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1

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

PubMed

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

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

2014-06-01

2

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

PubMed Central

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

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

2014-01-01

3

Mitral valve prolapse  

MedlinePLUS

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

4

Mitral Valve Prolapse  

MedlinePLUS

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

5

Mitral valve surgery - open  

MedlinePLUS

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

6

Mitral Valve Repair  

MedlinePLUS

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

7

Mitral Valve Prolapse  

MedlinePLUS

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

8

Mitral Valve Prolapse  

MedlinePLUS

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

9

Mitral Valve Prolapse.  

ERIC Educational Resources Information Center

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

Bergy, Gordon G.

1980-01-01

10

Mitral Valve Repair Surgery  

MedlinePLUS

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

11

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

Microsoft Academic Search

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

Harisios Boudoulas; Charles F. Wooley

2001-01-01

12

Mitral Valve Prolapse  

MedlinePLUS

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

13

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

PubMed

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

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

2010-03-01

14

Mitral valve surgery - minimally invasive  

MedlinePLUS

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

15

Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra  

ClinicalTrials.gov

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

2014-08-08

16

Mitral valve prolapse.  

PubMed

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

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

1980-07-01

17

Mitral Valve Prolapse (For Parents)  

MedlinePLUS

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

18

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

PubMed

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

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

2013-08-01

19

On-pump fibrillating heart mitral valve replacement with the SAPIEN™ XT transcatheter heart valve.  

PubMed

In some high-risk patients, standard mitral valve replacement can represent a challenging procedure, requiring a risky extensive decalcification of the annulus. In particular, high-risk redo patients and patients with a previously implanted transcatheter aortic valve, who develop calcific mitral disease, would benefit from the development of new, minimally invasive, transcatheter or hybrid techniques for mitral valve replacement. In particular, mixing transcatheter valve therapies and well-established minimally invasive techniques for mitral replacement or repair can help in decreasing the surgical risk and the technical complexity. Thus, placing transcatheter, balloon-expandable Sapien™ XT stent-valves in calcified, degenerated mitral valves through a right thoracotomy, a left atriotomy and on an on-pump fibrillating heart, represents an attractive alternative to standard surgery in redo patients, in patients with concomitant transcatheter aortic stent-valves in place and in patients with a high-risk profile. We describe this hybrid technique in detail. PMID:23847181

Ferrari, Enrico; Niclauss, Lars; Locca, Didier; Marcucci, Carlo

2014-04-01

20

Living with Mitral Valve Prolapse  

MedlinePLUS

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

21

Robotic mitral valve surgery.  

PubMed

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

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

2003-12-01

22

Mechanics of the mitral valve  

PubMed Central

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

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

2013-01-01

23

Mitral valve replacement after percutaneous transluminal mitral commissurotomy  

Microsoft Academic Search

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

Makoto Kamada; Kenji Ohsaka; Susumu Nagamine; Hidemitsu Kakihata

2004-01-01

24

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

PubMed

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

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

2014-10-01

25

Mitral valve regurgitation  

MedlinePLUS

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

26

Mitral annular calcification predicts immediate results of percutaneous transvenous mitral commissurotomy  

PubMed Central

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

2011-01-01

27

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

PubMed

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

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

2014-06-01

28

Prosthetic mitral valve leaflet escape.  

PubMed

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

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

2013-06-01

29

Surgical timing for mitral valve regurgitation.  

PubMed

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

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

2000-04-01

30

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

PubMed Central

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

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

2013-01-01

31

Haemolysis and acute renal failure after mitral valve repair.  

PubMed

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

Viaene, Els; Schroeyers, Pascal; Dujardin, Karl

2013-04-01

32

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

PubMed

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

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

2013-03-15

33

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

PubMed

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

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

1991-01-01

34

Recurrent stuck mitral valve: eosinophilia an unusual pathology.  

PubMed

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

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

2015-03-01

35

Mitral Valve Area During Exercise After Restrictive Mitral Valve Annuloplasty  

PubMed Central

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

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

2015-01-01

36

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

PubMed

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

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

2013-11-01

37

Nonobstructing Accessory Mitral Valve Tissue and Ventricular Septal Defect  

Microsoft Academic Search

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

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

1996-01-01

38

How Is Mitral Valve Prolapse Treated?  

MedlinePLUS

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

39

How Is Mitral Valve Prolapse Diagnosed?  

MedlinePLUS

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

40

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

PubMed Central

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

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

2013-01-01

41

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

PubMed

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

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

2014-10-01

42

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

PubMed Central

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

Wang, Jian-Gang; Ren, Bi-Qiao

2013-01-01

43

Study of collagen structure in canine myxomatous mitral valve disease   

E-print Network

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

Hadian, Mojtaba

2009-01-01

44

Acute Renal Infarction Secondary to Calcific Embolus from Mitral Annular Calcification  

SciTech Connect

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

Bande, Dinesh [University of North Dakota School of Medicine and Health Sciences, Department of Medicine (United States); Abbara, Suhny; Kalva, Sanjeeva P., E-mail: skalva@partners.org [Massachusetts General Hospital, Department of Radiology (United States)

2011-06-15

45

Clinical Presentation and Treatment Options for Mitral Valve Myxoma  

Microsoft Academic Search

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

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

1997-01-01

46

Mitral Valve Prolapse in Persons with Down Syndrome.  

ERIC Educational Resources Information Center

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

Pueschel, Siegfried M.; Werner, John Christian

1994-01-01

47

Viability of fresh mitral homograft valves  

PubMed Central

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

Al-Janabi, Nawal; Ross, Donald N.

1973-01-01

48

Signaling pathways in mitral valve degeneration.  

PubMed

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

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

2012-03-01

49

Mitral Valve Prolapse in Young Patients.  

ERIC Educational Resources Information Center

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

McFaul, Richard C.

1987-01-01

50

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

PubMed Central

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

Guler, Niyazi; Ozkara, Cenap; Akyol, Aytac

2006-01-01

51

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

PubMed Central

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

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

2012-01-01

52

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

PubMed Central

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

Eyal, Allon; Raanani, Ehud; Shapira, Yaron

2013-01-01

53

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

PubMed

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

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

2014-09-01

54

Robotically assisted minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

55

Natural history of mitral valve prolapse  

Microsoft Academic Search

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

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

1995-01-01

56

Effect of the mitral valve on diastolic flow patterns  

NASA Astrophysics Data System (ADS)

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

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

2014-12-01

57

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation  

PubMed Central

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

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

2013-01-01

58

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.  

PubMed

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

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

2013-01-01

59

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

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

60

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

PubMed Central

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

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

2013-01-01

61

Caseous Calcification of the Mitral Annulus: A Rare Cause of Intracardiac Mass  

PubMed Central

Caseous calcification of the mitral annulus is a rare form of periannular calcification with a mass-like appearance, that has to be in the differential of the cardiologist and radiologist. It classically looks like a round or semilunar hyperdense mass with an even denser peripheral rim, located in the posterior mitral annulus and having in general no clinical significance. PMID:23243545

Martinez-de-Alegria, Anxo; Rubio-Alvarez, Jose; Baleato-Gonzalez, Sandra

2012-01-01

62

Efficacy and Safety of Beating Heart Mitral Valve Replacement  

PubMed Central

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

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

2014-01-01

63

Robotic mitral valve surgery: A United States multicenter trial  

Microsoft Academic Search

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

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

2005-01-01

64

Port-access mitral valve replacement in dogs  

Microsoft Academic Search

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

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

1996-01-01

65

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

PubMed

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

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

2015-04-01

66

[Mitral valve tissue characterization using acoustic microscopy].  

PubMed

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

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

1998-01-01

67

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

PubMed Central

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

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

2015-01-01

68

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

PubMed

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

Daniel, W; Walpurger, G; Lichtlen, P

1976-07-01

69

Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus  

PubMed Central

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

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

2014-01-01

70

Mitral Valve Prolapse and the Association with Cutaneous Mucin Infiltration  

PubMed Central

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

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

2013-01-01

71

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

PubMed Central

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

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

2014-01-01

72

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

PubMed

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

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

2014-09-01

73

Tricuspid regurgitation after successful mitral valve surgery  

PubMed Central

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

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

2012-01-01

74

Transapical Transcatheter Valve-in-valve Replacement for Deteriorated Mitral Valve Bioprosthesis without Radio-Opaque Indicators: The "Invisible" Mitral Valve Bioprosthesis.  

PubMed

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

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

2015-02-01

75

Transcatheter Aortic Valve Implantation in a Patient with Previous Mitral Valve Replacement  

PubMed Central

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve. PMID:25278988

Moon, Sung Woo; Ko, Young-Guk; Hong, Geu-Ru; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran

2014-01-01

76

Transcatheter aortic valve implantation in a patient with previous mitral valve replacement.  

PubMed

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve. PMID:25278988

Moon, Sung Woo; Ko, Young-Guk; Hong, Geu-Ru; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran; Hong, Myeong-Ki

2014-09-01

77

Association of Serum Phosphate Levels with Aortic Valve Sclerosis and Annular Calcification: the Cardiovascular Health Study  

PubMed Central

Objectives To evaluate mineral metabolism markers as potential risk factors for calcific aortic valve disease. Background Mineral metabolism disturbances are common among older people and may contribute to cardiac valvular calcification. Associations of serum mineral metabolism markers with cardiac valvular calcification have not been evaluated in a well-characterized general population of older adults. Methods We measured serum levels of phosphate, calcium, parathyroid hormone, and 25-hydroxyvitamin D in 1,938 Cardiovascular Health Study participants who were free of clinical cardiovascular disease and who underwent echocardiography measurements of aortic valve sclerosis (AVS), mitral annular calcification (MAC), and aortic annular calcification (AAC). We used logistic regression models to estimate associations of mineral metabolism markers with AVS, MAC, and AAC after adjustment for relevant confounding variables, including kidney function. Results The respective prevalences of AVS, MAC, and AAC were 54%, 39%, and 44%. Each 0.5 mg/dl higher serum phosphate concentration was associated with a greater adjusted odds of AVS (odds ratio 1.17, 95% confidence interval 1.04 to 1.31, p = 0.01), MAC (odds ratio 1.12, 95% confidence interval 1.00 to 1.26, p =0.05), and AAC (odds ratio 1.12, 95% confidence interval 0.99 to 1.25, p = 0.05). In contrast, serum calcium, parathyroid hormone, and 25-hydroxyvitamin D concentrations were not associated with aortic or mitral calcification. Conclusions Higher serum phosphate levels within the normal range are associated with valvular and annular calcification in a community-based cohort of older adults. Phosphate may be a novel risk factor for calcific aortic valve disease and warrants further study. PMID:21737022

Linefsky, Jason P.; O’Brien, Kevin D.; Katz, Ronit; de Boer, Ian H.; Barasch, Eddy; Jenny, Nancy S.; Siscovick, David S.; Kestenbaum, Bryan

2011-01-01

78

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

PubMed

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

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

2012-12-01

79

Basic mechanisms of calcific aortic valve disease.  

PubMed

Calcific aortic valve disease (CAVD) is the most common heart valve disorder. There is no medical treatment to prevent and/or promote the regression of CAVD. Hence, it is of foremost importance to delineate and understand the key basic underlying mechanisms involved in CAVD. In the past decade our comprehension of the underpinning processes leading to CAVD has expanded at a fast pace. Hence, our understanding of the basic pathobiological processes implicated in CAVD might lead eventually to the development of novel pharmaceutical therapies for CAVD. In this review, we discuss molecular processes that are implicated in fibrosis and mineralization of the aortic valve. Specifically, we address the role of lipid retention, inflammation, phosphate signalling and osteogenic transition in the development of CAVD. Interplays between these different processes and the key regulation pathways are discussed along with their clinical relevance. PMID:25085215

Mathieu, Patrick; Boulanger, Marie-Chloé

2014-09-01

80

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

Microsoft Academic Search

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

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

81

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

PubMed

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

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

2015-01-01

82

Mitral valve disease: a cardiologic-surgical interaction.  

PubMed

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

Barlow, J B

1996-10-01

83

What Are the Signs and Symptoms of Mitral Valve Prolapse?  

MedlinePLUS

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

84

Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement  

PubMed Central

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

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

2013-01-01

85

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

PubMed Central

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

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

2013-01-01

86

Defect in mitochondrial functions in damaged human mitral valve  

Microsoft Academic Search

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

Santosh Shinde; Pawan Kumar; Kaushala Mishra; Neela Patil

2006-01-01

87

How to start a minimal access mitral valve program  

PubMed Central

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

2013-01-01

88

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

E-print Network

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

Liu, Mengmeng

2014-11-28

89

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

PubMed Central

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

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

2012-01-01

90

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

PubMed

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

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

2012-01-01

91

Dissection of the atrial wall after mitral valve replacement.  

PubMed Central

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

Lukács, L; Kassai, I; Lengyel, M

1996-01-01

92

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

PubMed

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

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

2014-01-01

93

In-vitro calcification study of polyurethane heart valves.  

PubMed

Tri-leaflet polyurethane heart valves have been considered as a potential candidate in heart valve replacement surgeries. In this study, polyurethane (Angioflex(®)) heart valve prostheses were fabricated using a solvent-casting method to evaluate their calcification resistance. These valves were subjected to accelerated life testing (continuous opening and closing of the leaflets) in a synthetic calcification solution. Results showed that Angioflex(®) could be considered as a potential material for fabricating prosthetic heart valves with possibly a higher calcification resistance compared to tissue valves. In addition, calcification resistance of bisphosphonate-modified Angioflex(®) valves was also evaluated. Bisphosphonates are considered to enhance the calcification resistance of polymers once covalently bonded to the bulk of the material. However, our in-vitro results showed that bisphosphonate-modified Angioflex(®) valves did not improve the calcification resistance of Angioflex(®) compared to its untreated counterparts. The results also showed that cyclic loading of the valves' leaflets resulted in formation of numerous cracks on the calcified surface, which were not present when calcification study did not involve mechanical loading. Further study of these cracks did not result in enough evidence to conclude whether these cracks have penetrated to the polymeric surface. PMID:24411385

Boloori Zadeh, Parnian; Corbett, Scott C; Nayeb-Hashemi, Hamid

2014-02-01

94

Transapical JenaValve in a patient with mechanical mitral valve prosthesis.  

PubMed

We report the first case of transcatheter aortic valve replacement implantation using JenaValve™ in a patient with mechanical mitral valve prosthesis. We believe that the design features of this valve may be particularly suited for use in this setting. © 2014 Wiley Periodicals, Inc. PMID:24478237

O' Sullivan, Katie E; Casserly, Ivan; Hurley, John

2015-04-01

95

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

PubMed

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

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

2015-03-01

96

Overlapping annuloplasty of the mitral valve in children.  

PubMed

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

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

2004-05-01

97

Three-dimensional echocardiography in congenital malformations of the mitral valve  

Microsoft Academic Search

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

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

2002-01-01

98

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

PubMed

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

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

2014-09-01

99

Human Aortic Valve Calcification Is Associated With an Osteoblast Phenotype  

Microsoft Academic Search

Background—Calcific aortic stenosis is the third most common cardiovascular disease in the United States. We hypothesized that the mechanism for aortic valve calcification is similar to skeletal bone formation and that this process is mediated by an osteoblast-like phenotype. Methods and Results—To test this hypothesis, we examined calcified human aortic valves replaced at surgery (n22) and normal human valves (n20)

Nalini M. Rajamannan; Malayannan Subramaniam; David Rickard; Stuart R. Stock; Janis Donovan; Margaret Springett; Thomas Orszulak; David A. Fullerton; A. J. Tajik; Robert O. Bonow; Thomas Spelsberg

2010-01-01

100

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

E-print Network

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

Luo, Xiaoyu

2007-01-01

101

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

E-print Network

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

Han, Richard I-Ming

2009-01-01

102

Acute massive mitral regurgitation from prosthetic valve dysfunction.  

PubMed Central

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

Cooper, D K; Sturridge, M F

1976-01-01

103

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. PMID:21826258

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

2011-01-01

104

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

PubMed

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

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

2002-05-01

105

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

PubMed

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

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

2014-05-01

106

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

PubMed

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

Little, Sherard G

2014-12-01

107

State of the mitral valve in rabbits with hypokinesia  

NASA Technical Reports Server (NTRS)

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

Strelkovska, V. Y.

1979-01-01

108

FSI simulation of asymmetric mitral valve dynamics during diastolic filling  

Microsoft Academic Search

In this article, we present a fluid–structure interaction algorithm accounting for the mutual interaction between two rigid bodies. The algorithm was used to perform a numerical simulation of mitral valve (MV) dynamics during diastolic filling. In numerical simulations of intraventricular flow and MV motion, the asymmetry of the leaflets is often neglected. In this study the MV was rendered as

S. K. Dahl; J. Vierendeels; J. Degroote; S. Annerel; L. R. Hellevik; B. Skallerud

2010-01-01

109

Fibrillin and Other Matrix Proteins in Mitral Valve Prolapse Syndrome  

Microsoft Academic Search

Background. Unlike myxomatous degeneration in Marfan syndrome, which has been reported to result from a mutation in the gene that codes for the extracel- lular structural protein fibrillin, no specific molecular abnormality has been documented to be the underlying cause of myxomatous degeneration in mitral valve pro- lapse syndrome (MVPS). The present study examined the distribution of fibrillin and other

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

110

Mitral Valve Surgery After Previous CABG With Functioning IMA Grafts  

Microsoft Academic Search

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

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

111

Mitral valve surgery after previous CABG with functioning IMA grafts  

Microsoft Academic Search

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

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

1999-01-01

112

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

PubMed Central

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

Sgouropoulou, Sophia

2013-01-01

113

Minimally invasive approach for redo mitral valve surgery  

PubMed Central

Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining “mitral valve” with the following terms: ‘minimally invasive’, ‘reoperation’, and ‘alternative approach’. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed “mini” thoracotomy or “port access”. The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these procedures has never been compared to open reoperations in a randomized trial, although published case series and comparisons to historical cohorts suggest that they are an effective and feasible alternative. Ongoing follow-up on current series will further define these procedures and provide valuable clinical outcome data. PMID:24251029

Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

2013-01-01

114

Minimally invasive approach for redo mitral valve surgery.  

PubMed

Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these procedures has never been compared to open reoperations in a randomized trial, although published case series and comparisons to historical cohorts suggest that they are an effective and feasible alternative. Ongoing follow-up on current series will further define these procedures and provide valuable clinical outcome data. PMID:24251029

Botta, Luca; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

2013-11-01

115

Coronary Revascularization Alone or with Mitral Valve Repair  

PubMed Central

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

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

2009-01-01

116

First in human percutaneous implantation of a balloon expandable transcatheter heart valve in a severely stenosed native mitral valve.  

PubMed

Transcatheter implantation of a balloon expandable valve in calcified severely stenosed native mitral valves has recently been described. The two cases reported so far utilized the surgical transapical approach generally used for transapical transcatheter aortic valve replacement. A percutaneous approach has not been published. We report the first successful percutaneous implantation of a balloon expandable transcatheter valve in the native mitral valve without a surgical incision. PMID:24532349

Guerrero, Mayra; Greenbaum, Adam; O'Neill, William

2014-06-01

117

Review of mitral valve insufficiency: repair or replacement  

PubMed Central

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

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

2014-01-01

118

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

PubMed Central

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

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

2015-01-01

119

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

Microsoft Academic Search

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

Avrum I. Gotlieb; Alan Rosenthal; Pedram Kazemian

2002-01-01

120

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

NASA Astrophysics Data System (ADS)

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

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

2012-06-01

121

Robotic Tissue Tracking for Beating Heart Mitral Valve Surgery  

PubMed Central

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

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

2010-01-01

122

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

PubMed

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

2014-08-01

123

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

Microsoft Academic Search

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

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

1992-01-01

124

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

125

Disc erosion in Models 103 and 104 of Beall mitral valve prostheses  

PubMed Central

Three cases of severe disc variance and erosion of the Teflon-disc Beall mitral valve prosthesis (Models 103 and 104) are reported. In two patients, the Beall mitral valves were excised and replaced with two Björk-Shiley mitral valves. The remaining patient did not survive, and at autopsy, the lens was found at the aortic bifurcation level. Because of this potentially lethal complication, careful follow-up of patients with Beall mitral valve prostheses (Models 103 and 104) is recommended. Images PMID:15216211

Gómez, Ricardo; Verduras, María José; Lopez-Quintana, Alfonso; Riera, Luis; Zerolo, Ignacio; Martinez-Bordiu, Cristóbal

1981-01-01

126

Echocardiographic and phonocardiographic confirmation of suspected caged mitral valve malfunction.  

PubMed

Seven patients studied by echocardiography with and without simultaneous phonocardiography for suspected malfunction of a caged mitral valve prosthesis are presented. In case 1, with inaudible prosthetic clicks, thrombosis of the cage and immobility of the ball were suggested by echocardiographic studies and confirmed at surgery. In case 2, simultaneous echocardiographic and phonocardiographic studies demonstrated wide and variable intervals between the aortic second sound the the opening click and also "sticking" of the ball. In case 3 a thrombus prevented full motion of the ball to the apex of the cage, which was seen on the echocardiogram, while in case 4, with a thrombus within the ventricle and prosthesis, the prosthetic opening click was present intermittently and was associated with only subtle echocardiographic changes. In case 5, echocardiographic studies demonstrated abnormal rocking of the cage secondary to severe prosthetic dehiscence. In case 6, dul prosthetic clicks were to be secondary to a low cardiac-output state. In case 7, with multiple valve prostheses, simultaneous echocardiographic and phonocardiographic studies allowed identification of individual valve sounds and abnormal timing of valve opening. Based on these studies, we believe that echocardiography and simultaneous phonocardiography can yield very useful information in the evaluation of patients with suspected malfunction of a caged mitral valve prosthesis. PMID:947687

Berndt, T B; Goodman, D J; Popp, R L

1976-08-01

127

[Thromboembolic accident after mitral valve replacement].  

PubMed

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

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

2004-03-01

128

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

PubMed

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

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

1994-12-01

129

Modelling chorded prosthetic mitral valves using the immersed boundary method.  

PubMed

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

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

2004-01-01

130

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

PubMed Central

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

2011-01-01

131

Value of Robotically Assisted Surgery for Mitral Valve Disease  

PubMed Central

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

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

2014-01-01

132

Carotid-access transcatheter aortic valve replacement in a patient with a previous mitral valve replacement.  

PubMed

We describe a case of transcatheter aortic valve replacement (TAVR) using carotid artery access and regional anesthesia in a patient with rheumatic heart disease, previous mitral valve replacement, and multiple co-morbidities. It highlights the role of the multidisciplinary Heart Team and multimodality imaging in reaching and implementing an appropriate management plan in this complex patient group. doi: 10.1111/jocs.12324 (J Card Surg 2015;30:256-259). PMID:24612338

Daly, Michael J; Blair, Paul H; Modine, Thomas; Donnelly, Patrick M; Jeganathan, Reuben; Manoharan, Ganesh; Spence, Mark S

2015-03-01

133

Mitral Annulus Calcification is associated with valvular and cardiac structural abnormalities  

Microsoft Academic Search

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

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

2007-01-01

134

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

Microsoft Academic Search

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

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

2008-01-01

135

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

PubMed

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

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

2014-02-01

136

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

PubMed

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

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

2015-02-01

137

Regional stiffening of the mitral valve anterior leaflet in the beating ovine heart  

Microsoft Academic Search

Left atrial muscle extends into the proximal third of the mitral valve (MV) anterior leaflet and transient tensing of this muscle has been proposed as a mechanism aiding valve closure. If such tensing occurs, regional stiffness in the proximal anterior mitral leaflet will be greater during isovolumic contraction (IVC) than isovolumic relaxation (IVR) and this regional stiffness difference will be

Gaurav Krishnamurthy; Akinobu Itoh; Julia C. Swanson; Wolfgang Bothe; Matts Karlsson; Ellen Kuhl; D. Craig Miller; Neil B. Ingels Jr.

2009-01-01

138

Near fatal puerperal thrombosis on Björk-Shiley mitral valve prosthesis.  

PubMed Central

A 22-year-old woman required emergency mitral valve replacement three weeks post partum because of thrombotic obstruction of her prosthetic mitral valve. Low dose subcutaneous heparin was administered from the 17th week of pregnancy. Though there was a successful fetal outcome, heparin did not prevent thrombosis on the prosthesis and its continuation into the puerperium proved nearly fatal. Images PMID:687495

McLeod, A A; Jennings, K P; Townsend, E R

1978-01-01

139

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

Microsoft Academic Search

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

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

1998-01-01

140

Left ventricular pannus causing inflow obstruction late after mitral valve replacement for endocardial fibroelastosis  

Microsoft Academic Search

A case of mitral stenosis following mitral valve replacement in a patient with endocardial fibroelastosis is reported. A 14-year-old\\u000a boy presented with cardiac failure. He had been diagnosed as having endocardial fibroelastosis at the age of 7 months and\\u000a had undergone resection of endocardial fibrous tissue in the left ventricle at that time. Five years later his mitral valve\\u000a was

S. Dinarevic; A. Redington; M. Rigby; M. N. Sheppard

1996-01-01

141

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

Microsoft Academic Search

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

Giuseppe Gatti; Gabriele Cardu; Rosanna Trane; Peppino Pugliese

2002-01-01

142

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

Microsoft Academic Search

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

Giuseppe Gatti; Gabriele Cardu; Rosanna Trane; Peppino Pugliese

2010-01-01

143

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

SciTech Connect

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

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

2007-08-29

144

Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery.  

PubMed

Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370 .). PMID:25774765

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

2015-04-01

145

[Celiac trunk compression syndrome associated with primary mitral valve prolapse].  

PubMed

A prospective study included 106 patients with celiac trunk compression syndrome (CTCS). Duplex scanning of the celiac trunk and superior mesenteric artery and echocardiography were performed during their examination. The investigation revealed primary mitral valve prolapse (PMVP) in 78 (74%) patients. Operations of decompression of the celiac trunk were made on 101 patients. After operation the symptoms (neurovegetative included) were found to disappear. No authentic distinctions were revealed in the clinical semiology and postoperative course of patients with CTCS and with a combination of CTCS and PMVP. PMID:19432138

Iaitski?, N A; Ignashov, A M; Rosukhovski?, D A; Tiurina, T V; Perle?, V E; Gichkin, A Iu

2009-01-01

146

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

PubMed

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

De Bonis, Michele; Bolling, Steven F

2013-01-01

147

Receptor activator of nuclear factor ?B ligand and osteoprotegerin regulate aortic valve calcification  

Microsoft Academic Search

Objective. – Recent studies have suggested that valvular calcification in calcific aortic stenosis (AS) may be actively regulated. “Receptor Activator of Nuclear factor ?B Ligand” (RANKL) and osteoprotegerin (OPG) are members of a cytokine system involved in bone turnover and vascular calcification. Their role in calcific AS is not known.Methods and Results. – By immunohistochemistry using human aortic valves, RANKL

Jens J. Kaden; Svetlana Bickelhaupt; Rainer Grobholz; Karl K. Haase; Asl?han Sar?koç; Ref?ka K?l?ç; Martina Brueckmann; Siegfried Lang; Ingrid Zahn; Christian Vahl; Siegfried Hagl; Carl-Erik Dempfle; Martin Borggrefe

2004-01-01

148

Antegrade percutaneous valve implantation for mitral ring dysfunction, a challenging case.  

PubMed

The operative risk for reoperation of degenerated bioprosthetic valves or failing mitral-valve annuloplasty is higher compared with the risks for first isolated native valve repair or replacement (Astor et al., Eur Heart J 2008;29:2382-2387). In the presence of comorbidities, these risks increase exponentially. The recent introduction of transcatheter valve implantation opened new perspectives for the treatment of patients at very high surgical risk. We report a percutaneous mitral valve (MV) implantation using a transatrial approach within a MV ring using the Edwars Sapien XT valve. PMID:22511617

Petronio, Anna; Giannini, Cristina; De Carlo, Marco; Guarracino, Fabio

2012-10-01

149

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

PubMed

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

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

2009-09-01

150

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

PubMed

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

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

2015-03-01

151

Characterization of Mitral Valve Anterior Leaflet Perfusion Patterns  

PubMed Central

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

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

2010-01-01

152

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

Microsoft Academic Search

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

K. Jane Grande-Allen; Jun Liao

2011-01-01

153

Mitral valve replacement with the Carpentier-Edwards standard bioprosthesis: performance into the second decade  

Microsoft Academic Search

From March 1978, 196 Carpentier-Edwards standard bioprostheses (stCE) were implanted in 194 patients. There were 154 isolated mitral valve replacements (MVR) and 42 aortic plus mitral valve replacements (AVR\\/MVR) with a mean follow-up of 7.05 (range 0–15.2) years and 7.15 (range 0–13.8) years, respectively. Freedom from structural valve failure at 10 years was 70.8% ± 4.9% (MVR) and 59.6% ±

C. A. M. van Doorn; K. D. C. Stoodley; N. R. Saunders; R. U. Nair; G. A. Davies; D. A. Watson

1995-01-01

154

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

PubMed

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

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

2015-01-01

155

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

PubMed Central

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

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

2011-01-01

156

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

PubMed

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

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

2014-04-01

157

Chylopericardium After Mitral Valve Repair for Rheumatic Valve Disease Treated with Surgery  

PubMed Central

ABSTRACT Chylopericardium is a rare disorder that may be primary (idiopathic) or secondary to injury of the thoracic duct or thymus gland. Pediatric cardiac operations are more commonly related to this complication because thymus gland is very active in this population and atrophies in the adult patients. We present a case of chylopericardium after mitral valve repair for rheumatic disease, due to thymus gland tributaries injury. PMID:24783919

Likaj, Ermal; Kacani, Andi; Dumani, Selman; Dibra, Laureta; Refatllari, Ali

2014-01-01

158

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

PubMed

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

Lartseva, F A; Cherenkova, N D

1981-02-01

159

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

Microsoft Academic Search

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

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

1996-01-01

160

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

PubMed Central

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

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

2013-01-01

161

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

1994-01-01

162

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

Microsoft Academic Search

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

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

1997-01-01

163

Percutaneous approaches to valve repair for mitral regurgitation.  

PubMed

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

Feldman, Ted; Young, Amelia

2014-05-27

164

Echoguided closed commissurotomy for mitral valve stenosis in a dog.  

PubMed

Surgical treatment of mitral stenosis (MS) usually consists of open mitral commissurotomy (MC) or percutaneous balloon MC, which require a cardiopulmonary bypass or transseptal approach, respectively. We describe here the first surgical management of congenital MS in a dog using a less invasive procedure, a surgical closed MC under direct echo guidance. A 5-year-old female Cairn terrier was referred for ascites, weakness, and marked exercise intolerance for 2 months, which was refractory to medical treatment. Diagnosis of severe MS associated with atrial fibrillation (AF) was confirmed by echo-Doppler examination and electrocardiography. Poor response to medical treatment suggested a corrective procedure on the valve was indicated. However, due to the cost and high mortality rate associated with cardiopulmonary bypass, a hybrid MC was recommended. A standard left intercostal thoracotomy was performed and three balloon valvuloplasty catheters of differing diameters were sequentially inserted through the left atrium under direct echo guidance. Transesophageal echocardiography revealed a 62% reduction in the pressure half-time compared to the pre-procedure. Thirteen months after surgery the dog is still doing well with resolution of ascites and a marked improvement of most echo-Doppler variables. PMID:21821477

Trehiou-Sechi, Emilie; Behr, Luc; Chetboul, Valérie; Pouchelon, Jean-Louis; Castaignet, Maud; Gouni, Vassiliki; Misbach, Charlotte; Petit, Amandine M P; Borenstein, Nicolas

2011-09-01

165

Myxomatous mitral valve disease in dogs: Does size matter?  

PubMed Central

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

2012-01-01

166

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

Microsoft Academic Search

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

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

2001-01-01

167

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

Microsoft Academic Search

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

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

1998-01-01

168

Dynamic simulation of heart mitral valve with transversely isotropic material model  

E-print Network

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

Weinberg, Eli, 1979-

2005-01-01

169

Molecular and Cellular Aspects of Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD) increasingly afflicts our aging population. One-third of our elderly have echocardiographic or radiological evidence of aortic valve sclerosis (CAVS), an early and subclinical form of CAVD. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes all contribute to the risk of disease that has worldwide distribution. Upon progression to its most severe form --- calcific aortic stenosis (CAS) --- CAVD becomes debilitating and devastating, and 2% of individuals over age 60 suffer from CAS to the extent that surgical intervention is required. No effective pharmacotherapies exist for treating those at risk for clinical progression. It is becoming increasingly apparent that a diverse spectrum of cellular and molecular mechanisms converge to regulate valvular calcium load; this is evidenced not only in histopathologic heterogeneity of CAVD but also from the multiplicity of cell types that can participate in valve biomineralization. In this review, we highlight our current understanding of CAVD disease biology, emphasizing molecular and cellular aspects of its regulation. We end by pointing to important biological and clinical questions that must be answered to enable sophisticated disease staging and the development of new strategies to medically treat CAVD. PMID:23833294

Towler, Dwight A.

2014-01-01

170

Systematic review of robotic minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

171

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

PubMed Central

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

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

2013-01-01

172

Aortic valve calcification: basic science to clinical practice.  

PubMed

Calcific aortic valve stenosis is the result of regulated cell processes. The histological hallmarks are inflammation and a remodelling of the extracellular matrix leading to bone formation. In the last 15 years the view has changed from it being an unmodifiable degenerative disease to an active biological process regulated by highly conserved ubiquitous cellular pathways. Many mechanisms and risk factors are the same as in atherosclerosis. Thus, statins and angiotensin II antagonists seemed promising treatment options. However, clinical trials failed to support this. This review describes the current understanding of major molecular mechanisms and discusses their role in clinical practice and possible therapy. PMID:18632833

Akat, K; Borggrefe, M; Kaden, J J

2009-04-01

173

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

E-print Network

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

Price, Paul A.

174

Myocardial deformation and rotational profiles in mitral valve prolapse.  

PubMed

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

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

2013-10-01

175

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy  

PubMed Central

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

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

2014-01-01

176

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

PubMed

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

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

2013-03-01

177

Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography  

PubMed Central

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

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

2013-01-01

178

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

PubMed

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

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

2014-08-01

179

Operative risks of the maze procedure associated with mitral valve surgery  

Microsoft Academic Search

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

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

1997-01-01

180

Transversely isotropic membrane shells with application to mitral valve mechanics. Constitutive modelling and finite element implementation  

Microsoft Academic Search

SUMMARY The present study addresses constitutive modelling and implementation of transversely isotropic hyper- elastic material models for the analysis of the mitral valve. This valve separates the left atrium and left ventricle in the heart. Two convex strain energy potentials are employed in derivation of stress tensors and elasticity tensors. The plane stress and incompressibility conditions are accounted for directly.

V. Prot; B. Skallerud; G. A. Holzapfel

2007-01-01

181

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

PubMed

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

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

2007-01-01

182

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

Microsoft Academic Search

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

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

2004-01-01

183

Successful Medical Treatment of Prosthetic Mitral Valve Endocarditis Caused by Brucella abortus  

PubMed Central

Although Brucella endocarditis is a rare complication of human brucellosis, it is the main cause of the mortality in this disease. Traditionally, the therapeutic approach to endocarditis caused by Brucella species requires a combination of antimicrobial therapy and valve replacement surgery. In the literature, only a few cases of mitral prosthetic valve endocarditis caused by Brucella species have been successfully treated without reoperation. We present a case of a 42-year-old man with a prosthetic mitral valve infected by Brucella abortus who was cured solely by medical treatment. PMID:25469149

Lee, Seung-Ah; Shin, Hyo-Sun; Lee, Hee-Sun; Choi, Hong-Mi; Kim, Hyung-Kwan

2014-01-01

184

Large free-floating left atrial thrombus with normal mitral valve  

PubMed Central

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.

2013-01-01

185

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

Microsoft Academic Search

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

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

2002-01-01

186

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

Microsoft Academic Search

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

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

187

Potential drug targets for calcific aortic valve disease  

PubMed Central

Calcific aortic valve disease (CAVD) is a major contributor to cardiovascular morbidity and mortality and, given its association with age, the prevalence of CAVD is expected to continue to rise as global life expectancy increases. No drug strategies currently exist to prevent or treat CAVD. Given that valve replacement is the only available clinical option, patients often cope with a deteriorating quality of life until diminished valve function demands intervention. The recognition that CAVD results from active cellular mechanisms suggests that the underlying pathways might be targeted to treat the condition. However, no such therapeutic strategy has been successfully developed to date. One hope was that drugs already used to treat vascular complications might also improve CAVD outcomes, but the mechanisms of CAVD progression and the desired therapeutic outcomes are often different from those of vascular diseases. We, therefore, discuss the benchmarks that must be met by a CAVD treatment approach, and highlight advances in the understanding of CAVD mechanisms to identify potential novel therapeutic targets. PMID:24445487

Hutcheson, Joshua D.; Aikawa, Elena; Merryman, W. David

2014-01-01

188

Computational Mitral Valve Evaluation and Potential Clinical Applications.  

PubMed

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

Chandran, Krishnan B; Kim, Hyunggun

2014-08-19

189

Postoperative coronary artery spasm after mitral valve replacement?  

PubMed Central

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

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

2015-01-01

190

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study  

E-print Network

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

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

2008-04-23

191

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

PubMed

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

Testa, Luca; Gelpi, Guido; Bedogni, Francesco

2013-10-01

192

Minimally invasive mitral valve surgery: a systematic review and meta-analysis.  

PubMed

The mitral valve has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, tissue telemanipulation, and perfusion technology have allowed for mitral valve surgery to be performed using progressively smaller incisions including the minithoracotomy and hemisternotomy. Due to reports of excellent results, minimally invasive mitral valve surgery has become a standard of care at certain specialized centers worldwide. This meta-analysis quantifies the effects of minimally invasive mitral valve surgery on morbidity and mortality compared with conventional mitral surgery and demonstrates equivalent perioperative mortality (1641 patients, odds ratio (OR) 0.46, 95% confidence interval 0.15-1.42, p=0.18), reduced need for reoperation for bleeding (1553 patients, OR 0.56, 95% CI 0.35-0.90, p=0.02) and a trend towards shorter hospital stays (350 patients, weighted mean difference (WMD) -0.73, 95% CI -1.52 to 0.05, p=0.07). These benefits were evident despite longer cardiopulmonary bypass (WMD 25.81, 95% CI 13.13-38.50, p<0.0001) and cross-clamp times (WMD 20.91, 95% CI 8.79-33.04, p=0.0007) in the minimally invasive group. Case-control studies show consistently less pain and faster recovery compared to those having a conventional approach. Data for minimally invasive mitral valve surgery after previous cardiac surgery are limited but consistently demonstrate reduced blood loss, fewer transfusions and faster recovery compared to reoperative sternotomy. Long-term follow-up data from multiple cohort studies are also examined revealing equivalent survival and freedom from reoperation. Thus, current clinical data suggest that minimally invasive mitral valve surgery is a safe and a durable alternative to a conventional approach and is associated with less morbidity. PMID:18829343

Modi, Paul; Hassan, Ansar; Chitwood, Walter Randolph

2008-11-01

193

Interstitial cells from the atrial and ventricular sides of the bovine mitral valve respond differently to denuding endocardial injury  

Microsoft Academic Search

Summary  The mitral valve has atrial and ventricular sides, each lined by endocardial cells. The valve stroma contains ? smooth muscle\\u000a actin positive interstitial cells, collagen, glycosaminoglycans, and elastic tissue. To eliminate the effect of endocardium\\u000a on wound repair in bovine mitral valve organ culture, the endocardium was removed from both sides of the valve. At 6 days,\\u000a organ cultures of

Wanda M. Lester; Ariff A. Damji; Ibolya Gedeon; Masaye Tanaka

1993-01-01

194

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

PubMed

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

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

1993-09-01

195

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

PubMed

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

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

2014-05-01

196

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

E-print Network

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

Wong, Kenneth K.Y.

197

Association between urokinase-plasminogen activator gene T4065C polymorphism and risk of mitral valve prolapse  

Microsoft Academic Search

Background: Abnormalities of collagen and elastic fibers were found in floppy mitral valves (FMV). Urokinase-plasminogen activator (PLAU) was suggested to be involved in the pathogenesis of elastin and collagen degradation in arterial aneurysm. The role of PLAU genetic variant in mitral valve prolapse (MVP) has not been studied. We, therefore, performed a case-controlled study investigating the possible relation between the

Hsiang-Tai Chou; Yng-Tay Chen; Jer-Yuarn Wu; Fuu-Jen Tsai

2004-01-01

198

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

NASA Technical Reports Server (NTRS)

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

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

1998-01-01

199

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

PubMed

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

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

2015-01-01

200

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

PubMed

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

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

2014-09-01

201

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

PubMed

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

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

2015-04-01

202

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

PubMed Central

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

2012-01-01

203

Transcatheter closures for fistula tract and paravalvular leak after mitral valve replacement and tricuspid annuloplasty.  

PubMed

Paravalvular leaks (PVLs) often occur after surgical valve replacement. Surgical reoperation has been the gold standard of therapy for PVLs, but it carries a higher operative risk and an increased incidence of re-leaks compared to the initial surgery. In high surgical risk patients with appropriate geometries, transcatheter closure of PVLs could be an alternative to redo-surgery. Here, we report a case of successful staged transcatheter closures of a fistula tract between the aorta and right atrium, and mitral PVLs after mitral valve replacement and tricuspid annuloplasty. PMID:24497891

Om, Sang Yong; Park, Gyung Min; Kim, Jin Yong; Yoon, Yong Hoon; Lee, Sinwon; Kim, Young-Hak; Song, Jae-Kwan

2014-01-01

204

Transcatheter Closures for Fistula Tract and Paravalvular Leak after Mitral Valve Replacement and Tricuspid Annuloplasty  

PubMed Central

Paravalvular leaks (PVLs) often occur after surgical valve replacement. Surgical reoperation has been the gold standard of therapy for PVLs, but it carries a higher operative risk and an increased incidence of re-leaks compared to the initial surgery. In high surgical risk patients with appropriate geometries, transcatheter closure of PVLs could be an alternative to redo-surgery. Here, we report a case of successful staged transcatheter closures of a fistula tract between the aorta and right atrium, and mitral PVLs after mitral valve replacement and tricuspid annuloplasty. PMID:24497891

Om, Sang Yong; Park, Gyung Min; Kim, Jin Yong; Yoon, Yong Hoon; Lee, Sinwon; Kim, Young-Hak

2014-01-01

205

Side-Specific Endothelial-Dependent Regulation of Aortic Valve Calcification  

PubMed Central

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.

2014-01-01

206

Atorvastatin inhibits calcification and enhances nitric oxide synthase production in the hypercholesterolaemic aortic valve  

Microsoft Academic Search

Objective: To study in a rabbit model the expression of endothelial nitric oxide synthase (eNOS) in association with the development of calcification of the aortic valve, and to assess the effects of atorvastatin on eNOS expression, nitrite concentration, and aortic valve calcification.Methods: Rabbits (n = 48) were treated for three months: 16, forming a control group, were fed a normal

N M Rajamannan; M Subramaniam; S R Stock; N J Stone; M Springett; K I Ignatiev; J P McConnell; R J Singh; R O Bonow; T C Spelsberg

2005-01-01

207

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

PubMed

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

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

2015-02-01

208

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

PubMed

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

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

1992-09-01

209

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

PubMed

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

Cebi, Niyazi; Bozkurt, Engin

2004-07-01

210

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

NASA Astrophysics Data System (ADS)

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

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

2012-03-01

211

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

PubMed

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

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

2011-10-01

212

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

PubMed

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

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

2014-09-01

213

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

PubMed Central

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

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

2015-01-01

214

The Impact of Sub-valvular Apparatus Preservation on Prosthetic Valve Dysfunction During Mitral Valve Replacement  

PubMed Central

Background: Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new concept. Some surgeons prefer to excise the apparatus. Objectives: The aim of this study was to reduce the risk of prosthetic valve dysfunction. Materials and Methods: This retrospective study included 151 patients with the mean age of 46 years who underwent MVR (Female/male = 93/58). In the group I consisting of 39 patients, MVR with chordae preservation was performed (Bi-leaflet preservation = 20; posterior leaflet preservation = 19). In the group II consisting of 112 patients, sub-valvular apparatus was resected completely during MVR. Preoperative patients’ characteristics, including age, sex, functional status, left ventricular ejection fraction, and end-diastolic or end-systolic dimensions were statistically similar in both groups. Mean follow-up period was 60.3 ± 26 months. Results: The improvement of functional status was seen in almost all survivors but was more obvious in the group I. In early follow-up, 56.4% of group I cases and 44.1% of group II patients were classified as New York Heart Association class I. These rates were 84.2% and 71.2% in mid-term follow-up, respectively (P < 0.001). Mortality rate was significantly lower in the group I (2.6%) compared to the group II (8.9%) (P = 0.03). There was a trend for higher frequency of postoperative atrial fibrillation in the group II compared to that in the group I (52.7% vs. 38.5%, P = 0.12).The incidence of prosthetic valve dysfunction (PVD) was 5.1% in the group I and 4.5% in the group II, but this difference was not statistically significant (P = 0.56). Conclusions: Preservation of mitral annulus and papillary muscle continuity may enhance post- MVR cardiac performance with low mortality and morbidity rates. The risk of PVD was not significantly higher than conventional MVR in our series. PMID:25478491

Alizadeh-Ghavidel, Alireza; Mirmesdagh, Yalda; Sharifi, Mehrzad; Sadeghpour, Anita; Nakhaeizadeh, Reza; Omrani, Gholamreza

2013-01-01

215

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

E-print Network

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

Luo, Xiaoyu

216

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

E-print Network

, 29 Oxford Street, Cambridge, MA, 02138, USA bDepartment of Cardiovascular Surgery, ChildrenRobotic Tissue Tracking for Beating Heart Mitral Valve Surgery Shelten G. Yuena , Nikolay V surgery 1. Introduction Beating heart surgery is a promising alternative to con- ventional procedures

217

Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease  

Microsoft Academic Search

Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the

F Loperfido; F Pennestri; A Digaetano; E Scabbia; P Santarelli; R Mongiardo; G Schiavoni; E Coppola; U Manzoli

1983-01-01

218

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

E-print Network

, a healthy mitral valve permits the flow of oxygenated blood from the left atrium to the left ventricle while with the Fig. 2 Subjects use the surgical simulator to analyze the mobility of leaflet segments. The blue the flow of oxygenated blood.

219

Effects of Mitral Valve Replacement on Regional Left Ventricular Systolic Strain  

Microsoft Academic Search

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

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

2010-01-01

220

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

PubMed Central

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

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

2013-01-01

221

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

NASA Astrophysics Data System (ADS)

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

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

2005-11-01

222

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. PMID:23372624

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

2013-01-01

223

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

PubMed Central

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

Obel, IWP

2009-01-01

224

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

PubMed

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

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

2014-09-01

225

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

NASA Technical Reports Server (NTRS)

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

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

2001-01-01

226

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

Microsoft Academic Search

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

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

2010-01-01

227

Transcatheter valve-in-ring implantation after a failed surgical mitral repair using a transseptal approach and a veno-arterial loop for valve placement.  

PubMed

A failure of a mitral valve repair, which includes the implantation of a mitral annuloplasty ring in the majority of cases, is associated with relevant mortality. Surgery is considered as the standard treatment for these patients. For patients who have an unacceptable high peri-surgical risk a transcatheter valve-in-ring (TVIR) procedure might be an option. Isolated case reports and small case series report on the feasibility of a TVIR implantation in mitral position. We present a case where a 29-mm Edwards Sapien valve was placed in a 32-mm Carpentier Edwards ring. To our knowledge no valve has been implanted so far in this ring size and this is the first case where a veno-arterial loop was used as guide rail for valve implantation and helped considerably to position the valve properly. PMID:24307006

Wunderlich, Nina C; Kische, Stephan; Ince, Hüseyin; Bozda?-Turan, Ilkay

2014-12-01

228

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

229

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

PubMed

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

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

2001-11-01

230

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

PubMed Central

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

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

2014-01-01

231

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

PubMed Central

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

2014-01-01

232

Core valve implant failure in the presence of mechanical mitral prosthesis: Importance of assessing left ventricular outflow tract.  

PubMed

Transcatheter aortic valve replacement in the presence of a mitral prosthetic valve is a technically challenging endeavor. The presence of a mitral prosthesis can alter the geometry of the landing zone for the device. A multi slice computerized tomography with comprehensive review of left ventricular outflow tract and aortic root in its entirety is critical for preventing implant failure. Technical expedients to treat implant failure involve understanding of the device as well its relationship with the mitral prosthesis. © 2014 Wiley Periodicals, Inc. PMID:24403211

Sarkar, Kunal; Speciale, Giulio; Ussia, Gian Paolo

2015-04-01

233

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

SciTech Connect

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

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

1982-01-01

234

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

PubMed

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

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

2014-08-01

235

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

PubMed Central

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

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

2014-01-01

236

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

PubMed

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

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

2013-12-01

237

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

PubMed

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

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

2013-07-01

238

The risk of stroke in the early postoperative period following mitral valve replacement  

Microsoft Academic Search

All patients (285) undergoing mitral valve replacement (MVR) with a Carpentier-Edwards (C-E) bioprosthesis ± coronary bypass grafts (CABG) were reviewed (109 men and 176 women with a median age of 70 years). Overall, the 5-year survival rate was 58.9%, 62.7% for MVR (199 patients) and 50.1% for MVR + CABG (86 patients). Late survival was adversely affected by the operative

T. A. Orszulak; H. V. Schaff; J. R. Pluth; G. K. Danielson; F. J. Puga; D. M. Ilstrup; B. J. Anderson

1995-01-01

239

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

Microsoft Academic Search

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

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

1999-01-01

240

The risk of stroke in the early postoperative period following mitral valve replacement  

Microsoft Academic Search

All patients (285) undergoing mitral valve replacement (MVR) with a Carpentier-Edwards (C-E) bio- prosthesis _+ coronary bypass grafts (CABG) were reviewed (109 men and 176 women with a median age of 70 years). Overall, the 5-year survival rate was 58.9 %, 62.7 % for MVR (199 patients) and 50.1% for MVR + CABG (86 patients). Late survival was adversely affected

T. A. Orszulak; H. V. Schaff; J. R. Pluth; G. K. Danielson; F. J. Puga; D. M. Ilstrup; B. J. Anderson

2009-01-01

241

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

Microsoft Academic Search

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

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

2000-01-01

242

Effects of mitral valve replacement on regional left ventricular systolic strain  

Microsoft Academic Search

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

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

1999-01-01

243

Effect of the prosthetic mitral valve on vortex dynamics and turbulence of the left ventricular flow  

NASA Astrophysics Data System (ADS)

Mechanical heart valves implanted in mitral position have a great effect on the ventricular flow. Changes include alteration of the dynamics of the vortical structures generated during the diastole and the onset of turbulence, possibly affecting the efficiency of the heart pump or causing blood cell damage. Modifications to the hemodynamics in the left ventricle, when the inflow through the mitral orifice is altered, were investigated in vitro using a silicone rubber, flexible ventricle model. Velocity fields were measured in space and time by means of an image analysis technique: feature tracking. Three series of experiments were performed: one with a top hat inflow velocity profile (schematically resembling physiological conditions), and two with mechanical prosthetic valves of different design, mounted in mitral position—one monoleaflet and the other bileaflet. In each series of runs, two different cardiac outputs have been examined by changing the stroke volume. The flow was investigated in terms of phase averaged velocity field and second order moments of turbulent fluctuations. Results show that the modifications in the transmitral flow change deeply the interaction between the coherent structures generated during the first phase of the diastole and the incoming jet during the second diastolic phase. Top hat inflow gives the coherent structures which are optimal, among the compared cases, for the systolic function. The flow generated by the bileaflet valve preserves most of the beneficial features of the top hat inflow, whereas the monoleaflet valve generates a strong jet which discourages the permanence of large coherent structures at the end of the diastole. Moreover, the average shear rate magnitudes induced by the smoother flow pattern of the case of top hat inflow are nearly halved in comparison with the values measured with the mechanical valves. Finally, analysis of the turbulence statistics shows that the monoleaflet valves yield higher turbulence intensity in comparison with the bileaflet and, with top hat inflow, there is not a complete transition to turbulence.

Querzoli, G.; Fortini, S.; Cenedese, A.

2010-04-01

244

Automated auscultation : using acoustic features to diagnose mitral valve prolapse  

E-print Network

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

Jung, Marcia Yeojin, 1982-

2004-01-01

245

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

PubMed Central

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

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

2014-01-01

246

Iatrogenic Left Main Coronary Artery Stenosis Following Aortic and Mitral Valve Replacement  

PubMed Central

Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.

Alsaddah, Jadan; Alkandari, Saad; Younan, Hany

2015-01-01

247

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

248

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

PubMed Central

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

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

2015-01-01

249

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

PubMed

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

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

2014-07-01

250

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

PubMed

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

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

2014-08-17

251

Real-time imaging required for optimal echocardiographic assessment of aortic valve calcification  

PubMed Central

Introduction Aortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored. Methods Two-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1–5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted. Results Visual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P<0·001) compared to evaluation of stop frames by visual assessment (r = 0·66, P<0·001) or the GSMn score (r = 0·64, P<0·001). High inter- and intra-observer correlations were observed for real-time visual score (both intraclass correlation coefficient = 0·93). Conclusion Real-time evaluation of the level of AVC is superior to using stop frames assessed either visually or by dedicated computer grey scale measurement software. PMID:23031068

Yousry, Mohamed; Rickenlund, Anette; Petrini, Johan; Gustavsson, Tomas; Prahl, Ulrica; Liska, Jan; Eriksson, Per; Franco-Cereceda, Anders; Eriksson, Maria J; Caidahl, Kenneth

2012-01-01

252

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

PubMed

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

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

2015-01-01

253

Differentiating the aging of the mitral valve from human and canine myxomatous degeneration  

PubMed Central

During the course of both canine and human aging, the mitral valve remodels in generally predictable ways. The connection between these aging changes and the morbidity and mortality that accompany pathologic conditions has not been made clear. By exploring work that has investigated the specific valvular changes in both age and disease, with respect to the cells and the extracellular matrix found within the mitral valve, heretofore unexplored connections between age and myxomatous valve disease can be found. This review addresses several studies that have been conducted to explore such age and disease related changes in extracellular matrix, valvular endothelial and interstitial cells, and valve innervation, and also reviews attempts to correlate aging and myxomatous disease. Such connections can highlight avenues for future research and help provide insight as to when an individual diverts from an aging pattern into a diseased pathway. Recognizing these patterns and opportunities could result in earlier intervention and the hope of reduced morbidity and mortality for patients. PMID:22364720

Connell, Patrick S.; Han, Richard I.; Grande-Allen, K. Jane

2012-01-01

254

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

PubMed Central

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

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

2012-01-01

255

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

PubMed Central

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

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

2015-01-01

256

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

PubMed

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

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

1982-03-01

257

Development of a twin-flap, porous ceramic mitral valve prosthesis.  

PubMed

The pressure drop in most existing cardiac valve prostheses is at least ten times greater than for healthy valves. Steady flow testing indicates that the causes are (i) poor orifice diameter/sewing ring diameter ratio; (ii) occluding mechanism causes obstruction in the region of highest blood velocity. A new mitral prosthesis was constructed to overcome these deficiencies. The significant features are (a) tubular construction to maximize flow area; (b) twin flaps with hinges well above the outlet to minimize obstruction; (c) divergent nozzle to aid pressure recovery. Prostheses were manufactured from porous alumina, promoting firmly anchored, thin tissue growth to reduce haemolysis and thromboembolism. Preliminary trials in mini-pigs show good valve function. The ceramic behaves especially well. Future models will use ceramic flaps to replace the delrin flaps used ast present, which encourage fibrin deposits. PMID:7464088

Gentle, C R; Arundel, P A; Hamilton, D I; Swales, P D

1981-01-01

258

Management-Oriented Classification of Mitral Valve Regurgitation  

PubMed Central

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

El Oakley, Reida; Shah, Aijaz

2011-01-01

259

Percutaneous balloon mitral commissurotomy during pregnancy.  

PubMed Central

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

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

1997-01-01

260

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

PubMed

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

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

2014-01-01

261

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

Microsoft Academic Search

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

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

262

Anaesthetic Management for Caesarean Section Surgery in Two Pregnant Women with Severe Pulmonary Hypertension Due to Mitral Valve Stenosis  

PubMed Central

Background: Mitral stenosis is the most important and common cardiac complication seen during pregnancy. Conception is discouraged in cases where pulmonary hypertension develops during the course of mitral stenosis. Successful general and regional anaesthetic interventions have been reported in some cases of severe pulmonary hypertension. Case Reports: We present our experiences with anaesthetic management in two pregnant patients with pulmonary hypertension due to mitral valve stenosis. Conclusion: We preferred to continue spinal anaesthesia because gradually increasing the local anaesthetic dose during the procedure may minimise probable undesirable haemodynamic changes, such as hypotension and tachycardia. PMID:25207156

Çelik, Mine; Dostbil, Ay?enur; Alici, Hac? Ahmet; Sevimli, Serdar; Aksoy, Ay?enur; Erdem, Ali Fuat; Kür?ad, Hüsnü

2013-01-01

263

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

PubMed

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

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

2014-01-01

264

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

PubMed

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

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

1985-11-13

265

Spatial heterogeneity of endothelial phenotypes correlates with side-specific vulnerability to calcification in normal porcine aortic valves.  

PubMed

Calcific aortic valve sclerosis involves inflammatory processes and occurs preferentially on the aortic side of endothelialized valve leaflets. Although the endothelium is recognized to play critical roles in focal vascular sclerosis, the contributions of valvular endothelial phenotypes to aortic valve sclerosis and side-specific susceptibility to calcification are poorly understood. Using RNA amplification and cDNA microarrays, we identified 584 genes as differentially expressed in situ by the endothelium on the aortic side versus ventricular side of normal adult pig aortic valves. These differential transcriptional profiles, representative of the steady state in vivo, identify globally distinct endothelial phenotypes on opposite sides of the aortic valve. Several over-represented biological classifications with putative relevance to endothelial regulation of valvular homeostasis and aortic-side vulnerability to calcification were identified among the differentially expressed genes. Of note, multiple inhibitors of cardiovascular calcification were significantly less expressed by endothelium on the disease-prone aortic side of the valve, suggesting side-specific permissiveness to calcification. However, coexisting putative protective mechanisms were also expressed. Specifically, enhanced antioxidative gene expression and the lack of differential expression of proinflammatory molecules on the aortic side may protect against inflammation and lesion initiation in the normal valve. These data implicate the endothelium in regulating valvular calcification and suggest that spatial heterogeneity of valvular endothelial phenotypes may contribute to the focal susceptibility for lesion development. PMID:15761200

Simmons, Craig A; Grant, Gregory R; Manduchi, Elisabetta; Davies, Peter F

2005-04-15

266

Role of Wnt/?-catenin signaling pathway in the mechanism of calcification of aortic valve.  

PubMed

Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/?-catenin signaling pathway is involved in the process of calcification of aortic valve, porcine aortic valve interstitial cells (VICs) were isolated, cultured and stimulated with oxidized low density lipoprotein (ox-LDL) for 48 h to induce the differentiation of VICs into osteoblast-like cells. The key proteins and genes of Wnt/?-catenin signaling pathway, such as glycogen synthase kinase 3? (GSK-3?) and ?-catenin, were detected by using Western blotting and real-time polymerase chain reaction (PCR). The results showed that the VICs managed to differentiate into osteoblast-like cells after the stimulation with ox-LDL and the levels of proteins and genes of GSK-3? and ?-catenin were increased significantly in VICs after stimulation for 48 h (P<0.05). It is suggested that Wnt/?-catenin signaling pathway may play a key role in the differentiation of VICs into osteoblast-like cells and make great contribution to aortic valve calcification. PMID:24496676

Gu, Gang-jian; Chen, Tao; Zhou, Hong-min; Sun, Ke-xiong; Li, Jun

2014-02-01

267

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

PubMed

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

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

2014-06-24

268

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

NASA Technical Reports Server (NTRS)

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

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

2001-01-01

269

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

PubMed

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

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

2012-09-01

270

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

NASA Astrophysics Data System (ADS)

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

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

2001-10-01

271

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

PubMed Central

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

2009-01-01

272

Simplified surgical-hybrid Melody® valve implantation for paediatric mitral valve disease.  

PubMed

Children suffering from left atrioventricular valve (LAVV) disease not amenable to repair represent a significant challenge. The results of surgical reconstruction are not optimal. Valve replacement as an alternative is associated with poor results. The surgical-hybrid approach with implantation of a stented biological valve (bovine jugular vein graft, Melody® valve) seems to represent a new therapeutic option. Here we demonstrate our case, the consideration and the approach to extreme clinical findings in a small child. We describe a simplified surgical-hybrid Melody valve implantation in a LAVV position. The technique of implantation is relatively simple and the immediate postoperative result very good. PMID:25015952

Hofmann, Michael; Dave, Hitendu; Hübler, Michael; Kretschmar, Oliver

2015-05-01

273

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

PubMed

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

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

2015-03-01

274

Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats  

Microsoft Academic Search

Aims Renal failure is associated with aortic valve calcification (AVC). Our aim was to develop an animal model for exploring the pathophysiology and reversibility of AVC, utilizing rats with diet-induced kidney disease. Methods and results Sprague-Dawley rats (n ¼ 23) were fed a phosphate-enriched, uraemia-inducing diet for 7 weeks followed by a normal diet for 2 weeks ('diet group'). These

Mony Shuvy; Suzan Abedat; Ronen Beeri; Haim D. Danenberg; David Planer; Iddo Z. Ben-Dov; Karen Meir; Jacob Sosna; Chaim Lotan

2008-01-01

275

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

PubMed Central

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

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

2014-01-01

276

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

PubMed Central

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

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

2014-01-01

277

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis  

PubMed Central

Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival. PMID:24903989

Ding, Chao; Jiang, Da-ming; Tao, Kai-yu; Duan, Qun-jun; Li, Jie; Kong, Min-jian; Shen, Zhong-hua; Dong, Ai-qiang

2014-01-01

278

Bileaflet versus posterior-leaflet-only preservation in mitral valve replacement.  

PubMed

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function. PMID:24808776

Ozdemir, Ahmet Coskun; Emrecan, Bilgin; Baltalarli, Ahmet

2014-04-01

279

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

PubMed Central

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

Ranjan, R.; Lawrence, T.

2015-01-01

280

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

PubMed

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

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

2014-12-01

281

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

PubMed

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

Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

2015-06-01

282

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

PubMed Central

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

Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

2015-01-01

283

Neomycin fixation followed by ethanol pretreatment leads to reduced buckling and inhibition of calcification in bioprosthetic valves  

PubMed Central

Glutaraldehyde crosslinked bioprosthetic heart valves (BHVs) have two modalities of failure: degeneration (cuspal tear due to matrix failure) and calcification. They can occur independently as well as one can lead to the other causing co-existence. Calcific failure has been extensively studied before and several anticalcification treatments have been developed; however, little research is directed to understand mechanisms of valvular degeneration. One of the shortcomings of glutaraldehyde fixation is its inability to stabilize all extracellular matrix components in the tissue. Previous studies from our lab have demonstrated that neomycin could be used as a fixative to stabilize glycosaminoglycans (GAGs) present in the valve to improve matrix properties. But neomycin fixation did not prevent cuspal calcification. In the present study, we wanted to enhance the anti-calcification potential of neomycin fixed valves by pre-treating with ethanol or removing the free aldehydes by sodium borohydride treatment. Ethanol treatment has been previously used and found to have excellent anti-calcification properties for valve cusps. Results demonstrated in this study suggest that neomycin followed by ethanol treatment effectively preserves GAGs both in vitro as well as in vivo after subdermal implantation in rats. In vivo calcification was inhibited in neomycin fixed cusps pretreated with ethanol compared to glutaraldehyde (GLUT) control. Sodium borohydride treatment by itself did not inhibit calcification nor stabilized GAGs against enzymatic degradation. Neomycin fixation followed by ethanol treatment of BHVs could prevent both modalities of failure, thereby increasing the effective durability and lifetime of these bioprostheses several fold. PMID:19810110

Raghavan, Devanathan; Shah, Sagar R.; Vyavahare, Naren R.

2009-01-01

284

Percutaneous balloon dilatation of calcific aortic valve stenosis: anatomical and haemodynamic evaluation.  

PubMed Central

Two groups of elderly patients with calcified aortic stenosis were treated by balloon dilatation. In group 1, the valve was dilated just before surgical replacement of the valve. The valvar and annular changes occurring during dilatation were examined visually. In 20 of the 26 patients in this group there was no change. In the six remaining patients mobilisation of friable calcific deposits (1 case), slight tearing of the commissure (4 cases), or tearing of the aortic ring (1 case) were seen. Dilatation did not appear to alter valvar rigidity. In 14 patients (group 2) the haemodynamic gradient across the aortic valve was measured before and immediately after dilatation and one week after the procedure. Dilatation produced an immediate significant decrease of the aortic mean gradient and a significant increase of the aortic valve area. Eight days later the mean gradient had increased and the aortic valve area had decreased. Nevertheless there was a significant difference between the initial gradient and the gradient eight days after dilatation. The initial aortic valve area was also significantly larger than the area eight days after dilatation. The aortic valve gradient rose significantly in the eight days after dilatation and at follow up the gradients were those of severe aortic stenosis. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 PMID:3342163

Commeau, P; Grollier, G; Lamy, E; Foucault, J P; Durand, C; Maffei, G; Maiza, D; Khayat, A; Potier, J C

1988-01-01

285

Outcomes of Nonpledgeted Horizontal Mattress Suture Technique for Mitral Valve Replacement  

PubMed Central

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

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

2014-01-01

286

Rothia aeria mitral valve endocarditis complicated by multiple mycotic aneurysms: laboratory identification expedited using MALDI-TOF MS.  

PubMed

Rothia aeria has only rarely been described as a human pathogen. We describe a case of Rothia aeria causing mitral valve endocarditis and multiple mycotic aneurysms, including cerebral mycotic aneurysms. In the case described, early identification of Rothia aeria was achieved using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). PMID:24078192

Crowe, A; Ding, N S; Yong, E; Sheorey, H; Waters, M J; Daffy, J

2014-04-01

287

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

1997-01-01

288

Endothelial-Derived Oxidative Stress Drives Myofibroblastic Activation and Calcification of the Aortic Valve  

PubMed Central

Aims Oxidative stress is present in and contributes to calcification of the aortic valve, but the driving factors behind the initiation of valve oxidative stress are not well understood. We tested whether the valve endothelium acts as an initiator and propagator of oxidative stress in aortic valve disease. Methods and Results Calcified human aortic valves showed side-specific elevation of superoxide in the endothelium, co-localized with high VCAM1 expression, linking oxidative stress, inflammation, and valve degeneration. Treatment with inflammatory cytokine TNF? increased superoxide and oxidative stress and decreased eNOS and VE-cadherin acutely over 48 hours in aortic valve endothelial cells (VEC) and chronically over 21 days in ex vivo AV leaflets. Co-treatment of VEC with tetrahydrobiopterin (BH4) but not apocynin mitigated TNF?-driven VEC oxidative stress. Co-treatment of ex vivo AV leaflets with TNF?+BH4 or TNF?+peg-SOD rescued endothelial function and mitigated inflammatory responses. Both BH4 and peg-SOD rescued valve leaflets from the pro-osteogenic effects of TNF? treatment, but only peg-SOD was able to mitigate the fibrogenic effects, including increased collagen and ?SMA expression. Conclusions Aortic valve endothelial cells are a novel source of oxidative stress in aortic valve disease. TNF?-driven VEC oxidative stress causes loss of endothelial protective function, chronic inflammation, and fibrogenic and osteogenic activation, mitigated differentially by BH4 and peg-SOD. These mechanisms identify new targets for tailored antioxidant therapy focused on mitigation of oxidative stress and restoration of endothelial protection. PMID:25874717

Farrar, Emily J.; Huntley, Geoffrey D.; Butcher, Jonathan

2015-01-01

289

Inhibition of ectonucleotidase with ARL67156 prevents the development of calcific aortic valve disease in warfarin-treated rats.  

PubMed

Calcific aortic valve disease is the most common heart valve disorder. So far, there is no medical treatment for calcific aortic valve disease. The expression of ectonucleotidases, which metabolize nucleotides into phosphate products, may influence the calcification of the aortic valve. In this study, we investigated if the administration of an ectonucleotidase inhibitor, ARL67156 (6-N,N-Diethyl-D-?,?-dibromomethyleneATP trisodium salt), may prevent the calcification of the aortic valve in the warfarin-induced mineralization rat model. Male Wistar rats were treated with warfarin or warfarin+ARL67156 for 28 days. All rats had comprehensive Doppler-echocardiographic studies at 28 day. A gene profiling of ectonucleotidases expressed in aortas of rats was documented by quantitative real-time PCR. The amount of calcium was determined by quantitative method and von Kossa staining. Ex vivo cultures of rat aortas were also used to further assess the effect of ARL67156 on the calcifying process and Akt signaling. Mineralization of the aorta/aortic valve was documented in warfarin-treated rats and was accompanied by the development of aortic stenosis. These changes were paralleled by an increased of ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1). Administration of the ectonucleotidase inhibitor, ARL67156 prevented the development of aortic stenosis by lowering the level of apoptosis and mineralization of the aortic valve/aorta. In addition, ARL67156 normalized the level of pAkt, an important kinase involved in the survival pathway. Inhibition of ectonucleotidase activity prevented the development of calcific aortic valve disease in a rat model. On that account, ectonucleotidase may represent a novel target in the treatment of calcific aortic valve disease. PMID:22659116

Côté, Nancy; El Husseini, Diala; Pépin, Andrée; Bouvet, Céline; Gilbert, Liz-Ann; Audet, Audrey; Fournier, Dominique; Pibarot, Philippe; Moreau, Pierre; Mathieu, Patrick

2012-08-15

290

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. PMID:22350774

Concistrè, Giovanni; Farneti, Pierandrea; Miceli, Antonio; Glauber, Mattia

2012-01-01

291

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

PubMed Central

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

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

2014-01-01

292

Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope  

PubMed Central

Background Conventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems. Methods Between 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5?±?19.8% vs 64.4?±?12.0%; p?=?0.046), and significantly higher Euro SCORE was found in Group I (4.8?±?2.0 vs 3.8?±?2.4; p?=?0.037). Results Although Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262?±?46 min vs 300?±?57 min; p?=?0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8?±?0.6 days vs 3.0?±?1.7 days; p?=?0.025). Conclusions The higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries. PMID:23587412

2013-01-01

293

Numerical simulation of patient-specific left ventricular model with both mitral and aortic valves by FSI approach.  

PubMed

Intraventricular flow is important in understanding left ventricular function; however, relevant numerical simulations are limited, especially when heart valve function is taken into account. In this study, intraventricular flow in a patient-specific left ventricle has been modelled in two-dimension (2D) with both mitral and aortic valves integrated. The arbitrary Lagrangian-Eulerian (ALE) approach was employed to handle the large mesh deformation induced by the beating ventricular wall and moving leaflets. Ventricular wall deformation was predefined based on MRI data, while leaflet dynamics were predicted numerically by fluid-structure interaction (FSI). Comparisons of simulation results with in vitro and in vivo measurements reported in the literature demonstrated that numerical method in combination with MRI was able to predict qualitatively the patient-specific intraventricular flow. To the best of our knowledge, we are the first to simulate patient-specific ventricular flow taking into account both mitral and aortic valves. PMID:24332277

Su, Boyang; Zhong, Liang; Wang, Xi-Kun; Zhang, Jun-Mei; Tan, Ru San; Allen, John Carson; Tan, Soon Keat; Kim, Sangho; Leo, Hwa Liang

2014-02-01

294

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

PubMed

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

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

2011-01-01

295

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

PubMed

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

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

2012-04-01

296

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

PubMed

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

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

2003-12-01

297

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

PubMed Central

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

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

2015-01-01

298

[Performance of fragmenting operation for restoration of a correct rhythm while treating the isolated failure of a mitral valve].  

PubMed

Possibilities of application of the proposed procedure for intraoperative restoration of the sinus rhythm while the mitral valve prosthesis (MVP) were studied up. In 161 patients, suffering the isolated mitral valve failure stage IV, a surgical treatment was conducted in Department of surgical treatment of acquired heart failures. The left atrium plasty was conducted in 119 (73.9%) of them with the objective to reduce its size and eliminate the re-entry waves passability. Fragmentation in left atrium was conducted in lowradiofrequency regime of diathermy (25-35 W) in accordance to variant (cut and sew) of operations Maze - 3 and Maze - 4. On a hospital stage 3 patients died (hospital lethality 1.9%). MVP in combination with Maze operation in a lowradiofrequency regime have permitted to restore successfully a correct rhythm in 80.2% of patients on a hospital stage and to stabilize it during 1 year postoperatively. PMID:25509432

Popov, V V; Dzakhoeva, L S; Zakharova, V P; Pukas, E V; Rudenko, E V

2014-09-01

299

Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis  

PubMed Central

Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. However, its efficacy has not been completely assessed for the treatment of MRSA endocarditis when it is associated with pulmonary septic emboli. Hereby, we present a case of MRSA mitral and tricuspid native valve endocarditis with pulmonary septic emboli, which was treated with daptomycin as a sole agent, resulting in worsening pulmonary infiltrates and treatment failure. PMID:24371532

Stephane, Wassim; Alkhoury, Ghattas; Weinmann, Allison

2013-01-01

300

Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis.  

PubMed

Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. However, its efficacy has not been completely assessed for the treatment of MRSA endocarditis when it is associated with pulmonary septic emboli. Hereby, we present a case of MRSA mitral and tricuspid native valve endocarditis with pulmonary septic emboli, which was treated with daptomycin as a sole agent, resulting in worsening pulmonary infiltrates and treatment failure. PMID:24371532

Zainah, Hadeel; Zervos, Marcus; Stephane, Wassim; Chamas Alhelo, Sara; Alkhoury, Ghattas; Weinmann, Allison

2013-01-01

301

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

Microsoft Academic Search

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

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

1989-01-01

302

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

Microsoft Academic Search

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

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

2002-01-01

303

Isolation of Bartonella washoensis from a dog with mitral valve endocarditis.  

PubMed

We report the first documented case of Bartonella washoensis bacteremia in a dog with mitral valve endocarditis. B. washoensis was isolated in 1995 from a human patient with cardiac disease. The main reservoir species appears to be ground squirrels (Spermophilus beecheyi) in the western United States. Based on echocardiographic findings, a diagnosis of infective vegetative valvular mitral endocarditis was made in a spayed 12-year-old female Doberman pinscher. A year prior to presentation, the referring veterinarian had detected a heart murmur, which led to progressive dyspnea and a diagnosis of congestive heart failure the week before examination. One month after initial presentation, symptoms worsened. An emergency therapy for congestive heart failure was unsuccessfully implemented, and necropsy evaluation of the dog was not permitted. Indirect immunofluorescence tests showed that the dog was strongly seropositive (titer of 1:4,096) for several Bartonella antigens (B. vinsonii subsp. berkhoffii, B. clarridgeiae, and B. henselae), highly suggestive of Bartonella endocarditis. Standard aerobic and aerobic-anaerobic cultures were negative. However, a specific blood culture for Bartonella isolation grew a fastidious, gram-negative organism 7 days after being plated. Phenotypic and genotypic characterizations of the isolate, including partial sequencing of the citrate synthase (gltA), groEL, and 16S rRNA genes, indicated that this organism was identical to B. washoensis. The dog was seronegative for all tick-borne pathogens tested (Anaplasma phagocytophilum, Ehrlichia canis, and Rickettsia rickettsii), but the sample was highly positive for B. washoensis (titer of 1:8,192) and, according to indirect immunofluorescent-antibody assay, weakly positive for phase II Coxiella burnetii infection. PMID:14605197

Chomel, Bruno B; Wey, Aaron C; Kasten, Rickie W

2003-11-01

304

[Anesthesia in endoscopic and percutaneous procedures in cardio-thoracic and cardiovascular interventions, Part 1-- percutaneous aortic valve replacement and mitral valve repair].  

PubMed

Further development of surgical techniques and instruments provide complex endoscopic or transcatheter guided interventions in thoracic organs. However, minimalinvasive surgery does not mean minimalinvasive anaesthesia. Particularly concerning cardiothoracic surgery, complex endoscopic procedures represent a challenge to the anaesthesiological management. These interventions require a close interdisciplinary cooperation. Considering the surgical procedures, this review describes the anaesthesiological management for transcatheter aortic valve implantation (TAVI) and percutaneous mitral valve repair. Furthermore it focuses on the anaesthesiological management of pitfalls and complications related to the surgical procedure. PMID:22918648

Adler, Klaudia; Pullmann, Barbara; Byhahn, Christian

2012-07-01

305

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

PubMed Central

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

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

2014-01-01

306

Juvenile idiopathic arthritis, mitral valve prolapse and a familial variant involving the integrin-binding fragment of FBN1.  

PubMed

Mutations in Fibrillin 1 (FBN1) are associated with Marfan syndrome and in some instances with the MASS phenotype (myopia, mitral valve prolapse, borderline non-progressive aortic root dilatation, skeletal features, and striae). Potential confusion over diagnosis and management in patients with borderline features has been addressed through the revised Ghent nosology, which emphasizes the importance of aortic root dilatation and ectopia lentis as features of Marfan syndrome. The overlapping and more common mitral valve prolapse syndrome is precluded by ectopia lentis or aortic dilatation. Among these clinically related conditions, there is no compelling evidence that genotype predicts phenotype, with the exception of neonatal Marfan syndrome, mutations in which cluster within FBN1 exons 24-32. Recent reports also link two very different phenotypes to changes in FBN1. Heterozygous mutations in transforming growth factor ?-binding protein-like domain 5 (TB5) can cause acromicric or geleophysic dysplasias-and mutations in the TB4 domain, which contains an integrin binding RGD loop, have been found in congenital scleroderma/stiff skin syndrome. We report on a variant in an evolutionarily conserved residue that stabilizes the integrin binding fragment of FBN1, associated with juvenile idiopathic arthritis, mitral valve prolapse or apparently normal phenotype in different family members. PMID:23794388

Wilson, Brian T; Jensen, Sacha A; McAnulty, Ciaron P; Brennan, Paul; Handford, Penny A

2013-08-01

307

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

PubMed

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

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

2014-08-01

308

The Long Non-Coding HOTAIR Is Modulated by Cyclic Stretch and WNT/?-CATENIN in Human Aortic Valve Cells and Is a Novel Repressor of Calcification Genes  

PubMed Central

Aortic valve calcification is a significant and serious clinical problem for which there are no effective medical treatments. Individuals born with bicuspid aortic valves, 1–2% of the population, are at the highest risk of developing aortic valve calcification. Aortic valve calcification involves increased expression of calcification and inflammatory genes. Bicuspid aortic valve leaflets experience increased biomechanical strain as compared to normal tricuspid aortic valves. The molecular pathogenesis involved in the calcification of BAVs are not well understood, especially the molecular response to mechanical stretch. HOTAIR is a long non-coding RNA (lncRNA) that has been implicated with cancer but has not been studied in cardiac disease. We have found that HOTAIR levels are decreased in BAVs and in human aortic interstitial cells (AVICs) exposed to cyclic stretch. Reducing HOTAIR levels via siRNA in AVICs results in increased expression of calcification genes. Our data suggest that ?-CATENIN is a stretch responsive signaling pathway that represses HOTAIR. This is the first report demonstrating that HOTAIR is mechanoresponsive and repressed by WNT ?-CATENIN signaling. These findings provide novel evidence that HOTAIR is involved in aortic valve calcification. PMID:24788418

Carrion, Katrina; Dyo, Jeffrey; Patel, Vishal; Sasik, Roman; Mohamed, Salah A.; Hardiman, Gary; Nigam, Vishal

2014-01-01

309

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

PubMed

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

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

2015-04-01

310

Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities  

SciTech Connect

Patients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). The authors performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ventriculography (/sup 99m/technetium), and perfusion scintigrams (/sup 201/thallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams. A significant correlation in pathological results was found only between exercise ECG and both radionuclide ventriculography and pulmonary arterial pressure measurements. Because of the high prevalence of false-positive perfusion scintigrams in patients with typical or atypical chest pain, the use of exercise /sup 201/Tl imaging as a screening method to separate patients with MVP from those with CAD will not be appropriate. The variability of cardiac abnormalities in our patients with MVP and angiographically normal coronary arteries suggests that the MVP syndrome may represent a variable combination of metabolic, ischemic, or myopathic disorders.

Tebbe, U.; Schicha, H.; Neumann, P.; Voth, E.; Emrich, D.; Neuhaus, K.L.; Kreuzer, H.

1985-06-01

311

Impaired Corneal Biomechanical Properties and the Prevalence of Keratoconus in Mitral Valve Prolapse  

PubMed Central

Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery. PMID:24864193

Kalkan Akcay, Emine; Akcay, Murat; Uysal, Betul Seher; Kosekahya, Pinar; Aslan, Abdullah Nabi; Caglayan, Mehtap; Koseoglu, Cemal; Yulek, Fatma

2014-01-01

312

Predictive model for the detection of pulmonary hypertension in dogs with myxomatous mitral valve disease  

PubMed Central

Pulmonary hypertension (PH) often occurs due to a left heart disease, such as myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs requires expertise in echocardiography: however, the examination for PH is difficult to perform in a clinical setting. Thus, simple and reliable methods are required for the diagnosis of PH in dogs. The purpose of this study was to develop models using multiple logistic regression analysis to detect PH due to left heart disease in dogs with MMVD without echocardiography. The medical records of dogs with MMVD were retrospectively reviewed, and 81 dogs were included in this study and classified into PH and non-PH groups. Bivariate analysis was performed to compare all parameters between the groups, and variables with P values of <0.25 in bivariate analysis were included in multiple logistic regression analysis to develop models for the detection of PH. In multiple logistic regression analysis, the model included a vertebral heart scale short axis of >5.2 v, and a length of sternal contact of >3.3 v was considered suitable for the detection of PH. The predictive accuracy of this model (85.9%) was judged statistically adequate, and therefore, this model may be useful to screen for PH due to left heart disease in dogs with MMVD without echocardiography. PMID:25319513

MIKAWA, Shoma; MIYAGAWA, Yuichi; TODA, Noriko; TOMINAGA, Yoshinori; TAKEMURA, Naoyuki

2014-01-01

313

Prenatal ultrasonographic diagnosis of generalized arterial calcification of infancy.  

PubMed

A healthy 19-year-old nulliparous pregnant woman was referred to our clinic because of fetal pericardial effusion and ascites. The sonographic examination performed at 28 weeks' gestation revealed scalp edema, severe skin edema, bilateral hydrocele, ascites, and pleural and pericardial effusion. Fetal echocardiographic examination showed that both ventricles were dilated with severely depressed contractility. The aortic annulus, ascending aorta, aortic arch, descending aorta, common iliac arteries, main pulmonary artery, tricuspid valve, and mitral chordae tendinae were hyperechogenic. Right ventricular outflow tract was narrow with decreased blood flow. There was tricuspid and mitral valve regurgitation and tricuspid valve stenosis. On the basis of these findings, we made the diagnosis of generalized arterial calcification, which is characterized by extensive calcification of internal elastic lamina and intimal proliferation of medium-sized and large arteries. This diagnosis was confirmed histologically after the termination of pregnancy. PMID:24420383

Corbacioglu Esmer, Aytul; Kalelioglu, Ibrahim; Omeroglu, Rukiye Eker; Kayserili, Hulya; Gulluoglu, Mine; Has, Recep; Yuksel, At?l

2015-01-01

314

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

PubMed Central

SUMMARY The remodeling that occurs after a posterolateral myocardial infarction can alter mitral valve function by creating conformational abnormalities in the mitral annulus and in the posteromedial papillary muscle, leading to mitral regurgitation (MR). It is generally assumed that this remodeling is caused by a volume load and is mediated by an increase in diastolic wall stress. Thus, mitral regurgitation can be both the cause and effect of an abnormal cardiac stress environment. Computational modeling of ischemic MR and its surgical correction is attractive because it enables an examination of whether a given intervention addresses the correction of regurgitation (fluid-flow) at the cost of abnormal tissue stress. This is significant because the negative effects of an increased wall stress due to the intervention will only be evident over time. However, a meaningful fluid-structure interaction model of the left heart is not trivial; it requires a careful characterization of the in-vivo cardiac geometry, tissue parameterization though inverse analysis, a robust coupled solver that handles collapsing Lagrangian interfaces, automatic grid-generation algorithms that are capable of accurately discretizing the cardiac geometry, innovations in image analysis, competent and efficient constitutive models and an understanding of the spatial organization of tissue microstructure. In this manuscript, we profile our work toward a comprehensive fluid-structure interaction model of the left heart by reviewing our early work, presenting our current work and laying out our future work in four broad categories: data collection, geometry, fluid-structure interaction and validation. PMID:20454531

Einstein, Daniel R.; Del Pin, Facundo; Jiao, Xiangmin; Kuprat, Andrew P.; Carson, James P.; Kunzelman, Karyn S.; Cochran, Richard P.; Guccione, Julius M.; Ratcliffe, Mark B.

2009-01-01

315

Raman microspectroscopy of human aortic valves: investigation of the local and global biochemical changes associated with calcification in aortic stenosis.  

PubMed

Raman microimaging was applied to study the biochemical composition in the aortic valves obtained from patients with calcific aortic stenosis. This progressive disease affects an increasing number of elderly patients with hyperlipidemia and hypercholesterolemia. Lipid accumulation in the tissue is associated with pathogenesis and progression of cardiac valve calcification. This is in line with our finding that lipid deposits, predominantly composed of cholesterol and its esters, are frequently co-localized with calcium salt deposits, even at an early stage of their development. Overall changes in the biochemical composition of the tissue upon pathology progression are less obvious. Globally, although the cholesterol level rises, the relative lipid-to-protein content decreases. The results broaden the knowledge of biochemical alterations in dysfunctional human aortic valves and may be helpful in designing lipid lowering therapies. PMID:25632409

Czamara, Krzysztof; Natorska, Joanna; Kapusta, Przemys?aw; Baranska, Malgorzata; Kaczor, Agnieszka

2015-03-16

316

Early post-operative thrombosis of the prosthetic mitral valve in patient with heparin-induced thrombocytopenia.  

PubMed

Heparin-induced thrombocytopenia (HIT) is one of the most common immune-mediated adverse drug reactions, with frequencies as high as 2-3% for certain groups of post-cardiac surgery patients. We report on an 50-year-old woman with early post-operative thrombosis of the prosthetic mitral valve due to heparin-induced thrombocytopenia. Non-invasive imaging (two-dimensional transesophageal echocardiography; 2D-TEE) allowed the exact localisation of thrombotic masses and revealed the increase of the mean diastolic mitral gradient. The HIT diagnosis was proved by the clinical scoring system, and with the identification of heparin platelet factor 4-induced antibodies. After the withdrawal of LMWH therapy and the start of intravenous lepirudin treatment, the patient's medical condition improved continuously. Follow-up echocardiography showed a step-wise decrease in the severity of the mean diastolic mitral valve gradient and a complete resolution of thrombus formations. Perhaps we may remind ourselves that, whilst HIT is one of the most common immune-mediated adverse drug reactions for certain groups of post-cardiac surgery patients, it can be managed successfully. We would also stress the importance of serial 2D-TEE examinations in the early post-operative period. PMID:22414337

Cziráki, Attila; Ajtay, Zénó; Nagy, Agnes; Márton, László; Verzár, Zsófia; Szabados, Sándor

2012-01-01

317

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

PubMed Central

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

2014-01-01

318

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

PubMed Central

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

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

2009-01-01

319

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

Microsoft Academic Search

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

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

2007-01-01

320

Effect of heart failure on the mechanism of exercise-induced augmentation of mitral valve flow.  

PubMed

The exercise response of left ventricular (LV) filling dynamics may be altered by congestive heart failure (CHF). Accordingly, we studied 18 conscious dogs, instrumented to measure micromanometer LV and left atrial (LA) pressures and determine LV volume from three dimensions. CHF was produced by 4-5 weeks of right ventricular rapid pacing. Before CHF, exercise (5.5-8.5 mph for 8-15 minutes) increased the maximum rate of LV filling (dV/dtmax) (197 +/- 37 versus 297 +/- 56 ml/sec [mean +/- SD], p < 0.05) in response to an increase in the maximum early diastolic LA to LV pressure gradient (5.8 +/- 2.0 versus 9.8 +/- 1.9 mm Hg, p < 0.05) produced by a fall in minimum LV pressure (1.0 +/- 2.9 versus -3.9 +/- 3.1 mm Hg, p < 0.01), whereas mean LA pressure was unchanged (6.4 +/- 3.1 versus 6.4 +/- 4.2 mm Hg, p = NS). The time constant of LV relaxation was shortened (28.1 +/- 3.2 versus 21.0 +/- 4.2 msec, p < 0.05). After CHF, dV/dtmax (141 +/- 51 versus 200 +/- 59 ml/sec, p < 0.05) and the maximum LA to LV pressure gradient (6.0 +/- 1.1 versus 11.1 +/- 2.7 mm Hg, p < 0.05) continued to increase with exercise (3-5.0 mph for 4-8 minutes). However, the time constant of LV relaxation was prolonged (35.6 +/- 4.8 versus 38.9 +/- 5.5 msec, p < 0.05), and minimum LV pressure (15.1 +/- 5.6 versus 17.6 +/- 5.9 mm Hg, p < 0.05) and mean LA pressure increased (22.6 +/- 7.2 versus 29.1 +/- 7.3 mm Hg, p < 0.05). These altered effects of exercise on LV diastolic filling dynamics persisted when heart rate and wall stress during exercise before and after CHF were matched by varying the level of exercise. We conclude that, during normal exercise, mitral valve flow is augmented by a fall of early diastolic LV pressure without a rise in LA pressure. After CHF, early diastolic LV pressure does not fall but increases during exercise. Thus, the increase in the early diastolic LA to LV pressure gradient and the rate of mitral valve flow results from an increase in LA pressure during exercise after CHF. This study suggests that the failure of the enhancement of LV relaxation and an increase in early diastolic LV pressure with exercise after CHF may contribute to exercise intolerance in CHF. PMID:8095187

Cheng, C P; Noda, T; Nozawa, T; Little, W C

1993-04-01

321

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.

1983-05-01

322

Quantification and simulation of layer-specific mitral valve interstitial cells deformation under physiological loading.  

PubMed

Within each of the four layers of mitral valve (MV) leaflet tissues there resides a heterogeneous population of interstitial cells that maintain the structural integrity of the MV tissue via protein biosynthesis and enzymatic degradation. There is increasing evidence that tissue stress-induced MV interstitial cell (MVIC) deformations can have deleterious effects on their biosynthetic states that are potentially related to the reduction of tissue-level maintenance and to subsequent organ-level failure. To better understand the interrelationships between tissue-level loading and cellular responses, we developed the following integrated experimental-computational approach. Since in vivo cellular deformations are not directly measurable, we quantified the in-situ layer-specific MVIC deformations for each of the four layers under a controlled biaxial tension loading device coupled to multi-photon microscopy. Next, we explored the interrelationship between the MVIC stiffness and deformation to layer-specific tissue mechanical and structural properties using a macro-micro finite element computational model. Experimental results indicated that the MVICs in the fibrosa and ventricularis layers deformed significantly more than those in the atrialis and spongiosa layers, reaching a nucleus aspect ratio of 3.3 under an estimated maximum physiological tension of 150N/m. The simulated MVIC moduli for the four layers were found to be all within a narrow range of 4.71-5.35kPa, suggesting that MVIC deformation is primarily controlled by each tissue layer's respective structure and mechanical behavior rather than the intrinsic MVIC stiffness. This novel result further suggests that while the MVICs may be phenotypically and biomechanically similar throughout the leaflet, they experience layer-specific mechanical stimulatory inputs due to distinct extracellular matrix architecture and mechanical behaviors of the four MV leaflet tissue layers. This also suggests that MVICs may behave in a layer-specific manner in response to mechanical stimuli in both normal and surgically modified MVs. PMID:25791285

Lee, Chung-Hao; Carruthers, Christopher A; Ayoub, Salma; Gorman, Robert C; Gorman, Joseph H; Sacks, Michael S

2015-05-21

323

Ultrasonic decalcification of calcified valve and annulus during heart valve replacement.  

PubMed Central

A heavily calcified heart valve annulus increases the likelihood of sequelae after prosthetic valve replacement. Such sequelae include cerebral embolism, paravalvular leakage, valvular dysfunction, rhythm disturbance, hemolysis, communication of the heart chambers, and rupture of the posterior wall of the left ventricle. From January 1991 through June 1994, we performed heart valve replacement on 30 patients, using an ultrasonic surgical aspirator to remove calcific deposits. We placed aortic valve prostheses in 12 patients, mitral valve prostheses in 13 patients, and both aortic and mitral prostheses in 5 patients, after ultrasonic débridement of calcified annuli. All patients were re-examined 6 months after surgery: echocardiographic study showed no paravalvular leakage or valve-related complications. In our experience, ultrasonic decalcification of the annulus is superior to traditional methods. We advocate the use of ultrasonic débridement as an adjunctive tool in calcified heart valve replacement. PMID:8792537

Unal, M; Saniso?lu, I; Konuralp, C; Akay, H; Orhan, G; Aydo?an, H; Aka, S A; Eren, E E

1996-01-01

324

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. PMID:21666755

Hu, Yingying; Shi, Liang; Parameswaran, Siva; Smirnov, Sergey; He, Zhaoming

2011-01-01

325

Relationship between IFN-gamma production by blood lymphocytes and constitutional personality features of patients with idiopathic mitral valve prolapse.  

PubMed

Psychological testing using Eysenck Personality Inventory and immunological testing of 75 patients with idiopathic mitral valve prolapse revealed low production of interferon-gamma by blood lymphocytes and a correlation between interferon-gamma production and patient's temperament. Low neuroticism and extroversion scores were found in patients with normal interferon-gamma production. High neuroticism score was detected in 82% patients with lowest interferon-gamma production, which refers these patients to a group at high immunological risk and prompts the use of interferon and/or its inductors in complex therapy of these patients. PMID:11550034

Surkina, I D; Yu Sokolov, O; Gabaeva, M V; Gurevich, K G; Alfimova, M V; Akatova, E V; Pak, L S

2001-04-01

326

Mitral valve repair via right thoracotomy for multidrug resistant Pseudomonal endocarditis in a burn patient: Case report and review of the literature.  

PubMed

Diagnosis and management of infectious endocarditis are particularly challenging in patients with severe burns. Cases requiring operative intervention are likely to have higher complication rates as a result of poor wound healing, recurrent bacteremia secondary to burn wound manipulation, and sequelae of anticoagulation in patients who require repeated reconstructive and cosmetic procedures. Few case reports exist describing mitral valve replacement for infectious endocarditis in burn patients. In this article, we review the literature to describe and address these challenges, and present what we believe to be the first case of mitral valve repair for infectious endocarditis in a thermally injured patient. PMID:25703662

Mohebali, Jahan; Ibrahim, Amir E; MacGillivray, Thomas E; Goverman, Jeremy; Fagan, Shawn P

2015-05-01

327

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

PubMed

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

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

2014-06-27

328

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

329

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

PubMed Central

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

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

2015-01-01

330

Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position  

PubMed Central

Introduction Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. Objective To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. Methods We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. Results The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. Conclusion Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature. PMID:24896164

de Campos, Nelson Leonardo Kerdahi Leite

2014-01-01

331

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

PubMed Central

Background The prevalence of mitral regurgitation in cardiac diseases requires annuloplasty systems that can be implanted without excessive patient burden. This study was designed to examine the morphological and functional outcome of a new double helix mitral annuloplasty ring in an ovine model in comparison to the classical Carpentier-Edwards (CE) annuloplasty ring as measured by reduction of mitral regurgitation and tissue integration. The Medtentia annuloplasty ring (MAR) is a helical device that is rotated into the annulus self-restoring the valve geometry, enabling a faster fixation without the need of elaborate repair of the valve geometry. The ventricular part of the helical ring encircles the valve chords. Methods Twenty adult sheep were overpaced until 2+ level mitral valve regurgitation was achieved. Seven animals per group received either the MAR or the CE ring. Implantation was performed on-pump in a beating heart through the left atrial appendix. The animals were sacrificed 3.6?±?0.3 months after surgery following an echocardiography for assessing mitral regurgitation as primary endpoint. The annuloplasty rings with surrounding tissue were harvested for histological analyses as secondary endpoints. The remaining six sheep received the MAR system and were sampled seven, nine or 12 months after surgery. Results Implantation time (p?valve function repair in nearly all animals with a normalization of the ventricle diameters in both groups (group difference: p?=?0.147). The weights of the hearts did not differ significantly. Histology revealed adequately covered atrial annuloplasty rings with functional endothelium and lack of excessive granulation tissue or fibrosis in all specimens. The ventricular projections of the MAR systems encircling the chordae tendineae were not completely covered with neointimal tissue, although in no case were microthrombi detected and no thromboembolic events were recorded. Conclusions The new MAR system is an easy to use annuloplasty system with a functional outcome comparable to that of the well–proven CE ring. Mitral valve regurgitation is effectively stopped both by restricting the pathological expansion of the annulus and by gathering the chords without thrombus formation. PMID:23566678

2013-01-01

332

Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis  

PubMed Central

BACKGROUND Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. OBJECTIVES This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. METHODS In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. RESULTS During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ? 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. CONCLUSIONS This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS. PMID:25236511

Clavel, Marie-Annick; Pibarot, Philippe; Messika-Zeitoun, David; Capoulade, Romain; Malouf, Joseph; Aggarval, Shivani; Araoz, Phillip A.; Michelena, Hector I.; Cueff, Caroline; Larose, Eric; Miller, Jordan D.; Vahanian, Alec; Enriquez-Sarano, Maurice

2014-01-01

333

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

PubMed

A method is proposed to estimate the bias and variability of eight diagnostic spectral parameters extracted from mitral closing sounds produced by bioprosthetic heart valves. These spectral parameters are: the frequency of the dominant (F1) and second dominant (F2) spectral peaks, the highest frequency of the spectrum found at -3 dB (F-3), -10 dB (F-10) and -20 dB (F-20) below the highest peak, the relative integrated area above -20 dB of the dominant peak (RIA20), the bandwidth at -3 dB of the dominant spectral peak (BW3), and the ratio of F1 divided by BW3 (Q1). The bias and variability of four spectral techniques were obtained by comparing parameters extracted from each technique with the parameters of a spectral "standard." This "standard" consisted of 19 normal mitral sound spectra computed analytically by evaluating the Z transform of a sum of decaying sinusoids on the unit circle. Truncation of the synthesized mitral signals and addition of random noise were used to simulate the physiological characteristics of the closing sounds. Results show that the fast Fourier transform method with rectangular window provides the best estimates of F1 and Q1, that the Steiglitz-McBride method with maximum entropy (pole-zero modeling with four poles and four zeros) can best evaluate F2, F-20, RIA20 and BW3, and that the all-pole modeling with covariance method (16 poles) is best suited to compute F-3. It was also shown that both the all-pole modeling and the Steiglitz-McBride methods can be used to estimate F-10. It is concluded that a single algorithm would not provide the best estimates of all spectral parameters. PMID:2759640

Cloutier, G; Durand, L G; Guardo, R; Sabbah, H N; Stein, P D

1989-08-01

334

The Leaflex™ Catheter System - a viable treatment option alongside valve replacement? Preclinical feasibility of a novel device designed for fracturing aortic valve calcification.  

PubMed

Aims: To demonstrate the feasibility of the Leaflex™ Catheter System, a novel percutaneous device for fracturing valve calcification using mechanical impact in order to regain leaflet mobility. Methods and results: Radiographic analysis of calcium patterns in 90 ex vivo human aortic valve leaflets demonstrated that 82% of leaflets had a typical "bridge" or "half-bridge" pattern, which formed the basis for the catheter design. The therapeutic effect was quantified in 13 leaflets showing a reduction of 49±16% in leaflet resistance to folding after treatment. A pulsatile flow simulator was then used with 11 ex vivo valves demonstrating an increase in aortic valve area of 35±12%. Using gross pathology and histology on fresh calcified leaflets, we then verified that mechanical impacts do not entail excessive risk of embolisation. In vivo safety and usability were then confirmed in the ovine model. Conclusions: We demonstrated preclinically that it is feasible to improve valve function using the Leaflex™ technology. Once demonstrated clinically, such an approach may have an important role as preparation for or bridging to TAVI, as destination treatment for patients where TAVI is clinically or economically questionable and, in the future, maybe even as a means to slow disease progression in asymptomatic patients. PMID:25420790

Jonas, Michael; Rozenman, Yoseph; Moshkovitz, Yaron; Hamdan, Ashraf; Kislev, Yael; Tirosh, Nitzan; Sax, Sharon; Trumer, Dror; Golan, Erez; Raanani, Ehud

2014-11-25

335

[A case of the giant and pedunculated thrombus formation in the left atrium with normal mitral valve].  

PubMed

Occurrence of thrombus formation in the left atrium is rare without accompanying abnormalities at the mitral valve. Only a few cases of giant and pedunculated thromboses in the left atrium have been reported in the Japanese literatures. This is a case report of giant thrombus in the left atrium treated surgically. Patient was 61 years old male suffering from palpitation. Physical examination of the heart revealed increased first sound and diastolic rumbling at the apex. ECG revealed atrial fibrillation and LVH. Echocardiography and chest CT demonstrated a huge tumor like mass in the left atrium attached to the septal area. There were no abnormalities found at mitral valvular structures or motion. Catheterization studies revealed no disturbance of valvular functions. Angiographic examination demonstrated smooth surfaced tumor mass occupied left atrium. Coronary angiography revealed significant stenosis in segments 6, 7, 9, 12 and 14. Prior to surgery, patient was diagnosed myxoma of the left atrium and ischemic heart disease. Removal of the mass and CABG were carried out at a same time. Pathology revealed giant and pedunculated globular thrombus. Contributional factors possibly growing of such huge thrombus formation explained resulting from atrial fibrillation and decreased contractile force of the hypertrophied ventricle. PMID:8753102

Ando, S; Inoue, K; Tanaka, H; Narisawa, T; Yamada, M; Takaba, T

1996-06-01

336

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

PubMed

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

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

2013-06-01

337

Video-assisted Port-Access mitral valve surgery: from debut to routine surgery. Will Trocar-Port-Access cardiac surgery ultimately lead to robotic cardiac surgery?  

PubMed

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

1999-07-01

338

Accessory mitral valve without subaortic obstruction of left ventricular outflow tract in a middle-aged male.  

PubMed

Accessory mitral valve (AMV) is a rare congenital abnormality with a usually early-age clinical onset, being potentially a cause of subvalvular obstruction of the left ventricular outflow tract. This report describes the case of a 60-year-old patient presented with palpitations and chest pain. Primary evaluation revealed a ventricular tachycardia episode while transthoracic echocardiography showed an intracardiac additional structure at the level of the left ventricular outflow tract. After transoesophageal echocardiography and paraclinical investigations this structure was proven to be an AMV tissue which did not provoke left ventricular outflow obstruction. This case presents an unusual late-age clinical onset of AMV without a clinically significant LVOT (left ventricular outflow tract) obstruction and highlights the importance of transthoracic and transoesophageal echocardiography in the diagnosis of this rare cardiological entity. PMID:23175008

Golias, Christos; Bitsis, Theodosis; Krikidis, Dimitrios; Charalabopoulos, Konstantinos

2012-01-01

339

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. PMID:22327292

Amini, Rouzbeh; Eckert, Chad E.; Koomalsingh, Kevin; McGarvey, Jeremy; Minakawa, Mashito; Gorman, Joseph H.; Gorman, Robert C.; Sacks, Michael S.

2012-01-01

340

[Two-dimensional echo-cardiographic study on left atrial thrombi in patients with a mitral prosthetic valve].  

PubMed

Two-dimensional echocardiographic study was performed to detect left atrial thrombi in 33 patients with a prosthetic mitral valve. The subjects were 9 males and 24 females and their ages ranged from 21 to 61 years (average 43.2 years). Their prosthetic valves consisted of 18 Hancock, three Carpentier-Edwards, four Björk-Shiley, four Starr-Edwards and four St. Jude Medical valves. Two-dimensional echocardiograms were obtained using a Toshiba SSH-11A echograph with an electronic phased-array scanner. The left parasternal, apical, subcostal and right parasternal windows were used to detect left atrial thrombi. In five of the 33 patients, a left atrial thrombus was demonstrated as a mass echo attached to the posterior wall of the left atrium. The clinical and echographic features of five patients with a left atrial thrombus (Group A) were compared to those of 28 patients without it (Group B). The average age at the time of operation was 44.6 +/- 9.7 years in Group A and 43.0 +/- 9.5 years in Group B, showing no difference between the two groups. In 10 of the 33 patients, a left atrial thrombus was confirmed by the initial operation. In only one of these 10 patients, a left atrial thrombus was demonstrated by post-operative two-dimensional echocardiographic examination. The presence or absence of a left atrial thrombus in the pre-operative stage did not clearly relate to the occurrence of a left atrial thrombus in the post-operative stage. The cardio-thoracic ratio was significantly greater (p less than 0.01) in Group A (74.4 +/- 6.3%) than in Group B (58.1 +/- 8.1%). Left atrial dimension by M-mode echocardiograms was significantly greater (p less than 0.05) in Group A (70.6 +/- 11.3 mm) than in Group B (51.6 +/- 7.7 mm). The length of the pseudo-septalized left ventricular posterior wall was longer (p less than 0.05) in Group A (34.0 +/- 11.5 mm) than in Group B (12.8 +/- 9.4 mm). The angle between the perpendicular to the mitral annulus and the upper part of the interventricular septum was significantly greater (p less than 0.01) in Group A (58.6 +/- 18.0 degrees) than in Group B (18.8 +/- 9.6 degrees). The characteristics observed in Group A were thought to be caused mainly by the giant left atrium. Therefore it is concluded that there is a close relationship between left atrial thrombi and the giant left atrium in patients with a mitral prosthetic valve. PMID:6678957

Tsuyuguchi, N; Shigeta, H; Hashimoto, M; Tamagawa, M; Yokode, M; Tanaka, M; Suwo, M; Yokota, Y

1983-12-01

341

Left ventricular outflow tract obstruction in the presence of asymmetric septal hypertrophy and accessory mitral valve tissue treated with alcohol septal ablation.  

PubMed

Redundant or accessory mitral valve tissue (AMVT) is a rare clinical condition. It is an even rarer cause of left ventricular outflow tract obstruction. We report a case of an adult male with medically unresponsive hypertrophic obstructive cardiomyopathy in whom real-time three-dimensional transesophageal echocardiography was used to both diagnose the presence of coexistent asymmetric septal hypertrophy and AMVT as well as confirm the safety and efficacy of treatment with alcohol septal ablation. PMID:18490281

Kim, Michael S; Klein, Andrew J; Groves, Bertron M; Quaife, Robert A; Salcedo, Ernesto E

2008-09-01

342

Endothelial deletion of murine Jag1 leads to valve calcification and congenital heart defects associated with Alagille syndrome  

PubMed Central

The Notch signaling pathway is an important contributor to the development and homeostasis of the cardiovascular system. Not surprisingly, mutations in Notch receptors and ligands have been linked to a variety of hereditary diseases that impact both the heart and the vasculature. In particular, mutations in the gene encoding the human Notch ligand jagged 1 result in a multisystem autosomal dominant disorder called Alagille syndrome, which includes tetralogy of Fallot among its more severe cardiac pathologies. Jagged 1 is expressed throughout the developing embryo, particularly in endothelial cells. Here, we demonstrate that endothelial-specific deletion of Jag1 leads to cardiovascular defects in both embryonic and adult mice that are reminiscent of those in Alagille syndrome. Mutant mice display right ventricular hypertrophy, overriding aorta, ventricular septal defects, coronary vessel abnormalities and valve defects. Examination of mid-gestational embryos revealed that the loss of Jag1, similar to the loss of Notch1, disrupts endothelial-to-mesenchymal transition during endocardial cushion formation. Furthermore, adult mutant mice exhibit cardiac valve calcifications associated with abnormal matrix remodeling and induction of bone morphogenesis. This work shows that the endothelium is responsible for the wide spectrum of cardiac phenotypes displayed in Alagille Syndrome and it demonstrates a crucial role for Jag1 in valve morphogenesis. PMID:23095891

Hofmann, Jennifer J.; Briot, Anais; Enciso, Josephine; Zovein, Ann C.; Ren, Shuxun; Zhang, Zhen W.; Radtke, Freddy; Simons, Michael; Wang, Yibin; Iruela-Arispe, M. Luisa

2012-01-01

343

Model based Estimation of Aortic and Mitral valves Opening and Closing Timings in Developing Human Fetuses.  

PubMed

Electromechanical coupling of the fetal heart can be evaluated non-invasively using Doppler Ultrasound (DUS) signal and fetal electrocardiography (fECG). In this study, an efficient model is proposed using K-means clustering and hybrid SVM-HMM modeling techniques. Opening and closing of the cardiac valves were detected from peaks in the high frequency component of the DUS signal decomposed by wavelet analysis. It was previously proposed to automatically identify the valve motion by hybrid Support Vector Machine- Hidden Markov Model (SVM-HMM) [1] based on the amplitude and timing of the peaks. However, in the present study, six patterns were identified for the DUS components which were actually variable on a beat to beat basis and found to be different for the early gestation (16- 32 weeks), compared to the late gestation fetuses (36-41 weeks). The amplitude of the peaks linked to the valve motion was different across the six patterns and this affected the precision of valve motion identification by the previous hybrid SVM-HMM method. Therefore in the present study, clustering of the DUS components based on K-means was proposed and the hybrid SVM-HMM was trained for each cluster separately. The valve motion events were consequently identified more efficiently by beat-to-beat attribution of the DUS component peaks. Applying this method, more than 98.6% of valve motion events were beatto- beat identified with average precision and recall of 83.4% and 84.2% respectively. It was an improvement compared to the hybrid method without clustering with average precision and recall of 79.0% and 79.8%. Therefore, this model would be useful for reliable screening of fetal wellbeing. PMID:25343774

Marzbanrad, Faezeh; Kimura, Yoshitaka; Endo, Miyuki; Oshio, Sayaka; Funamoto, Kiyoe; Sato, Naoaki; Palaniswami, Marimuthu; Khandoker, Ahsan

2014-10-16

344

Distinct Mitral Valve Proteomic Profiles in Rheumatic Heart Disease and Myxomatous Degeneration  

PubMed Central

Rheumatic heart disease (RHD) affects heart-valve tissue and is the most serious consequence of group A Streptococcus infection. Myxomatous degeneration (MXD) is the most frequent valvopathy in the western world. In the present work, key protein expression alterations in the heart-valve tissue of RHD and MXD patients were identified and characterized, with controls from cadaveric organ donors. Proteins were separated by two-dimensional (2D)-electrophoresis and identified by mass spectrometry. We found 17 differentially expressed protein spots, as compared to control samples. We observed an increased expression of ASAP-2 in the RHD patients’ valves, while collagen-VI, haptoglobin-related protein, prolargin, and cartilage oligomeric protein showed reduced expression. Valve tissue of MXD patients, on the other hand, presented lower expression of annexin-A1 and A2, septin-2, SOD (Cu/Zn), and transgelin. Tissue samples from both valvopathies displayed higher expression of apolipoprotein-A1. Biglycan was downexpressed in both diseases. Vimentin and lumican showed higher expression in RHD and lower in MXD. These results suggest that key pathogenetic mechanisms are intrinsically distinct in RHD and MXD. PMID:25232280

Martins, Carlo de Oliveira; Santos, Keity Souza; Ferreira, Frederico Moraes; Teixeira, Priscila Camillo; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos MA; Sampaio, Roney Orismar; Spina, Guilherme S; Kalil, Jorge; Guilherme, Luiza; Cunha-Neto, Edecio

2014-01-01

345

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

PubMed Central

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

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

2013-01-01

346

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology  

PubMed Central

Background and Objectives Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery. Subjects and Methods Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39). Results Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant. Conclusion Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease. PMID:22701133

Her, Ae-Young; Shim, Chi Young; Song, Byoung Wook; Lee, Sak; Ha, Jong-Won; Rim, Se-Joong; Hwang, Ki Chul; Chang, Byung Chul; Chung, Namsik

2012-01-01

347

[Open heart radio frequency left atrial compartmentation during mitral valve surgery: an alternative to the labyrinth procedure?].  

PubMed

The authors report their experience of radiofrequency left atrial compartimentation during open heart mitral valve surgery on 37 patients with a 42 +/- 12 months history of atrial fibrillation. The preoperative left ventricular ejection fraction was 62 +/- 8%; the left atrial diameter was 59 +/- 11 mm. The mean operative time was 245 +/- 60 minutes, which included 19 +/- 5 minutes for the ablation procedure. There were 2 early postoperative deaths and 2 deaths from non-cardiac causes at 3 and 6 months. The left ventricular ejection fraction and left atrial dimension were significantly decreased at the time of hospital discharge (54 +/- 12% and 51 +/- 7 mm respectively) (p < 0.01). After an average follow-up of 1 year, 81% of patients were free of atrial fibrillation: 6 patients had undergone DC cardioversion and 1 had a dual-chamber pacemaker. Patients in sinus rhythm after the ablation were associated with shorter periods of atrial fibrillation and smaller left atrial dimensions postoperatively than those who remained in fibrillation. The authors conclude that radiofrequency compartimentation of the left atrium associated with antiarrhythmic therapy can interrupt atrial fibrillation in 81% of patients at 1 year: the ablation procedure takes only 8% of the operation time. Predictive factors of success of ablation should be defined to determine which patients benefit most from this technique. PMID:12055767

Schläpfer, J; Ruchat, P; Delabays, A; Hurni, M; Milne, J; von Segesser, L K

2002-04-01

348

Defining the Role of Fluid Shear Stress in the Expression of Early Signaling Markers for Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD) is an active process presumably triggered by interplays between cardiovascular risk factors, molecular signaling networks and hemodynamic cues. While earlier studies demonstrated that alterations in fluid shear stress (FSS) on the fibrosa could trigger inflammation, the mechanisms of CAVD pathogenesis secondary to side-specific FSS abnormalities are poorly understood. This knowledge could be critical to the elucidation of key CAVD risk factors such as congenital valve defects, aging and hypertension, which are known to generate FSS disturbances. The objective of this study was to characterize ex vivo the contribution of isolated and combined abnormalities in FSS magnitude and frequency to early valvular pathogenesis. The ventricularis and fibrosa of porcine aortic valve leaflets were exposed simultaneously to different combinations of sub-physiologic/physiologic/supra-physiologic levels of FSS magnitude and frequency for 24, 48 and 72 hours in a double cone-and-plate device. Endothelial activation and paracrine signaling were investigated by measuring cell-adhesion molecule (ICAM-1, VCAM-1) and cytokine (BMP-4, TGF-?1) expressions, respectively. Extracellular matrix (ECM) degradation was characterized by measuring the expression and activity of the proteases MMP-2, MMP-9, cathepsin L and cathepsin S. The effect of the FSS treatment yielding the most significant pathological response was examined over a 72-hour period to characterize the time-dependence of FSS mechano-transduction. While cytokine expression was stimulated under elevated FSS magnitude at normal frequency, ECM degradation was stimulated under both elevated FSS magnitude at normal frequency and physiologic FSS magnitude at abnormal frequency. In contrast, combined FSS magnitude and frequency abnormalities essentially maintained valvular homeostasis. The pathological response under supra-physiologic FSS magnitude peaked at 48 hours but was then maintained until the 72-hour time point. This study confirms the sensitivity of valve leaflets to both FSS magnitude and frequency and suggests the ability of supra-physiologic FSS levels or abnormal FSS frequencies to initiate CAVD mechanisms. PMID:24376809

Sun, Ling; Rajamannan, Nalini M.; Sucosky, Philippe

2013-01-01

349

Optimizing the AV delay in DDD pacemaker patients with high degree AV block: mitral valve Doppler versus impedance cardiography.  

PubMed

In DDD-pacemaker patients with high degree AV block, Doppler echocardiography of transmitral blood flow can be used to find the individually optimal AV delay (AVO) for left heart AV synchronization. This study tried to validate a Doppler method (ECHO) recently proposed to optimize left ventricular filling by comparing it to stroke volume data derived from impedance cardiography (ICG). It should be further elucidated if optimizing the AV delay (AVD) by means of this method is superior to fixed AVD settings and which differential AVD (pace-sense-offset) should be programmed for atrially triggered (ATP) and AV sequential (AVP) pacing, respectively. AVO as measured in 53 patients showed a linear correlation between ECHO and ICG for both ATP (r = 0.66, P < 0.00001) and AVP (r = 0.53; P < 0.005). The mean deviation in AVO between ECHO and ICG was +/- 26 ms (ATP) and +/- 30 ms (AVP), respectively, with a tendency to longer AVDs with the Doppler method. ECHO limitations could mainly be attributed to: (1) restrictions of AVD programming options (which may be compensated for by slight modification of the proposal); and (2) to pathophysiological mechanisms that alter mitral valve dynamics. Optimization of the AVD by Doppler produced a stroke volume that was significantly higher (19%) than with a fixed AVD (150 ms in ATP; 200 ms in AVP). There was a wide scatter in pace-sense-offsets between-7 and 134 ms, which was reflected by both methods. It is concluded that AVO determinations by ECHO are valid provided that methodological pitfalls and limitations caused by the disease are recognized. Tailoring AVD with respect to diastolic filling improves systolic function and is superior to nominal AVD settings. Fixed differential AVDs as offered by some manufacturers are far from being physiological. Thus modern pulse generators should offer free programmability over a wide range of AV delays. PMID:9358487

Kindermann, M; Fröhlig, G; Doerr, T; Schieffer, H

1997-10-01

350

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

PubMed Central

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

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

2014-01-01

351

Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?†  

PubMed Central

OBJECTIVES The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery. METHODS Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n = 27) and the LAM group (n = 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of <0.5% were considered AF free (responders). The mean follow-up was 18.6 months (standard deviation 2.1 months), and the patient' data were evaluated every 3 months. RESULTS All patients were alive at discharge. No procedure-related complications occurred for either the ablation or the loop recorder implantation. Mean aortic clamping and ablation times were significantly longer in the LAM group than in the PVI group. The incidence of early AF paroxysm recurrence was significantly higher in the PVI group than in the LAM group (62.9 vs 24.0%, P < 0.001). At 20 months after surgery, 15 (55.6%) of the 27 patients in the PVI group and 22 (88.0%) of the 25 patients in the LAM group had no documented atrial arrhythmias and were considered responders (AF burden <0.5%). The mean AF burden during all follow-up periods was significantly lower in the LAM group (23.6 ± 8.7%) than in the PVI group (6.8 ± 2.2%) (P < 0.001). CONCLUSIONS According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery. PMID:24254537

Bogachev-Prokophiev, Alexandr; Zheleznev, Sergey; Pivkin, Alexey; Pokushalov, Evgeny; Romanov, Alexander; Nazarov, Vladimir; Karaskov, Alexander

2014-01-01

352

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

PubMed Central

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

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

2014-01-01

353

Early Experience With Percutaneous Transcatheter Implantation of Heart Valve Prosthesis for the Treatment of End-Stage Inoperable Patients With Calcific Aortic Stenosis  

Microsoft Academic Search

OBJECTIVES This study wad done to assess the results of percutaneous heart valve (PHV) implantation in non-surgical patients with end-stage calcific aortic stenosis. BACKGROUND Replacement of PHV has been shown to be feasible in animals and humans. We developed a PHV composed of three pericardial leaflets inserted within a balloon-expandable stainless steel stent. We report the acute and early follow-up

Alain Cribier; Helene Eltchaninoff; Christophe Tron; Fabrice Bauer; Carla Agatiello; Laurent Sebagh; Assaf Bash; Danielle Nusimovici; P. Y. Litzler; Jean-Paul Bessou; Martin B. Leon

354

Simultaneous mapping of the tricuspid and mitral valve annuli at electrophysiological study.  

PubMed Central

BACKGROUND--Mapping of the right free wall in patients with accessory pathways is difficult compared with that of the left free wall where the coronary sinus permits stable and accurate location of the electrodes used for endocardial mapping. Furthermore, the sequential roving catheter method is less satisfactory than multiple simultaneous electrode recordings spanning the circumference of the valve annulus. A new method for mapping the tricuspid annulus is described. METHODS--Mapping was performed in nine patients with a suspected right free wall accessory pathway or an atriofascicular connection. The tricuspid annulus was mapped using a specially shaped 1 cm interelectrode 10 pole catheter positioned in the right atrium immediately above the annulus. The coronary sinus was mapped with a 5 mm interelectrode 10 pole catheter and a 2 mm interelectrode 10 pole catheter recorded His bundle activity. Catheter positions were confirmed by multiplane fluoroscopy. Electrograms were digitised and recorded simultaneously using a custom computerised mapping system. The position of the multielectrode catheter around the tricuspid annulus relative to that of the coronary arteries was examined by coronary angiography in three patients. RESULTS--Seven right free wall and two posterior septal accessory pathways, and three atriofascicular connections were detected. Ventricular activation adjacent to both valve annuli was mapped in five patients with pre-excitation. The locations of eight of the nine accessory pathways and the three atriofascicular connections were confirmed at operative mapping. One right free wall accessory pathway in a patient with Ebstein's anomaly was not detected at operative mapping. No additional accessory pathways were found at operative mapping or routine 6 month postoperative electrophysiological study, or during a mean (SD) clinical follow up of 22 (7) months. The tricuspid annulus catheter was located during coronary angiography at a mean (SD) of about 2.5 (0.7) cm above and parallel to the right coronary artery in the right atrioventricular groove. CONCLUSIONS--This new catheter technique permits rapid detailed mapping of atrial and ventricular activation around the tricuspid annulus with a resolution of at least < or = % 1 cm, depending on the number and spacing of electrodes in each catheter. The technique was accurate as judged by mapping at surgery. This method is simple and safe compared with that of others for mapping the right free wall via the right coronary artery. It should facilitate detection and ablation of right free wall accessory pathways and atriofascicular connections. Images PMID:7756074

Davis, L. M.; Richards, D. A.; Uther, J. B.; Ross, D. L.

1995-01-01

355

The effect of left ventricular dP/dt on the in vitro dynamics of the Björk-Shiley Convexo-Concave mitral valve.  

PubMed

Left ventricular (LV) dP/dt is considered an important hemodynamic factor influencing the dynamics of mechanical heart valve prostheses. LV dP/dt is dependent on patient factors including age, cardiac activity, health, and medication. The objective of this study was to determine the effect of LV dP/dt on the closing dynamics of mechanical heart valve prostheses in the mitral position. Eight instrumented 29 mm Björk-Shiley Convexo-Concave (BSCC) heart valves were tested in the pulse duplicator of the Helmholtz Institute. The valves had miniature strain gages mounted at the base of the outlet strut to measure impact loads at closure. Closing velocities were measured with a "light gate" device which was triggered by the closing leaflet. Physiologic pressure and flow waveforms were generated by a computer-controlled hydraulic drive unit. LV dP/dt was varied from 500 to 4000 mmHg/s simulating a wide range of physiologic conditions. It was found that the closing velocity was almost linearly related to LV dP/dt. At 4000 mmHg/s, closing velocities ranged from 1.5 to 2.0 m/s. Impact loads increased monotonically with LV dP/dt and closing velocity. In some valves, impact loads reached 2800 g at LV dP/dt of 4000 mmHg/s, and closing velocities of 2.0 m/s. PMID:8581205

Rau, G; Reul, H; Eichler, M; Schreck, S; Wieting, D W

1995-07-01

356

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

NASA Technical Reports Server (NTRS)

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

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

2000-01-01

357

Famine in childhood and postmenopausal coronary artery calcification: a cohort study  

PubMed Central

Objective To assess the effects of famine exposure during childhood on coronary calcium deposition and, secondarily, on cardiac valve and aortic calcifications. Design Retrospective cohort. Setting Community. Patients 286 postmenopausal women with individual measurements of famine exposure during childhood in the Netherlands during World War II. Intervention/exposure Famine exposure during childhood. Main outcome measures Coronary artery calcifications measured by CT scan and scored using the Agatston method; calcifications of the aorta and cardiac valves (mitral and/or aortic) measured semiquantitatively. Logistic regression was used for coronary Agatston score of >100 or ?100, valve or aortic calcifications as the dependent variable and an indicator for famine exposure as the independent variable. These models were also used for confounder adjustment and stratification based on age groups of 0–9 and 10–17?years. Results In the overall analysis, no statistically significant association was found between severe famine exposure in childhood and a high coronary calcium score (OR 1.80, 95% CI 0.87 to 3.78). However, when looking at specific risk periods, severe famine exposure during adolescence was related to a higher risk for a high coronary calcium score than non-exposure to famine, both in crude (OR 3.47, 95% CI 1.00 to 12.07) and adjusted analyses (OR 4.62, 95% CI 1.16 to 18.43). No statistically significant association was found between childhood famine exposure and valve or aortic calcification (OR 1.66, 95% CI 0.69 to 4.10). Conclusions Famine exposure in childhood, especially during adolescence, seems to be associated with a higher risk of coronary artery calcification in late adulthood. However, the association between childhood famine exposure and cardiac valve/aortic calcification is less clear. PMID:24293207

Idris, Nikmah S; Uiterwaal, Cuno S P M; van der Schouw, Yvonne T; van Abeelen, Annet F M; Roseboom, Tessa J; de Jong, Pim A; Rutten, Annemarieke; Grobbee, Diederick E; Elias, Sjoerd G

2013-01-01

358

Two cases of warfarin-induced tracheobronchial calcification after Fontan surgery.  

PubMed

This study identified tracheobronchial cartilage calcification in children with congenital heart disease. Calcification of the tracheobronchial airways has been found previously in adults receiving warfarin and in children receiving warfarin after mitral valve replacement. A 9-year-old girl who had received a Fontan repair 6 years previously underwent a cardiac computed tomography (CT) scan to evaluate pulmonary artery size. The result was an incidental finding of extensive tracheobronchial cartilage calcification. A retrospective review of all pediatric Fontan patients who had undergone cardiac CT was conducted to search for calcification of the tracheobronchial cartilage. The study investigated ten pediatric Fontan patients who had undergone cardiac CT scanning. Two patients with extensive calcification of the tracheobronchial airways were identified. The index case had hypoplastic left heart syndrome, and the patient had undergone a staged repair with the Fontan at the age of 3 years. A 16-year-old boy with tricuspid atresia had undergone staged repair and Fontan at the age of 3.5 years. These two patients had received continuous warfarin therapy for 6 and 13 years, respectively. Other common causes of airway calcification were excluded from the study. This report describes warfarin-induced tracheobronchial calcification in patients after the Fontan procedure. This finding has possible implications for airway growth and vascular calcification. PMID:24584210

Eckersley, Luke; Stirling, John; Occleshaw, Christopher; Wilson, Nigel

2014-08-01

359

Ex Vivo Evidence for the Contribution of Hemodynamic Shear Stress Abnormalities to the Early Pathogenesis of Calcific Bicuspid Aortic Valve Disease  

PubMed Central

The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is frequently associated with calcific aortic valve disease (CAVD). The most prevalent type-I morphology, which results from left-/right-coronary cusp fusion, generates different hemodynamics than a tricuspid aortic valve (TAV). While valvular calcification has been linked to genetic and atherogenic predispositions, hemodynamic abnormalities are increasingly pointed as potential pathogenic contributors. In particular, the wall shear stress (WSS) produced by blood flow on the leaflets regulates homeostasis in the TAV. In contrast, WSS alterations cause valve dysfunction and disease. While such observations support the existence of synergies between valvular hemodynamics and biology, the role played by BAV WSS in valvular calcification remains unknown. The objective of this study was to isolate the acute effects of native BAV WSS abnormalities on CAVD pathogenesis. Porcine aortic valve leaflets were subjected ex vivo to the native WSS experienced by TAV and type-I BAV leaflets for 48 hours. Immunostaining, immunoblotting and zymography were performed to characterize endothelial activation, pro-inflammatory paracrine signaling, extracellular matrix remodeling and markers involved in valvular interstitial cell activation and osteogenesis. While TAV and non-coronary BAV leaflet WSS essentially maintained valvular homeostasis, fused BAV leaflet WSS promoted fibrosa endothelial activation, paracrine signaling (2.4-fold and 3.7-fold increase in BMP-4 and TGF-?1, respectively, relative to fresh controls), catabolic enzyme secretion (6.3-fold, 16.8-fold, 11.7-fold, 16.7-fold and 5.5-fold increase in MMP-2, MMP-9, cathepsin L, cathepsin S and TIMP-2, respectively) and activity (1.7-fold and 2.4-fold increase in MMP-2 and MMP-9 activity, respectively), and bone matrix synthesis (5-fold increase in osteocalcin). In contrast, BAV WSS did not significantly affect ?-SMA and Runx2 expressions and TIMP/MMP ratio. This study demonstrates the key role played by BAV hemodynamic abnormalities in CAVD pathogenesis and suggests the dependence of BAV vulnerability to calcification on the local degree of WSS abnormality. PMID:23119099

Sun, Ling; Chandra, Santanu; Sucosky, Philippe

2012-01-01

360

The loss of circadian heart rate variations in patients undergoing mitral valve replacement and Corridor procedure--comparison to heart transplant patients.  

PubMed

We have presently demonstrated that when added to mitral valve replacement (MVR) the corridor procedure is 75% efficient in restoring and maintaining sinus rhythm in patients with chronic atrial fibrillation (AF), caused by rheumatic mitral valve disease, (follow up 13.9months). In the same patient population, we observed that the typical day-night cycle heart rate (HR) variations were lost and our present study concentrates on this subject. Heart rate variability analysis based on 24-h Holter ECG recording (StrataScan 563 DelMar Avionics) or hospital discharge (12th-14th postoperative days) was performed in 3 patient groups: Group I: Patients with a Corridor procedure added to MVR (12pts, m/f 10/2, mean age 47.3+/-7.5yr); Group II (control): with patients MVR performed through the left atrial approach, without additional antiarrhythmic procedures (10pts, m/f 3/7 mean age 51.5+/-6.7yr), and Group III: heart transplant recipients (5pts, mean age 46.4+/-11.22yr). We analyzed the hourly heart rate over 24-h period divided into three 8-h segments (07-14h; 15-22h and 23-06h). Statistical comparison of mean hourly heart rate values was made between the three time periods of Holter monitoring. The Corridor procedure performed with mitral valve replacement resulted in conversion of sinus rhythm in 75% of patients (Group I), but postoperative heart rate variability analyses based on Holter monitoring disclosed that the mean heart rate was not statistically significantly difficult between the three 8-h segments of the day-night (P>0.05). The same results were found in the group of patients after heart transplant (P>0.05). The same results were found in the group of patients after heart transplant (P>0.05). In the second group (classical MVR), statistically significant differences in mean HR variation existed between the three 8-h intervals (P<0.05), and although atrial fibrillation occurred postoperatively physiologic circadian heart rate variations were preserved. With the Corridor procedure, both atria were surgically and electrically isolated and chronotropic function of the ventricles was restored by creating a small strip of atrial tissue with isolated sinus node and atrio-ventricular node, connected to the ventricles. This technique produced heart denervation nervous system influence, producing the loss of circadian HR variations, similar to the transplanted heart. PMID:11137811

Velimirovic, D B; Pavlovic, S U; Petrovic, P; Neskovic, A; Zivkovic, M; Bojic, M

2001-02-01

361

Mitral Valve Replacement  

MedlinePLUS

... amount of blood forward. This is called volume overload. The heart can compensate for this overload for many months or years, provided that the ... if any, restrictions on your activity. (For more information about your recovery, refer to What to Expect ...

362

Mitral Valve Prolapse  

MedlinePLUS

... test usually takes about 10 minutes. An echocardiogram (echo for short) uses sound waves to make a ... the wand takes pictures of your heart. An echo takes longer than an ECG — about 30 minutes. ( ...

363

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

Microsoft Academic Search

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

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

1999-01-01

364

Quantitative estimation of left ventricular ejection fraction from mitral valve E-point to septal separation and comparison to magnetic resonance imaging.  

PubMed

This study tested the hypothesis that the mitral valve E point-to-septal separation (EPSS) can be used to quantify the left ventricular (LV) ejection fraction (EF) on a continuous scale rather than simply as "normal" or "reduced." After excluding 5 patients with mitral valve prostheses, asymmetric septal hypertrophy, or significant aortic insufficiency, EPSS was measured in 42 patients by 3 independent observers on a cardiac magnetic resonance image identical to the echocardiographic parasternal long-axis view. In each patient, the reference standard LVEF was calculated from the magnetic resonance short-axis cross-sectional stack images by Simpson's rule and ranged from 11% to 72%. For all 42 patients, linear regression revealed the relation magnetic resonance imaging (MRI) LVEF = 75.5 - 2.5. EPSS (millimeters). Correlation between EPSS and the MRI LVEF for the 3 observers agreed closely, ranging from r = 0.78 to r = 0.82 (SEE 9 to 10), with similar regression coefficients. After blinded segmental wall motion scoring of the gated magnetic resonance cine images of the left ventricle in each patient, correlations, SEEs, and regression coefficients were found to be very similar in the 21 patients with the most homogenous wall motion, compared with the 21 patients with the most heterogenous wall motion. In conclusion, clinically useful quantitative prediction of the LVEF as a continuous variable can be obtained from the EPSS with a simple linear regression equation in a substantial portion of patients and may be a useful adjunct for assessment of LV function. PMID:16377299

Silverstein, Jay R; Laffely, Nicholas H; Rifkin, Robert D

2006-01-01

365

Surgical treatment of functional ischemic mitral regurgitation.  

PubMed

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

Jensen, Henrik

2015-03-01

366

Transcatheter mitral direct annuloplasty: state of the art.  

PubMed

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

Maisano, F; Kuck, K H

2014-06-01

367

Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prosthesis and renal microembolism in dogs  

SciTech Connect

At 24 hrs after implantation of Bjoerk-Shiley mitral prosthesis in 5 dogs, in vivo images were obtained with a gamma camera after intravenous administration (0.5-0.6 mCi) one hour postoperatively of autologous Indium-111-labeled platelets. The site of platelet deposition in the teflon ring and perivascular damaged cardiac tissue is clearly delineated in the scintiphoto. In vitro biodistribution (mean % +/- SD of injected dose) at 24 hrs after injection of the 5 implanted and 7 normal dogs performed with a gamma counter demonstrated that (45.1 +/- 10.6)% and (0.7 +/- 0.4)% were in blood and kidneys in normal dogs and (28.5 +/- 6.8)%, (1.6 +/- 0.6)%, (0.3 +/- 0.1)%, and (0.2 +/- 0.1)% were in blood, kidneys, teflon rings, and perivascular damaged cardiac tissue, respectively. The strut and pyrolytic carbon-coated disc retained only (0.0033 +/- 0.0004)% and (0.0031 +/- 0.0003)%, respectively. There was a 2.3-fold increase of labeled platelets in kidneys of implanted dogs due to renal trapping of microembolism. Also, three- to fivefold increase in ratios of lung, brain, cardiac, and skeletal muscle to blood indicates that internal organs and whole body work as filter for microembolism generated by cardiovascular surgery and mitral prosthesis. Twenty percent of the administered platelets are consumed in surgical repair of damaged tissue. Indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of Bjoerk-Shiley mitral prosthesis, thromboembolism after implantation of prosthetic device, and in vitro quantitation of surgical consumption.

Dewanjee, M.K.; Kaye, M.P.; Fuster, V.; Rao, S.A.

1980-01-01

368

Amounts of coronary arterial narrowing by atherosclerotic plaques in clinically isolated mitral valve stenosis: analysis of 76 necropsy patients older than 30 years.  

PubMed

Although several studies have described the status of the coronary arteries by angiography in patients with mitral stenosis (MS), few necropsy studies of the coronary arteries in these patients are available. The present report describes in detail the amounts of narrowing by atherosclerotic plaque of the 4 major epicardial coronary arteries in 76 necropsy patients, aged 31 to 79 years (mean 53) with clinically isolated MS (with or without associated mitral regurgitation but without aortic valve dysfunction). Of the 76 patients, greater than or equal to 1 major coronary artery was narrowed greater than 75% in cross-sectional area (XSA) in 38 (50%) and in 10 of the 38 patients greater than or equal to 1 major coronary artery was totally occluded or nearly so (greater than 95% XSA narrowing). A higher percent of the 29 men had significant (greater than 75% XSA) coronary narrowing than did the 47 women (62 vs 44%) and the men had more major coronary arteries significantly narrowed compared with the women (31 of 116 arteries [27%] vs 33 of 188 arteries [18%]). The 4 major coronary arteries in the 76 patients were divided into 5-mm segments and examined histologically: of the 3,124 segments (41 per patient), 620 segments (20%) were narrowed 0 to 25% in XSA, 1,826 (58%) were narrowed 26 to 50%, 470 (15%) were narrowed 51 to 75%, 188 (6%) were narrowed 76 to 95%, and 20 segments (1%) were narrowed 96 to 100% in XSA. The percent of segments narrowed greater than 75% in XSA was 9% in the men and 5% in the women.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3706163

Reis, R N; Roberts, W C

1986-05-01

369

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

NASA Technical Reports Server (NTRS)

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

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

2003-01-01

370

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

PubMed Central

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

Kossaify, Antoine; Akiki, Vanessa

2014-01-01

371

Potential Inherited Causes of Recurrent Prosthetic Mitral Valve Thrombosis in a Pregnant Patient Suffering from Recurrent Miscarriage  

PubMed Central

An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagulation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient in the present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwent a thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prosthetic valve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C and heterozygous mutations of ?-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphisms may be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss. PMID:25089140

Gursoy, M. Ozan; Karakoyun, Suleyman; Yesin, Mahmut; Astarcioglu, Mehmet Ali; Ozkan, Mehmet

2014-01-01

372

Comparative expression profiles of microRNA in left and right atrial appendages from patients with rheumatic mitral valve disease exhibiting sinus rhythm or atrial fibrillation  

PubMed Central

Background The atrial fibrillation (AF) associated microRNAs (miRNAs) were found in the right atrium (RA) and left atrium (LA) from patients with rheumatic mitral valve disease (RMVD). However, most studies only focus on the RA; and the potential differences of AF-associated miRNAs between the RA and LA are still unknown. The aim of this study was to perform miRNA expression profiles analysis to compare the potential differences of AF-associated miRNAs in the right atrial appendages (RAA) and left atrial appendages (LAA) from RMVD patients. Methods Samples tissues from the RAA and LAA were obtained from 18 RMVD patients (10 with AF) during mitral valve replacement surgery. From these tissues, miRNA expression profiles were created and analyzed using a human miRNA microarray. Then, the results were validated using qRT-PCR analysis for 12 selected miRNAs. Finally, potential targets of 10 validated miRNAs were predicted and their functions and potential pathways were analyzed using the miRFocus database. Results In RAA, 65 AF-associated miRNAs were found and significantly dysregulated (i.e. 28 miRNAs were up-regulated and 37 were down-regulated). In LAA, 42 AF-associated miRNAs were found and significantly dysregulated (i.e. 22 miRNAs were up-regulated and 20 were down-regulated). Among these AF-associated miRNAs, 23 of them were found in both RAA and LAA, 45 of them were found only in RAA, and 19 of them were found only in LAA. Finally, 10 AF-associated miRNAs validated by qRT-PCR were similarly distributed in RAA and LAA; 3 were found in both RAA and LAA, 5 were found only in RAA, and 2 were found only in LAA. Potential miRNA targets and molecular pathways were identified. Conclusions We have found the different distributions of AF-associated miRNAs in the RAA and LAA from RMVD patients. This may reflect different miRNA mechanisms in AF between the RA and LA. These findings may provide new insights into the underlying mechanisms of AF in RMVD patients. PMID:24708751

2014-01-01

373

Acute aortic insufficiency due to rupture of an aortic valve commissure.  

PubMed

Myxomatous degeneration generally involves the atrioventricular valves (mitral and tricuspid). Rarely, it may affect the aortic or pulmonary valve. We report a case of an acute severe aortic insufficiency due to a rupture of a commissure of the aortic valve in a patient who had previously undergone mitral valve surgery for myxomatous mitral valve prolapse. PMID:24417221

Kassem, Samer; Polvani, Gianluca; Al Jaber, Emad; Gennari, Marco

2014-07-01

374

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

PubMed Central

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

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

2014-01-01

375

Frequency spectra of the first heart sound and of the aortic component of the second heart sound in patients with degenerated porcine bioprosthetic valves.  

PubMed

To determine the usefulness of the frequency of heart sounds in the assessment of porcine bioprosthetic valve degeneration, frequency spectra of phonocardiograms of the first heart sound and the aortic component of the second sound were analyzed in 31 patients with degenerated porcine bioprosthetic valves. Comparisons were made with 35 control patients whose valves were inserted 1 month or less. Among 23 patients with degenerated porcine bioprosthetic valves in the mitral position, the dominant frequency of the first heart sound was 95 +/- 11 Hz, which exceeded the first sound in 18 controls (51 +/- 3 Hz) (p less than 0.01). The degenerated mitral porcine bioprosthetic valves of 14 patients showed calcification or fibrosis and the first heart sound in these patients was 115 +/- 16 Hz, which exceeded that of control subjects (p less than 0.001). The degenerated mitral porcine bioprosthetic valves of 9 patients showed torn leaflets only, and the first heart sound in these patients was 64 +/- 9 Hz, which did not differ from that of control subjects. In the aortic position, 8 valves were degenerated and the aortic component of the second sound was 109 +/- 12 Hz, which was higher than that in 17 control subjects (63 +/- 4 Hz) (p less than 0.001). Only 2 of these degenerated valves showed tears unaccompanied by calcific deposits or fibrosis, and the frequencies were comparable to that of control subjects. These observations indicate that the frequency of heart sounds in patients with degenerated porcine bioprosthetic valves becomes abnormally elevated when degeneration is accompanied by calcification or fibrosis, which causes the cusps to stiffen. PMID:6695784

Stein, P D; Sabbah, H N; Lakier, J B; Kemp, S R; Magilligan, D J

1984-02-01

376

Basic mechanisms of mitral regurgitation.  

PubMed

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

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

2014-09-01

377

Noninvasive radioisotopic technique for detection of platelet deposition on bovine pericardial mitral-valve prosthesis and in vitro quantification of visceral microembolism in dogs  

SciTech Connect

Platelet deposition on bovine pericardial-tissue mitral-valve prostheses in dogs was observed noninvasively by use of /sup 111/In-labeled platelets and quantified after sacrifice at one, 14 and 30 days postimplantation (300-400 microCi of labeled platelets having been injected 24 hrs previously). Thrombosis on the sewing ring and pericardial leaflets at one and 14 days and on the leaflets at 30 days was delineated in scintiphotos. In vitro quantification (% injected dose) indicated that the sewing ring and perivalvular tissue retained 0.75% of labeled platelets at one day postimplantation, 0.084% at 14 days, and 0.0042% at 30 days. Platelet survival was reduced to 38 hrs at 21 days postimplantation but returned toward the normal (50 hrs) with endothelial covering of the sewing ring. Microemboli in lung and kidney, as measured by tissue/blood radioactivity ratio, decreased significantly at 30 days. /sup 111/In-labeled platelets thus provide a sensitive marker for noninvasive imaging and in vitro quantification of platelet deposition on valvular prostheses and microemboli trapped in viscera.

Dewanjee, M.K.; Trastek, V.F.; Tago, M.; Torianni, M.; Kaye, M.P.

1983-01-01

378

Evaluation of plasma and urinary levels of 6-keto-prostaglandin F1alpha as a marker for asymptomatic myxomatous mitral valve disease in dogs.  

PubMed

Endothelial dysfunction might be involved in the pathogenesis of myxomatous mitral valve disease (MMVD). The aims of this study were (1) to validate an enzyme immunoassay (EIA) for canine 6-keto-prostaglandin (PG)F(1alpha) (prostacyclin metabolite and marker for endothelial function) and (2) to compare plasma and urinary 6-keto-PGF(1alpha) in dogs with asymptomatic MMVD. The study included two breeds predisposed to MMVD and two control groups (Cairn terriers and dogs of different breeds). Echocardiography was used to estimate the severity of MMVD. The intra- and inter-assay coefficients of variation were between 3.1% and 24.5% in the assay range. No echocardiographic parameter was correlated with plasma or urinary 6-keto-PGF(1alpha) (P>0.05), but all control dogs had lower urinary 6-keto-PGF(1alpha) (P<0.02) and the Cairn terriers had higher plasma 6-keto-PGF(1alpha) (P<0.02). The EIA appeared valid for measuring canine 6-keto-PGF(1alpha) in plasma and urine. It is suggested that 6-keto-PGF(1alpha) levels are related to breed and not MMVD in asymptomatic stages. PMID:19324577

Rasmussen, Caroline E; Sundqvist, Anna V; Kjempff, Christina T; Tarnow, Inge; Kjelgaard-Hansen, Mads; Kamstrup, Thea S; Sterup, Anne-Lise; Soerensen, Tina M; Olsen, Lisbeth H

2010-05-01

379

Options for Heart Valve Replacement  

MedlinePLUS

... the damaged valve aortic valve TAVI/TAVR procedure — Transcatheter aortic valve replacement Newer surgery options The procedure chosen will depend ... on to live a full and healthy life. Mitral valve repair can often provide a ... replacements. Aortic valve replacement is more likely to require ...

380

Mitral stenosis and acute ST elevation myocardial infarction  

PubMed Central

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

Cardoz, Joseph; George, Raju

2015-01-01

381

Cuspal dehiscence at a post and along the stent cloth in a bovine pericardium heart valve implanted for seven years.  

PubMed

A failing mitral valve prosthesis made from bovine pericardium was explanted from a 50-year-old patient. Preoperative transthoracic-echocardiography had confirmed severe mitral regurgitation due to structural failure of this HP Bio bovine pericardium heart valve prosthesis. The explanted device was examined macroscopically, by scanning electron microscopy (SEM), by light microscopy, and by transmission electron microscopy (TEM). Samples of unassembled patches of bovine pericardium were used as a pre-implantation control to better understand the changes that occurred in the structure of the pericardium following the 7 years of implantation. Examination confirmed complete dehiscence of a cusp along a valve post and the stent: This detached cusp was observed floating in the bloodstream at echocardiography. The fibrous pannus overgrowth was well developed along the stent and extended to the bottom of the cusps both on the inflow and the outflow sides. The fibrous panni were found to be poorly adhesive to the pericardium cusps and had become stiff, thus impairing the opening and closure of the valve. The structure of the pericardium cusps was severely deteriorated compared to the control bovine pericardium tissue samples. The collagen bundles were frequently broken and more stretched in the explanted device, lacking the wavy histological pattern of normal collagen fibers. However, the tissues were devoid of any calcification. In conclusion, the failure mode of this valve was the dehiscence of a cusp from a valve post and along the stent cloth in the absence calcification. PMID:23428246

Guidoin, Robert; Bes, Taniela Marli; Cianciulli, Tomas Francisco; Klein, Julianne; Li, Bin; Gauvin, Robert; Guzman, Randolph; Rochette-Drouin, Olivier; Germain, Lucie; Zhang, Ze

2012-01-01

382

Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction  

PubMed Central

Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e? and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e? in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD. PMID:24955040

Bradley, Elisa A.; Novak, Eric L.; Rasalingam, Ravi; Cedars, Ari M.; Ewald, Gregory A.; Silvestry, Scott C.; Joseph, Susan M.

2014-01-01

383

Prosthetic valve endocarditis. A survey  

Microsoft Academic Search

Fifty eight patients (aged 8-59 years, mean 27) treated for prosthetic valve endocarditis from January 1966 to January 1985 were studied retrospectively by review of case notes. There were 12 cases of early and 46 cases of late prosthetic valve endocarditis. These developed in 28 patients with an isolated aortic valve, in 26 with an isolated mitral valve, and in

M Ben Ismail; N Hannachi; F Abid; Z Kaabar; J F Rougé

1987-01-01

384

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

PubMed Central

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

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

2012-01-01

385

Anterior mitral leaflet reconstruction with pericardium in a 1.9 kg infant with endocarditis.  

PubMed

A premature twin of 1.9 kg had mitral valve endocarditis develop during neonatal intensive care. Vegetation involving the entire anterior mitral valve leaflet was identified. Reconstruction was achieved by near complete resection of the anterior mitral valve leaflet and retention of the peripheral margin of coaptation including primary and secondary chordae. The body of the anterior mitral valve leaflet was reconstructed using fresh autologous pericardium, a technique not previously reported in an infant of this size. Three and a half years later, the child is well and has required no further intervention. PMID:16731184

Healy, David G; Wood, Alfred E

2006-06-01

386

The effect of respiratory static volumes on heart valve sounds  

E-print Network

comparatively long, vibrating sound. It is the sound vena cava aorta pulmonary valve left atrium right atrium rtic valve tricuspid valve (AV valve) in s ~ 'L 4 D O a bicuspid valve (AV valve, mitral valve) right ventricle left ventricle Fig I...

Im, Jae Joong

1988-01-01

387

Arterial calcifications  

PubMed Central

Abstract Arterial calcifications as found with various imaging techniques, like plain X-ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP-2], RANKL) and inhibitory (matrix Gla protein, BMP-7, osteoprotegerin, fetuin-A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk. PMID:20716128

Rennenberg, Roger J M W; Schurgers, Leon J; Kroon, Abraham A; Stehouwer, Coen D A

2010-01-01

388

Cardiovascular calcification: an inflammatory disease.  

PubMed

Cardiovascular calcification is an independent risk factor for cardiovascular morbidity and mortality. This disease of dysregulated metabolism is no longer viewed as a passive degenerative disease, but instead as an active process triggered by pro-inflammatory cues. Furthermore, a positive feedback loop of calcification and inflammation is hypothesized to drive disease progression in arterial calcification. Both calcific aortic valve disease and atherosclerotic arterial calcification may possess similar underlying mechanisms. Early histopathological studies first highlighted the contribution of inflammation to cardiovascular calcification by demonstrating the accumulation of macrophages and T lymphocytes in `early' lesions within the aortic valves and arteries. A series of in vitro work followed, which gave a mechanistic insight into the stimulation of smooth muscle cells to undergo osteogenic differentiation and mineralization. The emergence of novel technology, in the form of animal models and more recently molecular imaging, has enabled accelerated progression of this field, by providing strong evidence regarding the concept of this disorder as an inflammatory disease. Although there are still gaps in our knowledge of the mechanisms behind this disorder, this review discusses the various studies that have helped form the concept of the inflammation-dependent cardiovascular calcification paradigm. PMID:21566338

New, Sophie E P; Aikawa, Elena

2011-01-01

389

Intraoperative transesophageal echocardiography for surgical repair of mitral regurgitation.  

PubMed

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

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

2014-04-01

390

Visualizing novel concepts of cardiovascular calcification  

PubMed Central

Cardiovascular calcification is currently viewed as an active disease process similar to embryonic bone formation. Cardiovascular calcification mainly affects the aortic valve and arteries and is associated with increased mortality risk. Aortic valve and arterial calcification share similar risk factors, including age, gender, diabetes, chronic renal disease, and smoking. However, the exact cellular and molecular mechanism of cardiovascular calcification is unknown. Late-stage cardiovascular calcification can be visualized with conventional imaging modalities such as echocardiography and computed tomography. However, these modalities are limited in their ability to detect the development of early calcification and the progression of calcification until advanced tissue mineralization is apparent. Due to the subsequent late diagnosis of cardiovascular calcification, treatment is usually comprised of invasive interventions such as surgery. The need to understand the process of calcification is therefore warranted and requires new imaging modalities which are able to visualize early cardiovascular calcification. This review focuses on the use of new imaging techniques to visualize novel concepts of cardiovascular calcification. PMID:23290463

Hjortnaes, Jesper; New, Sophie E.P.; Aikawa, Elena

2012-01-01

391

Quantitation of mitral regurgitation.  

PubMed

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

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

2011-01-01

392

Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound  

Microsoft Academic Search

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

L Hatle; A Brubakk; A Tromsdal; B Angelsen

1978-01-01

393

Large serpiginous thrombus straddling the patent foramen ovale and traversing through mitral and tricuspid valves into both ventricles: a therapeutic dilemma of impending paradoxical embolism and recurrent pulmonary embolism  

PubMed Central

A 51-year-old male with history of resected renal cell carcinoma and prior pulmonary embolism presented with tachypnea, tachycardia and progressive dyspnea on exertion. Chest computed tomography revealed bilateral acute pulmonary embolism. Transthoracic echocardiogram showed severe pulmonary hypertension with severe cor-pulmonale and presence of a large worm-like thrombus extending across the foramen ovale, entering both ventricles through the mitral and tricuspid valves. The risks of anti-coagulation, pharmacologic thrombolysis, and surgical thrombectomy, in a hemodynamically stable patient, posed a significant therapeutic dilemma. Ultimately, a collective decision was made to start anticoagulation, without incident. At 1 month follow up, complete resolution of the intracardiac thrombus, pulmonary hypertension, and cor-pulmonale were observed with full clinical recovery of the patient. PMID:25426234

Hamirani, Yasmin S.; Hnatiuk, Oleh; Pett, Stuart; Roldan, Carlos A.

2014-01-01

394

Experimental transapical endoscopic ventricular visualization and mitral repair.  

PubMed

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

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

2015-04-01

395

Unusual expression of Gaucher's disease: cardiovascular calcifications in three sibs homozygous for the D409H mutation.  

PubMed Central

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 replacement. Tissue was obtained from one of the sibs and fibroblast and liver beta-glucocerebrosidase activity was reduced to 4% and 11% of mean normal values. Genotype analysis indicated that the patient was homozygous for the D409H mutation. It is tempting to relate the phenotype of severe cardiac involvement to the D409H/D409H genotype, although further cases will be needed before this association can be confirmed. Images PMID:8544197

Chabás, A; Cormand, B; Grinberg, D; Burguera, J M; Balcells, S; Merino, J L; Mate, I; Sobrino, J A; Gonzàlez-Duarte, R; Vilageliu, L

1995-01-01

396

Transcatheter closure of an iatrogenic ventricular septal defect after SAPIEN valve implantation.  

PubMed

A 57-year-old woman developed progressive calcific mitral and aortic valve disease with a porcelain aorta secondary to a history of radiation therapy. She was considered a very poor operative candidate and referred for transcatheter aortic valve replacement (TAVR). Four weeks after extensive coronary artery stenting, a TAVR was performed with a 23 mm Edwards SAPIEN valve (Edwards Life Sciences, Irvine, CA) through a transapical approach. Post-operatively, her symptoms of dyspnea persisted and worsened. She was found to have an acquired ventricular septal defect (VSD) measuring 8 mm by 5 mm by transesophageal echocardiogram and by a CT angiogram. Percutaneous VSD closure was accomplished with an 8 mm Muscular VSD Occluder (St. Jude Medical, St. Paul, MN) with elimination of her shunt, improvement of her dyspnea, and marked improvement in exercise tolerance. © 2014 Wiley Periodicals, Inc. PMID:24753435

Levi, Daniel S; Salem, Morris; Suh, William

2015-02-15

397

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

PubMed Central

Recent developments in three-dimensional echocardiography have made it possible to obtain images in real time, without the need for off-line reconstruction. These developments have enabled the technique to become an important tool for both research and daily clinical practice. A substantial proportion of the studies carried out using three-dimensional echocardiography have focused on the mitral valve, the pathophysiology of mitral valve disease and, in particular, functional mitral regurgitation. The aims of this article were to review the contribution of three-dimensional echocardiography to understanding of the functional anatomy of the mitral valve and to summarize the resulting clinical applications and therapeutic implications. PMID:19232192

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

2010-01-01

398

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

Microsoft Academic Search

New approaches for the assessment of mitral regurgitation have focused on the quantification of the regurgitant flow volume, but they are accompanied by uncertainties. Recently, a control volume (CV) method applied via multi-slice and 3-directional magnetic resonance phase velocity mapping (MRPVM) sh