and cathepsin K; and sulfated glycosaminoglycan (GAG) content in mitral valves increased with increased cyclic strain. Serotonin was present in the serum-free media of cultured mitral valves and concentrations increased with cyclic strain. Expression of the serotonin synthetic enzyme tryptophan hydroxylase 1 (TPH1) increased in strained mitral valves. Pharmacologic inhibition of the serotonin 2B/2C receptor or TPH1 diminished expression of phenotype markers (?-SMA and SMemb) and matrix catabolic enzyme (MMP1, MMP13, and cathepsin K) expression in 10- and 30%-strained mitral valves. These results provide first evidence that mitral valves synthesize serotonin locally. The results further demonstrate that tensile loading modulates local serotonin synthesis, expression of effector proteins associated with mitral valve degeneration, and GAG synthesis. Inhibition of serotonin diminishes strain-mediated protein expression patterns. These findings implicate serotonin and tensile loading in mitral degeneration, functionally link the pathogeneses of serotoninergic (carcinoid, drug-induced) and degenerative mitral valve disease, and have therapeutic implications. PMID:22345569

Lacerda, Carla M R; Kisiday, John; Johnson, Brennan; Orton, E Christopher



Mitral Bioprosthetic Valve Endocarditis Caused by an Unusual Microorganism, Gemella morbillorum, in an Intravenous Drug User  

PubMed Central

We report a case of Gemella morbillorum mitral bioprosthetic valve endocarditis with perivalvular extension in a 44-year-old human immunodeficiency virus-positive man who is an active intravenous drug user together with review of all published cases. This is only the second reported case of Gemella morbillorum endocarditis in a patient with a prosthetic valve.

Zakir, Ramzan M.; Al-Dehneh, Anthony; Dabu, Leticia; Kapila, Raj; Saric, Muhamed



Partial replacement of the tricuspid valve by mitral homografts in acute endocarditis  

Microsoft Academic Search

Background. Seven patients with acute tricuspid endocarditis underwent partial replacement of the tricuspid valve using mitral homograft tissue. Valve function was evaluated at midterm.Methods. Operative indications were uncontrolled sepsis in all cases associated with heart failure symptoms in 3 patients and septic pulmonary emboli in 2 patients. These patients were referred to our institution after a course of antibiotic treatment

Jean-Paul A. Couetil; Pantelis G. Argyriadis; Abdel Shafy; Ariel Cohen; Alain J. Berrebi; Didier F. Loulmet; Juan-Carlos Chachques; Alain F. Carpentier



Left atrial ball valve thrombus. Treatable cause of clinical deterioration in a patient with mitral stenosis  

Microsoft Academic Search

A 74 year old woman with mixed mitral valve disease presented with episodes of loss of consciousness and fainting. The attacks were noted to be closely related to posture, especially crouching, and this, with the clinical finding that the radial pulse disappeared before she lost consciousness, suggested the diagnosis of a ball valve thrombus. Cardiac catheterisation confirmed the diagnosis but

R G Dent; J P Dick; R Cory-Pearce



Reoperation for a patient 25 years after a Starr-Edwards ball mitral valve was installed.  


A 45-year-old female suffered from increasing dyspnea during exercise and edema of lower extremities from January 2000. She had undergone mitral valve replacement with Starr-Edwards ball prosthesis (model 6320) due to mitral valve regurgitation 25 years ago. The cardiac catheterization and echocardiography documented mitral, aortic and tricuspid valves regurgitation grade III. Left ventricular ejection fraction rate was 49% and the pressures of CVP, RA, RV and PA were also increased. Laboratory examination showed slight hemolytic anemia. Double valve replacement (ATS valve) and tricuspid annuloplasty were carried out in April 2000. Strut cloth wear was confirmed at operation. Her postoperative course was uneventful. We hereby review the published paper of all cases with an implanted Starr-Edwards ball valve who required redo valve replacement with over 15 years follow-up. We consider that cloth injury is the main cause for reoperation and it usually associated with hemolytic anemia; cloth wear not only involves the aortic position but also frequently involves the mitral position for over 15 years follow-up patients and can be corrected by reoperation. Cloth wear should be concerned for those surviving patients who have received the Starr-Edwards ball valve during long-term follow-up. PMID:12472416

Ye, Zhidong; Shiono, Motomi; Sezai, Akira; Inoue, Tatsuya; Hata, Mitsumasa; Niino, Tetsuya; Goshima, Masakazu; Nakamura, Tetsuya; Negishi, Nanao; Sezai, Yukiyasu



Mitral and aortic valve endocarditis caused by a rare pathogen: Streptococcus constellatus  

PubMed Central

Streptococcus constellatus endocarditis is associated with systemic embolism and frequently with a poor prognosis. We describe the first case reported in the literature of infective endocarditis by penicillin-resistant S. constellatus causing both mitral and aortic valve regurgitation, treated successfully with double-valve replacement.

Concistre, Giovanni; Chiaramonti, Francesca; Miceli, Antonio; Glauber, Mattia



An exceptional cause of progressive dyspnoea in a renal transplant recipient: hemangioma of the mitral valve.  


Primary cardiac hemangioma is a very rare benign vascular tumor, with valvular hemangiomas being even less frequent as valves are generally avascular structures. We present the first case of mitral valve hemangioma in a renal transplant recipient. Patient presented with progressive dyspnea. Transesophageal echocardiogram (TEE) demonstrated a 0.8x0.9-cm pedunculated tumor mass on the posterior leaflet of the mitral valve. Coronary angiography identified a small artery which filled from the circumflex artery and fed the tumor. The tumor was surgically removed. Histopathological examination revealed a hemangioma. The postoperative course was uneventful with stable graft function. PMID:23445870

Juric, Ivana; Hadzibegovic, Irzal; Kes, Petar; Biocina, Bojan; Milicic, Davor; Basic-Jukic, Nikolina



Computational assessment of bicuspid aortic valve wall-shear stress: implications for calcific aortic valve disease.  


The bicuspid aortic valve (BAV) is associated with a high prevalence of calcific aortic valve disease (CAVD). Although abnormal hemodynamics has been proposed as a potential pathogenic contributor, the native BAV hemodynamic stresses remain largely unknown. Fluid-structure interaction models were designed to quantify the regional BAV leaflet wall-shear stress over the course of CAVD. Systolic flow and leaflet dynamics were computed in two-dimensional tricuspid aortic valve (TAV) and type-1 BAV geometries with different degree of asymmetry (10 and 16% eccentricity) using an arbitrary Lagrangian–Eulerian approach. Valvular performance and regional leaflet wallshear stress were quantified in terms of valve effective orifice area (EOA), oscillatory shear index (OSI) and temporal shear magnitude (TSM). The dependence of those characteristics on the degree of leaflet calcification was also investigated. The models predicted an average reduction of 49% in BAV peak-systolic EOA relative to the TAV. Regardless of the anatomy, the leaflet wall-shear stress was side-specific and characterized by high magnitude and pulsatility on the ventricularis and low magnitude and oscillations on the fibrosa. While the TAV and non-coronary BAV leaflets shared similar shear stress characteristics, the base of the fused BAV leaflet fibrosa exhibited strong abnormalities, which were modulated by the degree of calcification (6-fold, 10-fold and 16-fold TSM increase in the normal, mildly and severely calcified BAV, respectively, relative to the normal TAV). This study reveals the existence of major differences in wall-shear stress pulsatility and magnitude on TAV and BAV leaflets. Given the ability of abnormal fluid shear stress to trigger valvular inflammation, the results support the existence of a mechano-etiology of CAVD in the BAV. PMID:22294208

Chandra, Santanu; Rajamannan, Nalini M; Sucosky, Philippe



Normal sympathetic neural activity in patients with mitral valve prolapse.  


The hemodynamic and neurohumoral responses to head-up tilt and isometric exercise were studied in 14 mitral valve prolapse (MVP) patients with and 10 MVP patients without complaints and in 16 healthy control subjects. Plasma catecholamines at rest were not different between the three groups and neither were their changes during either test. The hemodynamic changes during head-up tilt were not different between the three groups. The symptomatic MVP patients showed a lower rise in diastolic blood pressure (14.3 +/- 6.4%) than the controls (22.9 +/- 9.6%) (p less than 0.05) during isometric exercise. In view of the fact that the neurohumoral responses to both tests were the same for all groups, we cannot support the suggestions from other studies that MVP patients have an impaired or enhanced sympathetic tone. Moreover, since there were no differences between symptomatic and asymptomatic MVP patients it is doubtful whether the complaints of symptomatic MVP patients are related to a high sympathetic neural activity. PMID:3708943

Lenders, J W; Fast, J H; Blankers, J; de Boo, T; Lemmens, W A; Thien, T



Mitral valve disease in Marfan syndrome and related disorders.  


Marfan syndrome (MFS) is a systemic disorder of the connective tissue with pleiotropic manifestations due to heterozygous FBN1 mutations and consequent upregulation of TGF? signaling in affected tissues. Myxomatous thickening and elongation of the mitral valve (MV) leaflets commonly occur in this condition. Investigation of murine models of this disease has led to improved understanding of the mechanisms that underlie many of the phenotypic features of MFS, including MV disease. Loeys-Dietz syndrome (LDS) is a related disorder due to heterozygous mutations in the genes encoding subunits of the TGF? receptor, and it may also involve the MV leaflets with similar elongation and thickening of the MV leaflets. Although the genetic basis and pathogenesis of nonsyndromic MV prolapse has been elusive to date, insights derived from monogenic disorders like MFS and LDS can be informative with regard to novel gene discovery and investigation into the pathogenesis of MV disease. This manuscript will review the prevalence of MV disease in MFS, its pathogenic basis as determined in mice with Fbn1 mutations, and ongoing studies that seek to better understand MV disease in the context of fibrillin-1 deficiency or excessive TGF? signaling. PMID:21866385

Judge, Daniel P; Rouf, Rosanne; Habashi, Jennifer; Dietz, Harry C



Silent destruction of aortic and mitral valve by Klebsiella pneumoniae endocarditis.  


Klebsiella endocarditis rarely affects the native valve especially in the immunocompromised and the elderly. We report a case of Klebsiella endocarditis in a 60-year-old man who had a nidus of infection on the aortic valve which led to severe aortic regurgitation. This possibly spread to the anterior mitral leaflet (AML) leading to AML perforation therefore causing moderate mitral regurgitation. The reason for this suspicion was that there was perforation of the AML in the absence of vegetation. Noteworthy is that he was asymptomatic apart from generalised fatigue. This case draws our attention to the nature of Klebsiella valvular affection due to the fact that it had bitten the aortic and mitral valve silently and compelled the patient to undergo double valve replacement without having a prolonged duration of symptomatic illness thereby calling for high suspicion especially in individuals in the extremes of ages where the symptoms are less-guiding than the signs. PMID:24057412

Srinivas, K H; Sharma, Rajni; Agrawal, Navin; Manjunath, C N



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


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

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



Clinical implications of left atrial spontaneous echo contrast in mitral valve disease.  


The aim of this study was to investigate the factors related to the presence of left atrial spontaneous echo contrast in mitral valve disease, and to ascertain whether it is a predictor of thromboembolism. One hundred and one patients (47 men, 54 women) with a mean age of 57.04 +/- 10.6 years who underwent transthoracic and transesophageal echocardiography were included in the study. Forty-five (44.5%) had isolated or predominant mitral valve stenosis, 12 (11.9%) predominant mitral insufficiency and 44 (43.6%) had had previous mitral valve replacement. Left atrial spontaneous echo contrast was detected by transesophageal echocardiography in 58 patients, while the transthoracic approach detected it in only 15 (14.9%) (P < 0.0001). An atrial thrombus was found in six cases, with a history of recent systemic embolism in three of them. There was no thrombus in the left atria of a further nine patients, despite definitive histories of recent systemic embolism. The finding of left atrial spontaneous echo contrast was related to the presence of atrial fibrillation or enlarged left atrium, the severity of mitral stenosis and the absence of significant mitral insufficiency. Anticoagulant therapy was not significantly associated with spontaneous left atrial echo contrast, but a stepwise linear regression analysis showed that its presence was the only independent predictor of thromboembolism (p < 0.0001). We conclude that left atrial spontaneous echo contrast in mitral valve disease can be discovered mainly by transesophageal echocardiography, and is correlated with factors which are associated with low left atrial blood flow velocity such as atrial fibrillation, enlarged left atrium, mitral stenosis of increased severity and the absence of significant mitral insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8269118

Kranidis, A; Koulouris, S; Anthopoulos, L



Diagnosis and Treatment of Early Bioprosthetic Malfunction in the Mitral Valve Position due to Thrombus Formation.  


Bioprosthetic valve thrombosis is uncommon and the diagnosis is often elusive and may be confused with valve degeneration. We report our experience with mitral bioprosthetic valve thrombosis and suggest a therapeutic approach. From 2002 to 2011, 149 consecutive patients who underwent mitral valve replacement with a bioprosthesis at a single center were retrospectively screened for clinical or echocardiographic evidence of valve malfunction. Nine were found to have valve thrombus. All 9 patients had their native valve preserved, representing 24% of those with preserved native valves. Five patients (group 1) presented with symptoms of congestive heart failure at 16.4 ± 12.4 months after surgery. Echocardiogram revealed homogenous echo-dense film on the ventricular surface of the bioprosthesis with elevated transvalvular gradient, resembling early degeneration. The first 2 patients underwent reoperation: valve thrombus was found and confirmed by histologic examination. Based on these, the subsequent 3 patients received anticoagulation treatment with complete thrombus resolution: mean mitral gradient decreased from 23 ± 4 to 6 ± 1 mm Hg and tricuspid regurgitation gradient decreased from 83 ± 20 to 49 ± 5 mm Hg. Four patients (group 2) were asymptomatic, but routine echocardiogram showed a discrete mass on the ventricular aspect of the valve: 1 underwent reoperation to replace the valve and 3 received anticoagulation with complete resolution of the echocardiographic findings. In conclusion, bioprosthetic mitral thrombosis occurs in about 6% of cases. In our experience, onset is early, before anticipated valve degeneration. Clinical awareness followed by an initial trial with anticoagulation is warranted. Surgery should be reserved for those who are not responsive or patients in whom the hemodynamic status does not allow delay. Nonresection of the native valve at the initial operation may play a role in the origin of this entity. PMID:23891426

Butnaru, Adi; Shaheen, Joseph; Tzivoni, Dan; Tauber, Rachel; Bitran, Daniel; Silberman, Shuli



Intermediate Term Evaluation of Starr-Edwards Ball Valves in the Mitral Position  

PubMed Central

The Model 6120 ball valve prosthesis introduced in 1965 is still strongly supported as a mitral valve substitute in many centers around the world. A current reassessment of the performance of this prosthesis is therefore pertinent to current medical practice. In this institution since 1974, 227 Starr-Edwards caged ball valves have been implanted in the mitral position during isolated valve replacement. Two models of caged ball valves were used concurrently: the silastic ball valve in 108 patients (48%) and the composite strut “tract” valve in 119 (52%). Hospital mortality was 7%, and 8-year survival (standard error) was 74 (6%), with 100% follow-up, documenting 752 total patient-years. No late deaths were known to be valve related, and there were no cases of prosthetic thrombosis. The actuarial estimate of patients free from thromboembolism at 8 years was 89 (4%) with a linearized rate of 1.3% per year. At the most recent follow-up, 95% of the patients were in the New York Heart Association (NYHA) Classes I or II. These good results were partly due to an awareness at operation of ventricular outflow tract size requirements and to strict control of postoperative anticoagulation. We conclude that the Starr-Edwards ball valve is the mitral valve of choice in the young patient who is able to take anticoagulation drugs and has a left ventricular outflow tract of satisfactory size.

Cotrufo, Maurizio; Renzulli, Attilio; Esposito, Vincenzo; Vosa, Carlo; Nappi, Giannantonio; Deluca, Luigi; Casale, Domenico; Bellitti, Renato; Festa, Michele



Additional value of biplane transoesophageal imaging in assessment of mitral valve prostheses.  

PubMed Central

OBJECTIVES--To determine whether biplane transoesophageal imaging offers advantages in the evaluation of mitral prostheses when compared with standard single transverse plane imaging or the precordial approach in suspected prosthetic dysfunction. DESIGN--Prospective mitral valve prosthesis in situ using precordial and biplane transoesophageal ultrasonography. SETTING--Tertiary cardiac referral centre. SUBJECTS--67 consecutive patients with suspected dysfunction of a mitral valve prosthesis (16 had bioprostheses and 51 mechanical prostheses) who underwent precordial, transverse plane, and biplane transoesophageal echocardiography. Correlative invasive confirmation from surgery or angiography, or both, was available in 44 patients. MAIN OUTCOME MEASURES--Number, type, and site of leak according to the three means of scanning. RESULTS--Transverse plane transoesophageal imaging alone identified all 31 medial/lateral paravalvar leaks but only 24/30 of the anterior/posterior leaks. Combining the information from both imaging planes confirmed that biplane scanning identified all paravalvar leaks. Five of the six patients with prosthetic valve endocarditis, all three with valvar thrombus or obstruction, and all three with mitral annulus rupture were diagnosed from transverse plane imaging alone. Longitudinal plane imaging alone enabled diagnosis of the remaining case of prosthetic endocarditis and a further case of subvalvar pannus formation. CONCLUSIONS--Transverse plane transoesophageal imaging was superior to the longitudinal imaging in identifying medial and lateral lesions around the sewing ring of a mitral valve prosthesis. Longitudinal plane imaging was superior in identifying anterior and posterior lesions. Biplane imaging is therefore an important development in the study of mitral prosthesis function. Images

Groundstroem, K; Rittoo, D; Hoffman, P; Bloomfield, P; Sutherland, G R



Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization  

Microsoft Academic Search

Liquefactive necrosis within a large spheroid zone of mitral annular calcification (LNMAC) is an atypical but increasingly\\u000a recognized variant of mitral annular calcification (MAC). Proposed MRI, echo, and CT imaging criteria for diagnosis of this\\u000a unusual disease entity are discussed along with a review of the prognosis, histopathology, and management implications. A\\u000a comprehensive ECHO, CT, and MRI imaging approach to

S. Sanjay Srivatsa; Michael D. Taylor; Kan Hor; David A. Collins; Melissa King-Strunk; Robert A. Pelberg; Wojciech Mazur


[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement].  


10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics. PMID:8289429

Zieli?ski, T; Korewicki, J; Sliwi?ski, M; Rajecka, A; Pogorzelska, H; Leszek, P; Sadowski, A



Harnessing osteopontin and other natural inhibitors to mitigate ectopic calcification of bioprosthetic heart valve material  

Microsoft Academic Search

Dystrophic calcification has been the long-standing major cause of bioprosthetic heart valve failure, and has been well studied in terms of the underlying causative mechanisms. Such understanding has yielded several anti-calcification strategies involving biomaterial modification at the preparation stage: chemical alteration, extraction of calcifiable components, or material modification with small-molecule anti-calcific agents. However, newer therapeutic opportunities are offered by the

Rachit Ohri



Late re-operation for aortic and mitral Starr-Edwards ball valve prostheses.  


Starr-Edwards ball valves removed more than 15 years after implantation were retrospectively investigated macroscopically. Eight patients required re-operation. Valve models used in the initial operations were a non-cloth-covered valve in 2 patients and a cloth-covered valve in 6. Two patients had replacement of an aortic ball valve (model 1260 and model 2320) and 6 underwent mitral valve replacement (model 6120 in one, model 6320 in 5). The mean time to re-operation was 23.0 +/- 4.8 years after implantation. Cloth wear causing significant hemolysis was observed in all cloth-covered valves, regardless of valve position. Autologous tissue growth was noted on the orifice ring and struts in both aortic and mitral prostheses. Thrombus formation was not found in any of the valves. Ball variance in silicone rubber balls was mild in the non-cloth-covered valves, even in the aortic position. The most significant problem with the cloth-covered ball valve was cloth wear. Cloth wear should always be considered when 15 years or more have passed since valve implantation. Significant hemolysis, elevation of lactate dehydrogenase values, and echocardiographic detection of transvalvular regurgitation are diagnostic of cloth wear, and are indications for replacement of a cloth-covered ball valve. PMID:17130320

Aoyagi, Shigeaki; Fukunaga, Shuji; Arinaga, Koichi; Yokokura, Yoshinori; Yokokura, Hiroko; Egawa, Noriko



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


We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. A condition of cardiogenic shock quickly developed. A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards-Sapien valve implantation through the Corevalve. This case strongly demonstrates how much a careful evaluation of the features of the mitral prosthesis and patient anatomy is crucial to select which specific transcatheter bioprosthesis would better perform. © 2013 Wiley Periodicals, Inc. PMID:23592397

Testa, Luca; Gelpi, Guido; Bedogni, Francesco



Inhibition of aortic wall calcification in bioprosthetic heart valves by ethanol pretreatment: Biochemical and biophysical mechanisms  

Microsoft Academic Search

The effectiveness of ethanol pretreatment on pre- venting calcification of glutaraldehyde-fixed porcine aortic bioprosthetic heart valve (BPHV) cusps was previously demonstrated, and the mechanism of action of ethanol was attributed in part to both lipid removal and a specific colla- gen conformational change. In the present work, the effect of ethanol pretreatment on BPHV aortic wall calcification was investigated using

Chi-Hyun Lee; Narendra Vyavahare; Robert Zand; Howard Kruth; Frederick J. Schoen; Richard Bianco; Robert J. Levy



New treatments using alginate in order to reduce the calcification of bovine bioprosthetic heart valve tissue  

Microsoft Academic Search

Calcification limits the functional lifetime of cardiac valve substitutes fabricated from glutaraldehyde preserved bovine pericardium. Host factors, mainly younger age, and implant factors, mainly glutaraldehyde cross-linking, are implicated in the calcification process. Glutaraldehyde cross-linking is believed to activate the potential sites in the tissues for biocalcification. In the present work, we investigated the possibility of using alginate azide (AA) instead

C. Shanthi; K. Panduranga Rao



Design and Validation of a Novel Splashing Bioreactor System for Use in Mitral Valve Organ Culture  

Microsoft Academic Search

Previous research in our lab suggested that heart valve tissues cultured without mechanical stimulation do not retain their\\u000a in vivo microstructure, i.e., cell density decreased within the deep tissue layers and increased at the periphery. In this study,\\u000a a splashing rotating bioreactor was designed to apply mechanical stimulation to a mitral valve leaflet segment. Porcine valve\\u000a segments (n = 9–10 per group)

Janet E. Barzilla; Anna S. McKenney; Ashley E. Cowan; Christopher A. Durst; K. Jane Grande-Allen



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

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.



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

Microsoft Academic Search

Background. The effect of aortic valve replacement on three-dimensional\\u000a mitral annular geometry has not been well described. Emerging\\u000a transcatheter approaches for aortic valve replacement employ\\u000a fundamentally different mechanical techniques for achieving fixation and\\u000a seal of the prosthetic valve than standard surgical aortic valve\\u000a replacement. This study compares the immediate impact of transcatheter\\u000a aortic valve replacement (TAVR) and standard surgical aortic

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



Impact of aortic valve replacement for aortic stenosis on dynamic mitral annular motion and geometry.  


The impact of aortic valve replacement (AVR) on the dynamic geometry and motion of the mitral annulus remains unknown. We analyzed the effects of AVR on the dynamic geometry and motion of the mitral annulus. We used 3-dimensional transesophageal echocardiography to analyze 39 consecutive patients undergoing elective surgical AVR for aortic stenosis. Intraoperative 3-dimensional transesophageal echocardiography was performed immediately before and after AVR. Volumetric data sets were analyzed using a software package capable of dynamically tracking the mitral annulus and leaflets during the entire systolic ejection phase. After AVR, there were significant decreases (p <0.01) in annular dimensions such as anteroposterior (3.5 ± 0.1 vs 3.2 ± 0.1 cm), anterolateral-posteromedial (3.7 ± 0.1 vs 3.5 ± 0.1 cm), and commissural diameters (3.7 ± 0.1 vs 3.3 ± 0.1 cm), as well as annular circumference (12.0 ± 0.30 vs 11.1 ± 0.2 cm) and 3-dimensional mitral annular area (mean 10.9 ± 0.6 vs 9.3 ± 0.3 cm(3)). Vertical mitral annular displacement was also reduced (6.2 ± 3.1 vs 4.3 ± 2.2 mm). Mitral annular nonplanarity angle (154 ± 1.5° vs 161 ± 1.6°) and aorto-mitral angle (133 ± 3.3° vs 142 ± 2.0°) were both increased after AVR, suggesting reduced nonplanar shape of the mitral annulus and reduced aorto-mitral flexion. In conclusion, these data demonstrate that mitral annular size is reduced immediately after AVR and that the dynamic motion of the mitral annulus is restricted. These findings may have important clinical implications for patients undergoing AVR with concurrent mitral regurgitation. PMID:23891429

Warraich, Haider J; Matyal, Robina; Bergman, Remco; Hess, Philip E; Khabbaz, Kamal; Manning, Warren J; Mahmood, Feroze



Reconstruction of mitral valve chordae and leaflets with one piece of autologous pericardium in extensively destructed mitral valve due to active infective endocarditis.  


A 20-year-old female patient underwent urgent surgery for extensive mitral valve endocarditis. All marginal chordae and rough zone of A3 leaflet, posterior commissure leaflet, and P3 leaflet down to the annulus became defective after complete debridement of infected tissues. After annular plication, defective leaflets and chordae were reconstructed with a piece of triangular shaped autologous pericardium. Top of the pericardium was directly attached to the posterior papillary muscle, side edges to remnant leaflets, and the base to the annulus, thus substituting for chordae and leaflets at once. No mitral regurgitation was observed during 3 years of follow-up after the operation. PMID:23292687

Ito, Toshiaki; Maekawa, Atsuo; Sawaki, Sadanari; Fujii, Genyo; Hoshino, Satoshi; Hayashi, Yasunari



Quantitative assessment of changes in left ventricular shape following mitral valve repair  

Microsoft Academic Search

Mitral valve (MV) repair is the preferential treatment for mitral regurgitation (MR) associated with degenerative MV disease, and the functional benefits of early surgery are known. Our goal was to evaluate the changes in LV shape following MV repair, using a new method based on real-time 3D echocardiography (RT3DE). Fifty patients with severe asymptomatic MR were enrolled. Transthoracic RT3DE imaging

F. Maffessanti; G. Tamborini; M. Muratori; M. Zanobini; V. Mor-Avi; L. Sugeng; F. Alamanni; R. M. Lang; M. Pepi; E. G. Caiani



Minimally Invasive Mitral Valve Repair in a Patient With Porcelain Aorta.  


A woman aged 79 years with a history of stroke was admitted to undergo surgical treatment of a severe mitral regurgitation caused by active endocarditis. A preoperative computed tomography scan showed the presence of a porcelain aorta. The mitral valve was successfully repaired with an endovascular cardiopulmonary bypass system. The patient was discharged on postoperative day 10 with no complication. Endoaortic clamping is thought to be a useful technique in patients with a severely calcified aorta. PMID:23751148

Mazine, Amine; Khaliel, Feras; Rochon, Antoine; Pellerin, Michel



Excellent results for atrial fibrillation surgery in the presence of giant left atrium and mitral valve disease  

Microsoft Academic Search

Objective: The incidence of sinus conversion in the enlarged left atrium after atrial fibrillation surgery is reported to be low. The purpose of the current study was to investigate the effects of atrial fibrillation surgery on mitral valve disease associated with a giant left atrium (GLA). Method: From July of 1997 to February of 2002, 188 patients received mitral valve

Suk Jung Choo; Nam Hee Park; Sang Kwon Lee; Jong Woo Kim; Jae Kwan Song; Hyun Song; Meong Gun Song; Jae Won Lee



Excellent results for atrial fibrillation surgery in the presence of giant left atrium and mitral valve diseaseq  

Microsoft Academic Search

Objective: The incidence of sinus conversion in the enlarged left atrium after atrial fibrillation surgery is reported to be low. The purpose of the current study was to investigate the effects of atrial fibrillation surgery on mitral valve disease associated with a giant left atrium (GLA). Method: From July of 1997 to February of 2002, 188 patients received mitral valve

Suk Jung Choo; Nam Hee Park; Sang Kwon Lee; Jong Woo Kim; Jae Kwan Song; Hyun Song; Jae Won Lee


New insights into the reduction of mitral valve systolic anterior motion after ventricular septal myectomy in hypertrophic obstructive cardiomyopathy  

Microsoft Academic Search

To determine the mechanism of reduction of mitral valve systolic anterior motion by myectomy, we examined 33 patients with hypertrophic obstructive cardiomyopathy echocardiographically before and after myectomy. Measurements included outflow tract diameter, the direction of ejection streamline (the angle between the ejection flow and the mitral valve), midventricular fractional area change, and papillary muscle inward excursion in the short-axis image.

Satoshi Nakatani; Ehud Schwammenthal; Harry M. Lever; Robert A. Levine; Bruce W. Lytle; James D. Thomas



MitraClip: a novel percutaneous approach to mitral valve repair  

PubMed Central

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

Jilaihawi, Hasan; Hussaini, Asma; Kar, Saibal



Mechanical haemolytic anaemia after valve repair operations for non-rheumatic mitral regurgitation.  

PubMed Central

Two cases are described in which severe mechanical haemolytic anaemia developed shortly after operation for repair of non-rheumatic mitral regurgitation. One patient had a "floppy" valve and the other cleft mitral leaflets, and both had chordal rupture. In both there was residual regurgitation after repair though in one this was initially only trivial. Clinically manifest haemolysis ceased after replacement of the valve by a frame-mounted xenograft. There are two previously reported cases in which haemolytic anaemia followed an unsuccessful mitral valve repair operation. Subclinical haemolysis or mild haemolytic anaemia may occur with unoperated valve lesions, but hitherto frank haemolytic anaemia has been observed only when turbulent blood flow is associated with the presence of a prosthetic valve or patch of prosthetic fabric. In these four cases, however, polyester or Teflon sutures were the only foreign material, and it is suggested that when these are used for the repair of leaflets, particularly in non-rheumatic mitral valve disease, they may increase the damaging effect of turbulence on circulating red blood cells.

Warnes, C; Honey, M; Brooks, N; Davies, J; Gorman, A; Parker, N



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

PubMed Central

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

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



Effect of ventricle motion on the dynamic behaviour of chorded mitral valves  

NASA Astrophysics Data System (ADS)

An Immersed Boundary (IB) model is employed to investigate the dynamic behaviour of a novel chorded mitral prosthesis, which is in the early stages of its development, under physiological flow conditions. In vivo magnetic resonance images (MRIs) of the left ventricle are analysed to determine the relative motion of the mitral annulus and the papillary muscle regions of the ventricle. The dynamic boundary conditions are incorporated into IB simulations to test the valve in a more realistic dynamic geometric environment. The IB model has successfully identified the effect of the dynamic boundary conditions on the mechanical behaviour of the valve and revealed the strengths and weaknesses of the current mitral design. The mechanical performance of the prosthesis is compared with recent studies of native porcine valves; differences in mechanical behaviour are observed. Potential improvements for the design of the prosthesis are proposed.

Watton, P. N.; Luo, X. Y.; Yin, M.; Bernacca, G. M.; Wheatley, D. J.



Proteomic analysis of interstitial aortic valve cells acquiring a pro-calcific profile.  


Cell-driven processes are now considered of relevance for the pathogenesis of aortic stenosis. In particular, during calcific valve degeneration, interstitial valve cells (VIC) resident in the leaflet can acquire an osteogenic/pro-calcific profile and actively contribute to matrix mineralization. The proteomic study described in this chapter is undertaken to investigate modifications in the proteome of bovine aortic VIC acquiring a calcifying phenotype. This approach can be useful to clarify cellular pathways involved in VIC pro-calcific differentiation and identify innovative therapeutic targets. PMID:23606251

Renato, Millioni; Bertacco, Elisa; Franchin, Cinzia; Arrigoni, Giorgio; Rattazzi, Marcello



Developmental basis for filamin-A-associated myxomatous mitral valve disease  

PubMed Central

Aims We hypothesized that the structure and function of the mature valves is largely dependent upon how these tissues are built during development, and defects in how the valves are built can lead to the pathological progression of a disease phenotype. Thus, we sought to uncover potential developmental origins and mechanistic underpinnings causal to myxomatous mitral valve disease. We focus on how filamin-A, a cytoskeletal binding protein with strong links to human myxomatous valve disease, can function as a regulatory interface to control proper mitral valve development. Methods and results Filamin-A-deficient mice exhibit abnormally enlarged mitral valves during foetal life, which progresses to a myxomatous phenotype by 2 months of age. Through expression studies, in silico modelling, 3D morphometry, biochemical studies, and 3D matrix assays, we demonstrate that the inception of the valve disease occurs during foetal life and can be attributed, in part, to a deficiency of interstitial cells to efficiently organize the extracellular matrix (ECM). This ECM organization during foetal valve gestation is due, in part, to molecular interactions between filamin-A, serotonin, and the cross-linking enzyme, transglutaminase-2 (TG2). Pharmacological and genetic perturbations that inhibit serotonin-TG2-filamin-A interactions lead to impaired ECM remodelling and engender progression to a myxomatous valve phenotype. Conclusions These findings illustrate a molecular mechanism by which valve interstitial cells, through a serotonin, TG, and filamin-A pathway, regulate matrix organization during foetal valve development. Additionally, these data indicate that disrupting key regulatory interactions during valve development can set the stage for the generation of postnatal myxomatous valve disease.

Sauls, Kimberly; de Vlaming, Annemarieke; Harris, Brett S.; Williams, Katherine; Wessels, Andy; Levine, Robert A.; Slaugenhaupt, Susan A.; Goodwin, Richard L.; Pavone, Luigi Michele; Merot, Jean; Schott, Jean-Jacques; Le Tourneau, Thierry; Dix, Thomas; Jesinkey, Sean; Feng, Yuanyi; Walsh, Christopher; Zhou, Bin; Baldwin, Scott; Markwald, Roger R.; Norris, Russell A.



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

PubMed Central

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

Bullock, R E; Hall, R J



Intraoperative transesophageal echocardiographic assessment of acute prosthetic aortic valve regurgitation after mitral valve replacement: Value of the deep transgastric long-axis view  

Microsoft Academic Search

The transesophageal echocardiographic assessment of prosthetic aortic valve function is made more difficult by the presence of a mechanical mitral valve prosthesis because echocardiographic views conventionally used to assess the aortic valve function are obscured by acoustic shadowing and artifacts. We report the use of intraoperative transesophageal echocardiography in a patient who developed severe prosthetic aortic valve regurgitation after implantation

Tat W. Koh; Sandeep Gandhi



Late results of combined percutaneous balloon valvuloplasty of mitral and tricuspid valves.  


Although combined mitral and tricuspid stenosis are rarely seen in patients with rheumatic heart disease, when both exist together, combined percutaneous balloon valvuloplasty can be an alternative to surgical treatment in suitable cases. We present the immediate and late follow up results of 12 patients with rheumatic tricuspid and mitral stenosis treated with combined percutaneous balloon valvuloplasty. Twelve patients (11 female, 91.7%; 1 male, 8.3%) with a mean age of 35.3 +/- 6.4 years were enrolled in the study. The patients were followed up for 38.8 +/- 12.6 months. The mitral valve area increased from 1.2 +/- 0.2 cm2 to 2.3 +/- 0.2 cm2 (P < 0.01) and on follow up the mitral valve area did not differ significantly (2.2 +/- 0.2 cm2; P > 0.05). The tricuspid valve area increased from 1.6 +/- 0.3 cm2 to 3.2 +/- 0.2 cm2 (P < 0.01) and on follow up the tricuspid valve area did not differ significantly (3.1 +/- 0.2 cm2; P > 0.05). Two patients (16.6%) had tricuspid restenosis and tricuspid re-valvuloplasty. One other patient (8.3%) was referred to surgery 14 months after the procedure secondary to severe tricuspid regurgitation. In conclusion, this study demonstrates a sustained benefit on late follow up after combined percutaneous balloon valvuloplasty of mitral and tricuspid valves and confirms the efficacy and safety of the procedure as an alternative to surgery in selected cases of combined mitral and tricuspid stenosis. PMID:9829880

Sancaktar, O; Kumbasar, S D; Semiz, E; Yalçinkaya, S



Prevalence of mitral valve prolapse in healthy adult Nigerians as diagnosed by echocardiography.  


Fifty (male = 24; female = 26; age 49.33 +/- 12.16) presumably healthy adult Nigerians were prospectively examined for the presence of mitral valve prolapse (MVP). We performed clinical, electrocardiographic (ECG), M-mode echocardiographic (M-mode echo) and two-dimensional echocardiographic (2-D echo) examinations on these subjects. 2-D echos were obtained from parasternal and apical acoustic windows. Parasternal long axis view obtained when the transducer was perpendicular to the chest wall with both mitral valve leaflets and left atrium recorded was considered optimal for studying mitral valve systolic motion. MVP was defined as late or holosystolic bowing of mitral valve leaflet at least 2 mm or 3 mm, respectively, below the C-D line at M-mode echo; or, marked systolic extension of one or both mitral valve leaflets cephalad to the plane of mitral annulus into the left atrium. No subject had classical features of Marfan's Syndrome. Of the four subjects with cardiac symptoms, only one had diagnostic MVP. Three subjects had mid-to late systolic click following valsalva manouver. Seven subjects had apical late systolic murmur none of which was louder than grade II/VI. Four of them had combined anterior and posterior leaflet prolapse and one had posterior leaflet prolapse compatible with diagnostic MVP, thus resulting in 10% prevalence rate of MVP in the study population. Two other subjects with late systolic murmur had no echocardiographic evidence of MVP. Three subjects with non-diagnostic mild-to moderate prolapse of the anterior leaflet alone on 2-D echo had no clinical murmur even though two of them complained of palpitations. Seven otherwise normal subjects had holosystolic bowing of mitral valve leaflets on M-mode echo but not on 2-D echo and were thus classified into non-diagnostic MVP group. No subject with MVP had serious arrhythmias on resting ECG. These results indicate that the prevalence of MVP in presumably healthy adult Nigerians was 10%. The use of M-mode echo resulted in over-diagnosis, whereas 2-D echo was more accurate in identifying true anatomical and structural abnormalities of the mitral valve. PMID:14510142

Oladapo, O O; Falase, A O


Earlier accumulation of calcium, phosphorus, and magnesium in the coronary artery in comparison with the ascending aorta, aortic valve, and mitral valve.  


To explore reasons for a high accumulation of Ca and P occurring in the coronary artery of Thai with aging, the authors investigated age-related changes of elements in the coronary artery, ascending aorta near the heart, and cardiac valves in single individuals, and the relationships in the elements between the coronary artery and either the ascending aorta or cardiac valves. After an ordinary dissection by medical students at Chiang Mai University was finished, the anterior descending arteries of the left coronary artery, ascending aortas, mitral valves, and aortic valves were resected from the subjects. The subjects consisted of 17 men and 9 women, ranging in age from 46 to 76 yr. The element content was analyzed by inductively coupled plasma-atomic emission spectrometry. The average content of Ca and P was the highest in the coronary artery and decreased in the order aortic valve, ascending aorta, and mitral valve. The Ca, P, and Mg content increased in the coronary artery in the fifties and in the ascending aorta, aortic valve, and mitral valve in the sixties. It should be noted that the accumulation of Ca, P, and Mg occurred earlier in the coronary artery than in the ascending aorta, aortic valve, and mitral valve. It was found that with respect to the Ca, P, Mg, and Na contents, the coronary artery correlated well with both the aortic valve and ascending aorta, especially with the aortic valve, but it did not correlate with the mitral valves. This finding suggests that the accumulation of Ca, P, Mg, and Na occurs in the coronary artery together with the aortic valve and ascending aorta, but not together with the mitral valve. Because regarding the accumulation of Ca, P, and Mg, the ascending aorta and aortic valve are preceded by the coronary artery, it is unlikely that the accumulation of Ca, P, and Mg spreads from the ascending aorta or aortic valve to the coronary artery. PMID:16943614

Tohno, Yoshiyuki; Tohno, Setsuko; Mahakkanukrauh, Pasuk; Azuma, Cho; Moriwake, Yumi; Ongkana, Nutcharin; Kumai, Tsukasa; Minami, Takeshi; Maruyama, Hirohisa



Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement  

PubMed Central

Background: Thromboembolic events (TEs) are frequent after mechanical mitral valve replacement (MVR), but their association to anticoagulation quality is unclear and has never been studied in a population-based setting with patients who have a complete anticoagulation record. Methods: We compiled a complete record of all residents of Olmsted County, MN, who underwent mechanical MVR between 1981 and 2004, for all TE, bleeding episodes, and international normalized ratios (INRs) measured from prosthesis implantation. Results: In the 112 residents (mean [± SD] age, 57 ± 16 years; 60% female residents) who underwent mechanical MVR, 19,647 INR samples were obtained. While INR averaged 3.02 ± 0.57, almost 40% of INRs were < 2 or > 4.5. Thirty-four TEs and 28 bleeding episodes occurred during a mean duration of 8.2 ± 6.1 years of follow-up. There was no trend of association of INR (average, SD, growth variance rate, or intensity-specific incidence of events) with TE. Previous cardiac surgery (p = 0.014) and ball prosthesis (hazard ratio [HR], 2.92; 95% CI, 1.43 to 5.94; p = 0.003) independently determined TE. With MVR using a ball prosthesis, despite higher anticoagulation intensity (p = 0.002), the 8-year rate of freedom from TE was considerably lower (50 ± 9% vs 81 ± 5%, respectively; p < 0.0001). Compared with expected stroke rates in the population, stroke risk was elevated with non-ball prosthesis MVR (HR 2.6; 95% CI, 1.3 to 5.2; p = 0.007) but was considerable with ball prosthesis MVR (HR 11.7; 95% CI, 7.5 to 18.4; p < 0.0001). INR variability (SD) was higher with a higher mean INR value (p < 0.0001). INR variability (HR 2.485; 95% CI, 1.11 to 5.55; p = 0.027) and cancer history (p < 0.0001) independently determined bleeding rates. Conclusion: This population-based comprehensive study of anticoagulation and TE post-MVR shows that, in these closely anticoagulated patients, anticoagulation intensity was highly variable and not associated with TE incidence post-MVR. Higher anticoagulation intensity is linked to higher variability and, thus, to bleeding. The MVR-ball prosthesis design is associated with higher TE rates notwithstanding higher anticoagulation intensity, and its use should be retired worldwide.

Le Tourneau, Thierry; Lim, Vanessa; Inamo, Jocelyn; Miller, Fletcher A.; Mahoney, Douglas W.; Schaff, Hartzell V.; Enriquez-Sarano, Maurice



A case report of valve dysfunction associated with abrasion of the Delrin disk used in early Björk-Shiley mitral valves requiring resurgery.  


A 39-year-old woman had undergone mitral valve replacement (MVR) (29-mm Björk-Shiley Delrin disk) at 6 years of age. Severe mitral regurgitation, aortic regurgitation, and left ventricular dilatation were detected by echocardiography in October 2006, and MVR (ON-X 25 mm) and aortic valve replacements (St. Jude Medical Regent, 21 mm) were performed in December. The Delrin disk of the previous prosthetic valve, located at the position of the mitral valve, was markedly abraded, broadening the clearance from the valve seat. The postoperative course was smooth without complications, and the patient was discharged, walking by herself, on day 19 after surgery. A Delrin disk was used for the tilting valve in early Björk-Shiley valves, but has been replaced by pyrolytic carbon because of problems with durability of the Delrin material. Follow-ups of patients who have undergone procedures using Delrin disks ares necessary, with consideration of valve replacement. PMID:19471217

Masumoto, Hidetoshi; Shimamoto, Mitsuomi; Yamazaki, Fumio; Nakai, Masanao; Fujita, Shoji; Miura, Yujiro; Itonaga, Tatsuya; Ito, Hiroki



Characterization of normal leakage flow of Monostrut tilting disk prosthetic mitral valves by multiplane transesophageal echocardiography  

Microsoft Academic Search

To assess normal prosthetic mitral valve function, multiplane transesophageal Doppler echocardiographic studies were performed on 22 patients with Monostrut tilting disk valves. Mean follow-up after implantation was 63 ± 12 months. Two holosystolic red low-velocity regurgitant jets were detected in all but one case. The length of these jets ranged from 0.8 to 6.9 cm and the area ranged from 0.5

Andras Temesvari; Werner Mohl; Natascha Kupilik



The 'Pomeroy procedure': a new method to correct post-mitral valve repair systolic anterior motion.  


Systolic anterior motion (SAM), a recognized complication of mitral valve repair, is often associated with left ventricular outflow gradient and mitral regurgitation. Current surgery to prevent these conditions is to perform sliding annuloplasty to reduce the posterior mitral leaflet (PML) height and to oversize the annuloplasty ring. However, these techniques do not consistently eliminate post-repair SAM, and removal of excess tissue and reduction of anterior mitral leaflet (AML) height may be more effective; this is the 'Pomeroy procedure'. Here, we report a patient in whom all standard procedures to prevent SAM were performed, but the condition still developed. This was corrected on a second pump run, using the Pomeroy procedure. PMID:11380092

Raney, A A; Shah, P M; Joyo, C I



Fragmentation hemolysis in a patient with hypertrophic obstructive cardiomyopathy and mitral valve prolapse.  


We encountered a 65-year-old female with hypertrophic obstructive cardiomyopathy and mitral valve prolapse who had infective endocarditis and hemolytic anemia. The infecting organism of endocarditis was group A streptococci. With regard to the etiology of the hemolytic anemia, fragmentation hemolysis was considered because fragmented red cells and elevated lactic dehydrogenase were observed. Haptoglobin was markedly decreased. Coombs' test, Ham's test and abnormal hemoglobin were negative. She had not had a hemolytic attack in the past. Ultrasonic cardiography showed asymmetrical septal hypertrophy, mitral valve prolapse and 285 mmHg of calculated pressure gradient in the left ventricle. Cardiac catheterization showed 115 mmHg of left intraventricular pressure gradient and mitral regurgitation (grade 2). Hemolysis was slightly improved after treatment with propranolol. Thus, fragmentation of the normal red cells seemed to be due to shear stress. PMID:1404852

Maeda, T; Ashie, T; Kikuiri, K; Fukuyama, S; Yamaguchi, Y; Yoshida, E; Shimamoto, K; Iimura, O



Mitral valve restoration using the No-React(R) MitroFix(TM): a novel concept  

PubMed Central

Background Mitral Valve Repair (MVRP) has been shown to be significantly superior to Mitral Valve Replacement (MVR). Since the majority of repairs involve the Posterior Mitral Leaflet (PML) and not the Anterior Mitral Leaflet (AML), the monocuspidalisation of the Mitral Valve (MV) can be achieved with a bio-posterior leaflet that imitates a closed PML. This approach may have the benefit of restoring the competence of the MV without reducing its effective orifice area. Methods We have used a new concept and device, the MitroFixTM, to correct MV regurgitation due to pathology of the PML. The device comes with functional sizers both of which have identical shape and size. This allows the surgeon to pre-test the success of the restoration. From December 2006 to October 2011, 51 MitroFixTM devices were implanted at three institutions. Results The mean age of the patients (32 males and 19 females) was 67.7 years. 37 of them were in NYHA class III or IV and all patients suffered from severe mitral valve regurgitation (MR). 31 patients underwent combined surgery. Successful implantation of the MitroFix™ device was performed in 51/53 patients.Mean cross-clamp time was 63.6 min (range: 29-118 min). Six patients had additional reconstructive procedures of the AML (chordae transfer, neo-chordae, triangular resection). At discharge, 33 patients showed no MR in the TTE and 17 patients exhibited trivial (I) or moderate (II) MR. The mean gradient was 4.0 mmHg and mean EOA was 2.52cm^2 (range: 1.5-4.0cm2). All patients were classified as being in NYHA class I or II. Conclusion The MitroFixTM Mitral Valve Restoration Device is a new concept that offers an effective treatment of MR. The restoration of the mitral valve with the MitroFix™ device offers the advantage of preserving the AML and providing good coaptation with a prosthetic PML. Importantly, this preliminary evaluation indicates a mean effective orifice area ( EOA ) of 2.5cm2 in MV receiving a MitroFix™ device, witch is higher than EOA resulting from MVR or MVRP. The present study has also shown that severe regurgitation due to ischemic/rheumatic MR, endocarditis and complex prolapse of the PML are clear candidates for correction with the MitroFix™. Larger studies and a longer follow up period are needed to validate these promising results.



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

NASA Astrophysics Data System (ADS)

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

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



Increased expression of endothelin B receptor in static stretch exposed porcine mitral valve leaflets.  


The aim of this study was to evaluate the effect of mechanical stretch on the expression of ET-1 and ET(A)- and ET(B)-receptors in porcine mitral valve leaflets. Leaflet segments from 10 porcine mitral valves were exposed to a static stretch load of 1.5 N for 3.5h in buffer at 37 degrees C together with matching control segments. Subsequently, the mRNA expression of ET-1, ET(A)-R and ET(B)-R was measured by real-time RT-PCR in the chordal insertion areas. The analyses showed an increased transcription of ET(B)-receptors in stretch-exposed leaflet segments compared to unstretched segments median 2.23 (quartiles 1.37 and 2.70) vs. median 1.56 (quartiles 1.38 and 2.17, P=0.03) whereas the mRNA expression of ET(A)-receptors (P=0.90) and ET-1 (P=0.51) remained unchanged. Stretch increased the expression of ET(B)-receptors in porcine mitral valve leaflets. The finding could lead to a better understanding of the pathogenesis of myxomatous mitral valve disease. PMID:17011002

Pedersen, L G; Zhao, J; Yang, J; Thomsen, P D; Gregersen, H; Hasenkam, J M; Smerup, M; Pedersen, H D; Olsen, L H



Mitral valve thrombus mimicking a primary tumor in the antiphospholipid syndrome  

Microsoft Academic Search

Cardiac valvular abnormalities detected by echocardiography are relatively common in patients with the primary antiphospholipid syndrome. Valvular thickening with small vegetations are typical, but reports of lesion histology are rare. We report the case of a 50-year-old man presenting with thromboembolic phenomena who had a large (>2 cm), mobile, pedunculated, mass attached to the mitral valve that had the echocardiographic

Philip M. Mottram; John S. Gelman



Percutaneous mitral valve repair: the beginning of the end or the end of the beginning?  

PubMed Central

The new percutaneous mitral valve repair techniques are at an early stage. Preliminary series show that they are feasible; however, they need to be further evaluated in comparison with contemporary treatment to accurately assess their efficiency. Potential applications may benefit high-risk patients after thorough evaluation.

Himbert, Dominique; Brochet, Eric; Messika-Zeitoun, David



Determinants of weak femoral artery pulse in dogs with mitral valve prolapse  

Microsoft Academic Search

In three substudies encompassing 247 dogs from two breeds predisposed to myxomatous mitral valve disease (MMVD), femoral artery pulse strength was palpated and related to potential explanatory factors, including quantitative echocardiographic measures of MMVD, aortic and femoral artery diameter and wall thickness and blood pressure. In addition, in 109 Cavalier King Charles Spaniels (of which 61 were included in the

I. Tarnow; L. H. Olsen; M. B. Jensen; K.-M. Pedersen; H. D. Pedersen



Left ventricular pseudoaneurysm found after mitral valve replacement performed 30 years earlier.  


Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier. PMID:20197588

Castilla, Elena; Gato, Manuel; Ruiz, José Ramón



The material properties of the native porcine mitral valve chordae tendineae: An in vitro investigation  

Microsoft Academic Search

The material properties of the mitral valve chordae tendineae are important for the understanding of leaflet coaptation configuration and chordal pathology. There is limited information about the mechanical properties of the chordae during physiologic loading. Dual camera stereo photogrammetry was used to measure strains of the chordae in vitro under physiologic loading conditions. Two high-speed, high-resolution cameras captured the movement

Jennifer Ritchie; Jorge Jimenez; Zhaoming He; Michael S. Sacks; Ajit P. Yoganathan



Left atrial plication combined with mitral valve surgery in patients with a giant left atrium  

Microsoft Academic Search

The benefits of performing left atrial plication during mitral valve surgery for patients with a giant left atrium were evaluated by analyzing the short- and long-term surgical results and changes in the left atrial dimension (LAD) and respiratory function of 30 patients. Of the 30 patients, 2 (7%) died of multiple organ failure on postoperative days 26 and 117, but

Hiroji Hagihara; Soichiro Kitamura; Kanji Kawachi; Ryuichi Morita; Shigeki Taniguchi; Masaaki Fukutomi; Tetsuji Kawata; Junichi Hasegawa; Yoshitsugu Yoshida



Effects of Mitral Valve Replacement on Regional Left Ventricular Systolic Strain  

Microsoft Academic Search

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

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



The prevalence of mitral valve prolapse in patients undergoing echocardiography for clinical reason  

Microsoft Academic Search

BackgroundThe prevalence of mitral valve prolapse (MVP) has been reported to be 2.4% according to the Framingham Heart Study. However larger trials have found the prevalence of MVP to be less than 1.5%. We studied the prevalence of MVP using a large echocardiographic database.

Absalom D. Hepner; Mastaneh Ahmadi-Kashani; Mohammad-Reza Movahed



In Vivo Dynamic Strains of the Ovine Anterior Mitral Valve Leaflet  

PubMed Central

Understanding the mechanics of the mitral valve is crucial in terms of designing and evaluating medical devices and techniques for mitral valve repair. In the current study we characterize the in vivo strains of the anterior mitral valve leaflet. On cardiopulmonary bypass, we sew miniature markers onto the leaflets of 57 sheep. During the cardiac cycle, the coordinates of these markers are recorded via biplane fluoroscopy. From the resulting four-dimensional data sets, we calculate areal, maximum principal, circumferential, and radial leaflet strains and display their profiles on the averaged leaflet geometry. Average peak areal strains are 13.8±6.3%, maximum principal strains are 13.0±4.7%, circumferential strains are 5.0±2.7%, and radial strains are 7.8±4.3%. Maximum principal strains are largest in the belly region, where they are aligned with the radial direction during diastole switching into the circumferential direction during systole. Circumferential strains are concentrated at the distal portion of the belly region close to the free edge of the leaflet, while radial strains are highest in the center of the leaflet, stretching from the posterior to the anterior commissure. In summary, leaflet strains display significant temporal, regional, and directional variations with largest values inside the belly region and toward the free edge. Characterizing strain distribution profiles might be of particular clinical significance when optimizing mitral valve repair techniques in terms of forces on suture lines and on medical devices.

Rausch, Manuel K.; Bothe, Wolfgang; Kvitting, John-Peder Escobar; Goktepe, Serdar; Miller, D. Craig; Kuhl, Ellen



Surface Strains in the Anterior Leaflet of the Functioning Mitral Valve  

Microsoft Academic Search

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

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



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


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

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



Development of post-pump syndrome in a sheep after mitral valve stenting  

Microsoft Academic Search

Summary A one-year-old healthy sheep received an implant stenting the mural ('posterior') leaflet of the mitral valve. The experiment was authorized by the Cantonal Ethical Committee. The surgery was performed on the open, beating heart during cardiopulmonary bypass (CPB). Management of anaesthesia was based on isoflurane with mechanical intermittent positive pressure ventilation (IPPV) of the lungs, combined with intercostal nerve

Olivier Levionnois; Peter Kronen



Malignant fibrous histiocytoma of the pulmonary vein with prolapse through the mitral valve orifice  

Microsoft Academic Search

We present the case of a 33 year old white woman with malignant fibrous histiocytoma arising from the pulmonary vein and prolapsing through the mitral valve, causing acute heart failure. The patient underwent emergency cardiothoracic surgery with resection of the tumour while on cardiopulmonary bypass. The patient's heart failure improved immediately following the resection, demonstrating the benefit of palliative surgery.

M. A. Khan; R. C. Davidson



Harnessing osteopontin and other natural inhibitors to mitigate ectopic calcification of bioprosthetic heart valve material  

NASA Astrophysics Data System (ADS)

Dystrophic calcification has been the long-standing major cause of bioprosthetic heart valve failure, and has been well studied in terms of the underlying causative mechanisms. Such understanding has yielded several anti-calcification strategies involving biomaterial modification at the preparation stage: chemical alteration, extraction of calcifiable components, or material modification with small-molecule anti-calcific agents. However, newer therapeutic opportunities are offered by the growing illustration of the pathology as a dynamic, actively regulated process involving several gene products, such as osteopontin (OPN), matrix-gla protein (MGP) and glycosaminoglycans (GAGs). Osteopontin, a multi-functional matricellular glycosylated phosphoprotein has emerged as a prime candidate for the role of an in vivo inhibitor of ectopic calcification with two putative mechanisms: crystal poisoning and mineral-dissolution. The full therapeutic realization of its potential necessitates a better understanding of the mechanisms of anti-calcification by osteopontin, as well as appropriate in vivo models in which to evaluate its efficacy, potency and molecular mechanisms. In this work, we pursued the development and characterization of a reliable in vivo model with the OPN-null mouse to simulate the calcification of bioprosthetic valve material, namely glutaraldehyde-fixed bovine pericardium (GFBP) tissue. Subsequently, we used the calcification model to evaluate hypotheses based on the anti-calcific potential of osteopontin. Several modes of administering exogenous OPN to the implant site in OPN-null mice were explored, including soluble injected OPN, OPN covalently immobilized on the biomaterial, and OPN adsorbed onto the biomaterial. An investigation of the structure-function aspects of the anti-calcific ability of OPN was also pursued in the in vivo model. The OPN-null mouse was also used as an in vivo test-bed to evaluate the anti-calcific potential of other biomolecules, namely hyaluronic acid (HA) and natural reducing agents, such as glutathione. Direct rescue of the calcification phenotype in the OPN-null mice was achieved by administration of exogenous OPN, providing strong evidence of OPN's ability to mitigate ectopic calcification. Significant reduction in calcification was observed on administering OPN in soluble injected form and also when immobilized (adsorbed) onto the biomaterial. Mechanistic insights were also gained, since maximal anti-calcific effect was offered by OPN only when the protein had adequate phosphorylation as well as a functional RGD domain---suggesting synergy between these two structural elements and also a "threshold effect" for the degree of phosphorylation. In addition, the OPN-null in vivo calcification model was employed to gain evidence for the anti-calcific potential of covalently-immobilized hyaluronic-acid (HA) and the natural reducing agent glutathione.

Ohri, Rachit


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

PubMed Central

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



Relationship between renal stone formation, mitral annular calcification and bone resorption markers  

PubMed Central

BACKGROUND AND OBJECTIVES: Mitral annular calcification (MAC) is associated with osteoporosis and there is evidence of reduced bone mineral density (BMD) in patients with renal stone formation (RSF). Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. METHODS: Fifty-nine patients (mean age, 41.5 years) with RSF and 40 healthy subjects (mean age, 44.2 years) underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. RESULTS: MAC was diagnosed in 11 (18%) patients with RSF compared with 1 (2.5%) control (P=.01). Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower (P<.001, P=.02, P<.001, P<.001 and P<.001, respectively), but serum alkaline phosphatase, calcium and potassium levels were higher (P=.008, P=.007 and P=.001, respectively) in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative (more osteopenic) in patients and subjects with MAC than in those without MAC (P=.01 and P=.004, respectively). In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC (P=.03 and P=.04, respectively). CONCLUSIONS: Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies.

Celik, Ahmet; Davutoglu, Vedat; Sarica, Kemal; Erturhan, Sakip; Ozer, Orhan; Sari, Ibrahim; Yilmaz, Mustafa; Baltaci, Yasemin; Akcay, Murat; Al, Behcet; Yuce, Murat; Yilmaz, Necat



A computer model of early diastolic filling through the mitral valve.  


The current paper presents a computer model of early diastolic (E-wave) left ventricular filling through the mitral valve. It is believed that this lumped-parameter model will be clinically useful, for example in the diagnosis of diastolic dysfunction. The model is based on the solution of the ordinary differential equations describing flow through the mitral valve, as well as equations that model the intrinsic and extrinsic behaviour of a mitral valve with variable orifice area (mimicking the opening and closing of the valve leaflets). The model was developed and calibrated using porcine data. The model has now been further validated in 12 canine trials. Values are reported of canine atrial and ventricular stiffness, active relaxation characteristics, valve natural frequency, damping coefficient, and effective orifice area measured by solving the inverse problem to obtain a best-fit match between canine empirical and simulated waveforms. The best fit was determined by minimizing the error between the simulated and empirical pressure and velocity waveforms using a minimized sum-of-squares figure of merit. The paper also presents human data addressing the feasibility of using the model in man, with Doppler velocity waveforms as the primary input to the model. The paper reports parameters measured in human patients by solving the inverse problem. PMID:21485327

Waite, L; Veres, G; Fine, J; Szabó, G



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

NASA Astrophysics Data System (ADS)

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

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



Extended vertical transseptal approach in mitral valve reoperation with a small left atrium Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno  

Microsoft Academic Search

Objective: Evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. Method: From January 2001 to December 2002, 15 patients with previous mitral operation, small left atrium and atrial fibrillation underwent mitral valve surgery through an extended vertical transseptal incision. There were nine women and six men. Their ages ranged from 22

Walter Vosgrau FAGUNDES; Bruno Botelho PINHEIRO


Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement  

Microsoft Academic Search

Introduction: In order to improve the prognosis, repair of severe mitral regurgitation should be undertaken at the same time as aortic valve replacement in patients with severe aortic valve stenosis. However, mitral regurgitation may be secondary to pressure overload or ventricular dysfunction and improve after surgery. Aim: To assess the incidence of non-severe functional mitral regurgitation before and after isolated

Juan Caballero-Borrego; Juan José Gómez-Doblas; Fernando Cabrera-Bueno; José Manuel García-Pinilla; José María Melero; Carlos Porras; Eduardo Olalla; Eduardo De Teresa Galván



Relationship between the physical size, incompetence, and stenosis of prosthetic mitral valves  

PubMed Central

One each of 17 commercially available prosthetic mitral valves has been subjected to in vitro testing using a pulse duplicator. Measurements of mean diastolic pressure difference, incompetence, dimensions, mechanical movements, and turbulence were made, and the quality of manufacture was examined. Although most valves would be effective in the treatment of incompetence, only those with large orifice diameters produced no significant stenosis. All the valves tested were in clinical use at some time in the period 1966-71. Most of the prostheses were obtained in 1968 or 1969. Many of this group showed a manufacturing standard which was less than impeccable. Images

Wright, J. T. M.; Temple, L. J.



A case of colonization of a prosthetic mitral valve by Acremonium strictum.  


A case of colonization of a prosthetic mitral valve in a 73-year-old Spanish male by the fungus Acremonium strictum W. Gams is described. The valve was replaced due to paravalvular leak and severe insufficiency and the patient died of multiorgan failure. The identity of the fungus was determined by morphological studies and it was confirmed by the analysis of the ITS region sequence analysis. Molecular studies seem to demonstrate that A. strictum is a species complex. The case emphasizes the potential high risk of fungal infection for patients with prosthetic valves. PMID:19631164

Guarro, Josep; Del Palacio, Amalia; Gené, Josep; Cano, Josep; González, Carmen Gómez



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

PubMed Central

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

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



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


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

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



Different ways to repair the mitral valve with artificial chordae: a systematic review  

PubMed Central

Myxomatous mitral regurgitation (type II Carpentier's functional classification) affects about 1-2% of the population. This represents a very common indication for valve surgery resulting in a low percentage of repairs compared to replacement which is actually performed. In the last decades, several methods for mitral valve repair have been developed, to make the surgical feasibility easier, improve the long-term follow-up thus avoiding the need for reoperations. A very interesting method is represented by the combination of various valve repair techniques, depending on the involvement of the anterior, posterior, or both leaflets, and the use of PTFE artificial chordae tendineae when excessive chordal elongation or rupture due to myxomatous degeneration co-exists. The aim of this review is to summarize the evolution of these techniques from the beginning till now.



Mechanisms of the in vivo inhibition of calcification of bioprosthetic porcine aortic valve cusps and aortic wall with triglycidylamine\\/mercapto bisphosphonate  

Microsoft Academic Search

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.

H. Scott Rapoport; Jeanne M. Connolly; James Fulmer; Ning Dai; Brandon H. Murti; Robert C. Gorman; Joseph H. Gorman; Ivan Alferiev; Robert J. Levy



[Radiofrequency ablation in patients with persistent atrial fibrillation undergoing mitral valve replacement].  


The most frequent arrhythmia is an atrial fibrillation, which involves 10% of population over 70. The mortality in this group is 2 times higher than in general population. Moreover, if the atrial fibrillation co-exists with the rheumatic disease, the risk of the brain embolism is growing up 17 times. In the many European medical centers, intraoperative ablation is the obligatory procedure performed during mitral valve replacement/mitral valvuloplasty or coronary artery bypass grafting. Results of that procedure (in experienced centers) are evaluated on 75%. It reduces significantly the cost of the farther pharmacological treatment and improves the quality of life of the patients. In our Clinic ablation is performed in patients qualified to the mitral valve replacement or mitral valvuloplasty. All procedures are performed in extracorporeal circulation, in general and local hypothermia, with using crystal cardioplegine. Before the clumping of the aorta, on the beating heart ablation in the right atrium is performed. After that, the aorta is being clumped and the heart is being stopped. The left cardiac auricle is being cut off. Then the ablation around the ostia of the pulmonary veins is being done. After that, mitral valve replacement or mitral valvuloplasty procedure is being performed. Changes in the heart wall are transmural through the full wall. From the December 2001 till today 4 ablation procedures were done. Units Cobra (Boston Scientific) and Cardioblate Surgical Ablation System (Medtronic) were used. Both units are based on the unipolar energy with frequency similar to the radio-waves. After this procedure, regular rhythm came back in our 4 patients. Advantages of the intraoperative ablation are: simultaneous procedure with open heart operation, reduction of the price of the treatment, minimal risk of complication. PMID:15052716

Sadowski, Jerzy; Myrdko, Tomasz; Sniezek-Maciejewska, Maria; Rudzi?ski, Pawe?; Traczy?ski, Marek



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


Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) is a rare lysosomal storage disorder in which the pathologic storage of glycosaminoglycans in various tissues can lead to severe symptoms, including cardiomyopathy. We report on a child with Maroteaux-Lamy syndrome whose cardiac condition deteriorated and eventually led to cardiac failure at the age of 7 years due to severe mitral regurgitation. She received a mitral valve replacement and tricuspid repair with successful outcome. Histologic examination of the mitral valve showed abundant "clear" cells in both the leaflets and chordae tendineae. In Hurler disease (MPS I), similar cells have been identified as activated valvular interstitial cells (VICs, a myofibroblast like cell type). Here we report that the "clear" cells are CD68 positive, a frequently used marker of macrophage lineage. The "clear" cells remained unstained with the more specific macrophage marker CD14 while persistent staining of other cells demonstrated macrophage infiltration. From these observations, we infer that macrophages are involved in mitral valve pathology in MPS VI. © 2013 Wiley Periodicals, Inc. PMID:23949968

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



Examination of mitral valve repair with port-access method—Aiming at early and less invasive mitral valve repair—  

Microsoft Academic Search

Objective  We reviewed the results of mitral valvuloplasty by port-access minimally invasive cardiac surgery to examine the validity\\u000a of operating during an early phase.\\u000a \\u000a \\u000a \\u000a Methods  From 1988 through March 2007, a total of 126 patients requiring mitral valvuloplasty were treated with port-access minimally\\u000a invasive cardiac surgery. Their mean age was 51 ± 13 years, and 88 were male. The operative procedures were

Mikihiko Kudo; Ryohei Yozu; Kiyokazu Kokaji; Naritaka Kimura; Misato Kobayashi; Tatsuo Takahashi



Mitral valve repair is superior to valve replacement for the early preservation of cardiac function: Relation of ventricular geometry to function  

Microsoft Academic Search

The immediate effect of mitral valve repair (MVP) or replacement (MVR) on cardiac function was compared in patients with mitral regurgitation in relation to the changes in left ventricular (LV) function and geometry by using intraoperative transesophageal echocardiography in 29 patients with MVP and 21 patients with MVR, before and immediately after cardiopulmonary bypass. The LV volumes, ejection fraction, and

Jian-Fang Ren; Seydi Aksut; George W. Lighty; Gary J. Vigilante; James D. Sink; Bernard L. Segal; W. Clark Hargrove



Relation between severity of mitral valve disease and results of routine lung function tests in non-smokers  

Microsoft Academic Search

The effects of mitral valve disease on lung function have been studied in 26 non-smoking patients by relating values for lung volumes and carbon monoxide transfer factor (TLCO) to various indices of cardiac function measured at catheterisation. In general, more severe mitral disease was associated with greater abnormalities of lung function. Reductions of the one-second forced expiratory volume, vital capacity,

K M Rhodes; K Evemy; S Nariman; G J Gibson



Anomalous Coronary Artery Origin Associated with Bicuspid Aortic Valve in a Patient with Rheumatic Mitral StenosisA Case Report  

Microsoft Academic Search

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva asso ciated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.

Julio G. Tejada; Agustín Albarran; Felipe Hernandez; Santiago Jimenez; Juan C. Tascon



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

Microsoft Academic Search

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

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


Simple, safe and easy technique to ensure the correct length of artificial chordae in mitral valve repair.  


Replacement of diseased chordae with Gore-Tex sutures (W. L. Gore & Assoc, Flagstaff, AZ) in patients with degenerative mitral valve insufficiency has become a standard technique used by surgeons in mitral valve repair with good long-term results. Nevertheless, determining the correct length of the artificial chordae has remained problematic. Although various procedures have been previously published, in this article we describe our approach used to achieve an accurate chordal height adjustment. PMID:17462435

Fattouch, Khalil; Bianco, Giuseppe; Sbraga, Fabrizio; Sampognaro, Roberta; Ruvolo, Giovanni



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


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

Rausch, Manuel K; Famaey, Nele; Shultz, Tyler O'Brien; Bothe, Wolfgang; Miller, D Craig; Kuhl, Ellen



Original Article Influence of Blood Contact on the Calcification of Glutaraldehyde-pretreated Porcine Aortic Valves  

Microsoft Academic Search

Background: The rat subcutaneous model reproduces clinically observed mineralization of bioprosthetic tissues. However, the effectiveness of antimineralization treatment can be over- estimated in subcutaneous implants, since specimens using this model are not subjected to mechanical and dynamic stress or blood-surface contact. The purpose of this study was to evaluate the influence of blood contact on the calcification of bioprosthetic valves.

Shigeyuki Ozaki; Paul Herijgers; Willem Flameng


Quantitative histologic analysis of the mitral valve anterior leaflet: ischemic alterations and implications for valve replacement design  

NASA Astrophysics Data System (ADS)

There is a current trend to design innovative mitral valve replacements that mimic the native mitral valve (MV). A prerequisite for these new designs is the characterization of MV structure. This study was conducted to determine the distribution of MV collagen and glycosaminoglycan (GAGs) in MV anterior leaflets. Methods: Specimens from the mid-line of eight sheep MV anterior leaflets were stained with aniline blue (collagen) and alcian blue (GAGs). These specimens were analyzed using an image analysis system running Optimas software. Based on the luminance of stains within individual valve layers, the distribution of valvular collagen and GAGs from leaflet annulus to free-edge were determined. Results: Near the annulus, 100% of MV thickness is fibrosa (collagen dominated layer). Moving towards the free-edge, fibrosa prominence decreases and there is a transition to spongiosa (GAG dominated layer). Near the free-edge 100% of MV thickness is dominated by the spongiosa. Conclusions: Valvular collagen dominates MV structure near the annulus to support the stresses of bending and pressurization. Valvular GAGs dominate the MV near the free-edge to absorb the impact of leaflet coaptation. Image analysis has proven to be an effective tool to evaluate MV structure and facilitate the design of valve replacements.

Quick, David W.; Kunzelman, Karyn S.; Cochran, Richard P.



Cardioplegia delivery by transcutaneous pigtail catheter in minimally invasive mitral valve operations.  


For cardioplegia delivery and removing air from the aorta in minimally invasive mitral valve operations, we would like to propose a cost-effective pigtail method. The 8F pigtail punctures the aorta, delivers cardioplegia, and stays in place for removing air from the aorta. We then slide its tip out of the aorta as an accessory drain. With more than 100 successes, we are using it in every case and would like to share it with peer surgeons. PMID:23438572

Chiu, Kuan-Ming; Chen, Robert Jeen-Chen; Lin, Tzu-Yu; Chen, Jer-Shen; Huang, Jih-Hsin; Chu, Shu-Hsun



Surgical Treatment for Primary Mitral Valve Tumor: A 25Year Single-Center Experience  

Microsoft Academic Search

Objective: Primary mitral valve (MV) tumor is a rare lesion, and to date, there have been few larger surgical series of MV tumors. We retrospectively analyzed 11 cases of primary MV tumors regarding clinical and pathological features, surgical procedure and long-term outcomes. Methods: From November 1983 to December 2008, we operated on 11 patients (age 36.3 ± 17.7 years, weight

Guo-Hua Luo; Wei-Guo Ma; Han-Song Sun; Shi-Wei Pan; Zhi-Xiong Huang; Hong-Yue Wang; Xiao-Dong Zhu



Design and Mechanical Evaluation of a Physiological Mitral Valve Organ Culture System  

Microsoft Academic Search

The physiological mechanical environment of the intact mitral valve is presumed to allow mechanotransductive, cell–cell and\\u000a cell-extracellular matrix (ECM) signaling, which regulates cellular remodeling of the tissue ECM composition and structure.\\u000a The goal of this work was to design an organ culture system to mimic the mechanical aspects of this environment, which in\\u000a the future should allow for investigations to

Nikhil Gheewala; K. Jane Grande-Allen



Modeling active muscle contraction in mitral valve leaflets during systole: a first approach  

Microsoft Academic Search

The present study addresses the effect of muscle activation contributions to mitral valve leaflet response during systole.\\u000a State-of-art passive hyperelastic material modeling is employed in combination with a simple active stress part. Fiber families\\u000a are assumed in the leaflets: one defined by the collagen and one defined by muscle activation. The active part is either assumed\\u000a to be orthogonal to

B. Skallerud; V. Prot; I. S. Nordrum



Mitral valve prosthetic endocarditis: development of left ventricular-coronary sinus fistula following replacement  

Microsoft Academic Search

We report the history and course of a patient in whom a left ventricular-coronary sinus fistula developed following mitral valve replacement due to prosthetic endocarditis. Six months after the intervention the patient suddenly presented with deterioration of her symptoms, holosystolic murmur and signs of congestive heart failure. Transesophageal echocar- diography showed a left-to-right shunt but did not show its exact

G. Paolini; C. Gallorini; M. Tiiggiani; M. G. Pala; P. L. Stefano; A. Grossi



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


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

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



Mitral Valve Disease Presentation and Surgical Outcome in African-American Patients Compared With White Patients  

Microsoft Academic Search

Background. Disparities associated with race, particu- larly African-American race, in access to medical and surgical care for patients with cardiac disease have pre- viously been documented. The purpose of this study was to determine the presentation, etiology, and hospital outcome differences between African-American patients and white patients with regard to surgically corrected mitral valve disease. Methods. All 1,425 adult patients

Paul L. DiGiorgi; F. Gregory Baumann; Anne M. O'Leary; Charles F. Schwartz; Eugene A. Grossi; Greg H. Ribakove; Stephen B. Colvin; Aubrey C. Galloway; Juan B. Grau



Acute aortic dissection and medial degeneration in patients with 'floppy' mitral valves.  

PubMed Central

Mitral regurgitation due to 'floppy' valves is frequently associated with areas of medical necrosis in the ascending aorta. Application of the aortic clamp to such an area during valve replacement may produce an intimal tear followed by acute dissection. This complication occurred in three patients and was treated successfully by repair of the tear in the two cases where the dissection was observed at the time of operation. Is is suggested that infrequent clamping of the aorta and careful control of the pefusion pressure may decrease the risk of intimal trauma and acute dissection. Images

McKay, R; Yacoub, M H



Distribution of NADPH-diaphorase and AChE activity in the anterior leaflet of rat mitral valve.  


The mitral valve, as an active flap, forms the major part of the left ventricular inflow tract and therefore plays an important function in many aspects of left ventricular performance. The anterior leaflet of this valve is the largest and most ventrally placed of two leaflets that come together during ventricular systole to close the left atrioventricular orifice. Various neurotransmitters are responsible for different functions including controlling valve movement, inhibiting or causing the failure of impulse conduction in the valve and the sensation of pain. Nitric oxide acts as a gaseous free radical neurotransmitter, neuromediator and effective cardiovascular modulator. Acetyl-choline is known to function as a typical neurotransmitter. Histochemical methods for detection of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), as an indirect nitric oxide-synthase marker, and method for detection of acetylcholinesterase (AChE) were used. Both methods were performed on the same valve sample. A widespread distribution of nerve fibres was observed in the anterior leaflet of the mitral valve. The fine NADPH-d positive (nitrergic) nerve fibres were identified in all zones of valve leaflet. AChE positive (cholinergic) nerve fibres were identified forming dense network and fibres organized in stripes. Endocardial cells and vessels manifested heavy NADPH-d activity. Our observations suggest a different arrangement of nitrergic and cholinergic nerve fibres in the anterior leaflet of the mitral valve. The presence of nitrergic and cholinergic activity confirms the involvement of both neurotransmitters in nerve plexuses and other structures of mitral valve. PMID:20353912

Lovasova, K; Kluchova, D; Bolekova, A; Dorko, F; Spakovska, T



Distribution of NADPH-diaphorase and AChE activity in the anterior leaflet of rat mitral valve  

PubMed Central

The mitral valve, as an active flap, forms the major part of the left ventricular inflow tract and therefore plays an important function in many aspects of left ventricular performance. The anterior leaflet of this valve is the largest and most ventrally placed of two leaflets that come together during ventricular systole to close the left atrioventricular orifice. Various neurotransmitters are responsible for different functions including controlling valve movement, inhibiting or causing the failure of impulse conduction in the valve and the sensation of pain. Nitric oxide acts as a gaseous free radical neurotransmitter, neuromediator and effective cardiovascular modulator. Acetyl-choline is known to function as a typical neurotransmitter. Histochemical methods for detection of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), as an indirect nitric oxide-synthase marker, and method for detection of acetylcholinesterase (AChE) were used. Both methods were performed on the same valve sample. A widespread distribution of nerve fibres was observed in the anterior leaflet of the mitral valve. The fine NADPH-d positive (nitrergic) nerve fibres were identified in all zones of valve leaflet. AChE positive (cholinergic) nerve fibres were identified forming dense network and fibres organized in stripes. Endocardial cells and vessels manifested heavy NADPH-d activity. Our observations suggest a different arrangement of nitrergic and cholinergic nerve fibres in the anterior leaflet of the mitral valve. The presence of nitrergic and cholinergic activity confirms the involvement of both neurotransmitters in nerve plexuses and other structures of mitral valve.

Lovasova, K.; Kluchova, D.; Bolekova, A.; Dorko, F.; Spakovska, T.



Relation between phasic mitral flow and the echocardiogram of the mitral valve in man.  

PubMed Central

Ten patients without valvular disease were studied by ventriculography, and the rate and pattern of phasic blood flow into the left ventricle were determined by ventricular volume determinations at intervals of 33 ms during a single diastolic filling period. The derived left ventricular inflow patterns were then compared with the echocardiographic mitral EF slope obtained no more than 25 minutes before left ventriculography. The steepness of the EF slope was found to be inversely correlated with the time required to reach peak inflow velocity (r = 0.80, P less than 0.01) and directly correlated with the peak left ventricular inflow velocity divided by the time required to reach peak velocity (r = 0.72, P less than 0.05). No correlation was found between mean flow velocity into the left ventricle and the EF slope (r = 0.40, P = NS). A significant inverse correlation was found between the EF slope and the fraction of the diastolic filling period elapsed when 50 per cent of the filling volume had entered the left ventricle (r = 0.85, P less than 0.01). These findings suggest that the time required to reach left ventricular peak inflow velocity is one of the determinants of the mitral EF slope.

Vignola, P A; Walker, H J; Pohost, G M; Zir, L M



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


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

Sack, Stefan; Kahlert, Philipp; Erbel, Raimund



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

PubMed Central

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

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



Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation  

Microsoft Academic Search

Introduction: Latest techniques enable positioning of devices into the coronary sinus (CS) for mitral valve (MV) annuloplasty. We evaluate the feasibility of non-invasive assessment to determine CS anatomy and its relation to MVannulus and coronary arteries by multi-slice CT (MSCT) in normal and insufficient MV. Methods: Fifty patients (33 males, 17 females, age 67 11 years) were studied retrospectively by

Andre Plass; Ines Valenta; Oliver Gaemperli; Philipp Kaufmann; Hatem Alkadhi; Gregor Zund; Michele Genoni



Changes in Mitral Valve Annular Geometry After Repair: Saddle-Shaped Versus Flat Annuloplasty Rings  

PubMed Central

Background Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. Methods Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the “Image Arena” software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. Results Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. Conclusions Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings.

Mahmood, Feroze; Gorman, Joseph H.; Subramaniam, Balachundhar; Gorman, Robert C.; Panzica, Peter J.; Hagberg, Robert C.; Lerner, Adam B.; Hess, Philip E.; Maslow, Andrew; Khabbaz, Kamal R.



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


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

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



Premeditated reoperation after mitral valve replacement with a Starr-Edwards ball valve for young women who desire to bear a child: report of two cases.  


There are many difficulties for young women with a Starr-Edwards ball valve who want to attempt pregnancy. There is no consensus regarding whether they should maintain anticoagulation therapy throughout pregnancy with the risk of a thromboembolism or to undergo a reoperation with bioprosthetic heart valves, followed by a third operation when the valve deteriorates. This report presents two cases of young women who underwent mitral valve replacement (MVR) with Starr-Edwards ball valves (model 6120: 1M) during their childhood. Although they did not have any cardiac symptoms, transthoracic echocardiography and cardiac catheterization data demonstrated that both the patients had asymptomatic mild relative mitral stenosis. They both wished to bear a child. After the patients and their family provided thorough informed consent, redo MVRs were preformed safely with biological prostheses. The presence of significant pannus formation along the strut and sewing ring of the excised valves could also have a positive impact on the decision to undergo reoperation. PMID:19639442

Asano, Ryota; Nakano, Kiyoharu; Kodera, Kojiro; Murai, Noriyuki; Sasaki, Akihito; Ikeda, Masahiro; Kataoka, Go; Yamaguchi, Akiko; Domoto, Satoru; Takeuchi, Yasuo



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

PubMed Central

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

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



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


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

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



Role of vortices in growth of microbubbles at mitral mechanical heart valve closure.  


This study is aimed at refining our understanding of the role of vortex formation at mitral mechanical heart valve (MHV) closure and its association with the high intensity transient signals (HITS) seen in echocardiographic studies with MHV recipients. Previously reported numerical results described a twofold process leading to formation of gas-filled microbubbles in-vitro: (1) nucleation and (2) growth of micron size bubbles. The growth itself consists of two processes: (a) diffusion and (b) sudden pressure drop due to valve closure. The role of diffusion has already been shown to govern the initial growth of nuclei. Pressure drop at mitral MHV closure may be attributed to other phenomena such as squeezed flow, water hammer and primarily, vortex cavitation. Mathematical analysis of vortex formation at mitral MHV closure revealed that a closing velocity of approximately 12 m/s can induce a strong regurgitant vortex which in return can instigate a local pressure drop of about 0.9 atm. A 2D experimental model of regurgitant flows was used to substantiate the impact of vortices. At simulated flow and pressure conditions, a regurgitant vortex was observed to drastically enlarge micron size hydrogen bubbles at its core. PMID:17404890

Rambod, Edmond; Beizai, Masoud; Sahn, David J; Gharib, Morteza



Management-oriented classification of mitral valve regurgitation.  


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

El Oakley, Reida; Shah, Aijaz



Management-Oriented Classification of Mitral Valve Regurgitation  

PubMed Central

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

El Oakley, Reida; Shah, Aijaz



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


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

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



Side-specific endothelial-dependent regulation of aortic valve calcification: interplay of hemodynamics and nitric oxide signaling.  


Arterial endothelial cells maintain vascular homeostasis and vessel tone in part through the secretion of nitric oxide (NO). In this study, we determined how aortic valve endothelial cells (VEC) regulate aortic valve interstitial cell (VIC) phenotype and matrix calcification through NO. Using an anchored in vitro collagen hydrogel culture system, we demonstrate that three-dimensionally cultured porcine VIC do not calcify in osteogenic medium unless under mechanical stress. Co-culture with porcine VEC, however, significantly attenuated VIC calcification through inhibition of myofibroblastic activation, osteogenic differentiation, and calcium deposition. Incubation with the NO donor DETA-NO inhibited VIC osteogenic differentiation and matrix calcification, whereas incubation with the NO blocker l-NAME augmented calcification even in 3D VIC-VEC co-culture. Aortic VEC, but not VIC, expressed endothelial NO synthase (eNOS) in both porcine and human valves, which was reduced in osteogenic medium. eNOS expression was reduced in calcified human aortic valves in a side-specific manner. Porcine leaflets exposed to the soluble guanylyl cyclase inhibitor ODQ increased osteocalcin and ?-smooth muscle actin expression. Finally, side-specific shear stress applied to porcine aortic valve leaflet endothelial surfaces increased cGMP production in VEC. Valve endothelial-derived NO is a natural inhibitor of the early phases of valve calcification and therefore may be an important regulator of valve homeostasis and pathology. PMID:23499458

Richards, Jennifer; El-Hamamsy, Ismail; Chen, Si; Sarang, Zubair; Sarathchandra, Padmini; Yacoub, Magdi H; Chester, Adrian H; Butcher, Jonathan T



[Early calcification of bioprosthetic valve in a hemodialysis patient with secondary hyperparathyroidism;report of a case].  


Aortic valve replacement using CEP Magna 21 mm bioprosthetic valve was performed because of aortic valve stenosis in a 75-year-old man with maintenance dialysis. In the 39th postoperative month, the bioprosthetic valve malfunction due to calcification was noted, and it was replaced. Judging from the previously reported cases, malfunction of an artificial valve in the 39th month is thought to be relatively early. Early-stage calcification of a bioprosthetic valve is considered to be caused by secondary hyperparathyroidism due to artificial dialysis. Therefore, careful consideration is necessary in selecting an artificial valve in a dialysis patient. To prevent early-stage calcification of a bioprosthetic valve in a dialysis patient, strict control of parathyroid hormones, blood phosphorus and calcium levels is necessary. In addition, due to the attendant risk of calcification of bioprosthetic valves, mechanical valves are recommended to dialysis patients, who are expected to survive for more than 3 years and who are not expected to develop hemorrhagic complications. PMID:23917238

Ito, Yukinobu; Ohuchi, Shingo; Okubo, Tadashi; Harima, Takanori; Sato, Makoto; Igarashi, Tomonori



Normal echocardiographic characteristics of the Sorin Bicarbon bileaflet prosthetic heart valve in the mitral and aortic positions.  


Doppler echocardiographic characteristics of normally functioning Sorin Bicarbon prostheses were prospectively assessed in 226 consecutive patients (135 male and 91 female patients, mean age 61 +/- 10 years) with 233 valves in the mitral (n = 67) and aortic (n = 166) positions whose function was considered normal by clinical and echocardiographic evaluation. Patterns of "normal" transprosthetic leakage were assessed with transthoracic echocardiography in all valves and with transesophageal echocardiography in six selected mitral valve prostheses. For the mitral valve prostheses, we found that peak and mean gradient, as well as pressure half-time, were not significantly different in either the 25 or the 31 mm valves (median values from 15 to 10 mm Hg, from 4 to 4 mm Hg, and from 70 to 83 ms; p = Not significant for all). On transthoracic study, 12 patients (17%) with a Sorin Bicarbon valve in the mitral position showed minimal transprosthetic leakage. On transesophageal study, all patients showed a transprosthetic leakage whose spatial distribution had a complex pattern: in planes orthogonal to the leaflet axis, two to four jets arising from the hinge points and converging toward the center of the valve plane could be visualized; in planes parallel to the leaflet axis, there were three jets, the two lateral ones diverging and the central one perpendicular to the valve plane. For the aortic valve prostheses, there was a significant decrease in transprosthetic gradients and an increase in effective orifice areas as prosthesis size increased. Peak and mean gradients decreased from a median value of 25 and 13 mm Hg in the 19 mm valves to 9 and 5 mm Hg in the 29 mm valves, respectively. Effective prosthetic valve area calculated with the continuity equation increased from a median value of 0.97 cm2 for the 19 mm size valves to 3.45 cm2 for the 29 mm size. With analysis of variance, effective prosthetic aortic valve area differentiated various valve sizes (F = 40.9, p < 0.0001) better than peak (F = 10.3, p < 0.0001) or mean (F = 8.04, p < 0.0001) gradients alone did. Furthermore, effective prosthetic aortic valve area correlated better than peak and mean gradients with prosthetic size (r = 0.76, r = -0.45, and r = -0.39, respectively). On transthoracic study, 109 patients (66%) showed minimal transprosthetic leakage. These normal values, obtained in a large number of patients with normofunctioning mitral and aortic Sorin Bicarbon valves, may help to identify Sorin Bicarbon prosthesis dysfunction. PMID:9282353

Badano, L; Mocchegiani, R; Bertoli, D; DeGaetano, G; Carratino, L; Pasetti, L; Caudullo, M; Budini, A; Mannello, B; Passerone, G


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


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

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



Calcific nodule morphogenesis by heart valve interstitial cells is strain dependent.  


Calcific aortic valve disease (CAVD) results in impaired function through the inability of valves to fully open and close, but the causes of this pathology are unknown. Stiffening of the aorta is associated with CAVD and results in exposing the aortic valves to greater mechanical strain. Transforming growth factor ?1 (TGF-?1) is enriched in diseased valves and has been shown to combine with strain to synergistically alter aortic valve interstitial cell (AVIC) phenotypes. Therefore, we investigated the role of strain and TGF-?1 on the calcification of AVICs. Following TGF-?1 pretreatment, strain induced intact monolayers to aggregate and calcify. Using a wound assay, we confirmed that TGF-?1 increases tension in the monolayer in parallel with ?-smooth muscle actin (?SMA) expression. Continual exposure to strain accelerates aggregates to calcify into mature nodules that contain a necrotic core surrounded by an apoptotic ring. This phenotype appears to be mediated by strain inhibition of AVIC migration after the initial formation of aggregates. To better interpret the extent to which externally applied strain physically impacts this process, we modified the classical Lamé solution, derived using principles from linear elasticity, to reveal strain magnification as a novel feature occurring in a mechanical environment that supports nodule formation. These results indicate that strain can impact multiple points of nodule formation: by modifying tension in the monolayer, remodeling cell contacts, migration, apoptosis, and mineralization. Therefore, strain-induced nodule formation provides new directions for developing strategies to address CAVD. PMID:22307683

Fisher, Charles I; Chen, Joseph; Merryman, W David



Robotically-Assisted Left Atrial Fibrillation Ablation and Mitral Valve Repair Through a Right Mini-Thoracotomy  

Microsoft Academic Search

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

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



Mitral valve annular bacterial vegetative mass masquerading as a left atrial myxoma.  


A 49-year-old male with chronic kidney disease and history of renal transplantation in 2006 on chronic immunosuppressant therapy presented with a 1-week history of chills and generalized myalgia. He had a temperature of 101 degrees F. One set of blood cultures grew methicillin-sensitive Staphylococcus aureus. Transesophageal echo (TEE) revealed a mobile mass that was 2 cm in length attached by a thin stalk to the base of the anterior leaflet of the mitral valve. The surgical diagnosis was a left atrial myxoma. The echocardiographic as well as the surgical findings were consistent with an atrial myxoma. However, the histopathology of the specimen showed no evidence of myxoma as the characteristic stellate mesenchymal cells were absent. Instead the milieu of inflammatory cells, fibrin and multimicrobial colonization of both Gram-positive and Gram-negative cocci suggested a super infected vegetative mass. It is interesting that the mitral valve was intact as de novo vegetation being formed on a structurally normal native valve is rare. In some instances, the echocardiographic distinction between atrial masses such as vegetation, thrombus or an atrial myxoma may be ambiguous. Not only does surgical removal allow histological determination of the diagnosis that is critical for treatment, but in cases where an infected mass is mobile and greater than 15 mm, as in this case, there is high potential for embolization. Surgical removal significantly decreases the risk of an embolic event. PMID:20545987

Bullock-Palmer, Renee P; Tak, Vinay; Mitchell, Judith E



Mitral valve closure and left ventricular filling time in patients with VDD pacemakers. Assessment of the onset of left ventricular systole and the end of diastole  

Microsoft Academic Search

The effect of mitral valve closure on left ventricular filling time and its relation to the onset of systole were assessed from mitral valve echocardiograms and simultaneous apex cardiograms in 21 normal subjects, 11 patients with left bundle branch block, and 19 patients with VDD pacemakers programmed for atrioventricular intervals of 50, 150, and 250 ms. The interval between the

H von Bibra; A Wirtzfeld; R Hall; K Ulm; H Blömer



Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: long-term impact on the mitral valve  

Microsoft Academic Search

Background. Infants presenting with anomalous left coronary artery off the pulmonary artery (ALCAPA) are generally in heart failure and often have significant mitral valve regurgitation (MR). Although establishing a dual coronary circulation is the procedure of choice, there remains controversy as to how the mitral valve is handled.Methods. We reviewed our experience with this lesion at St. Louis Children’s Hospital.

Charles B Huddleston; David T Balzer; Eric N Mendeloff



Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-Senning patient with transposition of the great arteries  

PubMed Central

Accessory mitral valve tissue is a rare congenital anomaly associated with congenital cardiac defects and is usually detected in the first decade of life. We describe the case of an 18-year old post-Senning asymptomatic patient who was found to have accessory mitral valve tissue on transthoracic echocardiography producing severe left ventricular outflow tract obstruction.

Panduranga, Prashanth; Eapen, Thomas; Al-Maskari, Salim; Al-Farqani, Abdullah



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


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

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



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

PubMed Central

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

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



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


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

Reif, T H; Huffstutler, M C



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


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

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



Coconut Atrium: Transmural Calcification of the Entire Left Atrium  

PubMed Central

Massive calcification of the left atrium usually spares the interatrial septum, which provides a cleavage plane for surgical access to the mitral valve. Endoatriectomy with mitral valve replacement is the currently accepted corrective procedure because it affords maximum exposure while decreasing the risk of embolization and intraoperative hemorrhage. We describe a case in which the entire left atrium, including the septum, was thickly calcified and resembled a coconut shell. This condition prevented surgical correction of severe mitral stenosis. To our knowledge, this is the most severe case of left atrial calcification yet reported in the literature. Although it is not possible to establish preoperatively that the atrium is completely calcified and impossible to incise, when predisposing factors and evidence of complete transmural calcification are present, the surgeon should be aware of this possibility and should weigh carefully the decision to operate.

Campo, Carlos Del; Weinstein, Paul; Kunnelis, Constantine; DiStefano, Peter; Ebers, Gloria M.



Relation of circulating Matrix Gla-Protein and anticoagulation status in patients with aortic valve calcification.  


Matrix-Gla Protein (MGP) is a vitamin K-dependent protein acting as a local inhibitor of vascular calcification. Vitamin K-antagonists (oral anticoagulant; OAC) inhibit the activation of MGP by blocking vitamin K-metabolism. The aim of this study was to investigate the effect of long-term OAC treatment on circulating MGP levels in humans and on MGP expression in mice. Additionally, we tested the association between circulating inactive MGP (ucMGP) levels and the presence and severity of AVC in patients with aortic valve disease (AVD). We analysed circulating ucMGP levels in 191 consecutive patients with echocardiographically proven calcific AVD and 35 control subjects. The extent of AVC in the patients was assessed by multislice spiral computed tomography. Circulating ucMGP levels were significantly lower in patients with AVD (348.6 +/- 123.1 nM) compared to the control group (571.6 +/- 153.9 nM, p < 0.001). Testing the effect of coumarin in mice revealed that also the mRNA expression of MGP in the aorta was downregulated. Multifactorial analysis revealed a significant effect of glomerular filtration rate and long-term OAC therapy on circulating ucMGP levels in the patient group. Subsequently, patients on long-term OAC had significantly increased AVC scores. In conclusion, patients with calcific AVD had significantly lower levels of circulating ucMGP as compared to a reference population, free of coronary and valvular calcifications. In addition, our data suggest that OAC treatment may decrease local expression of MGP, resulting in decreased circulating MGP levels and subsequently increased aortic valve calcifications as an adverse side effect. PMID:19350115

Koos, Ralf; Krueger, Thilo; Westenfeld, Ralf; Kühl, Harald Peter; Brandenburg, Vincent; Mahnken, Andreas Horst; Stanzel, Sven; Vermeer, Cees; Cranenburg, Ellen C M; Floege, Jürgen; Kelm, Malte; Schurgers, Leon J



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


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

Otoni, Cristiane; Abbott, Jonathan A



[Usefulness of magnetic resonance imaging in diagnosis of mitral valve anulus abscess--case report].  


Magnetic resonance imaging (MRI) is a non-invasive method characterised by high temporal and spacial resolution that makes it possible to obtain very high-quality pictures. It is a less invasive method than TEE and is very significant in the diagnosis of heart tumours. MRI makes it possible to assess the parameters influencing hemodynamic as well as morphological qualities of the tumour such a its size, its movement, its relation to the surrounding structures and the presence of a capsule. With the use of additional programming, it is possible to evaluate, indirectly, the metabolism of the diagnosed lesion as well as the degree of blood perfusion. Thus, MRI diagnosis of the heart is a valuable complementary technique in the verification of the diagnosis and in the referral to cardiosurgical treatment. The aim of this paper is to present the use of MRI in the diagnosis of an abscess of the mitral valve anulus in a female patient who did not agree to the transoesophageal echocardiography (TEE). In this case, the usefulness of MRI to establish the diagnosis of the anular abscess of the mitral valve was proved. The final diagnosis was confirmed during the operation. PMID:12638334

Pasowicz, Mieczys?aw; Klimeczek, Piotr; Wicher-Muniak, Ewa; Podolec, Piotr; Kapelak, Bogus?aw; Sadowski, Jerzy; Tracz, Wies?awa



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


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

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



Nonlinear solid finite element analysis of mitral valves with heterogeneous leaflet layers  

NASA Astrophysics Data System (ADS)

An incompressible transversely isotropic hyperelastic material for solid finite element analysis of a porcine mitral valve response is described. The material model implementation is checked in single element tests and compared with a membrane implementation in an out-of-plane loading test to study how the layered structures modify the stress response for a simple geometry. Three different collagen layer arrangements are used in finite element analysis of the mitral valve. When the leaflets are arranged in two layers with the collagen on the ventricular side, the stress in the fibre direction through the thickness in the central part of the anterior leaflet is homogenized and the peak stress is reduced. A simulation using membrane elements is also carried out for comparison with the solid finite element results. Compared to echocardiographic measurements, the finite element models bulge too much in the left atrium. This may be due to evidence of active muscle fibres in some parts of the anterior leaflet, whereas our constitutive modelling is based on passive material.

Prot, V.; Skallerud, B.



Anesthetic and hemodynamic management of a rare case of Brucella multivalvular endocarditis in cardiogenic shock undergoing emergency aortic valve replacement and mitral valve repair.  


We describe a very rare case of human brucella multivalvular endocarditis. Patient presented in a state of cardiogenic shock with low urine output and a history of breathlessness. Patient was diagnosed to have brucellosis 2 months back by blood cultures and agglutination tests and was receiving doxycycline and rifampicin therapy. Echocardiography showed severe aortic regurgitation, moderate mitral regurgitation, severe left ventricular dysfunction and a mobile vegetation attached to the aortic valve. Patient was scheduled for emergency surgery; while preparing for surgery hemodynamic monitoring, non-invasive ventilation and inotropic supports were started. During surgery, the aortic valve was found perforated and the aortomitral continuity was disrupted. Aortic valve replacement and mitral valve repair were performed. Hemofiltration was used during cardiopulmonary bypass. Weaning from bypass was achieved with the help of inodilators, dual chamber pacing and intra-aortic balloon pump. PMID:24107698

Kandasamy, Ashok; Ramalingam, Senthil Kumar; Reddy, Bhaktavatsala Deva; Krupananda, Harshavardhan


Sutureless aortic bioprosthesis in severe aortic root calcification: an innovative approach  

PubMed Central

Aortic valve replacement (AVR) in patients with severe aortic root calcification is technically a very difficult procedure which requires a long cardiopulmonary bypass (CPB) time, especially in patients undergoing complex procedures such as multivalve or valve and coronary surgery. We report a case of successful AVR with an innovative approach in a patient with an extensively calcified aortic root and concomitant tricuspid valve regurgitation who underwent mitral valve replacement 20 years ago.

Concistre, Giovanni; Farneti, Pierandrea; Miceli, Antonio; Glauber, Mattia



Lack of periostin leads to suppression of Notch1 signaling and calcific aortic valve disease  

PubMed Central

The Postn gene encodes protein periostin. During embryonic development, it is highly expressed in the outflow tract (OFT) endocardial cushions of the developing heart, which give rise to several structures of the mature heart including the aortic valve. Periostin was previously implicated in osteoblast differentiation, cancer metastasis, and tooth and bone development, but its role in cardiac OFT development is unclear. To elucidate the role that periostin plays in the developing heart we analyzed cardiac OFT phenotype in mice after deletion of the Postn gene. We found that lack of periostin in the embryonic OFT leads to ectopic expression of the proosteogenic growth factor pleiotrophin (Ptn) and overexpression of delta-like 1 homolog (Dlk1), a negative regulator of Notch1, in the distal (prevalvular) cushions of the OFT. This resulted in suppression of Notch1 signaling, strong induction of the central transcriptional regulator of osteoblast cell fate Runx2, upregulation of osteopontin and osteocalcin expression, and subsequent calcification of the aortic valve. Our data suggest that periostin represses a default osteogenic program in the OFT cushion mesenchyme and promotes differentiation along a fibrogenic lineage. Lack of periostin causes derepression of the osteogenic potential of OFT mesenchymal cells, calcium deposition, and calcific aortic valve disease. These results establish periostin as a key regulator of OFT endocardial cushion mesenchymal cell fate during embryonic development.

Tkatchenko, Tatiana V.; Moreno-Rodriguez, Ricardo A.; Conway, Simon J.; Molkentin, Jeffery D.; Markwald, Roger R.



Best evidence topic - Valves What is the optimal level of anticoagulation in adult patients receiving warfarin following implantation of a mechanical prosthetic mitral valve?  

Microsoft Academic Search

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was what is the optimal target INR for warfarin therapy in patients who have undergone implantation of a prosthetic mechanical mitral heart valves? Altogether 894 papers were identified on Medline and 1235 on Embase using the reported search including all major international

Andrew Bayliss; Peter Faber; Joel Dunning; Andrew Ronald


Normal echocardiographic characteristics of the sorin bicarbon bileaflet prosthetic heart valve in the mitral and aortic positions  

Microsoft Academic Search

Doppler echocardiographic characteristics of normally functioning Sorin Bicarbon prostheses were prospectively assessed in 226 consecutive patients (135 male and 91 female patients, mean age 61  ± 10 years) with 233 valves in the mitral (n = 67) and aortic (n = 166) positions whose function was considered normal by clinical and echocardiographic evaluation. Patterns of “normal” transprosthetic leakage were assessed with transthoracic

Luigi Badano; Roberto Mocchegiani; Daniele Bertoli; Giuseppe DeGaetano; Lorenzo Carratino; Laura Pasetti; Michelangelo Caudullo; Antonietta Budini; Bruno Mannello; Giancarlo Passerone



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

SciTech Connect

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.

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



Association of Mitral Annulus Calcification with High-Sensitivity C-Reactive Protein, Which Is a Marker of Inflammation  

PubMed Central

Objectives. There are limited clinical data revealing the relationship between mitral annular calcification (MAC) and systemic inflammation. The goal of the present study was to compare high-sensitivity C-reactive protein (hs-CRP) levels in patients with and without MAC and investigate the relationship between MAC and hs-CRP. Methods. One hundred patients with MAC who underwent transthoracic echocardiography (TTE) and 100 age-matched controls without MAC who underwent TTE were included in our study. Hs-CRP levels were compared between groups. Results. Prevalence of female gender, hypertension, and coronary artery disease were significantly higher in the MAC group than in the control group (64% versus 45%, P = 0.007, 42% versus 28%, P = 0.03 and 37% versus 18%, P = 0.003, resp.). On multivariate analysis, age, gender, and coronary artery disease were the only independent predictors of MAC. The levels of hs-CRP were higher in the MAC group than in the control group (2.02 ± 0.35 versus 1.43 ± 0.47?mg/dl, P < 0.001). This increase in hs-CRP levels in the MAC group persisted in patients without hypertension, coronary artery disease, and in male patients when compared to the control group. Conclusions. Our study demonstrated that hs-CRP, which is a sensitive marker of systemic inflammation, increased in patients with MAC.

Kurtoglu, Ertugrul; Korkmaz, Hasan; Akturk, Erdal; Y?lmaz, Mucahid; Altas, Yakup; Uckan, Ahmet



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.  


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

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



Doppler sonographic evaluation of mechanical and bioprosthetic mitral valve prostheses during exercise with a rate corrected pressure half time.  

PubMed Central

OBJECTIVE--To compare the effect of exercise on pressure half time in patients with mechanical or bioprosthetic mitral valves. A relative pressure half time (pressure half time as a percentage of RR interval) was used in an attempt to correct for the shortening of the diastolic time interval caused by the increase in heart rate during exercise and thus to uncover the effects of valve design on pressure half time during exercise. PATIENTS--Twenty clinically stable (New York Heart Association grade I-II) patients with mechanical (n = 12) or bioprosthetic (n = 8) mitral valves (median age 51) years. The median time since valve replacement was 42 months. METHODS--Continuous wave Doppler echocardiography from the apical view at rest and during moderate supine bicycle exercise (50 W). RESULTS--During exercise the mean (SD) heart rate increased from 79 (12) to 101 (12) beats per minute (95% confidence interval (95% CI) of difference, 15 to 29/min) and the peak pressure gradient from 11 (5) to 18 (6) mm Hg (95% CI of difference 5 to 9 mm Hg). The pressure half time decreased from 114 (30) to 78 (26) ms (95% CI of difference (30-42 ms). There was no difference between the valve types. The relative pressure half time remained unchanged in patients with mechanical valves during exercise (13 (4) rest and 13 (5)% exercise, respectively) and decreased in patients with bioprostheses (17 (3) and 12 (3)%, respectively (95% CI of difference 2 to 8%, p = 0.025). CONCLUSIONS--In patients with mechanical mitral valves the decrease in the pressure half time during exercise is probably mostly the result of the shortening of the diastolic time interval with increasing heart rate whereas in patients with bioprosthetic valves an increase in functional valve area may contribute to the shortening of pressure half time during exercise.

Weiss, P; Hoffmann, A; Burckhardt, D



An augmented reality environment for image-guidance of off-pump mitral valve implantation  

NASA Astrophysics Data System (ADS)

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.

Linte, Christian; Wiles, Andrew D.; Hill, Nick; Moore, John; Wedlake, Chris; Guiraudon, Gerard; Jones, Doug; Bainbridge, Daniel; Peters, Terry M.



Role of Angiogenetic Factors in Cardiac Valve Homeostasis and Disease  

Microsoft Academic Search

The aging of populations worldwide and the habitual consumption of food high in calories and cholesterol have led to recent\\u000a increases in morbidity from calcific aortic valve disease. At the same time, rupture of the chordae tendineae cordis, which\\u000a is a component of the mitral valve complex, is one of the major causes of mitral regurgitation. Surgery is the basis

Daihiko Hakuno; Naritaka Kimura; Masatoyo Yoshioka; Keiichi Fukuda


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

PubMed Central

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.

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



Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: Implications for interpretation of perioperative echocardiography  

PubMed Central

BACKGROUND: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty (MVA) and is associated with a poor prognosis. It was hypothesized that the anterior displacement of the posterior aspect of the annulus caused by annuloplasty could induce a change in the direction of MR jet. METHODS: The echocardiograms of 21 patients who underwent restrictive MVA for ischemic MR and who had detectable postoperative MR were analyzed before and early after surgery to evaluate the direction of MR jet. RESULTS: The MR jet direction was posterior in 15 patients (72%) and central or anterior in six patients (28%) before the operation, compared with four patients (20%) and 17 patients (80%), respectively, after MVA (P<0.001). Overall, the jet direction was modified in 16 of 21 7patients (76%) following MVA. Among the subset of 11 patients with clinically significant persistent MR (vena contracta width greater than 3 mm), the MR jet direction changed in nine patients (82%) compared with their preoperative evaluation. Importantly, the initial clinical interpretation, based on a subjective evaluation, had classified MR severity as nonsignificant in six of 11 patients (55%), likely due to the eccentricity of the jet and its change in direction. CONCLUSION: The direction of the persistent MR jet early after annuloplasty is often different from that of preoperative MR jet and may lead to significant misinterpretation of the postoperative echocardiogram.

Senechal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G; Dagenais, Francois; Charbonneau, Eric; Dubois, Michelle



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


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

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



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

PubMed Central

Beating heart intracardiac procedures promise significant benefits for patients, however, the fast motion of the heart poses serious challenges to surgeons. We present a new 3D ultrasound-guided motion (3DUS) compensation system that synchronizes instrument motion with the heart. The system utilizes the fact that the motion of some intracardiac structures, including the mitral valve annulus, is largely constrained to translation along one axis. This allows the development of a real-time 3DUS tissue tracker which we integrate with a 1 degree-of-freedom actuated surgical instrument, real-time 3DUS instrument tracker, and predictive filter to devise a system with synchronization accuracy of 1.8 mm RMSE. User studies involving the deployment of surgical anchors in a simulated mitral annuloplasty procedure demonstrate that the system increases success rates by over 100%. Furthermore, it enables more careful anchor deployment by reducing forces to the tissue by 50% while allowing instruments to remain in contact with the tissue for longer periods.

Yuen, Shelten G.; Kesner, Samuel B.; Vasilyev, Nikolay V.; Del Nido, Pedro J.; Howe, Robert D.



Giant left atrial myxoma causing drop attacks by prolapsing into the mitral valve  

PubMed Central

Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation varies greatly from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We herein describe the clinicopathological and imaging features of a huge left atrial myxoma protruding into the left ventricle during diastole and obstructing diastolic filling of the left ventricle thus causing drop attacks by prolapsing into the mitral valve. The patient (a 56-year-old female) underwent emergency surgery with complete removal of a 74 g weighing myxoma from the left atrium. She recovered without any complications. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention to avoid irreversible cardiovascular complications.

Strecker, Thomas; Agaimy, Abbas



Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study.  


Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy. PMID:23600893

Candan, Ozkan; Ozdemir, Nihal; Aung, Soe Moe; Dogan, Cem; Karabay, Can Yucel; Gecmen, Cetin; Omaygenç, Onur; Güler, Ahmet



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


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

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



Unusual expression of Gaucher's disease: cardiovascular calcifications in three sibs homozygous for the D409H mutation  

Microsoft Academic Search

Three sisters suffering from an unusual form of Gaucher's disease are described. These patients had cardiovascular abnormalities consisting of calcification of the ascending aorta and of the aortic and mitral valves. Neurological findings included ophthalmoplegia and saccadic eye movements in two patients, and tonic-clonic seizures in the third. The three patients died, two of them after having undergone aortic valve

A Chabás; B Cormand; D Grinberg; J M Burguera; S Balcells; I Mate; J A Sobrino; R Gonzàlez-Duarte; L Vilageliu



The Effect of Concomitant Radiofrequency Ablation and Surgical Technique (Repair Versus Replacement) on Release of Cardiac Biomarkers During Mitral Valve Surgery  

Microsoft Academic Search

Allpatientsundergoingheartsurgeryexperienceacer- tain amount of nonspecific myocardial injury docu- mented by the release of cardiac biomarkers and asso- ciated with poor outcome. We investigated the role of unipolar radiofrequency ablation of atrial fibrillation on the release of cardiac biomarkers in 71 patients un- dergoing mitral valve surgery and concomitant left atrial ablation case-matched with 71 patients undergo- ing isolated mitral surgery.

Alberto Zangrillo; Giuseppe Crescenzi; Giovanni Landoni; Stefano Benussi; Martina Crivellari; Federico Pappalardo; Enrica Dorigo; Carlo Pappone; Ottavio Alfieri



A rare case of spontaneous rectus sheath haematoma in a patient with mechanical prosthetic aortic and mitral valves.  


Every year nearly 300 000 patients have heart valve operations and mostly prosthetic valves are inserted. Coumadin is the mainstay of therapy in these individuals but it has many side effects, mostly related to its anticoagulant effect. Rectus sheath haematoma (RSH) is a rare complication of abdominal trauma, surgery and excessive strain, however, anticoagulant agents may predispose to this condition without any precipitating event. Reversal of anticoagulation and resuscitation with fluids and blood products are necessary but anticoagulation is crucial in patients with prosthetic valves, as they have acquired thrombotic diathesis. Herein we report on a case of spontaneous RSH in a patient with prosthetic mitral and aortic valves and a history of prosthetic valve thrombosis. He was successfully managed medically. PMID:22832479

Aykan, Ahmet; Oguz, Ali; Yildiz, Mustafa; Özkan, Mehmet



[Open mitral commissurotomy. Indications and results].  


We have reviewed the clinical history of 106 patients that were done an open mitral commissurotomy from june 1971 to march 1974. Hospital mortality was less than 1% and morbility was low. The patients average age was 40 years. Fifteen patients had suffered a previous closed mitral commissurotomy, and systemic embolism occurred in 62.2% of them. Ninety eight of the surviving patients have been followed; 80.6% of them had improved by at least one degree of the N.Y.H.A. functional scale. According to these results we have widened the indications for open mitral commissurotomy. However, we still use the closed technique in young patients without previous mitrol commissurotomy or past history of system embolism, which no fluoroscopic evidence of mitral valve calcifications and without associated valvular lesions. PMID:1180611

Maroñas, J M; O'Conner, F; Rufilanchas, J J; Téllez, G; Agosti, J; Figuera, D


Pseudoaneurysm of mitro-aortic intervalvular fibrosa during the course of mitral valve endocarditis with aorto-left ventricle outflow tract fistula  

PubMed Central

The mitro-aortic intervalvular fibrosa (MAIVF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The pseudoaneurysm of MAIVF is one of the uncommon but catastrophic complications of native or prosthetic aortic valve endocarditis or chest trauma. We report a case of infective endocarditis of mitral valve complicated by development of pseudoaneurysm of MAIVF, and fistulous formation causing massive shunt flow from the ascending aorta above the non-coronary cusp to the left ventricle outflow tract.

Fazlinezhad, A.; Fatehi, H.; Tabaee, S.; Alavi, M.; Hoseini, L.; Yousefzadeh, H.



[Anticoagulant therapy in a pregnant patient with prosthetic mitral valve-emergency for caesarian section and postoperative bleeding].  


Pregnant patients with prosthetic valve need anticoagulation therapy during pregnancy to prevent stuck valve. Regarding the thrombosed valve, there is a dilemma between anticoagulation to prevent further thrombus formation and postoperative bleeding after caesarian section until valve replacement surgery. A 35-year-old woman in her 34th weeks of pregnancy with a thrombus on prosthetic mitral valve was scheduled for emergency caesarian section under general anesthesia. Anticoagulation therapy with heparin was started after admission to the intensive care unit targeting the range between 70-100 second of activated partial thromboplastin time to prevent further thrombus formation. Heparin was administered intravenously (25,000 units per day), but APTT was kept over 110 seconds. Abdominal wall hematoma was detected by percutaneous echo next day and surgery for removal of hematoma was performed. Mitral valve replacement surgery was performed on the postoperative third days successfully. Postoperative anticoagulation therapy with heparin should be started carefully in consideration of physiological change of clotting ability after the termination of pregnancy. PMID:21710773

Masubuchi, Tetsuhito; Yoshitani, Kenji; Maeda, Takuma; Takada, Makiko; Ohnishi, Yoshihiko



Mitral valve prolapse: a consistent manifestation of type IV Ehlers-Danlos syndrome. The pathogenetic role of the abnormal production of type III collagen.  


To evaluate whether abnormal production of type III collagen, the characteristic biochemical feature of patients with the type IV Ehlers-Danlos syndrome, consistently predisposes to mitral valve prolapse, we evaluated the family of a proband with classic type IV Ehlers-Danlos syndrome. Production of type III collagen was assessed with the use of cultured skin fibroblasts. Mitral valve prolapse was detected by M-mode and two-dimensional echocardiography. Biochemical abnormalities in the production of type III collagen and echocardiographic findings of mitral valve prolapse were completely concordant. All patients with abnormal production of type III collagen had mitral valve prolapse and all subjects with normal production of type III collagen had entirely normal echocardiograms. Six of the eight patients with abnormal production of type III collagen had subtle cutaneous abnormalities. The consistent association of abnormal production of type III collagen and mitral valve prolapse in this family suggests that this abnormality of collagen may give rise to mitral valve prolapse. PMID:7237708

Jaffe, A S; Geltman, E M; Rodey, G E; Uitto, J



Advances in catheter ablation: atrial fibrillation ablation in patients with mitral mechanical prosthetic valve.  


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

Santangeli, Pasquale; Di Biase, Luigi; Bai, Rong; Horton, Rodney; Burkhardt, J David; Sanchez, Javier; Price, Justin; Natale, Andrea



A physical model describing the mechanism for formation of gas microbubbles in patients with mitral mechanical heart valves.  


This study was aimed at developing a physical model, supported by experimental observations, to describe the formation and growth of microbubbles seen in patients with mitral mechanical heart valves (MHV). This phenomenon, often referred to as high intensity transient signals (HITS), appears as bright, intense, high-velocity and persistent echoes detected by Doppler ultrasonography at the instant of closure. The long-term clinical implications of HITS has yet to be determined. However, there are reports of a certain degree of neurological disorder in patients with mitral MHV. The numerical analysis has shown the existence of a twofold process (1) nucleation and (2) microbubble growth as a result of cavitation. While mild growth of nuclei is governed by diffusion, explosive growth of microbubbles is controlled by pressure drop on the atrial side of mitral MHV. It was demonstrated that there exist limits on both microbubble size and regurgitant velocity, above which microbubbles grow explosively, and below which growth is almost nonexistent. Therefore, prevention of excessive pressure drops induced by high closing velocities related to the dynamics of closure of mitral MHV may offer design changes in the future generations of mechanical valves. PMID:10625150

Rambod, E; Beizaie, M; Shusser, M; Milo, S; Gharib, M


Pseudo-False-Positive Exercise Treadmill Testing Caused by Systolic Anterior Motion of the Anterior Mitral Valve Leaflet  

PubMed Central

Subendocardial ischemia as indicated by electrocardiography during exercise, in association with severe systolic anterior motion of the anterior mitral valve leaflet without left ventricular hypertrophy, has not been well described. We report the case of a 42-year-old man who presented with symptoms of exertional angina and 2-mm ST depression on treadmill electrocardiography but had a normal perfusion scan and coronary angiogram. Initially, the negative angiographic results caused us to regard the treadmill results as false-positive. Subsequently, low-dose dobutamine echocardiography showed severe systolic anterior motion of the anterior mitral valve leaflet with a >144-mmHg left ventricular outflow tract gradient; we then recognized the original treadmill results to be pseudo-false-positive. Electrocardiographic changes in association with the above-described motion of the anterior mitral valve leaflet and increased left ventricular outflow tract gradient were verified by use of treadmill and supine bicycle stress echocardiography. (Tex Heart Inst J 2001;28:308–11)

Lau, Theodore K.; Navarijo, Joseph; Stainback, Raymond F.



Mitral valve replacement. A comparative clinical and haemodynamic study of the new Lillehei-Kaster and Björk-Shiley prostheses.  


A comparison is made between the clinical and haemodynamic results after mitral valve replacement with the Lillehei-Kaster and the Björk-Shiley disc valve prostheses, which were used alternatively in 54 patients with isolated mitral valve disease. No difference in functional improvement in the two groups was noted. Haemodynamic studies indicated a striking decrease in left atrial and pulmonary artery pressure, irrespective of the type of prosthesis inserted. Cardiac output incresed after operation, but was significantly different from the pre-operative value only in patients with the Björk-Shiley prosthesis, which also had a more favourable relationship between cardiac output and oxygen uptake during excercise than the Lillehei-Kaster prosthesis. One major advantage of the Björk-Shiley prosthesis is probably its favourable ration between tissue diameter and orifice area in contrast to the relatively large seating ring with a more unfavourable corresponding ratio in the Lillehei-Kaster prosthesis. In addition, the former valve possesses a more definite ability to increase its effective valve area during exercise. PMID:897617

Nitter-Hauge, S; Hall, K V; Froysaker, T



Real-time three-dimensional transesophageal echocardiography in the assessment of mechanical prosthetic mitral valve ring thrombosis.  


Although 2-dimensional (2D) transesophageal echocardiography (TEE) is the gold standard for the diagnosis of prosthetic valve thrombosis, nonobstructive clots located on mitral valve rings can be missed. Real-time 3-dimensional (3D) TEE has incremental value in the visualization of mitral prosthesis. The aim of this study was to investigate the utility of real-time 3D TEE in the diagnosis of mitral prosthetic ring thrombosis. The clinical outcomes of these patients in relation to real-time 3D transesophageal echocardiographic findings were analyzed. Of 1,263 patients who underwent echocardiographic studies, 174 patients (37 men, 137 women) with mitral ring thrombosis detected by real-time 3D TEE constituted the main study population. Patients were followed prospectively on oral anticoagulation for 25 ± 7 months. Eighty-nine patients (51%) had thrombi that were missed on 2D TEE and depicted only on real-time 3D TEE. The remaining cases were partially visualized with 2D TEE but completely visualized with real-time 3D TEE. Thirty-seven patients (21%) had thromboembolism. The mean thickness of the ring thrombosis in patients with thromboembolism was greater than that in patients without thromboembolism (3.8 ± 0.9 vs 2.8 ± 0.7 mm, p <0.001). One hundred fifty-five patients (89%) underwent real-time 3D TEE during follow-up. There were no thrombi in 39 patients (25%); 45 (29%) had regression of thrombi, and there was no change in thrombus size in 68 patients (44%). Thrombus size increased in 3 patients (2%). Thrombosis was confirmed surgically and histopathologically in 12 patients (7%). In conclusion, real-time 3D TEE can detect prosthetic mitral ring thrombosis that could be missed on 2D TEE and cause thromboembolic events. PMID:23800549

Ozkan, Mehmet; Gürsoy, Ozan Mustafa; Astarc?o?lu, Mehmet Ali; Gündüz, Sabahattin; Cakal, Beytullah; Karakoyun, Süleyman; Kalç?k, Macit; Kahveci, Gökhan; Duran, Nilüfer Ek?i; Y?ld?z, Mustafa; Cevik, Cihan



Left Ventricular Vortex Under Mitral Valve Edge-to-Edge Repair  

PubMed Central

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.

Hu, Yingying; Shi, Liang; Parameswaran, Siva; Smirnov, Sergey; He, Zhaoming



The role of glutaraldehyde-induced cross-links in calcification of bovine pericardium used in cardiac valve bioprostheses.  

PubMed Central

Calcification is the principal cause of failure of tissue-derived cardiac valve replacements pretreated with glutaraldehyde (GLUT). The objective of this study was to determine the role of GLUT-induced cross-links in bovine pericardial tissue calcification. Various levels of 3H-GLUT incorporation were obtained by varying incubation pH, and protein modification was determined by amino acid analysis and resistance to collagenase digestion. Calcification of cross-linked tissue was studied using subdermal implants in rats. Low GLUT uptake (less than 150 nm/mg) resulted in minimal calcification (Ca2+, 12.8 micrograms/mg) and stability (4% residual weight following digestion) due to a limited crosslinking (lysine + hydroxylysine = 26.1 residues/1000 amino acids [AA]). In contrast, higher GLUT uptake induced more cross-links (Lys + Hyl = 8.2 residues/1000 AA) and consequent higher stability (95% residual wt); such tissues calcified severely (Ca2+, 93.5 micrograms/mg). Incorporation of GLUT two to three times beyond a critical level did not further enhance calcification. It is concluded that the amount of GLUT incorporated controls the extent of cross-links, which in turn directly determines tissue stability and calcification. Images Figure 4

Golomb, G.; Schoen, F. J.; Smith, M. S.; Linden, J.; Dixon, M.; Levy, R. J.



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


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

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



A navigation platform for guidance of beating heart transapical mitral valve repair.  


Traditional surgical approaches for repairing diseased mitral valves (MVs) have relied on placing the patient on cardiopulmonary bypass (on pump), stopping the heart and accessing the arrested heart directly. However, because this approach has the potential for adverse neurological, vascular, and immunological sequelae, less invasive beating heart alternatives are desirable. Emerging beating heart techniques have been developed to offer high-risk patients MV repair using ultrasound guidance alone without stopping the heart. This paper describes the first porcine trials of the NeoChord DS1000 (Minnetonka, MN), employed to attach neochordae to a MV leaflet using the traditional ultrasound-guided protocol augmented by dynamic virtual geometric models. The distance errors of the tracked tool tip from the intended midline trajectory (5.2 ± 2.4 mm versus 16.8 ± 10.9 mm, p = 0.003), navigation times (16.7 ± 8.0 s versus 92.0 ± 84.5 s, p = 0.004), and total path lengths (225.2 ± 120.3 mm versus 1128.9 ± 931.1 mm, p = 0.003) were significantly shorter in the augmented ultrasound compared to navigation with ultrasound alone, indicating a substantial improvement in the safety and simplicity of the procedure. PMID:23047858

Moore, John T; Chu, Michael W A; Kiaii, Bob; Bainbridge, Daniel; Guiraudon, Gerard; Wedlake, Chris; Currie, Maria; Rajchl, Martin; Patel, Rajni V; Peters, Terry M



Is there increased sympathetic activity in patients with mitral valve prolapse?  


The aim of this study was to investigate autonomic nervous system tone in patients with mitral valve prolapse (MVP). Heart rate variability (HRV) was assessed from 24-hour ambulatory Holter recordings in 28 patients with primary MVP and in 28 age and sex matched normal control subjects in a drug-free state. Sixteen of the MVP patients were symptomatic and 12 asymptomatic. Spectral HRV was calculated in terms of low (LF: 0.06-0.15 Hz) and high (HF: 0.15-0.40 Hz) frequency components using fast Fourier transform analysis, and the ratio LF/HF was calculated. Spectral analysis of HRV showed that the MVP patients, taken as a single group, had lower HF and LF and a higher LF/HF ratio than the controls. No significant difference in HRV was found between the 16 symptomatic and the 12 asymptomatic patients, but the symptomatic patients had a significantly higher LF/HF ratio than the controls. Our observations suggest that, during normal daily activities, patients with MVP experience a significant deviation in autonomic nervous system tone with predominance of the sympathetic branch. This predominance is more marked in symptomatic patients. PMID:8945059

Kochiadakis, G E; Parthenakis, F I; Zuridakis, E G; Rombola, A T; Chrysostomakis, S I; Vardas, P E



Angiotensin receptor blockers are associated with reduced fibrosis and interleukin-6 expression in calcific aortic valve disease.  


Background: Calcific aortic valve disease (CAVD) is a chronic disorder characterized by the mineralization of the aortic valve and involving fibrosis. Objectives: In this work we sought to determine if the fibrotic component of the remodeling process of CAVD was related to the use of angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARBs). Methods: In 477 patients with CAVD, the aortic valve was examined by histology. A semiquantitative score of fibrosis was generated and associations with clinical/cardiometabolic variables examined. In a subset of 103 patients the aortic valve was available to study the infiltration by inflammatory cells and expression of interleukin-6 (IL-6) by quantitative real-time PCR. Results: The fibrosis score of the aortic valve was independently related to the hemodynamic severity of CAVD measured by echocardiography. The fibrotic score of the aortic valve was also related to the expression of IL-6. The use of ARBs but not of ACEi was associated with a lower fibrosis score of the aortic valve even after correction for covariates. In addition, patients under ARBs had lower aortic valve inflammation and expression of IL-6. Conclusions: These findings suggest that ARBs may alter the fibrotic process of the aortic valve in CAVD, possibly by lowering tissue inflammation. PMID:23969418

Côté, Nancy; Mahmut, Ablajan; Fournier, Dominique; Boulanger, Marie-Chloé; Couture, Christian; Després, Jean-Pierre; Trahan, Sylvain; Bossé, Yohan; Pagé, Sylvain; Pibarot, Philippe; Mathieu, Patrick



[Hemodynamics after mitral valve replacement with Starr-Edwards, Björk-Shiley and Lillehei-Kaster protheses (author's transl)].  


After mitral valve replacement hemodynamic abnormalities persist. These abnormalities were studied 1 year postoperatively. In 50 randomized patients; 15 with Starr-Edwards (SEM), 15 with Lillehei-Kaster (LKM) and 20 with Björk-Shiley (BSM) prostheses at rest and during exercise. Simultaneously were determined: pulmonary arterial pressure, left atrial pressure, left ventricular enddiastolic pressure, mean diastolic pressure gradient across the prostheses, cardiac index, stroke volume index, valve orifice area, and ejection fraction. The results show an important stenosis by the prostheses leading to high pressure increase in pulmonary artery and left atrium during excercise. This stenosis depends on valve size and type. Björk-Shiley tilting disc valves show the best hemodynamic results. This may be due to the most favourable ratio between internal and external diameter. Starr-Edwards prostheses with identical sizes show the most identical results if compared to each other. Therfore we suggest that Starr-Edwards prostheses open completely in every case. However, there is an important pressure gradient caused by the small internal diameter. Lillehei-Kaster pivoting disc valves reach surprisingly small functional valve areas. This may be caused by an incomplete opening of the disc. PMID:878552

Haerten, K; Both, A; Lück, J; Herzer, J; Loogen, F



Repair of paravalvular prosthetic mitral valve leaks with septal occluder devices in severely high-risk patients: a word of caution  

PubMed Central

Paravalvular leak following a mitral valve replacement is a complication seen in approximately 1 of 10 replacements. The corrective method has traditionally been reoperation. Septal occluder devices are more commonly being utilized as an alternative percutaneous correction method. We report the use of septal occluder devices in the repair of mitral paravalvular leak in two patients at severely high EuroSCORE II mortality risk. In both patients, the occluder devices became unstable, leading to a recurrence of severe paravalvular leak.

Smith, Craig R.; Stamou, Sotiris C.; Merhi, William M.; Hooker, Robert L.



Elucidating the Molecular-Level Events in Valvular Interstitial Cell Calcification to Improve the Design of Tissue-Engineered Heart Valves  

NASA Astrophysics Data System (ADS)

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.

Gu, Xiaoxiao


Predicting systolic anterior motion after mitral valve reconstruction: using intraoperative transoesophageal echocardiography to identify those at greatest risk.  


OBJECTIVES: We set out to determine if intraoperative pre-bypass transoesophageal echocardiography could assist in predicting which patients are at greatest risk for systolic anterior motion (SAM) after mitral valve repair (MVR). METHODS: Three hundred and seventy-five consecutive patients who underwent reconstructive MVR surgery for degenerative disease were included. Data were collected using intraoperative echocardiographic images taken prior to the initiation of cardiopulmonary bypass. Based on the physiology of SAM, we postulated that 11 parameters could be potential risk factors for SAM: left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension, left ventricular end-diastolic dimension (LVEDD), basal septal diameter (basal-interventricular septal diameter in diastole (IVDd)), mid-ventricular septal diameter (mid-IVDd), coaptation-septal distance (c-sept), anterior leaflet height, posterior leaflet height, aorto-mitral angle, mitral annular diameter and left atrial diameter. These parameters were measured and recorded by a blinded single operator. Independent predictors of SAM were identified using multiple logistic regression analysis. RESULTS: Of the 375 patients, 345 (92%) did not develop SAM (No-SAM group), while 30 (8%) developed intraoperative or postoperative SAM (SAM group). The mean age was 56.8 ± 12.8 and 56.7 ± 13.8 in the No-SAM and SAM groups, respectively. The incidence of fibroelastic deficiency, forme fruste and Barlow's disease was similar in both groups. All patients received a complete annuloplasty ring as part of the repair. There was no statistical difference in the mean ring size used in each group. EF was similar in the No-SAM (56.2% ± 8.1) and SAM (57.0% ± 9.2) P = 0.63) groups. Independent predictors of developing SAM after valve repair were: EDD <45 mm [odds ratio (OR) 3.90; P = 0.028], aorto-mitral angle <120° (OR 2.74; P = 0.041), coaptation-septum distance <25 mm (OR 5.09; P = 0.003), posterior leaflet height >15 mm (OR 3.80; P = 0.012) and basal septal diameter ?15 mm (OR 3.63; P = 0.039). CONCLUSIONS: The risk for SAM can be predicted using intraoperative transoesophageal echocardiography. The combination of a smaller left ventricle, tall posterior leaflet, narrow aorto-mitral angle and enlarged basal septum significantly increases the risk for SAM. Knowing these parameters prior to valve repair can assist the surgeon in adjusting their repair technique to minimize the risk. PMID:23657548

Varghese, Robin; Itagaki, Shinobu; Anyanwu, Anelechi C; Trigo, Paula; Fischer, Gregory; Adams, David H



Carnitine Deficiency as the Possible Etiology of Idiopathic Mitral Valve Prolapse  

PubMed Central

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

Trivellato, Mario; De Palo, Elio; Gatti, Rosalba; Parenti, Anna; Piazza, Mario



Paravalvular Abscess of the Mitral Valve with Fistula to the Left Ventricle and Detachment of the Coronary Sinus in a Young Woman.  


Infective endocarditis (IE) of the mitral valve (MV) manifesting paravalvular abscess (PA) is challenging. A 30-year-old woman presented with PA fistulating to the left ventricle, detachment of the coronary sinus and systemic embolization. During a course of fever of unknown origin, the patient received laparoscopic surgery under the diagnosis of strangulating intestinal obstruction due to colitis. Following abdominal surgery, abscess having blood flow within it from the left ventricle was pointed out at the left ventriculo-atrial junction by transthoracic echocardiography. Emergency surgery was performed under the diagnosis of PA of MV. Abscess debridement followed by reconstruction of the mitral annulus and coronary sinus with fresh autologous pericardium and mitral valve replacement (MVR) using a mechanical prosthetic valve were successfully performed. Timely and accurate diagnosis followed by the early surgical intervention with aggressive debridement of abscess and reconstruction with autologous pericardium should improve the outcome of this high-risk disease. PMID:23666246

Amano, Jun; Takahashi, Kohei; Seto, Tatsuichiro; Terasaki, Takamitsu; Wada, Yuko Fabish; Fukui, Daisuke; Takano, Tamaki



Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prostheses and quantitation of visceral microembolism in dogs  

SciTech Connect

A noninvasive technique has been developed in the dog model for imaging, with a gamma camera, the platelet deposition on Bjoerk-Shiley mitral valve prostheses early postoperatively. At 25 hours after implantation of the prosthesis and 24 hours after intravenous administration of 400 to 500 microCi of platelets labeled with indium-111, the platelet deposition in the sewing ring and perivalvular cardiac tissue can be clearly delineated in a scintiphotograph. An in vitro technique was also developed for quantitation of visceral microemboli in brain, lungs, kidneys, and other tissues. Biodistribution of the labeled platelets was quantitated, and the tissue/blood radioactivity ratio was determined in 22 dogs in four groups: unoperated normal dogs, sham-operated dogs, prosthesis-implanted dogs, and prosthesis-implanted dogs treated with dipyridamole before and aspirin and dipyridamole immediately after operation. Fifteen to 20% of total platelets were consumed as a consequence of the surgical procedure. On quantitation, we found that platelet deposition on the components of the prostheses was significantly reduced in prosthesis-implanted animals treated with dipyridamole and aspirin when compared with prosthesis-implanted, untreated dogs. All prosthesis-implanted animals considered together had a twofold to fourfold increase in tissue/blood radioactivity ratio in comparison with unoperated and sham-operated animals, an indication that the viscera work as filters and trap platelet microemboli that are presumably produced in the region of the mitral valve prostheses. In the dog model, indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of platelet deposition on mechanical mitral valve prostheses, in vitro evaluation of platelet microembolism in viscera, in vitro quantitation of surgical consumption of platelets, and evaluation of platelet-inhibitor drugs.

Dewanjee, M.K.; Fuster, V.; Rao, S.A.; Forshaw, P.L.; Kaye, M.P.



Echocardiographic analysis of posterior mitral leaflet movement in mitral stenosis.  

PubMed Central

Echocardiographic analysis of the movement of the posterior mitral valve leaflet in 60 patients with lone mitral stenosis, 35 patients with aortic stenosis, and 18 patients with aortic and mitral stenosis showed a spectrum of initial posterior mitral valve leaflet movement in early diastole. The classical anterior movement was seen in 36 out of 60 patients with mitral stenosis (60%), and 8 out of 16 patients with aortic and mitral stenosis (50%). Normal posterior movement was present in all patients with lone aortic stenosis but was also seen in 10 patients (17%) with mitral stenosis and 6 patients (33%) with aortic and mitral stenosis. The remaining patients with mitral stenosis or aortic stenosis and mitral stenosis showed a biphasic type of initial movement. Patients with anterior movement had a mean calculated mitral valve area from cardiac catheterisation significantly smaller than the rest (P less than 0.001), but neither biphasic nor posterior movement excluded severe mitral stenosis. The distinction between patients with mitral stenosis and initial movement of the posterior mitral valve leaflet and patients with left ventricular discompliance is possible when there is sinus rhythm. Late diastolic anterior movement of the posterior mitral valve leaflet during atrial contraction is diagnostic of true mitral stenosis.

Shiu, M F; Jenkins, B S; Webb-Peploe, M M



Plasma natriuretic peptide levels reflect changes in heart failure symptoms, left ventricular size and function after surgical mitral valve repair  

Microsoft Academic Search

Background and aim  N-terminal pro-B-type natriuretic peptide (NT-proBNP) has diagnostic and prognostic value in patients with heart failure.\\u000a The present prospective study was designed to assess whether changes in NT-proBNP levels after surgical mitral valve repair\\u000a reflect changes in heart failure symptoms and changes in left atrial size, left ventricular size and left ventricular function.\\u000a \\u000a \\u000a \\u000a Methods  The study population consisted of 22

Harm H. H. Feringa; Don Poldermans; Patrick Klein; Jerry Braun; Robert J. M. Klautz; Ron T. van Domburg; Arnoud van der Laarse; Ernst E. van der Wall; Robert A. E. Dion; Jeroen J. Bax



Successful thrombolysis of late, non-obstructive mitral bioprosthetic valve thrombosis: case report and review of the literature.  


Bioprosthetic valve thrombosis is an unexpected complication which has no guidelines for its management. A 70-year-old female presented 10 days after a stroke, three years after having undergone mitral bioprosthetic valve implantation. Both, transthoracic echocardiography and transesophageal echocardiography (TEE) revealed a large mobile, non-obstructive mass attached to the atrial side of the sewing ring of the bioprosthesis. The administration of low-molecular-weight heparin and aspirin resulted only in a reduction of thrombus size, whereas a slow streptokinase infusion resulted in complete disappearance of the thrombus after 16 h. A review of the literature shows that late non-obstructive bioprosthetic valve thrombosis, as diagnosed with TEE, is a rare condition that can be successfully treated either by anticoagulant or thrombolytic therapy. Late bioprosthetic valve thrombosis should be considered as a cause of prosthetic valve dysfunction, and long-term preventive anticoagulant treatment of high-risk patients is warranted. Slow thrombolytic therapy is safe and successful, even for large non-obstructive bioprosthetic thrombi, if there are no contraindications. PMID:22066356

Pozsonyi, Zoltan; Lengyel, Maria



Pseudoaneurysm of mitro-aortic intervalvular fibrosa during the course of mitral valve endocarditis with aorto-left ventricle outflow tract fistula.  


The mitro-aortic intervalvular fibrosa (MAIVF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The pseudoaneurysm of MAIVF is one of the uncommon but catastrophic complications of native or prosthetic aortic valve endocarditis or chest trauma. We report a case of infective endocarditis of mitral valve complicated by development of pseudoaneurysm of MAIVF, and fistulous formation causing massive shunt flow from the ascending aorta above the non-coronary cusp to the left ventricle outflow tract. PMID:23960696

Fazlinezhad, A; Fatehi, H; Tabaee, S; Alavi, M; Hoseini, L; Yousefzadeh, H



[Acute dysfunction of Liotta mitral bioprosthesis 8 years after implantation].  


The low-profile porcine bioprosthesis Liotta was introduced in clinical practice in order to reduce the potential complications related to excessive protrusion of the stent into the left ventricle after mitral valve replacement. Otherwise the particular design of this device seems to determine an excessive stress at the commissural level. We describe a case of acute dysfunction of the Liotta bioprosthesis secondary to commissural tear associated with minimal calcifications that required a reoperation in emergency. PMID:12187640

Ius, Paolo; Biffis, Claudio; Valfré, Carlo



Time-varying effective mitral valve area: prediction and validation using cardiac MRI and Doppler echocardiography in normal subjects.  


Precise knowledge of the volume and rate of early rapid left ventricular (LV) filling elucidates kinematic aspects of diastolic physiology. The Doppler E wave velocity-time integral (VTI) is conventionally used as the estimate of early, rapid-filling volume; however, this implicitly requires the assumption of a constant effective mitral valve area (EMVA). We sought to evaluate whether the EMVA is truly constant throughout early, rapid filling in 10 normal subjects using cardiac magnetic resonance imaging (MRI) and contemporaneous Doppler echocardiography, which were synchronized via ECG. LV volume measurements as a function of time were obtained via MRI, and transmitral flow values were measured via Doppler echocardiography. The synchronized data were used to predict EMVA as a function of time during early diastole. Validation involved EMVA determination using 1) the short-axis echocardiographic images near the mitral valve leaflet tips, 2) the distance between leaflet tips in the echocardiographic parasternal long-axis view, and 3) the distance between leaflet tips from the MRI LV outflow tract view. Predicted EMVA values varied substantially during early rapid filling, and observed EMVA values agreed well with predictions. We conclude that the EMVA is not constant, and its variation causes LV volume to increase faster than is reflected by the VTI. These results reveal the mechanism of early rapid volumetric increase and directly affect the significance and physiological interpretation of the VTI of the Doppler E wave. Application to subjects in selected pathophysiological subsets is in progress. PMID:15155259

Bowman, Andrew W; Frihauf, Paul A; Kovács, Sándor J



Species differences in expression of angiotensin II receptors and angiotensin-converting enzyme in human, canine and rat mitral valve leaflets  

Microsoft Academic Search

In normal valvular collagen turnover in the rat, angiotensin (Ang) II and angiotensin-converting enzyme (ACE) seem to be involved. In common human and canine valvular diseases, changes in valvular collagen play a pathogenetic role and the valvular renin–angiotensin system is therefore of particular interest in these species. Healthy mitral valve leaflets and adjacent left ventricular myocardium were taken from five

Tomas Mow; Knud Poulsen; Arne H. Nielsen; Ulrik Baandrup; Birgit F. Hansen; Henrik D. Pedersen



A computer-driven control system for sensing and adjusting papillary muscle tension in an in-vitro model of mitral valve function  

Microsoft Academic Search

The model consists of a human mitral valve apparatus with papillary muscles and chordae tendineae intact. The structure is mounted on an elliptical sewing ring positioned in an acrylic model of the left ventricle. The papillary muscles are mounted on circular discs which are attached to rods extending out of the model. The rods are anchored to a stepper motor\\/load

Edward G. Cape; Elizabeth R. Gieseking; Armelle Cagniot; Michael S. Simpson; Arthur E. Weyman; Ajit P. Yoganathan; Robert A. Levine



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

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:

Huei-Fong Hung; Pai-Feng Kao; Yu-Shuang Lin; Feng-Chia Chen; Fu-Chean Chen; Jen-Chen Tsai; Paul Chan



On the in-vivo deformation of the mitral valve anterior leaflet: Effects of annular geometry and referential configuration  

PubMed Central

Alteration of the native mitral valve (MV) shape has been hypothesized to have a profound effect on the local tissue stress distribution, and is potentially linked to limitations in repair durability. The present study was undertaken to elucidate the relation between MV annular shape and central mitral valve anterior leaflet (MVAL) strain history, using flat annuloplasty in an ovine model. In addition, we report for the first time the presence of residual in-vivo leaflet strains. In-vivo leaflet deformations were measured using sonocrystal transducers sutured to the MVAL (n=10), with the 3D positions acquired over the full cardiac cycle. In six animals a flat ring was sutured to the annulus and the transducer positions recorded, while in the remaining four the MV was excised from the exsanguinated heart and the stress-free transducer positions obtained. In the central region of the MVAL the peak stretch values, referenced to the minimum left ventricular pressure (LVP), were 1.10 ± 0.01 and 1.31 ± 0.03 (mean ± standard error) in the circumferential and radial directions, respectively. Following flat ring annuloplasty, the central MVAL contracted 28% circumferentially and elongated 16% radially at minimum LVP, and the circumferential direction was under a negative strain state during the entire cardiac cycle. After valve excision from the exsanguinated heart, the MVAL contracted significantly (18% and 30% in the circumferential and radial directions, respectively), indicating the presence of substantial in-vivo residual strains. While the physiological function of the residual strains (and their associated stresses) are at present unknown, accounting for their presence is clearly necessary for accurate computational simulations of MV function. Moreover, we demonstrated that changes in annular geometry dramatically alter valvular functional strains in-vivo. As levels of homeostatic strains are related to tissue remodeling and homeostasis, our results suggest that surgically-introduced alterations in MV shape could lead to the long term MV mechanobiological and microstructural alterations that could ultimately affect MV repair durability.

Amini, Rouzbeh; Eckert, Chad E.; Koomalsingh, Kevin; McGarvey, Jeremy; Minakawa, Mashito; Gorman, Joseph H.; Gorman, Robert C.; Sacks, Michael S.



The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet  

SciTech Connect

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.

Liao,J.; Yang, L.; Grashow, J.; Sacks, M.



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

PubMed Central

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

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



Alcohol ablation at the posterior papillary muscle prevents ventricular fibrillation in swine without affecting mitral valve function  

PubMed Central

Aims Radiofrequency ablation at the posterior papillary muscle (PM) significantly reduced ventricular fibrillation (VF) inducibility in rabbits and dogs, suggesting that PM may be involved in the generation of VF. However, the effect of ablation at the PM on VF inducibility remains unknown in normal intact swine hearts because in this species radiofrequency energy delivered at PM provoked incessant VF. Methods and results Twelve anesthetized swine underwent median sternotomy. Under the ultrasonographic guidance, chemical ablation was performed via injection of dehydrated alcohol into the base of the posterior PM (group PM, n = 6) or anterior wall (control group, n = 6) in the left ventricle. Ventricular fibrillation inducibility and mitral valve function were measured pre- and post-ablation. Hearts were explanted and the ablated myocardium was stained with haematoxylin and eosin. Ventricular fibrillation inducibility was significantly decreased from 100 ± 0% pre-ablation to 11.9 ± 7.8% post-ablation in group PM (P = 0.001), whereas it was not statistically different in the control group (100 ± 0 vs. 92.9 ± 7.1%, pre-ablation vs. post-ablation). Haemorrhage and cellular necrosis was observed in the centre of ablated myocardium and no significant mitral regurgitation was observed following ablation at the posterior PM. Conclusion Alcohol ablation of the left posterior PM reduced VF inducibility in normal intact swine hearts, with no significant mitral regurgitation. This suggests that the posterior PM may be involved in the generation of VF, and the recurrence of VF may be prevented by chemical ablation at the posterior PM.

Guo, Lei-Sheng; Zhou, Xu; Li, Yan-Hui; Cai, Jun; Wei, Dong-Mei; Shi, Liang; Yang, Gang; Armoundas, Antonis A.; Yang, Xin-Chun



Video-assisted Port-Access mitral valve surgery: from debut to routine surgery. Will Trocar-Port-Access cardiac surgery ultimately lead to robotic cardiac surgery?  


A right thoracotomy is a well-known alternative for midsternotomy to have access to the left atrium. The Port-Access (Heartport, Inc, Redwood City, CA) approach is an invaluable option to avoid cracking of ribs and cartilage. EndoCPB (Heartport, Inc) and Endo-Aortic Clamp (Heartport, Inc) allows installation of the extracorporeal circulation and cardiac arrest from the groin. Videoassistance and shafted instruments help the surgeon to perform the surgery through a 5 x 2-cm port and fulfill the main goals of minimally invasive cardiac surgery, comfort, cosmesis, and fast rehabilitation. From February 1997 to November 1998, 75 patients (40 men/35 women) had either Port-Access mitral valve repair (n = 41) or replacement (n = 33) for a variety of reasons: myxoid degeneration (n = 45), rheumatic disease (n = 21), chronic endocarditis (n = 4), annular dilatation (n = 2), and sclerotic disease (n = 2). One valve was replaced because of an ingrowing myxoma. There was one closure of a paravalvular leak. The mean age was 59.3 years of age (range, 32 to 83 years). Most patients had normal ejection fractions but different grades of mitral valve insufficiency and were in NYHA class II. One 71-year-old patient died after reoperation on postoperative day 1 for failed repair. Two patients had conversion to sternotomy and conventional ECC for repair of a dissected aorta. One patient died, one patient suffered a minor cerebrovascular deficit. Three patients had prolonged intensive care unit (ICU) stays for respiratory insufficiency, 5 patients underwent revision for bleeding. Mean ICU stay was 2.5 days; and mean hospital stay, 9 days (range, 4 to 36). A significant difference between the first 30 and last 38 patients in terms of length of stay in the ICU and the hospital was noticed. Two late mitral valve replacements for chronic endocarditis after repair occurred. One patient had medical therapy for endocarditis after mitral valve replacement. The debut of Port-Access mitral valve surgery may be nerve-racking; the routine is a smooth and sure surgery with maximum comfort, a very discrete scar, and a fast rehabilitation. There were no paravalvular leakages nor myocardial infarctions. Cerebrovascular accidents owing to thromboembolic phenomena, vascular lower limb or wound complications were not seen. Port-Access mitral valve surgery is a very important investment in the future of cardiac surgery. Some learning curve pitfalls were associated with the process of starting this revolutionary technique. PMID:10451253

Vanermen, H; Wellens, F; De Geest, R; Degrieck, I; Van Praet, F



Genetic Associations with Valvular Calcification and Aortic Stenosis  

PubMed Central

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.)

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, B?rge 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; Kalsch, Hagen; Muhleisen, Thomas W.; Nothen, 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.



Urinary catecholamines and mitral valve prolapse in panic-anxiety patients  

Microsoft Academic Search

Free norepinephrine and epinephrine were measured in two consecutive 12-hour urine collections gathered during normal activity and sleep from 23 panic-anxiety patients and 9 normal subjects. Mitral value prolapse (MVP) was found in 7 of 20 patients who had echocardiograms. Mean nighttime nor- epinephrine and epinephrine excretion in panic-anxiety patients without MVP was significantly higher than that of control subjects,

Randolph M. Nesse; Oliver G. Cameron; Andrew J. Buda; Daisy S. McCann; George C. Curtis; Marla J. Huber-Smith



Repair of mitral valve and subaortic mycotic aneurysm in a child with endocarditis.  


Endocarditis requiring surgical intervention in children is uncommon. Individualized operative therapy must be fashioned to the particular pathology of each case. In this case we describe mitral anterior leaflet homograft patch augmentation valvuloplasty, subaortic homograft patch closure of a large mycotic aneurysm, and homograft aortic root replacement in a 3-year-old patient with endocarditis after remote repair of complete atrioventricular canal. PMID:9647110

Frank, M W; Mavroudis, C; Backer, C L; Rocchini, A P



Calcification characteristics of porcine stented valves in a juvenile sheep model  

Microsoft Academic Search

Background. Different antimineralization treatments of stented porcine bioprostheses were evaluated: ethanol (Epic), ?-amino-oleic