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1

Association of mitral annulus calcification, aortic valve sclerosis and aortic root calcification with abnormal myocardial perfusion single photon emission tomography in subjects age ?65 years old  

Microsoft Academic Search

OBJECTIVESWe examined the hypothesis that mitral annulus calcification (MAC), aortic valve sclerosis (AVS) and aortic root calcification (ARC) are associated with coronary artery disease (CAD) in subjects age ?65 years.BACKGROUNDMitral annulus calcification, AVS and ARC frequently coexist and are associated with coronary risk factors and CAD in the elderly.METHODSWe studied 338 subjects age ?65 years who underwent evaluation of chest

Doo-Soo Jeon; Shaul Atar; Andrea V Brasch; Huai Luo; James Mirocha; Tasneem Z Naqvi; Robert Kraus; Daniel S Berman; Robert J Siegel

2001-01-01

2

Calcific mitral stenosis in the hemodialysis patient.  

PubMed

The dialysis patient is prone to elevations in the calcium phosphorus product and hyperparathyroidism, which contributes to valvular and vascular calcification. We present the case of a young lady on chronic dialysis that developed mitral calcification complicated by severe mitral stenosis, caseous calcification and retinal embolization. She subsequently required mitral valve replacement. PMID:24015751

Sequeira, Adrian; Morris, Liam; Patel, Brijesh; Duvall, Lucas; Gali, Deepa; Menendez, Denisse; Alexander, Guy

2014-01-01

3

Near-infrared Raman spectroscopy to detect the calcification of the annular mitral valve  

NASA Astrophysics Data System (ADS)

Cardiac valves are subjected to high repetitive mechanical stresses, particularly at the hinge points of the cusps and leaflets due to the over 40 millions cardiac cycles per year. These delicate structures can suffer cumulative lesions, complicated by the deposition of calcium phosphate mineral, which may lead to clinically important disease. Near Infrared Raman Spectroscopy gives important information about biological tissues composition and it is being used for diagnosis of some pathologies. The aim of this work was to detect trough the use of the Raman Spectroscopy technique the mitral annular calcification. A Ti:sapphire laser operating at the near infrared wavelength of 785 nm was used for the excitation of the valve samples and the Raman radiation was detected by an optical spectrometer with a CCD liquid nitrogen cooled detector. In all, ten samples of normal and pathologic tissues were studied. They were approximately squared with the lateral size of 5 mm. It was observed that the Raman spectrum of the calcified mitral valve showed different behavior, when compared to normal tissues. Results indicate that this technique could be used to detect the deposition of the calcium phosphate mineral over the mitral valve.

Rocha, Rick; Otero, E. P.; Costa, M. S.; Villaverde, Antonio G. J. B.; Pomerarantzeff, P. M.; Pacheco, Marcos T. T.

2004-10-01

4

Mitral and aortic valve sclerosis/calcification and carotid atherosclerosis: results from 1065 patients.  

PubMed

This study assesses whether aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are associated with carotid artery atherosclerosis, independently of traditional cardiovascular risk factors. A total of 1065 patients underwent both echocardiography and carotid artery ultrasound scanning. AVS and MAC were defined as focal areas of increased echogenicity and thickening of the aortic leaflets or mitral valve annulus. Carotid artery atherosclerosis was defined as presence/absence of any atherosclerotic plaque or presence/absence of plaque >50 %. Of 1065 patients (65 ± 9 years; 38 % female) who comprised the study population, 642 (60 %) had at least one atherosclerotic plaque. AVS, but not mitral valve sclerosis; was associated with the presence of carotid atherosclerosis (odds ratio (OR) 1.9, 95 % confidence interval (CI) 1.2-3.9; P = 0.005) and the degree of carotid atherosclerosis (OR 2.1, 95 % CI 1.2-3.9; P = 0.01) in a multivariate model including age, gender, previous ischemic heart disease, hypertension, dyslipidemia, smoking, diabetes, family cardiovascular history, left ventricular size, mass, and ejection fraction, and left atrial size. AVS is a significant predictor of carotid atherosclerosis, independently of other cardiovascular clinical and echocardiographic risk factors. PMID:24196525

Rossi, Andrea; Faggiano, Pompilio; Amado, Alexandra E; Cicoira, Mariantonietta; Bonapace, Stefano; Franceschini, Lorenzo; Dini, Frank L; Ghio, Stefano; Agricola, Eustachio; Temporelli, Pier Luigi; Vassanelli, Corrado

2014-11-01

5

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

6

Caseous calcification of the mitral annulus.  

PubMed

A 61-year-old asymptomatic woman was referred for echocardiography to evaluate recently detected systolic murmur. Transthoracic echocardiography revealed an echodense obstructive mass in the left ventricular outflow tract of unclear origin. Subsequent transesophageal echo suggested an intracardiac calcified tumor and recommended surgical excision. Contrast-enhanced cardiac computed tomography (CT) confirmed a well-defined lobulated mass adherent to the anterior mitral valve leaflet, the non-enhanced scout view revealed marked hyper-attenuation confirming diffuse calcification. Caseous calcification was diagnosed and surgery was deferred. Caseous calcification is typically benign and most commonly involves the posterior mitral annulus. Our patient displayed an atypical location of exuberant mitral annular calcification. PMID:24282757

Plank, Fabian; Al-Hassan, Donya; Nguyen, Giang; Raju, Rekha; Wheeler, Miriam; Thompson, Chris; Hague, Cameron; Leipsic, Jonathon

2013-06-01

7

Mitral valve surgery - open  

MedlinePLUS

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

8

Mitral Valve Prolapse  

MedlinePLUS

... are "floppy" and don't close tightly. Most people who have the condition are born with it. ... dizziness, or anxiety Migraine headaches Chest discomfort Most people who have mitral valve prolapse (MVP) don't ...

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 Prolapse  

MedlinePLUS

... are connected to wires and a machine that records the electricity coming from your heart. The machine ... you can still be the MVP (most valuable player) even if you have MVP (mitral valve prolapse)! ...

11

Living with Mitral Valve Prolapse  

MedlinePLUS

... Tumblr. Share this page from the NHLBI on Twitter. Living With Mitral Valve Prolapse Most people who have mitral valve prolapse (MVP) have no symptoms or related problems, need no treatment, and are able to lead ...

12

Near-infrared Raman spectroscopy to detect the calcification of the annular mitral valve  

Microsoft Academic Search

Cardiac valves are subjected to high repetitive mechanical stresses, particularly at the hinge points of the cusps and leaflets due to the over 40 millions cardiac cycles per year. These delicate structures can suffer cumulative lesions, complicated by the deposition of calcium phosphate mineral, which may lead to clinically important disease. Near Infrared Raman Spectroscopy gives important information about biological

Rick Rocha; E. P. Otero; M. S. Costa; Antonio G. J. B. Villaverde; P. M. Pomerarantzeff; Marcos T. T. Pacheco

2004-01-01

13

Caseous calcification of the mitral annulus: a review.  

PubMed

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC). Since most cardiologists are unfamiliar with CCMA, it is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. In most cases, conservative management for this lesion is sufficient. In this review, we will discuss the various aspects of this condition and illustrate the gross and histologic pathology as well as various imaging modalities (Ultrasound, Computed tomography, Cardiac Magnetic resonance) to assess this unusual cardiac mass. PMID:24038099

Elgendy, Islam Y; Conti, C Richard

2013-10-01

14

Mitral Valve Prolapse  

MedlinePLUS

... from flowing back into the atria. For more information, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works. Mitral Valve Prolapse In MVP, when the ...

15

[Imaging in mitral valve interventions].  

PubMed

Percutaneous cardiac valve interventions have significantly extended the therapeutic options for patients with diseased cardiac valves. Technical miniaturization and major advancements in cardiac imaging techniques are the cornerstones of this successful development. Regarding mitral valve interventions periprocedural echocardiography in particular is of uttermost importance. This review describes the state of the art echocardiographic imaging techniques focusing on the clinically established mitral valve interventions: MitraClip® implantation, percutaneous closure of periprosthetic leaks and mitral balloon valvuloplasty. PMID:23838846

Kreidel, F; Alessandrini, H; Frerker, C; Thielsen, T; Schäfer, U; Kuck, K H

2013-08-01

16

Mitral Valve Annuloplasty  

PubMed Central

Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. Here we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted eleven flexible-incomplete, eleven semi-rigid-complete, and twelve rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally-spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably reduced annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials. PMID:22037916

Rausch, Manuel K.; Bothe, Wolfgang; Kvitting, John-Peder Escobar; Swanson, Julia C.; Miller, D. Craig; Kuhl, Ellen

2012-01-01

17

Bicuspid aortic valve endocarditis complicated by mitral valve aneurysm.  

PubMed

We describe a case of mitral valve aneurysm associated with concomitant aortic valve endocarditis. Aneurysms appear as a localized saccular bulge of the anterior leaflet into the left atrium and thus are often misdiagnosed as mitral valve prolapse, myxomatous mitral valve, or atrial myxoma. The presentation and management of mitral valve aneurysms are the subject of this case report.? PMID:21447085

Ruparelia, Neil; Lawrence, David; Elkington, Andrew

2011-05-01

18

Mitral valve surgery - minimally invasive  

MedlinePLUS

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

19

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

20

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

Microsoft Academic Search

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

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

1988-01-01

21

Caseous calcification of the mitral annulus on MDCT: a rare intracardiac mass  

PubMed Central

Caseous calcification of the mitral annulus is a rare form of chronic degenerative process in the mitral valve fibrous ring with a mass-like appearance that has to be in the differential of the radiologist and cardiologist. We present the case of an 82-year-old woman in whom a tumor-like calcified mass in the posterior side of the mitral valve annulus was detected at echocardiography, and the diagnosis of caseous calcification was confirmed on multidetector computed tomography (MDCT). The diagnostic features of this rare cardiac mass are described. PMID:24349713

Limeme, Manel; Zaghouani, Houneida; Mootemri, Feriel; Majdoub, Senda; Amara, Habib; Bakir, Dejla; Kraiem, Chakib

2013-01-01

22

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. ©RSNA, 2014. 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

23

Leakage test during mitral valve repair.  

PubMed

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

Watanabe, Taiju; Arai, Hirokuni

2014-11-01

24

Prosthetic Mitral Valve Leaflet Escape  

PubMed Central

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

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

2013-01-01

25

Unique mitral valve mass: Think beyond vegetation  

PubMed Central

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

Farhoud, Mahmoud; Bakdash, Husam

2014-01-01

26

Mitral valve repair in heart failure  

Microsoft Academic Search

Mitral regurgitation MR is a frequent complication of end-stage heart failure. Historically, these patients were either managed medically or with mitral valve replacement, both associated with poor outcomes. Mitral valve repair via an 'undersized' annuloplasty repair is safe and effectively corrects MR in heart-failure patients. All of the observed changes contribute to reverse remodeling and restoration of the normal left-ventricular

Iva A. Smolens; Francis D. Pagani; Steven F. BollingU

2000-01-01

27

A complicated case of mitral valve disease.  

PubMed Central

A patient with rheumatic mitral stenosis and previous cerebral embolism had a myocardial infarction during cardiac catheterisation. She later developed severe mitral regurgitation one year after open valvotomy and at valve replacement was found to have a papillary tumour of the mitral valve. Unexplained low cardiac output occurred four days after operation. Postmortem examination showed thrombotic occlusion of the xenograft prosthesis, a complication not previously seen with tissue valves. Both of these rare events were suggested by the patient's clinical course and could have been diagnosed with cross sectional echocardiography. Images PMID:3970791

James, S E; McKay, R; Ross, D N

1985-01-01

28

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

PubMed Central

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

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

2014-01-01

29

A simplified model for mitral valve dynamics.  

PubMed

Located between the left atrium and the left ventricle, the mitral valve controls flow between these two cardiac chambers. Mitral valve dysfunction is a major cause of cardiac dysfunction and its dynamics are little known. A simple non-linear rotational spring model is developed and implemented to capture the dynamics of the mitral valve. A measured pressure difference curve was used as the input into the model, which represents an applied torque to the anatomical valve chords. A range of mechanical model hysteresis states were investigated to find a model that best matches reported animal data of chord movement during a heartbeat. The study is limited by the use of one dataset found in the literature due to the highly invasive nature of getting this data. However, results clearly highlight fundamental physiological issues, such as the damping and chord stiffness changing within one cardiac cycle, that would be directly represented in any mitral valve model and affect behaviour in dysfunction. Very good correlation was achieved between modeled and experimental valve angle with 1-10% absolute error in the best case, indicating good promise for future simulation of cardiac valvular dysfunction, such as mitral regurgitation or stenosis. In particular, the model provides a pathway to capturing these dysfunctions in terms of modeled stiffness or elastance that can be directly related to anatomical, structural defects and dysfunction. PMID:22119761

Moorhead, K T; Paeme, S; Chase, J G; Kolh, P; Pierard, L; Hann, C E; Dauby, P C; Desaive, T

2013-02-01

30

Obstructive bioprosthetic mitral valve thrombus: Management options?  

PubMed

Bioprosthetic valve thrombosis is an extremely rare event, therefore, long-term anticoagulation can be avoided. There is limited experience in the diagnosis and treatment of such a situation. We present the case of a patient with a porcine mitral bioprosthesis who presented with acute pulmonary edema, likely secondary to obstructive valve thrombosis. A favorable outcome was observed after conservative anticoagulant treatment. PMID:24887839

Alshehri, Halia Z; Ismail, Magdi; Ibrahim, Mohamed F

2014-10-01

31

Late clinical and echocardiographic follow up after percutaneous balloon dilatation of the mitral valve.  

PubMed Central

OBJECTIVE--To assess the outcome after attempted percutaneous balloon dilatation of the mitral valve in patients with severe mitral stenosis between February 1986 and June 1992. DESIGN--Clinical state, mitral valve area, and restenosis at follow up were analysed. Mitral valve area as determined by the Gorlin formula, planimetry, and Doppler methods was compared before and after dilatation and at follow up. SETTING--University hospital. PATIENTS--176 patients had serial clinical and Doppler echocardiographic follow up and 44 of them also underwent recatheterisation. RESULT--At follow up 93% of patients were in New York Heart Association functional class I or class II. Mitral valve area (planimetry) increased from 0.97(0.24) cm2 before to 1.86(0.39) cm2 after dilatation (p = 0.0001) and then decreased to 1.72(0.39) cm2 at follow up (p < 0.001); mitral valve area (Doppler) increased from 1.01 (0.24) to 1.89 (0.42) cm2 (p = 0.0001) and then decreased to 1.78(0.40) cm2 (p < 0.05). The overall restenosis rate was 15% and over 90% of the patients were free from cardiovascular events. Age, valvar calcification, echocardiographic score, and mitral valve area after dilatation were found to be determinant predictors of restenosis. In patients who underwent recatheterisation, mitral valve area by the Gorlin method at follow up was comparable with that by planimetry and Doppler methods whereas a significant discrepancy between the three methods was noted immediately after dilatation. CONCLUSION--Balloon dilatation of the mitral valve provided sustained anatomical and functional improvement in over 80% of patients at late follow up. Older age, heavy calcification, high echocardiographic score, and suboptimal immediate results are significant predictors of restenosis. Doppler echocardiographic examination is the procedure of choice for follow up evaluation. PMID:8011410

Ruiz, C. E.; Zhang, H. P.; Gamra, H.; Allen, J. W.; Lau, F. Y.

1994-01-01

32

Recommended transoesophageal echocardiographic evaluation of mitral valve regurgitation  

PubMed Central

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

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

2006-01-01

33

Cross-sectional survey on minimally invasive mitral valve surgery  

PubMed Central

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

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

2013-01-01

34

Mitral valve lipomatous hamartoma: a rare entity.  

PubMed

Lipomatous hamartoma of cardiac valves is a very rare entity, with only three reported cases in children. We describe the case of a 9-year-old girl with a mass in the mitral valve, which was detected in an echocardiogram performed for heart murmur investigation. At surgery, a white round-shaped tumour was removed and histopathological examination revealed a lipomatous hamartoma. PMID:24044592

Francisco, Andreia; Gouveia, Rosa; Anjos, Rui

2014-10-01

35

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

36

Caseous calcification of the mitral annulus: case report.  

PubMed

We present a rare case of probable caseous calcification of the mitral. This pathology is more frequently detected in asymptomatic women older than 70 years. To recognize this image is important because echocardiography is the easiest way to elucidate this diagnosis, and more importantly because this structure could be easily misdiagnosed as tumors, thrombus and vegetations, which are much more common. Normally, it has a benign evolution, and the correct diagnosis is crucial to avoid unnecessary surgical interventions. PMID:24136767

França, Lucas Arraes de; Rodrigues, Ana Clara Tude; Vieira, Marcelo Luiz Campos; Oliveira, Wércules Antônio Alves de; Azevedo, Rudyney Eduardo Uchôa de; Cordovil, Adriana; Lira-Filho, Edgar Bezerra de; Fischer, Claudio Henrique; Morhy, Samira Saady

2013-01-01

37

Robotically assisted minimally invasive mitral valve surgery.  

PubMed

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

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

2013-11-01

38

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

39

The genetics of mitral valve prolapse.  

PubMed

Mitral valve prolapse (MVP) is a very common clinical condition that refers to a systolic billowing of one or both mitral valve leaflets into the left atrium. Improvements of echocardiographic techniques and new insights in mitral valve anatomy and physiology have rendered the diagnosis of this condition more accurate and reliable. MVP can be sporadic or familial, demonstrating autosomal dominant and X-linked inheritance. Three different loci on chromosomes 16, 11 and 13 have been found to be linked to MVP, but no specific gene has been described. Another locus on chromosome X was found to cosegregate with a rare form of MVP called 'X-linked myxomatous valvular dystrophy'. MVP is more frequent in patients with connective tissue disorders including Marfan syndrome, Ehlers-Danlos and osteogenesis imperfecta. The purpose of this review is to describe previous studies on the genetics and prevalence of MVP. The report warrants the need for further genetically based studies on this common, albeit not fully understood, clinical entity. PMID:17850623

Grau, J B; Pirelli, L; Yu, P-J; Galloway, A C; Ostrer, H

2007-10-01

40

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

PubMed Central

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

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

2012-01-01

41

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

42

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

PubMed

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

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

2014-01-01

43

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

44

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

45

Minimally invasive surgery of mitral valve (MIS-MV).  

PubMed

Following the revision of the therapeutic guideline of ACC/AHA in (Circulation 114:450-527, 2006), the incidence of mitral valve repair in asymptomatic patients with moderate or severe mitral valve regurgitation has increased. For mitral valve repair, the quality and outcomes as well as lower invasive procedure are important to obtain the confidence of cardiologists and ensure request of early phase operation from cardiologists. With recent innovations of technologies and the development of revolutionary techniques, minimally invasive surgery of the mitral valve (MIS-MV) has become a widespread surgical option of mitral valve repair. It is vital, however, that careful preoperative assessment, and planning of the approach and perfusion strategy are put in place to perform MIS-MV safely. PMID:24722958

Kudo, Mikihiko; Yozu, Ryohei

2014-06-01

46

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.

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

2014-01-01

47

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

48

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

49

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

50

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.

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

2014-01-01

51

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

52

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

53

Quality of life in children following mitral valve replacement  

Microsoft Academic Search

OBJECTIVETo measure the health related quality of life (QoL) following mitral valve replacement in childhood.DESIGNCross sectional study.SETTINGTertiary referral centre.METHODS19 patients, median age (range) 14.4 (9.7–25.4) years, were studied at a median of 7.6 (0.5–11.2) years after their most recent mitral valve replacement. General health status was measured using age specific validated questionnaires. Ten children aged between 9–15 years completed the

C van Doorn; R Yates; A Tunstill; M Elliott

2000-01-01

54

Preservation of left ventricular function in mitral valve surgery.  

PubMed Central

Surgery for degenerative mitral regurgitation has become complex. Preservation of annulo-ventricular continuity through the chordae tendineae is an important determinant of operative survival, postoperative left ventricular function, long-term survival, and quality of life. Some cardiologists believe that NYHA I function is never achieved after conventional mitral replacement with chordal transection. Valve repair is the procedure of choice but when valve replacement is inevitable every effort should be made to preserve the posterior leaflet and its chordal attachments. Valve replacement with preservation of the subvalvar apparatus provides a functional outcome similar to that after valve repair but usually leads to life long anti-coagulation. Images PMID:8705754

Westaby, S.

1996-01-01

55

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

PubMed

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

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

2011-09-01

56

How to start a minimal access mitral valve program.  

PubMed

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

Hunter, Steven

2013-11-01

57

Infective endocarditis and caseous calcification of the mitral annulus: the odd couple.  

PubMed

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis. PMID:24780164

Capín, Esmeralda; León, Diego; Rodríguez, María Luisa; Corros, Cecilia; García-Campos, Ana; de la Hera, Jesús; Martín, María

2014-01-01

58

Totally endoscopic mitral valve repair: a case report.  

PubMed

Minimum incision techniques in cardiac surgery have been on the rise after their inclusion in videothoracoscopy. Video-assisted minimally invasive cardiac surgery is considered by many centers in the world to be the approach of choice for treatment of mitral and aortic valve diseases. The aim of this is study is to report a case of valve repair in a patient with mitral restenosis after surgical repair 12 years before. Through a minimally invasive and totally endoscopic procedure, it was possible to successfully perform a mitral commissurotomy with only videoscopic support, and without any incisions larger than those needed to introduce the trocars for instrumentation. PMID:19082332

Fortunato Júnior, Jeronimo Antonio; Branco Filho, Alcides D; Branco, Anibal; Martins, André Luiz M; Pereira, Marcelo

2008-01-01

59

Underestimation of prosthetic mitral valve areas: role of transseptal catheterization in avoiding unnecessary repeat mitral valve surgery.  

PubMed

In patients with symptoms of heart failure after mitral valve replacement, identification of a stenosed prosthesis may be difficult. Twelve such patients were evaluated, presenting at a mean of 8.4 years after mitral valve replacement (four mechanical, eight porcine). Transvalvular pressure gradients were obtained using both indirect (pulmonary capillary wedge) and direct (transseptal catheterization) measurements of left atrial pressure. In all 12 patients, the diastolic gradient across the prosthetic valve was overestimated when pulmonary wedge rather than transseptal measurements were used. Calculated mitral valve prosthetic area was underestimated by the pulmonary wedge determinations. These findings may be caused by either the phase delay of the pulmonary wedge V wave relative to the transseptal V wave, resulting in a higher diastolic mean left atrial pressure, or the faulty wedge determinations in the setting of pulmonary hypertension, or both. In patients being considered for repeat mitral valve replacement because of prosthetic valve stenosis, transseptal catheterization allows for more accurate determination of prosthetic valve area and more accurately defines the need for repeat mitral valve surgery. PMID:3998319

Schoenfeld, M H; Palacios, I F; Hutter, A M; Jacoby, S S; Block, P C

1985-06-01

60

Evaluation of mitral valve replacement anchoring in a phantom  

NASA Astrophysics Data System (ADS)

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

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

2012-02-01

61

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

PubMed Central

Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral valve area, left atrial volume, transmitral pressure difference, pulmonary artery pressure, cardiac output, cardiac rhythm, New York Heart Association functional class, age, and sex were also studied. Because there was some increase in valve area in almost all patients the results were classified as optimal or suboptimal (final valve area less than 1.0 cm2, final left atrial pressure greater than 10 mm Hg, or final valve area less than 25% greater than the initial area). The best multiple logistic regression fit was found with the total echocardiographic score alone. A high score (advanced leaflet deformity) was associated with a suboptimal outcome while a low score (a mobile valve with limited thickening) was associated with an optimal outcome. No other haemodynamic or clinical variables emerged as predictors of outcome in this analysis. Examination of pre-dilatation and post-dilatation echocardiograms showed that balloon dilatation reliably resulted in cleavage of the commissural plane and thus an increase in valve area. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 6 PMID:3190958

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

1988-01-01

62

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

63

Is Rheumatic Mitral Valve Repair Still a Feasible Alternative?  

PubMed Central

Rheumatic heart disease is still a major cause of mitral valve dysfunction in developing countries. We present our early results of rheumatic mitral valve repair. From August 2009 through July 2011, 60 patients (24 male and 36 female) with rheumatic disease underwent mitral repair. The mean age was 51.1 ± 13.8 years (range, 16–77 yr). Forty-nine patients were in New York Heart Association functional class III or IV. Repair procedures included chordal and papillary muscle splitting, secondary chordal division, mitral ring annuloplasty (n=58), commissurotomy (n=36), chordal replacement (n=9), posterior leaflet extension (n=4), annular decalcification (n=2), and quadrangular resection (n=2). Secondary procedures included tricuspid ring annuloplasty, left atrial ablation, obliteration of left atrial appendage, aortic valve replacement, and left atrial reduction. The early (30-d) mortality rate was 1.7%. The mean follow-up time was 14.9 ± 5 months (range, 4–26 mo). Follow-up echocardiography revealed trivial or no mitral regurgitation (MR) in 35.5% and mild (1+) MR in 49.1% of patients. Only 1 patient presented with severe (3+) MR. The mean MR grade decreased from 3.2 ± 0.9 to 0.3 ± 0.4 postoperatively (P=0.001). Left ventricular end-diastolic diameter and left atrial diameter significantly decreased postoperatively (P=0.006 and P=0.001, respectively). The mean gradient over the mitral valve decreased significantly from 11 ± 5.9 mmHg to 3.5 ± 1.8 mmHg (P=0.001). Because current techniques of mitral repair can effectively correct valve dysfunction in most patients with rheumatic disease, the number of repair procedures should be increased in developing countries to prevent complications of mechanical valve placement. PMID:23678214

Bakir, Ihsan; Onan, Burak; Onan, Ismihan Selen; Gul, Mehmet; Uslu, Nevzat

2013-01-01

64

Association between neutrophil-lymphocyte ratio and mitral annular calcification.  

PubMed

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

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

2014-09-01

65

ECG-Gated MDCT After Aortic and Mitral Valve Surgery.  

PubMed

OBJECTIVE. The purpose of this article is to review the utility of ECG-gated MDCT in evaluating postsurgical findings in aortic and mitral valves. Normal and pathologic findings after aortic and mitral valve corrective surgery are shown in correlation with the findings of the traditionally used imaging modalities echocardiography and fluoroscopy to assist in accurate noninvasive anatomic and dynamic evaluation of postsurgical valvular abnormalities. CONCLUSION. Because of its superior spatial and adequate temporal resolution, ECG-gated MDCT has emerged as a robust diagnostic tool in the evaluation and treatment of patients with postsurgical valvular abnormalities. PMID:25415724

Ghersin, Eduard; Martinez, Claudia A; Singh, Vikas; Fishman, Joel E; Macon, Conrad J; Runco Therrien, Jennifer E; Litmanovich, Diana E

2014-12-01

66

Devised loop-in-loop technique in mitral valve repair.  

PubMed

The loop technique is useful for multiple chordal reconstructions in mitral valve repair. Although it is easy to anchor the loop to the tip of the prolapsed leaflet, take-down of the anchored loop is not easy. The devised loop-in-loop technique makes intraoperative adjustment of the neochordae quick and easy. This article describes a straightforward and reproducible method for secure anchoring and, if necessary, take-down of neochordae using the loop-in-loop technique for mitral valve repair. PMID:24887864

Tokunaga, Shigehiko; Yasuda, Shota; Masuda, Munetaka

2014-11-01

67

Relationships of Mitral Annular Calcification to Cardiovascular Risk Factors: The Multi-Ethnic Study of Atherosclerosis (MESA)  

PubMed Central

Background Mitral annular calcification (MAC) is a fibrous, degenerative calcification of the mitral valve. The relationship between MAC and cardiovascular disease (CVD) risk factors is not well defined. Thus, we performed a cross-sectional study to determine which CVD risk factors are independently associated with MAC in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods MESA includes 6,814 women and men ages 45–84 years old without apparent CVD in 4 ethnic groups (12% Chinese, 38% Caucasian, 22% Hispanic, and 28% African-American). MAC was defined by presence of calcium in the mitral annulus by cardiac computed tomography at enrollment. Multivariable logistic regression was used to evaluate relationships between MAC and CVD risk factors. Results The overall prevalence of MAC was 9%. The prevalence of MAC was highest in Caucasians (12%), followed by Hispanics (10%), African Americans (7%) and was lowest in Chinese (5%). Characteristics associated with MAC included age (p<0.01), female gender (p<0.01), increased body mass index (BMI) (p=0.03), and former smoking status (p<0.008). The MAC group had a higher prevalence of hypertension, diabetes mellitus (DM), and family history of heart attack (all p<0.001). After adjusting for all variables, age, female gender, diabetes mellitus, and increased BMI remained strongly associated with MAC. Conclusions Age, female gender, DM, and increased BMI were significantly associated with MAC. Prevalence of MAC was strongly associated with female gender and increasing age in all ethnicities. PMID:20926076

Kanjanauthai, Somsupha; Nasir, Khurram; Katz, Ronit; Rivera, Juan J.; Takasu, Junichiro; Blumenthal, Roger S.; Eng, John; Budoff, Matthew J.

2010-01-01

68

Phonocardiogram spectral analysis simulator of mitral valve prostheses.  

PubMed

Spectral analysis of sounds produced in vitro by mitral valve prostheses placed in a specially designed flow simulator has been carried out using a short-time Fourier representation of the recorded signal. Time variations of power spectra are displayed as a three-dimensional plot. Sounds produced by three types of valves, namely ball and cage, tilting disk and porcine valves, were analysed. Each valve type produced a characteristic spectrogram, and, for a given valve, spectrograms were reproducible to within a margin of 5 dB. The simulator may be used to detect structural deficiencies and functional abnormalities of prosthetic heart valves. In addition to quantifying the noise level of mechanical valves, the system may be used for quality control purposes to identify faulty valves. PMID:1818227

Picard, D; Charara, J; Guidoin, R; Haggag, Y; Poussart, D; Walker, D; How, T

1991-01-01

69

Mechanics of the mitral valve strut chordae insertion region.  

PubMed

Interest in developing durable mitral valve repair methods is growing, underscoring the need to better understand the native mitral valve mechanics. In this study, the authors investigate the dynamic deformation of the mitral valve strut chordae-to-anterior leaflet transition zone using a novel stretch mapping method and report the complex mechanics of this region for the first time. Eight structurally normal porcine mitral valves were studied in a pulsatile left heart simulator under physiological hemodynamic conditions -120 mm peak transvalvular pressure, 5 l/min cardiac output at 70 bpm. The chordal insertion region was marked with a structured array of 31 miniature markers, and their motions throughout the cardiac cycle were tracked using two high speed cameras. 3D marker coordinates were calculated using direct linear transformation, and a second order continuous surface was fit to the marker cloud at each time frame. Average areal stretch, principal stretch magnitudes and directions, and stretch rates were computed, and temporal changes in each parameter were mapped over the insertion region. Stretch distribution was heterogeneous over the entire strut chordae insertion region, with the highest magnitudes along the edges of the chordal insertion region and the least along the axis of the strut chordae. At early systole, radial stretch was predominant, but by mid systole, significant stretch was observed in both radial and circumferential directions. The compressive stretches measured during systole indicate a strong coupling between the two principal directions, explaining the small magnitude of the systolic areal stretch. This study for the first time provides the dynamic kinematics of the strut chordae insertion region in the functioning mitral valve. A heterogeneous stretch pattern was measured, with the mechanics of this region governed by the complex underlying collagen architecture. The insertion region seemed to be under stretch during both systole and diastole, indicating a transfer of forces from the leaflets to the chordae and vice versa throughout the cardiac cycle, and demonstrating its role in optimal valve function. PMID:20670053

Padala, Muralidhar; Sacks, Michael S; Liou, Shasan W; Balachandran, Kartik; He, Zhaoming; Yoganathan, Ajit P

2010-08-01

70

Surgical phantom for off-pump mitral valve replacement  

NASA Astrophysics Data System (ADS)

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

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

2011-03-01

71

Minimally Invasive Mitral Valve Surgery: A Systematic Review  

PubMed Central

In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival. PMID:23606959

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

2013-01-01

72

Joint hypermobility syndrome and mitral valve prolapse in panic disorder  

Microsoft Academic Search

Objective: The purpose of this study is to test the association between joint hypermobility syndrome (JHS) and panic disorder (PD) and to determine whether mitral valve prolapse (MVP) modifies or accounts in part for the association. Method: A total of 115 subjects are included in this study in three groups. Group I (n=42): panic disorder patients with MVP. Group II

Demet Gulpek; Erhan Bayraktar; Sebnem Pirildar Akbay; Kazým Capaci; Meral Kayikcioglu; Emil Aliyev; Cahide Soydas

2004-01-01

73

Joint hypermobility in primary mitral valve prolapse patients  

Microsoft Academic Search

Summary  Twenty-seven patients with echocardiographic evidence of primary mitral valve prolapse (MVP) were tested for the presence of joint hypermobility using the criteria of Beighton and Horan. In the examined group, joint hypermobility was found in 14 patients (52%). This occurrence was statistically significant. In patients with simultaneous occurrence of MVP and articular hypermobility we have found a number of pathologic

M. Ondrašík; I. Rybár; V. Rus; V. Bošák

1988-01-01

74

Custodiol HTK cardioplegia use in robotic mitral valve.  

PubMed

Robotic surgery is a growing subspecialty in cardiac surgery. Custodiol HTK cardioplegia offers long-term myocardial protection, decreased metabolism, and eliminates multiple cardioplegia dosing. This article reviews the technique, strategy, and considerations for use of Custodiol HTK for myocardial protection in robotic mitral valve surgery. PMID:23930386

Patel, Nirav; DeLaney, Ed; Turi, Gerard; Stapleton, Thomas

2013-06-01

75

Hemolytic anemia associated with heterograft replacement of the mitral valve.  

PubMed

The first case of overt hemolytic anemia following mitral valve replacement with a porcine heterograft is reported. Cardiac catheterization failed to reveal a paravalvular leak or valvular incompetence to account for the hemolysis. Red cell traumatization by the Dacron-covered Stellite ring and stent is suggested as the cause of hemolysis with the porcine heterograft. PMID:567264

Myers, T J; Hild, D H; Rinaldi, M J

1978-08-01

76

The mitral valve prolapse epidemic: fact or fiction.  

PubMed Central

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

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

1987-01-01

77

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

78

Mitral Valve Arcade with Concomitant Anomalous Left Coronary Artery from the Pulmonary Artery  

Microsoft Academic Search

The presence of congenital mitral valve arcade with concomitant anomalous coronary artery arising from the pulmonary artery (ALCAPA) is exceedingly rare. We describe a case of a 5-month-old female patient with both ALCAPA and severe mitral regurgitation secondary to mitral valve arcade.

Lowell S. Su; Harold M. Burkhart; Patrick W. O’Leary; Joseph A. Dearani

79

Mitral valve arcade with concomitant anomalous left coronary artery from the pulmonary artery.  

PubMed

The presence of congenital mitral valve arcade with concomitant anomalous coronary artery arising from the pulmonary artery (ALCAPA) is exceedingly rare. We describe a case of a 5-month-old female patient with both ALCAPA and severe mitral regurgitation secondary to mitral valve arcade. PMID:22115268

Su, Lowell S; Burkhart, Harold M; O'Leary, Patrick W; Dearani, Joseph A

2011-12-01

80

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

Microsoft Academic Search

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

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

1995-01-01

81

Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis.  

PubMed

Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 +/-10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 +/-2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity. PMID:17626989

Boyaci, Ayca; Gokce, V; Topaloglu, Serkan; Korkmaz, Sule; Goksel, Siber

2007-01-01

82

How Is Mitral Valve Prolapse Treated?  

MedlinePLUS

... is less likely than replacement to weaken the heart. Repair also lowers the risk of infection and decreases the need for lifelong use of blood-thinning medicines. If repair isn't an option, the valve can be replaced. Mechanical and biological valves are used as replacement valves. ...

83

Percutaneous Mitral Heart Valve Repair-MitraClip.  

PubMed

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

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

2014-01-01

84

Accessory mitral valve tissue: an unusual cause of congenital mitral stenosis  

PubMed Central

Accessory mitral valve tissue (AMVT) is a rare congenital anomaly of endocardial cushion. Usually, it arises from the anterior mitral leaflet and causes the left ventricular outflow tract obstruction. We report here the first and a rarest presentation of the AMVT in a 19-year old female patient diagnosed to have double outlet right ventricle, ventricular septal defect (VSD), infundibular stenosis and congenital mitral stenosis (MS). She presented with a history of shortness of breath and chest pain over 3 years. Diagnosis was made by chest X-ray, transthoracic and transoesophageal echocardiography, which was confirmed by cardiac catheterization, and angiography. A successful closure of the VSD with excision of the right ventricular bundle and excision of the AMVT was done. Post-operative course was uneventful and an echocardiogram before the discharge showed no residual shunt, no right ventricular outflow gradient or mitral regurgitation, and the gradient across the mitral valve was 5/3 mmHg. We emphasize that, although AMVT commonly produces left ventricular outflow tract obstruction, it should be considered a rare but an important cause of congenital MS. PMID:22108926

Rao, Nageswar; Gajjar, Trushar; Desai, Neelam

2012-01-01

85

Accessory mitral valve tissue: an unusual cause of congenital mitral stenosis.  

PubMed

Accessory mitral valve tissue (AMVT) is a rare congenital anomaly of endocardial cushion. Usually, it arises from the anterior mitral leaflet and causes the left ventricular outflow tract obstruction. We report here the first and a rarest presentation of the AMVT in a 19-year old female patient diagnosed to have double outlet right ventricle, ventricular septal defect (VSD), infundibular stenosis and congenital mitral stenosis (MS). She presented with a history of shortness of breath and chest pain over 3 years. Diagnosis was made by chest X-ray, transthoracic and transoesophageal echocardiography, which was confirmed by cardiac catheterization, and angiography. A successful closure of the VSD with excision of the right ventricular bundle and excision of the AMVT was done. Post-operative course was uneventful and an echocardiogram before the discharge showed no residual shunt, no right ventricular outflow gradient or mitral regurgitation, and the gradient across the mitral valve was 5/3 mmHg. We emphasize that, although AMVT commonly produces left ventricular outflow tract obstruction, it should be considered a rare but an important cause of congenital MS. PMID:22108926

Rao, Nageswar; Gajjar, Trushar; Desai, Neelam

2012-01-01

86

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

87

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

Microsoft Academic Search

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

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

1997-01-01

88

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

89

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

90

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

PubMed Central

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

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

2009-01-01

91

Myxomatous mitral valve disease bench to bedside: LDL-density-pressure regulates Lrp5  

PubMed Central

The myxomatous mitral valve is the most common form of valvular heart disease. The pathologic presentation of myxomatous mitral valve disease varies between valve thickness, degree of leaflet prolapse and the presence or absence of flail leaflets. Recent molecular biology studies have confirmed that the myxomatous changes in mitral valve prolapse equals a cartilage phenotype, which is regulated by the Lrp5 receptor. Clinically, echocardiography defines the valve pathology to determine the surgical approach to valve repair or replacement. Furthermore, the timing of surgical valve repair is controversial and is the subject of a current multicenter trial. The results will resolve the timing of whether watchful waiting versus early surgical valve repair decreases morbidity and mortality of this disease process. This review will summarize the current understanding of the cellular and hemodynamic mechanisms of myxomatous mitral valve disease, which may have future implications in the targeted therapy of this disease process. PMID:24575776

Rajamannan, Nalini M

2014-01-01

92

[Mitral valve repair in a patient with giant left atrial myxoma;report of a case].  

PubMed

In patients with left atrial myxoma, mitral valve regurgitation is often encountered. However, preoperative assessment of the mitral valve is difficult in cases with giant left atrial myxoma occupying the left atrial cavity. We experienced a patient with giant left atrial myxoma who underwent tumor excision and mitral valve repair. A 40-year-old woman was transferred to the emergency room due to respiratory failure. On admission, her hemodynamic status was unstable and percutaneous cardiopulmonary support was immediately started. Transesophageal echocardiography was performed, which showed giant left atrial tumor with the pedicle on the atrial septum with mitral valve regurgitation, but the severity of regurgitation was unclear. After excision of left atrial myxoma with atrial septum, the mitral valve was examined. The anterior leaflet( A3 scallop) prolapse due to a torn chordae was found. The mitral valve was repaired with leaflet resection and prosthetic ring annuloplasty. Postoperative course was uneventful and postoperative echocardiography showed no residual mitral valve regurgitation. The mitral valve should be carefully inspected intraoperatively after resection of left atrial myxoma, especially when the tumor is gigantic. PMID:25201370

Iizuka, Hirofumi; Aoki, Atushi; Omoto, Tadashi; Maruta, Kazuto; Sakurai, Sigeru; Kawaura, Hiromasa

2014-09-01

93

Cardiopulmonary effects of enoximone or dobutamine and nitroglycerin on mitral valve regurgitation and pulmonary venous hypertension  

Microsoft Academic Search

Objective: To compare the cardiovascular and pulmonary effects of the phosphodiesterase III inhibitor enoximone (EN) or a combination of dobutamine (DOB) and nitroglycerin (NTG) before and after mitral valve repair or replacement.Design: Prospective, randomized, controlled clinical study.Setting: University hospital.Participants: Twenty patients with mitral regurgitation and pulmonary venous hypertension scheduled for elective mitral valve surgery.Interventions: Patients fulfilling the inclusion criteria of

Thomas Hachenberg; Thomas Möllhoff; Dietmar Hoist; Dieter Hammel; Thomas Brüssel

1997-01-01

94

Dynamic three-dimensional imaging of the mitral valve and left ventricle by rapid sonomicrometry array localization  

Microsoft Academic Search

Objectives. The first objective was to develop a quantitative method for tracking the three-dimensional geometry of the mitral valve. The second was to determine the complex interrelationships of various components of the mitral valve in vivo. Methods and results. Sixteen sonomicrometry transducers were placed around the mitral valve anulus, at the tips and bases of both papillary muscles, at the

Joseph H. Gorman; Krishanu B. Gupta; James T. Streicher; Robert C. Gorman; Benjamin M. Jackson; Mark B. Ratcliffe; Daniel K. Bogen; L. Henry Edmunds

1996-01-01

95

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

PubMed Central

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

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

2013-01-01

96

Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China  

PubMed Central

Background Functional tricuspid regurgitation (TR) occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6%) had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc.) and 40 patients (88.9%) had atrial fibrillation. Twenty-six patients (57.8%) were in New York Heart Association (NYHA) functional class III, and 19 (42.2%) in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%), 4 for bioprosthetic mitral valve replacement (8.9%), and 7 for tricuspid annuloplasty (15.6%). Results The tricuspid valves were repaired with Kay's (7 cases, 15.6%) or De Vega technique (4 cases, 8.9%). Tricuspid valve replacement was performed in 34 cases (75.6%). One patient (2.2%) died. Postoperative low cardiac output (LCO) occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P < 0. 05). Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended. PMID:22490269

2012-01-01

97

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

PubMed Central

Clinical evidence for an abnormally of extracardiac connective tissue was sought in 21 patients with idiopathic mitral valve prolapse and was compared to that in 21 matched controls. The incidence of rheumatic and orthopaedic complaints and the prevalence of hypermobile joints, Marfanoid habitus, and skeletal deformity were compared in the 2 groups. Skin thickness and elasticity were measured, and the mean values in the 2 groups were compared. hypermobile joints were significantly commoner in patients with mitral valve prolapse. Easy bruising was reported significantly more commonly by patients with mitral prolapse; the incidence of other rheumatic complaints was similar in the 2 groups. There was no significant difference in skin thickness, skin elasticity, and the prevalence of either skeletal deformity or Marfanoid habitus between patients with mitral valve prolapse and controls. The results support previous evidence of an association between mitral valve prolapse and benign hypermobility of the joints, but emphasise that many patients with mitral valve prolapse have no clinically apparent connective tissue abnormality outside the heart. It remains uncertain whether the valve lesion in these patients represents a tissue-specific abnormality of mitral valve collagen or the only clinical expression of a minor systemic connective tissue abnormality. PMID:7114917

Pitcher, D; Grahame, R

1982-01-01

98

Mitral Valve and Short-Term Ventricular Assist Devices; Potential Mechanical Complications  

PubMed Central

Mechanical complications of ventricular assist devices (VADs) are rare but serious. The authors describe two cases of different mechanical complications of VADs that can affect the mitral valve. Attention should be paid to the position of the inflow/outflow cannula after off-loading of the ventricle, especially in acute heart failure and normal atrial dimensions. Complete off-loading of the left ventricle in the presence of a bioprosthetic mitral valve might cause fusion of the valve leaflets leading to mitral stenosis, which will call for another intervention. PMID:25360402

Mufti, Hani N.; Elghobary, Tamer; Murray, Shawn K.; Baskett, Roger J. F.

2013-01-01

99

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

Microsoft Academic Search

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

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

2009-01-01

100

Early changes in pulmonary functions after mitral valve replacement  

PubMed Central

BACKGROUND: This study evaluates changes in pulmonary functions before and after mitral valve replacement (MVR). MATERIALS AND METHODS: Twenty-five patients with rheumatic mitral lesions who had undergone MVR were divided into three groups, based on New York Heart Association (NYHA) class. They were evaluated for changes in pulmonary functions, preoperatively and postoperatively at 1 week, 1 month and 3 months to find any improvements after MVR. RESULTS: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rates were universally found to be decreased preoperatively. Total lung capacity (TLC) and diffusion capacity (DLCO) were significantly reduced preoperatively in NYHA Class III and IV. The pulmonary functions further declined at 1 week after surgery. Except for FVC in NYHA Class IV (32.3% improvement, P < 0.05), the changes were statistically insignificant. CONCLUSIONS: Pulmonary functions deteriorate immediately after surgery and then recover gradually over a period of 3 months. However, they remain below the predicted values. PMID:19727357

Saxena, Pankaj; Luthra, Suvitesh; Dhaliwal, Rajinder Singh; Rana, Surinder Singh; Behera, Digambar

2007-01-01

101

Adult women with mitral valve prolapse are more flexible  

PubMed Central

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

Araujo, C; Chaves, C

2005-01-01

102

[Caseous calcification of the mitral annulus, clinical polymorphism and contribution of cardiac CT in the diagnosis: report of two cases].  

PubMed

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification and a common echocardiographic finding. CCMA discovery is mostly incidental, considered as benign tumor and may be unrelated to patient symptoms. Multimodality imaging may have an additional value for the diagnosis of CCMA. We report the cases of two CCMA revealed by acute pulmonary oedema and stroke, respectively. The aims of this presentation are: to illustrate the variety of cardiac symptoms that led to the diagnosis of CCMA; and to highlight the usefulness of thoracic multisliced computed tomography for the diagnosis of CCMA. PMID:23806861

Cetran, L; Corneloup, O; Dijos, M; Montaudon, M; Roudaut, R; Coste, P; Laurent, F; Gerbaud, E

2014-04-01

103

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

104

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

105

Percutaneous transarterial balloon dilatation of the mitral valve: five year experience.  

PubMed Central

OBJECTIVE--To examine the value of transarterial balloon dilatation of the mitral valve for treatment of patients with mitral stenosis over a period of five years. DESIGN--Analysis of patients' functional state, and haemodynamic and echocardiographic variables, before and immediately after the procedure and during a follow up of up to five years. SETTING--A cardiovascular centre in Belgrade, Yugoslavia. PATIENTS--Two hundred and ninety four patients who underwent percutaneous transarterial dilatation of the mitral valve between February 1985 and February 1990. RESULTS--Mean mitral valve area was enlarged by 109%. Complications included death (0.7%), severe mitral insufficiency (2.3%), mild mitral insufficiency (9.9%), cerebral embolism (2%), and injury to the femoral artery (2%). Two more patients died at two and 11 months after the procedure. Late cardiac surgery was needed in eight patients (mitral insufficiency in three, restenosis in three, thrombus in one, and endocarditis in one. Restenosis occurred in seven patients. Four of these underwent repeat dilatation and three had surgery. Improvement of symptoms was seen in 94% of patients during the follow up. CONCLUSION--Transarterial balloon dilatation of the mitral valve gave good results with acceptable morbidity and mortality and had some advantages over the anterograde approach. Images PMID:1540441

Babic, U U; Grujicic, S; Popovic, Z; Djurisic, Z; Pejcic, P; Vucinic, M

1992-01-01

106

Severe mitral valve regurgitation in a 23-year-old man.  

PubMed

Early surgical repair of severe mitral valve regurgitation in symptomatic and asymptomatic patients is associated with better long-term outcomes than watchful waiting. This article describes an asymptomatic, 23-year-old man whose significant cardiac murmur (later confirmed to be mitral regurgitation) was found during a routine examination for a prescription refill of an antiviral drug. PMID:25343433

Guerra, Michael

2014-11-01

107

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

108

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

109

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

Microsoft Academic Search

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

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

2000-01-01

110

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

Microsoft Academic Search

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

H Reichenspurner; D Boehm; B Reichart

1999-01-01

111

Aortic Periannular Abscess Invading into the Central Fibrous Body, Mitral Valve, and Tricuspid Valve  

PubMed Central

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.

Oh, Hyun Kong; Kim, Nan Yeol; Kang, Min-Woong; Kang, Shin Kwang; Yu, Jae Hyeon; Lim, Seung Pyung; Choi, Jae Sung; Na, Myung Hoon

2014-01-01

112

Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study.  

PubMed

Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21-80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination. PMID:24420419

Guler, Ahmet; Karabay, Can Y; Gursoy, Ozan M; Guler, Yeliz; Candan, Ozkan; Akgun, Taylan; Bulut, Mustafa; Pala, Selcuk; Izgi, Akin I; Esen, Ali M; Kirma, Cevat; Ozkan, Mehmet

2014-03-01

113

Mitral valve repair in a patient with an anomalous left coronary artery.  

PubMed

Anomalous coronary arteries may course in close proximity to the mitral annulus, which increases the risk of iatrogenic occlusion due to annular suture placement. We report a mitral valve repair in a 55-year-old male with severe mitral regurgitation and an anomalous retro-aortic left coronary artery, originating from the right coronary sinus, coursing in close proximity to the anterior mitral annulus. To minimize iatrogenic occlusion risk an open annuloplasty ring was used with good long-term results. doi: 10.1111/jocs.12374 (J Card Surg 2014;29:782-784). PMID:24862914

Bakker, Robbert C; Bouma, Wobbe; Hamer, Inez J Wijdh-den; Natour, Ehsan; Mariani, Massimo A

2014-11-01

114

Two-dimensional echocardiographic examination of mitral valve abnormalities associated with coarctation of the aorta.  

PubMed

Coarctation of the aorta is frequently associated with left ventricular inflow tract abnormalities that may be difficult to detect even at cardiac catheterization. This study involved patients with coarctation who underwent comprehensive two-dimensional echocardiographic investigations emphasizing visualization of the mitral valve and its apparatus. Of the 56 patients studied, 23 had completely normal study results, while in 33 (59%) results showed abnormalities of the mitral complex. The latter were divided into two groups: those having major mitral abnormalities (n = 12) and those with minor anomalies of the valve and apparatus (n = 21). The first group included patients with a supravalve stenosing ring, congenital mitral stenosis, mitral valve prolapse, and parachute mitral valve. Minor anomalies were classified as abnormalities of the papillary muscles, chordae tendineae, or combinations of both. No mitral malformations were found in a control group of patients. We conclude that two-dimensional echocardiography is a sensitive and accurate noninvasive method for assessing either significant or subtle forms of left ventricular inflow disease in patients with aortic coarctation. Its use is recommended for the acute medical and surgical management of these patients as well as for their long-term follow-up evaluation. PMID:6705168

Celano, V; Pieroni, D R; Morera, J A; Roland, J M; Gingell, R L

1984-05-01

115

Calcific aortic valve disease: a consensus summary from the alliance of investigators on calcific aortic valve disease.  

PubMed

Calcific aortic valve disease (CAVD) is increasingly prevalent worldwide with significant morbidity and mortality. Therapeutic options beyond surgical valve replacement are currently limited. In 2011, the National Heart Lung and Blood Institute assembled a working group on aortic stenosis. This group identified CAVD as an actively regulated disease process in need of further study. As a result, the Alliance of Investigators on CAVD was formed to coordinate and promote CAVD research, with the goals of identifying individuals at risk, developing new therapeutic approaches, and improving diagnostic methods. The group is composed of cardiologists, geneticists, imaging specialists, and basic science researchers. This report reviews the current status of CAVD research and treatment strategies with identification of areas in need of additional investigation for optimal management of this patient population. PMID:25189570

Yutzey, Katherine E; Demer, Linda L; Body, Simon C; Huggins, Gordon S; Towler, Dwight A; Giachelli, Cecilia M; Hofmann-Bowman, Marion A; Mortlock, Douglas P; Rogers, Melissa B; Sadeghi, Mehran M; Aikawa, Elena

2014-11-01

116

Pathogenesis of Mitral Valve Disease in Mucopolysaccharidosis VII Dogs  

PubMed Central

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

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

2013-01-01

117

Modified surgical sequence in aortic and mitral valve replacement with or without tricuspid valve repair or replacement.  

PubMed

A mitral prosthesis, when implanted, can distort the aortic annulus, forcing to downsize the aortic prosthesis. Changing the sequence of tying the sutures (the aortic prosthesis first, then the mitral prosthesis) allows to insert an aortic true-sized prosthesis. In case of associated tricuspid valve surgery, the aortic prosthesis protrudes over the anteroseptal commissure area. The sutures on the tricuspid annulus can be passed before the aortic prosthesis is secured in place. PMID:25312523

Calafiore, Antonio Maria; Iaco, Angela Lorena; Shah, Aijaz; Di Mauro, Michele

2014-12-01

118

Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement  

PubMed Central

Aim: Long standing mitral valve disease is usually associated with severe pulmonary hypertension. Perioperative pulmonary hypertension is a risk factor for right ventricular (RV) failure and a cause for morbidity and mortality in patients undergoing mitral valve replacement. Phosphodiesterase 5 inhibitor-sildenafil citrate is widely used to treat primary pulmonary hypertension. There is a lack of evidence of effects of oral sildenafil on secondary pulmonary hypertension due to mitral valve disease. The study aims to assess the effectiveness of preoperative oral sildenafil on severe pulmonary hypertension and incidence of RV failure in patients undergoing mitral valve replacement surgery. Materials and Methods: A total of 40 patients scheduled for mitral valve replacement with severe pulmonary hypertension (RV systolic pressure (RVSP) ?60 mmHg) on preoperative transthoracic echo were randomly treated with oral sildenafil 25 mg (N = 20) or placebo (N = 20) eight hourly for 24 h before surgery. Hemodynamic variables were measured 20 min after insertion of pulmonary artery catheter (PAC) under anesthesia (T1), 20 min at weaning from cardiopulmonary bypass (CPB) (T2) and after 1,2, and 6 h (T3, T4, T5, respectively) during the postoperative period. Results: Systolic and mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) were significantly lower (P < 0.0001) in sildenafil group at all times. Ventilation time and postoperative recovery room stay were significantly lower (P < 0.001) in sildenafil group. Conclusion: Sildenafil produces significant pulmonary vasodilatory effect as compared with placebo in mitral valve replacement patients with severe pulmonary hypertension. It also reduces ventilation time and intensive care unit (ICU) stay time as compared with placebo. It is concluded that sildenafil is effective in reducing pulmonary hypertension when administered preoperatively in patients with severe pulmonary hypertension undergoing mitral valve replacement surgery. PMID:24987174

Gandhi, Hemang; Shah, Bipin; Patel, Ramesh; Toshani, Rajesh; Pujara, Jigisha; Kothari, Jignesh; Shastri, Naman

2014-01-01

119

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

Microsoft Academic Search

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

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

1996-01-01

120

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

121

Changes in Mitral Annular Geometry and Dynamics with ss-Blockade in Patients with Degenerative Mitral Valve Disease  

PubMed Central

Background Remodeling of the mitral annulus may contribute to progression of mitral regurgitation (MR). In patients with moderate to severe mitral regurgitation short term treatment with a ?-blockers has been shown to increase left ventricular end diastolic and end systolic volume and this could deleteriously increase mitral valve annular dimensions. The objective of this study was to quantify the effects of a short duration of ?-blocker treatment on mitral annular dimensions and dynamics in patients with mitral regurgitation due to primary degenerative valve disease. Methods and Results Twenty-five patients with moderate to severe degenerative MR and normal left ventricular systolic function were studied in a double blind crossover experiment using a ?1-selective adrenergic blocker and placebo administered for 14±3days. Cardiac magnetic resonance images were acquired after each treatment period to quantify mitral annular dimensions. At end diastole (ED) there was no change in annular area (1659±331 vs 1632±299mm2, P<0.19), annular perimeter (154.3±16.4 vs 152±13.9mm, P<0.13), septal-lateral dimension(38.0±5mm vs 39.0±4.5mm, P<0.15), nor annular height (9.8±3.8 vs 9.5±2.5mm, P<0.53). ?-blockade resulted in significant ED decreases in commissure-commissure (CC) dimension (48.9 ± 4.6mm vs 47.2 ± 4.0mm P<0.01) and eccentricity (1.3 ± 0.2 vs 1.2 ± 0.1 P<0.01). At end systole (ES), ß-blockade conferred a small, but significant decrease in annular perimeter (161.0±19.3 vs 156.8±16.9mm, P<0.04) and eccentricity (1.2±0.1 vs 1.1±0.1 P<0.02) and the SL dimension significantly increased (41.5±5.7 vs 43.0±5.3mm, P<0.03). CC, annular area, and annular height at ES were not significantly different. Conclusions Despite significant increases in LVEDV and LVESV, short-term ?-blocker treatment of patients with moderate to severe mitral regurgitation reduced or preserved all mitral annular dimensions, except SL at ES. PMID:20847190

Ennis, Daniel B.; Rudd-Barnard, Gabriel R.; Li, Bo; Foncesca, Carissa G.; Young, Alistair A.; Cowan, Brett R.; Stewart, Ralph A.H.

2011-01-01

122

TGF-?–dependent pathogenesis of mitral valve prolapse in a mouse model of Marfan syndrome  

PubMed Central

Mitral valve prolapse (MVP) is a common human phenotype, yet little is known about the pathogenesis of this condition. MVP can occur in the context of genetic syndromes, including Marfan syndrome (MFS), an autosomal-dominant connective tissue disorder caused by mutations in fibrillin-1. Fibrillin-1 contributes to the regulated activation of the cytokine TGF-?, and enhanced signaling is a consequence of fibrillin-1 deficiency. We thus hypothesized that increased TGF-? signaling may contribute to the multisystem pathogenesis of MFS, including the development of myxomatous changes of the atrioventricular valves. Mitral valves from fibrillin-1–deficient mice exhibited postnatally acquired alterations in architecture that correlated both temporally and spatially with increased cell proliferation, decreased apoptosis, and excess TGF-? activation and signaling. In addition, TGF-? antagonism in vivo rescued the valve phenotype, suggesting a cause and effect relationship. Expression analyses identified increased expression of numerous TGF-?–related genes that regulate cell proliferation and survival and plausibly contribute to myxomatous valve disease. These studies validate a novel, genetically engineered murine model of myxomatous changes of the mitral valve and provide critical insight into the pathogenetic mechanism of such changes in MFS and perhaps more common nonsyndromic variants of mitral valve disease. PMID:15546004

Ng, Connie M.; Cheng, Alan; Myers, Loretha A.; Martinez-Murillo, Francisco; Jie, Chunfa; Bedja, Djahida; Gabrielson, Kathleen L.; Hausladen, Jennifer M.W.; Mecham, Robert P.; Judge, Daniel P.; Dietz, Harry C.

2004-01-01

123

Papillary muscle sling placement for functional mitral regurgitation during minimally invasive valve surgery.  

PubMed

Herein, we report a case of a 39-year-old woman with an 18-month history of peripartum cardiomyopathy. Transthoracic echocardiography revealed severe functional mitral regurgitation and a left ventricular ejection fraction of 20%. Despite optimal medical therapy, she was in New York Heart Association heart failure class IV, with dyspnea on minimal exertion. The patient underwent minimally invasive mitral valve repair with placement of a papillary muscle sling, which improved her symptoms. PMID:23422810

Benjo, Alexandre M; Macedo, Franscisco Y B; Santana, Orlando; Lamelas, Joseph

2012-01-01

124

Cardio-embolic stroke due to valve tissue embolization during Percutaneous Transseptal Mitral Commissurotomy (PTMC)  

PubMed Central

Percutaneous Transseptal Mitral Commissurotomy (PTMC) has replaced surgical commissurotomy as a treatment of choice in selected patients of rheumatic mitral stenosis. Various randomized trials have shown PTMC to be equal or superior to surgical commissurotomy in terms of hemodynamic improvement as well as long term survival. Systemic embolism is one of the dreaded complications of PTMC, which is reported in 0.5–5% of cases and involves cerebral circulation in 1% of cases. Most of the time, periprocedural embolism during PTMC is caused by the mobilization of preexisting thrombus in the left atrial appendage. We report an unusual case of acute stroke due embolization of mitral valve tissue during PTMC.

Shetkar, Sudhir S.; Parakh, Neeraj; Singh, Birdevender; Mishra, N.K.; Ray, Ruma; Karthikeyan, Ganesan; Yadav, Rakesh; Goswami, Kewal C.

2014-01-01

125

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

PubMed Central

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

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

1985-01-01

126

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

PubMed Central

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

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

2013-01-01

127

Prevalence of mitral valve prolapse in ethnic groups.  

PubMed

Mitral valve prolapse (MVP) was reported to be a common disorder occurring in 5% to 15% of the general population and to be frequently associated with serious complications. The reported high prevalence and complication rates of MVP have been challenged recently by the findings of the Framingham Heart Study, which was conducted in a Caucasian population; the findings in other ethnic groups remain uncertain. The prevalence of MVP was studied in a true population sample comprising 972 Canadians of South Asian (n=336), European (n=322) and Chinese (n=314) descent. MVP was diagnosed by two-dimensional echocardiography. The prevalence of MVP for the entire study cohort was 2.7% and did not differ significantly between the three ethnic groups evaluated (2.7% in South Asian, 3.1% in European and 2.2% in Chinese [P=0.79]). Age, sex, history of cardiac risk factors, blood pressure, abnormalities on electrocardiography, left atrial size, left ventricular end-diastolic and end-systolic diameters and volumes, and left ventricular ejection fraction were similar in subjects with and without MVP. There was a trend toward lower body mass index in subjects with MVP compared to those without MVP (24.5+/-5.5 kg/m(2) versus 26.0+/-4.3 kg/m(2), respectively, P=0.10). The prevalence of cardiovascular diseases, including history of angina, previous myocardial infarction, previous cardiac surgery and previous stroke, was similar in subjects with MVP (7.7%) and in those without MVP (6.7%) (P=0.84). The authors concluded that MVP has a much lower prevalence than previously estimated and the prevalence of MVP is similar among different ethnic groups. From a population perspective, the prevalence of serious cardiovascular complications associated with MVP is low. PMID:15100753

Theal, Michael; Sleik, Khalid; Anand, Sonia; Yi, Qilong; Yusuf, Salim; Lonn, Eva

2004-04-01

128

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

129

Harken Caged-Disc Mitral Valve Replacement, 1969-1975: Analysis of Late Mortality, Thromboembolism, and Valve Failure  

PubMed Central

We evaluated the long-term outcome of mitral valve replacement with a Harken caged-disc prosthesis for up to 11 years (range, 50 to 130 months; mean, 81 months) in 170 patients whose mean age was 55 years. The early (30-day) mortality was 11.2% (19 out of 170 patients). Late follow-up information was obtained for 144 (95%) of the 151 survivors. The actuarial survival was 57% at 5 years and 40% at 10 years. Overall mortality was associated with advanced age, male sex, an ischemic origin for the mitral valve disease, and nonuse of warfarin anticoagulation. Late deaths (n=59) were valve-related in 46%, cardiac but non-valve-related in 44%, and noncardiac in 10% of the cases. One thromboembolic event or more occurred in 41 patients (incidence, 5.7% per patient year), 14 of whom died (24% of the late deaths). All four patients who were not on warfarin, aspirin, or other antithrombotic therapy experienced thromboemboli. This complication was correlated with the nonuse of warfarin-type anticoagulation, with mitral regurgitation, and with late cardiac death. Mechanical prosthetic failure resulted in reoperation or death in 7.6% of the late survivors (1.5% per patient year). In 75 patients with normally functioning prostheses, the disc-to-sewing ring ratio was established by means of cinefluoroscopy (0.93 ± 0.04, mean ± 25D). Because of the high proportion of cardiac valve-related deaths (46%), the high incidence of late mortality due to thromboembolic events (24%), and the 7.6% incidence of reoperation or death resulting from mechanical valve failure, close follow-up with cinefluoroscopy and continued warfarin anticoagulation (alone or in combination with dipyridamole) are essential after mitral valve replacement with the Harken caged-disc prosthesis. (Texas Heart Institute Journal 1987; 14:411-417) Images PMID:15227298

Gray, Richard J.; Czer, Lawrence S.C.; Chaux, Aurelio; Sethna, Dhun; Derobertis, Michele; Raymond, Marjorie; Matloff, Jack M.

1987-01-01

130

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

PubMed Central

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 diet; 16 were fed a 0.5% (wt/wt) high cholesterol diet; and 16 were fed a 0.5% (wt/wt) cholesterol diet plus atorvastatin (2.5 mg/kg/day). The aortic valves were examined with eNOS immunostains and western blotting. Cholesterol and high sensitivity C reactive protein (hsCRP) concentrations were determined by standard assays. Serum nitrite concentrations were measured with a nitric oxide analyser. eNOS was localised by electron microscopy and immunogold labelling. Calcification in the aortic valve was evaluated by micro-computed tomography (CT). Results: Cholesterol, hsCRP, and aortic valve calcification were increased in the cholesterol fed compared with control animals. Atorvastatin inhibited calcification in the aortic valve as assessed by micro-CT. eNOS protein concentrations were unchanged in the control and cholesterol groups but increased in the atorvastatin treated group. Serum nitrite concentrations were decreased in the hypercholesterolaemic animals and increased in the group treated with atorvastatin. Conclusion: These data provide evidence that chronic experimental hypercholesterolaemia produces bone mineralisation in the aortic valve, which is inhibited by atorvastatin. PMID:15894785

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

2005-01-01

131

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

PubMed Central

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

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

2013-01-01

132

Biochemical characterization of individual normal, floppy and rheumatic human mitral valves.  

PubMed Central

Human mitral valves (32 floppy and 17 rheumatic) obtained at surgery were analysed and compared with 35 normal (autopsy) valves. Total amounts of collagen, proteoglycan and elastin were increased approx. 3-fold in floppy and rheumatic valves. The water content of rheumatic cusps was lower than normal. The most significant changes in floppy valves were the 59% increase in mean value of the proteoglycan content, a large increase in the ease of extractability of proteoglycans from 26.7 to 57.2% of the total and a 62% increase in mean value of the elastin content in the anterior cusps. Normal human mitral valve cusps contained a mean proportion of 29.3 (and chordae 26.6) type III collagen (as % of total types III + I collagen), the values increasing significantly to 33.2 and 36.3% respectively in chronic rheumatic disease. The ratio observed in floppy valves depended on the extent of secondary surface fibrosis, which could be demonstrated histologically; in valve cusps with considerable secondary fibrosis, the percentage of type III increased significantly (to 34.4%), whereas it decreased significantly (to 25.2%) when fibrosis was negligible. It is concluded that the ratio of collagen types in floppy valves reflects the extent of secondary fibrosis rather than the pathogenesis of the disrupted collagen in the central core of the valve. PMID:3446179

Lis, Y; Burleigh, M C; Parker, D J; Child, A H; Hogg, J; Davies, M J

1987-01-01

133

The right vertical infra-axillary incision for mitral valve replacement  

PubMed Central

Background As the physiologic results of valve surgery have improved dramatically in recent years, the cosmetic effect of the procedure gains increased attention, and various alternatives to the standard median sternotomy have been developed for mitral valve surgery. We report a new minimally invasive and cosmetic approach for mitral valve replacement. Methods From December 2003 to December 2009, the right vertical infra-axillary incision (RVIAI) was employed to perform mitral valve replacement in 256 patients. 62.9% patients had replaced mechanical valve, others were bioprosthetic valve, at the same time 28.1% patients received tricuspid valvuloplasty. Results There were one hospital death in this series due to multiple organ failure, one reoperation for bleeding and one incision infection. Mean follow-up duration was 42.8 months (range, 3 to 72), and follow-up rate was 94%. There were no paravalvular leaks or late death during the follow up. Conclusions The RVIAI can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for MVR in selected patients. PMID:21054893

2010-01-01

134

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

PubMed

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

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

1980-12-01

135

Heart rate variability in soccer players with mitral valve prolapse or benign arrhythmia  

Microsoft Academic Search

Numerous studies have reported increased cardiac vagal activity in well endurance-trained athletes. However, no clear data exist regarding the cardiac autonomic activity in athletes with common cardiovascular findings, such as mild mitral valve prolapse (MVP) and transient benign arrhythmias. Therefore, the purpose of this study was to investigate and compare the cardiac autonomic outflow by heart rate variability (HRV) analysis

N. Koutlianos; E. Kouidi; A. Deligiannis

2004-01-01

136

In Vivo Dynamic Strains of the Ovine Anterior Mitral Valve Leaflet  

PubMed Central

Understanding the mechanics of the mitral valve is crucial in terms of designing and evaluating medical devices and techniques for mitral valve repair. In the current study we characterize the in vivo strains of the anterior mitral valve leaflet. On cardiopulmonary bypass, we sew miniature markers onto the leaflets of 57 sheep. During the cardiac cycle, the coordinates of these markers are recorded via biplane fluoroscopy. From the resulting four-dimensional data sets, we calculate areal, maximum principal, circumferential, and radial leaflet strains and display their profiles on the averaged leaflet geometry. Average peak areal strains are 13.8±6.3%, maximum principal strains are 13.0±4.7%, circumferential strains are 5.0±2.7%, and radial strains are 7.8±4.3%. Maximum principal strains are largest in the belly region, where they are aligned with the radial direction during diastole switching into the circumferential direction during systole. Circumferential strains are concentrated at the distal portion of the belly region close to the free edge of the leaflet, while radial strains are highest in the center of the leaflet, stretching from the posterior to the anterior commissure. In summary, leaflet strains display significant temporal, regional, and directional variations with largest values inside the belly region and toward the free edge. Characterizing strain distribution profiles might be of particular clinical significance when optimizing mitral valve repair techniques in terms of forces on suture lines and on medical devices. PMID:21306716

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

2011-01-01

137

3D Ultrasound-Guided Motion Compensation System for Beating Heart Mitral Valve Repair  

E-print Network

Marker Instrument ShaftA 0 200 400 600 800 1000 -5 0 5 10 Time (msec) Position(mm) Target MCI B Fig. 2. (A) MCI hardware proto- type. (B) MCI tracking recorded mitral valve annulus motion. inside the heart

138

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

Microsoft Academic Search

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

D Pitcher; R Grahame

1982-01-01

139

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

Microsoft Academic Search

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

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

1985-01-01

140

An Active Motion Compensation Instrument for Beating Heart Mitral Valve Surgery  

E-print Network

to beating-heart intracardiac procedures is robotic assistance. Here the robot controller tracks the motionAn Active Motion Compensation Instrument for Beating Heart Mitral Valve Surgery Daniel T. Kettler recoveries with fewer complications [2, 3, 4]. While beating-heart surgery has clear benefits and has been

141

Gentamicin Reduces Calcific Nodule Formation by Aortic Valve Interstitial Cells In Vitro  

PubMed Central

Purpose Gentamicin is a widely employed antibiotic, but may reduce calcium uptake by eukaryotic cells. This study was conducted to determine whether gentamicin reduces calcification by porcine aortic valvular interstitial cells (pAVICs) grown in 2D culture, which is a common model for calcific aortic valve disease (CAVD). Methods and Results The presence of gentamicin (up to 0.2 mM) in the medium of pAVICs cultured for 8 days significantly lowered calcification and alkaline phosphatase content in a dose-dependent manner compared to pAVICs cultured without gentamicin. Gentamicin also significantly increased cell proliferation and apoptosis at concentrations of 0.1–0.2 mM. Next, gentamicin was applied to previously calcified pAVIC cultures (grown for 8 days) to determine whether it could stop or reverse the calcification process. Daily application of gentamicin for 8 additional days significantly reduced calcification to below the pre-calcification levels. Conclusions These results confirm that gentamicin should be used cautiously with in vitro studies of calcification, and suggest that gentamicin may have the ability to reverse calcification by pAVICs. Given the nephrotoxicity and ototoxicity of this antibiotic, its clinical potential for the treatment of calcification in heart valves is limited. However, further investigation of the pathways through which gentamicin alters calcium uptake by valvular cells may provide insight into novel therapies for CAVD.

Kumar, Aditya; Wiltz, Dena C.; Grande-Allen, K. Jane

2014-01-01

142

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

PubMed

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

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

1997-09-01

143

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

NASA Astrophysics Data System (ADS)

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

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

2009-02-01

144

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

145

Comparison of three-dimensional imaging to transesophageal echocardiography for preoperative evaluation in mitral valve prolapse.  

PubMed

Transesophageal echocardiography (TEE) is not optimally suited for recognizing which valve segments are involved in type II mitral valve dysfunction. This study was conducted to compare the diagnostic value of TEE and 3-dimensional image reconstruction (3DIR) in the assessment of Carpentier type II mitral valve lesions. In 74 patients (mean age 59+/-13 years) with mitral regurgitation due to type II valve dysfunction, TEE and 3DIR were performed and analyzed by 2 experts before surgical repair. Leaflet scallops and commissures were displayed in short-axis en face and long-axis views. Echocardiographic results were surgically validated. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated, broken down by valve segments and Barlow's disease. Interobserver variability was also determined. Compared with TEE, 3DIR was superior with respect to sensitivity, positive and negative predictive values, and accuracy, although not always significantly (p<0.05). Specificity was higher for P2 lesions. The clearest advantage of 3DIR over TEE was higher sensitivity in commissural and bileaflet defects (p<0.05). Interobserver agreement on 3DIR was stronger than on TEE results (kappa values 0.52 vs 0.82, p<0.0001). There were 16 disagreements (23%) on TEE but only 5 (7%) on 3DIR readings. In conclusion, the more complex the lesion, the more valuable 3DIR is compared with TEE. Before repair, 3DIR is beneficial for the evaluation and classification of the specific pathology in type II mitral valve dysfunction. PMID:16828601

Müller, Silvana; Müller, Ludwig; Laufer, Günther; Alber, Hannes; Dichtl, Wolfgang; Frick, Matthias; Pachinger, Otmar; Bartel, Thomas

2006-07-15

146

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

147

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

148

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

149

[Angiographic and stress echocardiographic evaluation after surgical treatment of Bland-White-Garland syndrome and mitral valve insufficiency].  

PubMed

We report case of 58-year-old male patient with severe mitral insufficiency in whom in preoperative angiography anomalous left anterior descending coronary artery arising from pulmonary artery was revealed. Patient successfully underwent mitral valve replacement, ligation and bypass of left anterior descending artery. Eighteen months after surgery control exercise echocardiography and angiography were performed to evaluate coronary flow, valve prosthesis and left ventricle function. PMID:23080096

Hendzel, Piotr; Suwalski, Grzegorz; Gryszko, Leszek; Sza?a?ski, Przemys?aw; Go?owicz, Jaros?aw; Gierak, Ewa

2012-01-01

150

Filamin-a-related myxomatous mitral valve dystrophy: genetic, echocardiographic and functional aspects.  

PubMed

Myxomatous dystrophy of the cardiac valves is a heterogeneous group of disorders, including syndromic diseases such as Marfan syndrome and isolated valvular diseases. Mitral valve prolapse, the most common form of this disease, is presumed to affect approximately 2% to 3% of the population and remains one of the most common causes of valvular surgery. During the past years, important effort has been made to better understand the pathophysiological basis of mitral valve prolapse. Autosomal-dominant transmission is the usual inheritance with reduced penetrance and variable expressivity. Three loci have been mapped to chromosomes 16p11-p12, 11p15.4 and 13q31-32, but the underlying genetic defects are not currently known. An X-linked recessive form has been originally described by Monteleone and Fagan in 1969. Starting from one large French family and three smaller other families in which MVP was transmitted with an X-linked pattern, we have been able to identify three filamin A mutations p.Gly288Arg and p.Val711Asp and a 1,944-bp genomic deletion coding for exons 16 to 19. In this review, we describe the genetic, echocardiographic and functional aspects of the filamin-A-related myxomatous mitral valve dystrophy. PMID:21773876

Lardeux, Aurélie; Kyndt, Florence; Lecointe, Simon; Marec, Hervé Le; Merot, Jean; Schott, Jean-Jacques; Le Tourneau, Thierry; Probst, Vincent

2011-12-01

151

Image-based mass-spring model of mitral valve closure for surgical planning  

NASA Astrophysics Data System (ADS)

Surgical repair of the mitral valve is preferred in most cases over valve replacement, but replacement is often performed instead due to the technical difficulty of repair. A surgical planning system based on patient-specific medical images that allows surgeons to simulate and compare potential repair strategies could greatly improve surgical outcomes. In such a surgical simulator, the mathematical model of mechanics used to close the valve must be able to compute the closed state quickly and to handle the complex boundary conditions imposed by the chords that tether the valve leaflets. We have developed a system for generating a triangulated mesh of the valve surface from volumetric image data of the opened valve. We then compute the closed position of the mesh using a mass-spring model of dynamics. The triangulated mesh is produced by fitting an isosurface to the volumetric image data, and boundary conditions, including the valve annulus and chord endpoints, are identified in the image data using a graphical user interface. In the mass-spring model, triangle sides are treated as linear springs, and sides shared by two triangles are treated as bending springs. Chords are treated as nonlinear springs, and self-collisions are detected and resolved. Equations of motion are solved using implicit numerical integration. Accuracy was assessed by comparison of model results with an image of the same valve taken in the closed state. The model exhibited rapid valve closure and was able to reproduce important features of the closed valve.

Hammer, Peter E.; Perrin, Douglas P.; del Nido, Pedro J.; Howe, Robert D.

2008-03-01

152

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

PubMed

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

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

2013-10-01

153

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

154

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

Microsoft Academic Search

Summary  Analysis of a time-lapse film of cultured human mitral valve endothelium containing autochthonous lymphocytes reveals details\\u000a of a pattern of interaction suggesting a previously undescribed type of cellular surveillance. Highly mobile lymphocytes rapidly\\u000a approach individual endothelial cells, slowly circumnavigate the nuclear region, and rapidly move away to repeat this behavior\\u000a on adjacent cells during the 1-month culture period.

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

1980-01-01

155

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

Microsoft Academic Search

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

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

2011-01-01

156

Role of Vortices in Growth of Microbubbles at Mitral Mechanical Heart Valve Closure  

Microsoft Academic Search

This study is aimed at refining our understanding of the role of vortex formation at mitral mechanical heart valve (MHV) closure\\u000a and its association with the high intensity transient signals (HITS) seen in echocardiographic studies with MHV recipients.\\u000a Previously reported numerical results described a twofold process leading to formation of gas-filled microbubbles in-vitro: (1) nucleation and (2) growth of micron

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

2007-01-01

157

Mitral valve replacement with mechanical prostheses in children: improved operative risk and survivalq  

Microsoft Academic Search

Objective: The purpose of this study was to assess the early and late outcome following mitral valve replacement (MVR) with mechanical prostheses in children. Patients and methods: Between 1981 and 2000, 44 consecutive children (mean age 6.8 ^ 4.7 years, 2 months-16 years) underwent mechanical MVR in Southampton. Twenty-three children were less than 5-years-old and nine were infants. Disease aetiology

Christos Alexiou; Maria Galogavrou; Qiang Chen; Angus McDonald; Anthony P. Salmon; Barry K. Keeton; Marcus P. Haw; James L. Monro

158

Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival  

Microsoft Academic Search

Objective: The purpose of this study was to assess the early and late outcome following mitral valve replacement (MVR) with mechanical prostheses in children. Patients and methods: Between 1981 and 2000, 44 consecutive children (mean age 6.8±4.7 years, 2 months–16 years) underwent mechanical MVR in Southampton. Twenty-three children were less than 5-years-old and nine were infants. Disease aetiology was congenital

Christos Alexiou; Maria Galogavrou; Qiang Chen; Angus McDonald; Anthony P. Salmon; Barry K. Keeton; Marcus P. Haw; James L. Monro

2001-01-01

159

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

160

Impact of mitral annular calcification on cardiovascular events in a multiethnic community. The Northern Manhattan Study  

PubMed Central

OBJECTIVES We sought to determine the magnitude of the association between mitral annular calcification (MAC) and vascular events in a multiethnic cohort. BACKGROUND MAC is common in the elderly, and is associated with atherosclerotic risk factors. Its impact on the risk of cardiovascular events is controversial. METHODS The study cohort consisted of 1,955 subjects, aged ?40 years, and free of prior myocardial infarction (MI) and ischemic stroke (IS). MAC was assessed by transthoracic 2D echocardiography. The association between MAC and MI, IS, and vascular death (VD) was examined by Cox proportional hazard models with adjustment for established cardiovascular risk factors. The effect of MAC thickness was also analyzed. RESULTS The mean age of the cohort was 68.0 ± 9.7 years and the majority of subjects were Hispanics (56.8%). 519 subjects (26.6%) had MAC. Of 498 patients with MAC thickness measurement available, 253 (13.1%) had mild to moderate MAC (1–4mm) and 245 (12.7%) severe MAC (?4mm). During a mean follow-up of 7.4 ± 2.5 years, MI occurred in 100 (5.1%) subjects, IS in 104 (5.3%) subjects, and VD in 155 (8.0%) subjects. After adjustment for other cardiovascular risk factors, MAC was associated with an increased risk of MI (adjusted hazards ratio [HR] 1.75; 95% confidence interval [CI] 1.13–2.69: p=0.011) and VD (adjusted HR 1.53; 95%CI 1.09–2.15: p=0.015), but not IS (adjusted HR 1.34; 95%CI 0.87–2.05: p=0.18). Further analysis revealed that the impact of MAC was related to its thickness, with MAC >4mm being a strong and independent predictor of MI (adjusted HR 1.89: 95%CI 1.13–3.17: p=0.008) and VD (adjusted HR 1.81: 95%CI 1.21–2.72: p=0.002), and showing borderline association with IS (adjusted HR 1.59: 95%CI 0.95–2.67: p=0.084). CONCLUSIONS In this multiethnic cohort, MAC was a strong and independent predictor of cardiovascular events, especially MI and VD. The risk increase was directly related to MAC severity. PMID:19356491

Kohsaka, Shun; Jin, Zhezhen; Rundek, Tatjana; Boden-Albala, Bernadette; Homma, Shunichi; Sacco, Ralph L.; Di Tullio, Marco R.

2010-01-01

161

Molecular biology of calcific aortic valve disease: towards new pharmacological therapies.  

PubMed

Calcific aortic valve disease (CAVD) is a chronic process leading to fibrosis and mineralization of the aortic valve. Investigations in the last several years have emphasized that key underlying molecular processes are involved in the pathogenesis of CAVD. In this regard, the processing of lipids and their retention has been underlined as an important mechanism that triggers inflammation. In turn, inflammation promotes/enhances the mineralization of valve interstitial cells, the main cellular component of the aortic valve. On the other hand, transformation of valve interstitial cells into myofibroblasts and osteoblast-like cells is determined by several signaling pathways having reciprocal cross-talks. In addition, the mineralization of the aortic valve has been shown to rely on ectonucleotidase and purinergic signaling. In this review, the authors have highlighted key molecular underpinnings of CAVD that may have significant relevance for the development of novel pharmaceutical therapies. PMID:24857537

Mathieu, Patrick; Boulanger, Marie-Chloé; Bouchareb, Rihab

2014-07-01

162

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

PubMed

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

Boronyak, Steven M; Merryman, W David

2014-03-21

163

Nonsurgical Management of Mitral Valve Endocarditis Due to Cardiobacterium valvarum in a Patient with a Ventricular Septal Defect  

PubMed Central

Cardiobacterium valvarum is a relatively novel agent of infective endocarditis. We describe the first case of infective endocarditis due to this pathogen in the Asian Pacific. This case is unique in its involvement of the mitral valve as well as its clinical resolution exclusively resulting from treatment with antibiotics without resorting to valve replacement/explantation. PMID:23576538

Isais, Florante Santos; Lee, Cheng Chuan

2013-01-01

164

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

PubMed Central

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

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

2014-01-01

165

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

166

Distribution of selected elements in calcific human aortic valves studied by microscopy combined with SR-?XRF: influence of lipids on progression of calcification.  

PubMed

Calcified heart valves display a significant imbalance in tissue content of trace and essential elements. The valvular calcification is an age-related process and there are data suggesting involvement of lipids. We studied elemental composition and lipid distribution in three distinct regions of calcified human aortic valves, representing successive stages of the calcific degeneration: normal, thickened (early lesion) and calcified (late lesion), using SR-?XRF (Synchrotron Radiation Micro X-Ray Fluorescence) for elemental composition and Oil Red O (ORO) staining for demonstration of lipids. Two-dimensional SR-?XRF maps and precise point spectra were compared with histological stainings on consecutive valve sections to prove topographical localization and colocalization of the examined elements and lipids. In calcified valve areas, accumulation of calcium and phosphorus was accompanied by enhanced concentrations of strontium and zinc. Calcifications preferentially developed in lipid-rich areas of the valves. Calcium concentration ratio between lipid-rich and lipid-free areas was not age-dependent in early lesions, but showed a significant increase with age in late lesions, indicating age-dependent intensification of lipid involvement in calcification process. The results suggest that mechanisms of calcification change with progression of valve degeneration and with age. PMID:25169034

Lis, Grzegorz J; Czapla-Masztafiak, Joanna; Kwiatek, Wojciech M; Gajda, Mariusz; Jasek, Ewa; Jasinska, Malgorzata; Czubek, Urszula; Borchert, Manuela; Appel, Karen; Nessler, Jadwiga; Sadowski, Jerzy; Litwin, Jan A

2014-12-01

167

Calcific bicuspid aortic valve disease in a patient with Cornelia de Lange syndrome: linking altered Notch signaling to aortic valve disease  

Microsoft Academic Search

We describe a patient with Cornelia de Lange syndrome (CdLS) and a severely calcified bicuspid aortic valve. Cornelia de Lange syndrome is characterized by altered Notch signaling, and recent studies have provided a link between Notch signaling and heart valve development and calcific bicuspid aortic valve disease. In this case report, we propose that altered Notch signaling in CdLS may

Gavin Y. Oudit; Chi-Ming Chow; Warren J. Cantor

2006-01-01

168

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

PubMed Central

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

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

2012-01-01

169

Mitral valve replacement in infants and children 5 years of age or younger: Evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation  

PubMed Central

Objective Successful mitral valve replacement in young children is limited by the lack of small prosthetic valves. Supra-annular prosthesis implantation can facilitate mitral valve replacement with a larger prosthesis in children with a small annulus, but little is known about its effect on the outcomes of mitral valve replacement in young children. Methods One hundred eighteen children underwent mitral valve replacement at 5 years of age or younger from 1976–2006. Mitral valve replacement was supra-annular in 37 (32%) patients. Results Survival was 74% ± 4% at 1 year and 56% ± 5% at 10 years but improved over time (10-year survival of 83% ± 7% from 1994–2006). Factors associated with worse survival included earlier mitral valve replacement date, age less than 1 year, complete atrioventricular canal, and additional procedures at mitral valve replacement, but not supra-annular mitral valve replacement. As survival improved during our more recent experience, the risks of supra-annular mitral valve replacement became apparent; survival was worse among patients with a supra-annular prosthesis after 1991. A pacemaker was placed in 18 (15%) patients within 1 month of mitral valve replacement and was less likely in patients who had undergone supra-annular mitral valve replacement. Among early survivors, freedom from redo mitral valve replacement was 72% ± 5% at 5 years and 45% ± 7% at 10 years. Twenty-one patients with a supra-annular prosthesis underwent redo mitral valve replacement. The second prosthesis was annular in 15 of these patients and upsized in all but 1, but 5 required pacemaker placement for heart block. Conclusions Supra-annular mitral valve replacement was associated with worse survival than annular mitral valve replacement in our recent experience. Patients with supra-annular mitral valve replacement were less likely to have operative complete heart block but remained at risk when the prosthesis was subsequently replaced. PMID:18954636

Tierney, Elif Seda Selamet; Pigula, Frank A.; Berul, Charles I.; Lock, James E.; del Nido, Pedro J.; McElhinney, Doff B.

2014-01-01

170

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

PubMed Central

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

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

2014-01-01

171

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

PubMed

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

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

2011-05-01

172

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

PubMed

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

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

2007-07-01

173

Dynamics of left ventricular wall and mitral valve mechanics--a model study.  

PubMed

The relation between global left ventricular pumping characteristics and local cardiac muscle fiber mechanics is represented by a mathematical model of left ventricular mechanics in which the mitral valve papillary muscle system is incorporated. The wall of the left ventricle is simulated by a thick-walled cylinder. Transmural differences in fiber orientation are incorporated by changing the direction of material anisotropy across the wall. The cylinder is free to twist. The upper end of the cylinder is covered by a thin, flexible sheet, representing the base of the left ventricle. The mitral valve is incorporated in this sheet. The tips of the mitral leaflets are connected by chordae tendineae to the papillary muscles which are attached to the bottom of the cylinder. Canine cardiac cycles were simulated for various end-diastolic values of left ventricular volume (25-120 ml, control 60 ml), left atrial pressure (0-2.7 kPa, control 0.22 kPa) and aortic pressure (5-11 kPa, control 11 kPa). In this wide range of preload and afterload mechanical loading of the muscle fibers appeared to be distributed quite evenly (SD: +/- 5% of control value) over all muscular structures of the left ventricle, including the papillary muscles. PMID:2722896

Arts, T; Reneman, R S

1989-01-01

174

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

175

A multiscale computational comparison of the bicuspid and tricuspid aortic valves in relation to calcific aortic stenosis  

E-print Network

A multiscale computational comparison of the bicuspid and tricuspid aortic valves in relation Article history: Accepted 1 August 2008 Keywords: Aortic valve Bicuspid Calcific aortic stenosis Multiscale FSI a b s t r a c t Patients with bicuspid aortic valve (BAV) are more likely to develop

Mofrad, Mohammad R. K.

176

A multiscale computational comparison of the bicuspid and tricuspid aortic valves in relation to calcific aortic stenosis  

Microsoft Academic Search

Patients with bicuspid aortic valve (BAV) are more likely to develop a calcific aortic stenosis (CAS), as well as a number of other ailments, as compared to their cohorts with normal tricuspid aortic valves (TAV). It is currently unknown whether the increase in risk of CAS is caused by the geometric differences between the tricuspid and bicuspid valves or whether

Eli J. Weinberg; Mohammad R. Kaazempur Mofrad

2008-01-01

177

Atorvastatin Inhibits Hypercholesterolemia-Induced Calcification in the Aortic Valves via the Lrp5 Receptor Pathway  

PubMed Central

Background Calcific aortic valve disease is the most common indication for surgical valve replacement in the United States. The cellular mechanisms of valve calcification are not well understood. We have previously shown that cellular proliferation and osteoblastogenesis are important in the development of valvular heart disease. Lrp5, a known low-density receptor-related protein, plays an essential role in cellular proliferation and osteoblastogenesis via the ?-catenin signaling pathway. We hypothesize that Lrp5 also plays a role in aortic valve (AV) calcification in experimental hypercholesterolemia. Methods and Results We examined the effects of cholesterol and atorvastatin in Watanabe rabbits (n=54). Group I (n=18) received a normal diet, group II (n=18) a 0.25% cholesterol diet, and group III (n=18) a 0.25% (w/w) cholesterol diet with atorvastatin for the development of calcification. The AVs were examined for cellular proliferation, Lrp5/?-catenin, and bone matrix markers. Bone formation was assessed by micro-computed tomography, calcein injection, and osteopontin expression. Low-density lipoprotein with and without atorvastatin was also tested in AV myofibroblasts for cellular proliferation and regulation of the Lrp5/?-catenin pathway. Our results demonstrate that the cholesterol diet induced complex bone formations in the calcified AVs with an increase in the Lrp5 receptors, osteopontin, and p42/44 expression. Atorvastatin reduced bone formation, cellular proliferation, and Lrp5/?-catenin protein levels in the AVs. In vitro analysis confirmed the Lrp5/?-catenin expression in myofibroblast cell proliferation. Conclusion Hypercholesterolemic AV calcification is attenuated by atorvastatin and is mediated in part by the Lrp5/?-catenin pathway. This developmental pathway may be important in the signaling pathway of this disease. PMID:16159822

Rajamannan, Nalini M.; Subramaniam, Malayannan; Caira, Frank; Stock, Stuart R.; Spelsberg, Thomas C.

2014-01-01

178

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

Microsoft Academic Search

A combined robotic-assisted left atrial ablation and mitral valve repair was done through a 5-cm right anterior mini-thoracotomy. The patient was a 54-year-old man with severe mitral regurgitation and a 10-month history of persistent atrial fibrillation. The patient underwent off-pump, beating heart epicardial peripulmonary vein microwave ablation using the FLEX 10 catheter (AFx Inc, Fremont, CA), followed by supplemental on-pump

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

2004-01-01

179

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.

Celik, Mine; Dostbil, Aysenur; Alici, Hac? Ahmet; Sevimli, Serdar; Aksoy, Aysenur; Erdem, Ali Fuat; Kursad, Husnu

2013-01-01

180

Ablation for atrial fibrillation during mitral valve surgery: 1-year results through continuous subcutaneous monitoring.  

PubMed

Continuous monitoring of cardiac rhythm may play an important role in measuring the true symptomatic/asymptomatic atrial fibrillation (AF) burden and improve the management of anti-arrhythmic and anti-thrombotic therapies. Forty-seven patients with mitral valve disease and longstanding persistent AF (LSPAF) underwent a left atrial maze procedure with bipolar radiofrequency and valve surgery. The follow-up data recorded by an implanted loop recorder were analysed after 3, 6 and 12 months. On discharge, 40 (85.1%) patients were in stable sinus rhythm, as documented by in-office electrocardiography (ECG), 4 (8.5%) were in pacemaker rhythm and 3 (6.4%) were in AF. One (2.1%) patient died after 7 months. On 12-month follow-up examination, 30 (65.2%) patients had an AF burden <0.5% and were classified as responders. Three (6.5%) of the 16 non-responders had atrial flutter and 13 (27.7%) had documented AF recurrences with an AF burden >0.5%. Two (4.3%) patients with AF recurrences were completely asymptomatic. Among the symptomatic events stored by the patients, only 27.6% was confirmed as genuine AF recurrences according to the concomitant ECG recorded by the implanted loop recorder. A concomitant bipolar maze procedure during mitral valve surgery is effective in treating AF, as proved by detailed 1-year continuous monitoring. PMID:22514258

Bogachev-Prokophiev, Alexandr; Zheleznev, Sergey; Romanov, Alexander; Pokushalov, Evgeny; Pivkin, Alexey; Corbucci, Giorgio; Karaskov, Alexander

2012-07-01

181

Haemodynamic determinants of the mitral valve closure sound: a finite element study.  

PubMed

Automatic acoustic classification and diagnosis of mitral valve disease remain outstanding biomedical problems. Although considerable attention has been given to the evolution of signal processing techniques, the mechanics of the first heart sound generation has been largely overlooked. In this study, the haemodynamic determinants of the first heart sound were examined in a computational model. Specifically, the relationship of the transvalvular pressure and its maximum derivative to the time-frequency content of the acoustic pressure was examined. To model the transient vibrations of the mitral valve apparatus bathed in a blood medium, a dynamic, non-linear, fluid-coupled finite element model of the mitral valve leaflets and chordae tendinae was constructed. It was found that the root mean squared (RMS) acoustic pressure varied linearly (r2= 0.99) from 0.010 to 0.259 mmHg, following an increase in maximum dP/dt from 415 to 12470 mm Hg s(-1). Over that same range, peak frequency varied non-linearly from 59.6 to 88.1 Hz. An increase in left-ventricular pressure at coaptation from 22.5 to 58.5mm Hg resulted in a linear (r2= 0.91) rise in RMS acoustic pressure from 0.017 to 1.41mm Hg. This rise in transmitral pressure was accompanied by a non-linear rise in peak frequency from 63.5 to 74.1 Hz. The relationship between the transvalvular pressure and its derivative and the time-frequency content of the first heart sound has been examined comprehensively in a computational model for the first time. Results suggest that classification schemes should embed both of these variables for more accurate classification. PMID:15587476

Einstein, D R; Kunzelman, K S; Reinhall, P G; Cochran, R P; Nicosia, M A

2004-11-01

182

Unusual complication of heparin-induced thrombocytopenia after mitral valve surgery: spontaneous rupture of spleen.  

PubMed

A 64-year-old man presented with cardiac tamponade 2 weeks after mitral valve surgery. The patient was anticoagulated for persistent atrial fibrillation after cardiac surgery. A pericardial catheter was placed. Five days after presentation the patient was started on intravenous heparin infusion. The patient had abdominal pain and hypotension develop. A splenic hematoma was diagnosed and a splenectomy was performed. Pathology showed multiple fibrin thrombi in the spleen. The heparin-associated antibodies were detected. Heparin-induced thrombocytopenia is a potentially fatal condition in patients requiring heparin after cardiac surgery. Evaluation for heparin-associated antibodies in these patients may be warranted before heparin therapy. PMID:17307485

Mitchell, Christina; Riley, Catherine A; Vahid, Bobbak

2007-03-01

183

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

PubMed

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

Reif, T H; Huffstutler, M C

1985-01-01

184

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

PubMed

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

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

2014-10-01

185

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

186

Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions.  

PubMed

Effective myocardial protection and perfusion strategies during minimally invasive mitral valve surgery (Mini-MV) have evolved over the last decade. Our institutional approach for right-sided Mini-MV has been standardized over the last 15 years in more than 4,500 cases. Cardiopulmonary bypass (CPB) is usually instituted by right-sided femoral arterial and venous cannulation with additional cannulation of the right jugular vein in patients with a body weight greater than 75 kg or when a concomitant tricuspid valve (TV) procedure and/or atrial septal defect closure is performed. A single dosage of crystalloid-based cardioplegia [Custodial- histidine-trypthophan-ketoglutarate (Custodial-HTK)] administered via the aortic root in combination with moderate hypothermia (34-35 °C) has become the standard of care for induction and maintenance of myocardial protection at our institution. The present article highlights and discusses the principal techniques of myocardial protection for Mini-MV. PMID:24349985

Garbade, Jens; Davierwala, Piroze; Seeburger, Joerg; Pfannmueller, Bettina; Misfeld, Martin; Borger, Michael A; Mohr, Friedrich-Wilhelm

2013-11-01

187

Isolated effect of geometry on mitral valve function for in silico model development.  

PubMed

Computational models for the heart's mitral valve (MV) exhibit several uncertainties that may be reduced by further developing these models using ground-truth data-sets. This study generated a ground-truth data-set by quantifying the effects of isolated mitral annular flattening, symmetric annular dilatation, symmetric papillary muscle (PM) displacement and asymmetric PM displacement on leaflet coaptation, mitral regurgitation (MR) and anterior leaflet strain. MVs were mounted in an in vitro left heart simulator and tested under pulsatile haemodynamics. Mitral leaflet coaptation length, coaptation depth, tenting area, MR volume, MR jet direction and anterior leaflet strain in the radial and circumferential directions were successfully quantified at increasing levels of geometric distortion. From these data, increase in the levels of isolated PM displacement resulted in the greatest mean change in coaptation depth (70% increase), tenting area (150% increase) and radial leaflet strain (37% increase) while annular dilatation resulted in the largest mean change in coaptation length (50% decrease) and regurgitation volume (134% increase). Regurgitant jets were centrally located for symmetric annular dilatation and symmetric PM displacement. Asymmetric PM displacement resulted in asymmetrically directed jets. Peak changes in anterior leaflet strain in the circumferential direction were smaller and exhibited non-significant differences across the tested conditions. When used together, this ground-truth data-set may be used to parametrically evaluate and develop modelling assumptions for both the MV leaflets and subvalvular apparatus. This novel data may improve MV computational models and provide a platform for the development of future surgical planning tools. PMID:24059354

Siefert, Andrew William; Rabbah, Jean-Pierre Michel; Saikrishnan, Neelakantan; Kunzelman, Karyn Susanne; Yoganathan, Ajit Prithivaraj

2015-05-01

188

Towards subject-specific models of the dynamic heart for image-guided mitral valve surgery.  

PubMed

Surgeons need a robust interventional system capable of providing reliable, real-time information regarding the position and orientation of the surgical targets and tools to compensate for the lack of direct vision and to enhance manipulation of intracardiac targets during minimally-invasive, off-pump cardiac interventions. In this paper, we describe a novel method for creating dynamic, pre-operative, subject-specific cardiac models containing the surgical targets and surrounding anatomy, and how they are used to augment the intra-operative virtual environment for guidance of valvular interventions. The accuracy of these pre-operative models was established by comparing the target registration error between the mitral valve annulus characterized in the pre-operative images and their equivalent structures manually extracted from 3D US data. On average, the mitral valve annulus was extracted with a 3.1 mm error across all cardiac phases. In addition, we also propose a method for registering the pre-operative models into the intra-operative virtual environment. PMID:18044557

Linte, Cristian A; Wierzbicki, Marcin; Moore, John; Little, Stephen H; Guiraudon, Gérard M; Peters, Terry M

2007-01-01

189

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

190

[Mitral valve prolapse at pregnancy--is it a real clinical problem?].  

PubMed

Mitral valve prolapse (MVP) effects more often young women. Symptomatology of MVP varies, symptoms are often nagging and some complications are of importance (mitral insufficiency and arrhythmias). Main objective of investigation was: estimation of the frequency and symptomatology of MVP during pregnancy. A group of 120 women in II/III of pregnancy were admitted to the maternity ward, where echocardiography and a survey have been performed. Two criteria were considered as the classical MVP: displacement toward the left atrium at > 2 mm and the thickness of valve > or = 5 mm. In case when the first criterion was fulfilled, the diagnosis was MVP non classic, in the second case MVP named non classic 2. Classical MVP was diagnosed in 10 patients--8.3% of the examined group. The group of 22 patients--18.3% was diagnosed MVP named non classic 2. MVP during pregnancy is frequent, it accounts for 8.3%. Varies symptomatology was characteristic for all the groups MVP. The most frequent complaints were: dizziness, palpitation, and faintness. There were observed statistically more often in the group with MVP. Women with MVP are not protected by pregnancy. PMID:16789507

Kucharczyk-Petryka, Ewa; Mamcarz, Artur; Braksator, Wojciech; Sawicki, W?odzimierz; D?uzniewski, Miros?aw

2005-11-01

191

Nonlinear solid finite element analysis of mitral valves with heterogeneous leaflet layers  

NASA Astrophysics Data System (ADS)

An incompressible transversely isotropic hyperelastic material for solid finite element analysis of a porcine mitral valve response is described. The material model implementation is checked in single element tests and compared with a membrane implementation in an out-of-plane loading test to study how the layered structures modify the stress response for a simple geometry. Three different collagen layer arrangements are used in finite element analysis of the mitral valve. When the leaflets are arranged in two layers with the collagen on the ventricular side, the stress in the fibre direction through the thickness in the central part of the anterior leaflet is homogenized and the peak stress is reduced. A simulation using membrane elements is also carried out for comparison with the solid finite element results. Compared to echocardiographic measurements, the finite element models bulge too much in the left atrium. This may be due to evidence of active muscle fibres in some parts of the anterior leaflet, whereas our constitutive modelling is based on passive material.

Prot, V.; Skallerud, B.

2009-02-01

192

Anesthetic and hemodynamic management of a rare case of Brucella multivalvular endocarditis in cardiogenic shock undergoing emergency aortic valve replacement and mitral valve repair.  

PubMed

We describe a very rare case of human brucella multivalvular endocarditis. Patient presented in a state of cardiogenic shock with low urine output and a history of breathlessness. Patient was diagnosed to have brucellosis 2 months back by blood cultures and agglutination tests and was receiving doxycycline and rifampicin therapy. Echocardiography showed severe aortic regurgitation, moderate mitral regurgitation, severe left ventricular dysfunction and a mobile vegetation attached to the aortic valve. Patient was scheduled for emergency surgery; while preparing for surgery hemodynamic monitoring, non-invasive ventilation and inotropic supports were started. During surgery, the aortic valve was found perforated and the aortomitral continuity was disrupted. Aortic valve replacement and mitral valve repair were performed. Hemofiltration was used during cardiopulmonary bypass. Weaning from bypass was achieved with the help of inodilators, dual chamber pacing and intra-aortic balloon pump. PMID:24107698

Kandasamy, Ashok; Ramalingam, Senthil Kumar; Reddy, Bhaktavatsala Deva; Krupananda, Harshavardhan

2013-01-01

193

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

194

'Acquired' left ventricular to right atrial shunt after mitral valve replacement: Detection by transthoracic colour Doppler echocardiography  

PubMed Central

Left ventricular to right atrial communications are rare types of ventricular septal defects usually of congenital origin. A case of an iatrogenic shunt between the left ventricle and the right atrium as a rare complication of mitral valve replacement is reported. PMID:17622397

Uslu, Nevzat; Kayacioglu, Ilyas; Ates, Mehmet; Eren, Mehmet

2007-01-01

195

Identification of 2 loci associated with development of myxomatous mitral valve disease in Cavalier King Charles Spaniels.  

PubMed

Myxomatous mitral valve disease (MMVD) is the most common heart disease in dogs. It is characterized by chronic progressive degenerative lesions of the mitral valve. The valve leaflets become thickened and prolapse into the left atrium resulting in mitral regurgitation (MR). MMVD is most prevalent in small to medium sized dog breeds, Cavalier King Charles Spaniels (CKCS) in particular. The onset of MMVD is highly age dependent, and at the age of 10 years, nearly all CKCS are affected. The incidence of a similar disease in humans-mitral valve prolapse-is 1-5%. By defining CKCSs with an early onset of MMVD as cases and old dogs with no or mild signs of MMVD as controls, we conducted a genome-wide association study (GWAS) to identify loci associated with development of MMVD. We have identified a 1.58 Mb region on CFA13 (P(genome) = 4.0 × 10(-5)) and a 1.68 Mb region on CFA14 (P(genome) = 7.9 × 10(-4)) associated with development of MMVD. This confirms the power of using the dog as a model to uncover potential candidate regions involved in the molecular mechanisms behind complex traits. PMID:21846748

Madsen, Majbritt Busk; Olsen, Lisbeth Høier; Häggström, Jens; Höglund, Katja; Ljungvall, Ingrid; Falk, Torkel; Wess, Gerhard; Stephenson, Hannah; Dukes-McEwan, Joanna; Chetboul, Valérie; Gouni, Vassiliki; Proschowsky, Helle Friis; Cirera, Susanna; Karlskov-Mortensen, Peter; Fredholm, Merete

2011-01-01

196

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

SciTech Connect

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

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

2009-01-01

197

Ultrastructural characterization of calcification onset and progression in subdermally implanted aortic valves. Histochemical and spectrometric data.  

PubMed

Detailed characterization of the subdermal model is a significant tool for better understanding of calcification mechanisms occurring in heart valves. In previous ultrastructural investigation on six-week-implantated aortic valve leaflets, modified pre-embedding glutaraldehyde-cuprolinic-blue reactions (GA-CB) enabled sample decalcification with concurrent retention/staining of lipid-containing polyanionic material, which lined cells and cell-derived matrix-vesicle-like bodies (phthalocyanin-positive layers: PPLs) co-localizing with the earliest apatite nucleation sites. Additional post-embedding silver staining (GA-CB-S) revealed PPLs to contain calcium-binding sites. This investigation concerns valve leaflets subjected to shorter implantation times to shed light on the modifications associated with PPLs generation and calcification onset/progression. Spectrometric estimations revealed time-dependent calcium increase, for unreacted samples, and copper modifications indicating an increase in acidic, non-glycanic material, for GA-CB-reacted samples. Two-day-implant thin sections showed emission and subsequent reabsorption of lamellipodium-like protrusions by cells, originating ECM-containing vacuoles, and/or degeneration stages characterized by the appearance of GA-CB-S-reactive, organule-derived dense bodies and progressive dissolution of all cell membranes. In one-week-implants, the first PPL-lined cells were found to co-exist with cells where GA-CB-S-reactive material accumulated, or exudated towards their edges, or outcropped at the ECM milieu, so acquiring PPL features. PPL-derived material was observed increasingly to affect the ECM on thin sections of one-week- to six-week-implants. These results show an endogenous source for PPLs and reveal that a peculiar cascade of cell degenerative steps is associated with valve mineralization in the subdermal model, providing new useful parameters for more reliable comparison of this experimental calcification process versus the physiological and pathological processes. PMID:17163400

Ortolani, F; Bonetti, A; Tubaro, F; Petrelli, L; Contin, M; Nori, S L; Spina, M; Marchini, M

2007-03-01

198

Atrium of stone: A case of confined left atrial calcification without hemodynamic compromise  

PubMed Central

Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects. PMID:24868514

Jones, Christopher; Lodhi, Aadil Mubeen; Cao, Long Bao; Chagarlamudi, Arjun Kumar; Movahed, Assad

2014-01-01

199

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

200

Three-dimensional quantitation of mitral valve coaptation by a novel software system with transthoracic real-time three-dimensional echocardiography.  

PubMed

We investigated the degree of mitral valve coaptation with a custom quantitation software system using transthoracic three-dimensional (3D) echocardiography. With real-time 3D echocardiography, we obtained transthoracic volumetric images in 20 healthy subjects and 20 patients with dilated cardiomyopathy. With our novel software system, the surface area of mitral valve tenting in the onset of mitral leaflet closure [O] and the timing of maximum closure of mitral leaflet [M] were reconstructed for quantitative measurement. The coaptation index was calculated by the following formula: [(3D tenting surface area in O-3D tenting surface area in M)/3D tenting surface area in O]. The coaptation index in patients with dilated cardiomyopathy was significantly smaller than that in healthy subjects (11% +/- 4.1% vs. 18% +/- 8.0%, P = .004). The custom quantitation software system with 3D echocardiography allowed us to assess the degree of mitral valve coaptation. PMID:17628419

Tsukiji, Miwako; Watanabe, Nozomi; Yamaura, Yasuko; Okahashi, Noriko; Obase, Kikuko; Neishi, Yoji; Toyota, Eiji; Kawamoto, Takahiro; Okura, Hiroyuki; Ogasawara, Yasuo; Yoshida, Kiyoshi

2008-01-01

201

Emergency PCI after occlusion of the circumflex artery due to minimally invasive mitral valve replacement in re-do operation.  

PubMed

A lesion of the circumflex artery (RCX) is one of the potential complications of mitral valve (MV) surgery. An intraoperative transoesophageal echocardiography (TEE) should be performed for early detection of potential myocardial damage. We report on an emergency PCI after minimally invasive mitral valve replacement in a redo operation. The patient had previously a mechanical aortic valve replacement. A TEE was performed at the end of the redo operation and showed significant signs of segmental myocardial lateral wall dysfunction. A coronary angiogram was performed immediately and a balloon angioplasty and implantation of two stents in the circumflex artery was necessary. In cases of suspected distortion of the RCX, a coronary angiography must be performed without delay to prevent myocardial necrosis. PMID:25181921

Folkmann, Sandra; Mohr, Friedrich-Wilhelm; Garbade, Jens

2014-08-01

202

Scanning electron microscopy methodology for study of the pathophysiology of calcification in bioprosthetic heart valves  

SciTech Connect

Scanning electron microscope (SEM) morphologic analysis combined with energy dispersive characteristic X-ray (EDX) microprobe analysis provides insight into the mechanisms associated with disease-related crystal formation in biological materials. SEM and EDX were employed in analyzing specimens which were embedded in standard fashion in glycolmethacrylate. The specimen surfaces under electron microscope investigation resulted from microtomy used in the preparation of reference light microscope histological sections; thus histology served as a direct reference for the SEM and EDX analyses. The particular application of these methods was in the study of bioprosthetic heart valve calcification, largely responsible for clinical failure of these heart valve substitutes. To simulate the clinically observed mineralization processes, glutaraldehyde-pretreated porcine heart valve leaflets were implanted subcutaneously in rats and subsequently removed at various time intervals from 1 to 56 days. Also, to address the hypothesis that the calcification process generates crystalline materials analogous to those in bone, EDX data obtained from pure hydroxyapatite were compared with the embedded tissue results. Further, EDX results were compared with data obtained by chemical analysis of the bulk specimens to assess the validity of the electron microscope technique.

Nelson, A.C.; Schoen, F.J.; Levy, R.J.

1985-01-01

203

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

PubMed

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

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

2014-04-01

204

Aortic dissection type A after right atrial cryoablation during port access mitral valve surgery.  

PubMed

The case of a 63-year-old woman who underwent minimal invasive mitral and tricuspid valve repair and a concomitant CryoMaze is described. During creation of the last lesion of the right-sided maze procedure, dissection of the ascending aorta occurred that necessitated emergency sternotomy, replacement of the ascending aorta, and aortocoronary bypass grafting to the right coronary artery (RCA) because of detachment of the RCA from the aortic annulus. Repair of this complication was successful; nevertheless, the patient died 5 days after the operation because of multiorgan failure. The cause of this complication can only be speculated, but a relation to the CyroMaze is obvious. Because of the restricted incision with impaired vision especially in the area of the right atrial appendage, the cryoprobe could have come into contact with the orifice of the RCA during the last lesion, with subsequent detachment of the RCA from the aorta, which could subsequently have caused dissection. PMID:23274873

Fleck, Tatjana; Dworschak, Martin; Wisser, Wilfried

2012-01-01

205

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

PubMed Central

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

2013-01-01

206

Failure to detect Chlamydia pneumoniae in senile calcific aortic stenosis or calcified congenital bicuspid aortic valve by immunofluorescence, polymerase chain reaction and electron microscopy  

Microsoft Academic Search

Introduction:Chlamydia pneumoniae has been identified in arterial atherosclerosis. Aortic valves affected by senile calcific aortic stenosis (SCAS) or calcification of a congenital bicuspid valve (CCBAV) may have interior environments similar to atherosclerosis. This study aimed to detect C. pneumoniae within either SCAS or CCBAV. Methods: 60 valves showing either SCAS (n=36) or CCABV (n=22) and control valves (n=2) were studied

Alan G Rose

2002-01-01

207

Velocity of closure of Björk-Shiley Convexo-Concave mitral valves: effect of mitral annulus orientation and rate of left ventricular pressure rise.  

PubMed

The purpose of this study was to determine analytically the hemodynamic factors that affect the closing velocity of the disc of Björk-Shiley convexo-concave (BSCC) prosthetic mitral valves. The motion of the BSCC disk was modelled by Newton's second law written in the form of a second order differential equation which expressed the instantaneous angle of the disc with respect to the valve ring as a function of the instantaneous pressure drop across the mitral valve, delta P(t), and the angle of the pressure gradient vector acting upon the disc during closure. The disc closes in response to the negative pressure drop created by the crossover of left atrial and left ventricular (LV) pressures. The rate of closure depends on the rate of development of the pressure drop across the valve, d delta P/dt, which is largely dependent upon the rate of change of left ventricular pressure during isovolumic contraction, LV dP/dt. The closure rate is also strongly dependent on the initial angle of the pressure drop vector with respect to the disc. The disc was predicted to reach its highest velocity at the moment of impact, based on the Runge-Kutta solution. Modelling suggests that a high LV dP/dt during valve closure or distorted LV geometry, causing the angle between the fully open disc and the pressure drop vector to shift, will cause the valve to have a high velocity at the moment of impact and may produce high impact loads. PMID:8581208

Blick, E F; Wieting, D W; Inderbitzen, R; Schreck, S; Stein, P D

1995-07-01

208

Mitral valve replacement for severe mitral regurgitation in infants with anomalous left coronary artery from the pulmonary artery  

Microsoft Academic Search

Infants with anomalous left coronary artery from the pulmonary artery (ALCAPA) may present with heart failure, mitral regurgitation,\\u000a and dilated cardiomyopathy. Reestablishment of a two coronary artery system markedly improves the morbidity and mortality.\\u000a However, the mitral regurgitation may continue to deteriorate despite surgical correlation of the ALCAPA because of previous\\u000a ischemic damage to the papillary muscles and chordae. Surgical

M. C. Yam; S. Menahem

1996-01-01

209

Pulmonary hypertension in dogs with mitral regurgitation attributable to myxomatous valve disease.  

PubMed

Pulmonary hypertension has been associated with mitral insufficiency caused by chronic degenerative valve disease in dogs. Our aim was to search for associations between left atrial to aortic root ratio, end-systolic and end-diastolic volume indices, and changes in the right ventricular to right atrial pressure gradient as estimated by the peak velocity of tricuspid regurgitation in dogs with chronic degenerative valve disease and different classes of heart failure. Dogs, for which follow-up was available were evaluated for changes in the right ventricular to right atrial systolic pressure gradient over time. Three hundred and forty-four dogs were studied; 51 in the International Small Animal Cardiac Health Council class la, 75 in class 1b, 113 in class 2, 97 in class 3a, and 8 in class 3b. The mean values for right ventricular to right atrial systolic pressure gradient, end-systolic volume index, end-diastolic volume index, and left atrial to aortic ratio were 49.2 +/- 17.1 mmHg, 149.12 +/- 60.8 and 37.7 +/- 21.6 ml/m2, and 1.9 +/- 0.5, respectively. A weak positive correlation was found between the right ventricular to right atrial systolic pressure gradient and the left atrial to aorta ratio (r = 0.242, P < 0.0001), end-diastolic volume index (r = 0.242, P < 0.0001), and end-systolic volume index (r = 0.129, P < 0.001). Follow up was available for 49 dogs. Of these, 18 had an increased, 12 a decreased, and 19 a stable right ventricular to right atrial systolic pressure gradient despite therapy. The equivalence point between the sensitivity and specificity curves of about 80% in the coincident point corresponded to a right ventricular to right atrial systolic pressure gradient of 48 mmHg. Our results suggest an association between the progressive nature of chronic degenerative mitral valve disease and pulmonary hypertension. It is of clinical interest that, with a right ventricular to right atrial systolic pressure gradient pressure gradient at or above 48 mmHg, pulmonary hypertension does not appear to improve despite therapy targeted at lowering the left atrial load. PMID:19507386

Chiavegato, David; Borgarelli, Michele; D'Agnolo, Gino; Santilli, Roberto A

2009-01-01

210

Wide range force feedback for catheter insertion mechanism for use in minimally invasive mitral valve repair surgery  

NASA Astrophysics Data System (ADS)

Mitral valve regurgitation (MR) is a condition in which heart's mitral valve does not close tightly, which allows blood to leak back into the left atrium. Restoring the dimension of the mitral-valve annulus by percutaneous intervention surgery is a common choice to treat MR. Currently, this kind of open heart annuloplasty surgery is being performed through sternotomy with cardiomyopathy bypass. In order to reduce trauma to the patient and also to eliminate bypass surgery, robotic assisted minimally invasive surgery (MIS) procedure, which requires small keyhole incisions, has a great potential. To perform this surgery through MIS procedure, an accurate computer controlled catheter with wide-range force feedback capabilities is required. There are three types of tissues at the site of operation: mitral leaflet, mitral annulus and left atrium. The maximum allowable applied force to these three types of tissue is totally different. For instance, leaflet tissue is the most sensitive one with the lowest allowable force capacity. For this application, therefore, a wide-range force sensing is highly required. Most of the sensors that have been developed for use in MIS applications have a limited range of sensing. Therefore, they need to be calibrated for different types of tissue. The present work, reports on the design, modeling and simulation of a novel wide-range optical force sensor for measurement of contact pressure between catheter tip and heart tissue. The proposed sensor offers a wide input range with a high resolution and sensitivity over this range. Using Micro-Electro-Mechanical-Systems (MEMS) technology, this sensor can be microfabricated and integrated with commercially available catheters.

Ahmadi, Roozbeh; Sokhanvar, Saeed; Packirisamy, Muthukumaran; Dargahi, Javad

2009-02-01

211

Usefulness of novel hematologic inflammatory parameters to predict prosthetic mitral valve thrombosis.  

PubMed

Prosthetic valve thrombosis (PVT) is a life-threatening complication. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding valvular disease are lacking. The study population included patients with mitral PVT (n = 152) versus control subjects (n = 164) with functional mitral prosthesis. Transesophageal echocardiography was performed to diagnose PVT. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil and platelet levels did not differ between the groups (4.9 ± 2.0 vs 4.7 ± 1.5, p = 0.84 and 254.8 ± 89.7 vs 241.5 ± 62.8 p = 0.36, respectively), but lymphocyte levels were significantly lower in patients with PVT than the controls (1.8 ± 0.7 vs 2.2 ± 0.6, p <0.001). NLR, PLR, and CRP levels were significantly higher in patients with PVT than in controls (3.2 ± 2.1 vs 2.2 ± 0.8, p <0.001; 163 ± 77.5 vs 114.9 ± 37.3, p <0.001; and 1.97 ± 3.02 vs 1.02 ± 1.22, p = 0.01, respectively). A positive correlation was observed between NLR and PLR (r = 528, p <0.001). NLR level of >2.23, measured on admission, yielded an area under the curve value of 0.659 (95% confidence interval 0.582 to 0.736, sensitivity 66%, specificity 60%, p <0.001) and PLR level of >117.78 yielded an area under the curve value of 0.707 (95% confidence interval 0.636 to 0.777, sensitivity 70%, specificity 58%, p <0.001). Multivariate analysis showed that increased PLR and inadequate anticoagulation were independent predictors of thrombosis in patients with PVT. In conclusion, patients with PVT had increased NLR, PLR, and CRP levels compared with subjects with normofunctional prosthesis, and increased PLR was an independent predictor of mitral PVT. PMID:24411287

Gürsoy, Ozan Mustafa; Karakoyun, Süleyman; Kalçik, Macit; Gökdeniz, Tayyar; Yesin, Mahmut; Gündüz, Sabahattin; Astarcio?lu, Mehmet Ali; Ozkan, Mehmet

2014-03-01

212

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

213

Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.  

PubMed

Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER. PMID:24211894

Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

2014-01-01

214

Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography.  

PubMed

We sought to investigate the 3-dimensional geometric differences of mitral leaflet tenting in ischemic mitral regurgitation, comparing inferior and anterior myocardial infarction (MI). Using real-time 3-dimensional echocardiography, we obtained transthoracic volumetric images for patients with significant ischemic mitral regurgitation (9 inferior and 7 anterior). With our novel software system, 3-dimensional images of the leaflets were reconstructed for quantitation. Mitral leaflet configuration was then represented in contour in which the degree of the tenting could be observed. Calculated percent of tethered leaflet area (>5-mm tenting from the annular level) was compared in inferior and anterior MI. Percent of tethered leaflet area was significantly smaller in inferior than anterior MI, reflecting the localized leaflet tenting in inferior MI (16.7 +/- 18.8% vs 38.9 +/- 9.7%, P = .01). In anterior MI, mitral valve leaflets were widely tethered toward the left ventricle, in contrast with inferior MI showing localized tenting of the leaflet. PMID:16423672

Watanabe, Nozomi; Ogasawara, Yasuo; Yamaura, Yasuko; Yamamoto, Katsunori; Wada, Nozomi; Kawamoto, Takahiro; Toyota, Eiji; Akasaka, Takashi; Yoshida, Kiyoshi

2006-01-01

215

An integrated framework for finite-element modeling of mitral valve biomechanics from medical images: application to MitralClip intervention planning.  

PubMed

Treatment of mitral valve (MV) diseases requires comprehensive clinical evaluation and therapy personalization to optimize outcomes. Finite-element models (FEMs) of MV physiology have been proposed to study the biomechanical impact of MV repair, but their translation into the clinics remains challenging. As a step towards this goal, we present an integrated framework for finite-element modeling of the MV closure based on patient-specific anatomies and boundary conditions. Starting from temporal medical images, we estimate a comprehensive model of the MV apparatus dynamics, including papillary tips, using a machine-learning approach. A detailed model of the open MV at end-diastole is then computed, which is finally closed according to a FEM of MV biomechanics. The motion of the mitral annulus and papillary tips are constrained from the image data for increased accuracy. A sensitivity analysis of our system shows that chordae rest length and boundary conditions have a significant influence upon the simulation results. We quantitatively test the generalization of our framework on 25 consecutive patients. Comparisons between the simulated closed valve and ground truth show encouraging results (average point-to-mesh distance: 1.49 ± 0.62 mm) but also the need for personalization of tissue properties, as illustrated in three patients. Finally, the predictive power of our model is tested on one patient who underwent MitralClip by comparing the simulated intervention with the real outcome in terms of MV closure, yielding promising prediction. By providing an integrated way to perform MV simulation, our framework may constitute a surrogate tool for model validation and therapy planning. PMID:22766456

Mansi, Tommaso; Voigt, Ingmar; Georgescu, Bogdan; Zheng, Xudong; Mengue, Etienne Assoumou; Hackl, Michael; Ionasec, Razvan I; Noack, Thilo; Seeburger, Joerg; Comaniciu, Dorin

2012-10-01

216

Aortic coarctation associated with aortic valve stenosis and mitral regurgitation in an adult patient: a two-stage approach using a large-diameter stent graft.  

PubMed

We report a case of a staged surgical and endovascular management in a 62-year-old woman with aortic coarctation associated with aortic valve stenosis and mitral regurgitation. The patient was admitted for severe aortic valve stenosis and mitral valve incompetence. During hospitalization and preoperative imaging, a previously undiagnosed aortic coarctation was discovered. The patient underwent a 2-stage approach that combined a Bentall procedure and mitral valve replacement in the first stage, followed by correction of the aortic coarctation by percutaneous placement of an Advanta V12 large-diameter stent graft (Atrium, Mijdrecht, The Netherlands) which to our knowledge has not been used in an adult patient with this combination of additional cardiac comorbidities. A staged approach combining surgical treatment first and endovascular placement of an Advanta V12 stent graft in the second stage can be effective and safe in adult patients with coarctation of the aorta and additional cardiac comorbidities. PMID:24332897

Novosel, Luka; Perkov, Dražen; Dobrota, Savko; ?ori?, Vedran; Štern Padovan, Ranka

2014-02-01

217

Mechanism of Microbubble Growth at Mitral Mechanical Heart Valve (MHV) Closure  

NASA Astrophysics Data System (ADS)

The growth mechanism of microbubbles at mitral MHV closure has been experimentally studied. In the heart, some of the tiny bubbles grow explosively and form larger and persistent bubbles. An experimental set-up was designed to allow the passage of micron-size bubbles through an 80 micron-wide slot, simulating a typical gap between the housing ring and the occluders in MHV. The bubbles were generated using an air-liquid dispenser and were delivered to the system via a 250 micron-diameter hypedermic needle positioned vertically near the slot. A solenoid valve was used to deliver a 10cc volume of liquid in 25ms time through the slot. High-speed imaging was used to study the impact of flow through the slot on bubble growth. The velocity of liquid through the slot was assessed to be in the range of 12-15 m/s. Our observations confirmed the rapid and drastic growth of microbubbles following their passage through the narrow slot, due to pressure drop. Vortices, which were induced by flow separation on the downstream of the slot, caused the grown bubbles to shatter and form more stable bubbles.

Rambod, Edmond; Beizaie, Masoud; Shusser, Michael; Gharib, Morteza

1999-11-01

218

Carotid cutdown for surgical retrieval of a guidewire introducer: an unusual complication after mitral valve repair.  

PubMed

With the use of endovascular techniques and indwelling catheters, potential complications can include embolization of fragments or components of various systems. The authors describe the surgical retrieval of a guidewire introducer from the right common carotid artery (CCA). A 64-year-old man was found to have a foreign body within the right CCA on CT angiography after he had presented with a transient ischemic attack. He had undergone a complex mitral valve repair several months before presenting to the authors' facility. That procedure involved a femoral artery cutdown and the insertion of an endovascular aortic balloon for cardiac bypass. As in most endovascular procedures, guidewire introducers were probably used to facilitate the introduction of the guidewire into the system during the procedure. Although rare, iatrogenic embolization of the introducer probably occurred during use of the guidewire. The guidewire introducer was successfully retrieved without complication by using a standard carotid cutdown approach. It is extraordinarily unusual for an extracorporeal part of an implantable system to embolize to the carotid circulation. To the authors' knowledge, this is the only reported case of an embolized guidewire introducer and the use of a carotid exposure to retrieve an intraluminal foreign body. This case demonstrates that a carotid cutdown approach can be used successfully for the retrieval of intraluminal extracranial carotid artery foreign bodies. PMID:24926651

Meyers, Joshua E; Sorkin, Grant C; Shakir, Hakeem J; Snyder, Kenneth V

2014-10-01

219

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

220

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

221

Curious case of calciphylaxis leading to acute mitral regurgitation.  

PubMed

Calciphylaxis is uncommon and typically seen in patients with end-stage renal disease. It has been defined as a vasculopathic disorder characterised by cutaneous ischaemia and necrosis due to calcification, intimal fibroplasia and thrombosis of pannicular arterioles. We present the case of a 74-year-old woman with chronic kidney disease stage III who developed calciphylaxis leading to mitral valve calcification, chordae tendineae rupture and acute mitral regurgitation. Although an alternative explanation can typically be found for non-uraemic calciphylaxis, her evaluation did not reveal any usual non-uraemic causes including elevated calcium-phosphorus product, hyperparathyroidism, or evidence of connective tissue disease. Her wounds improved with sodium thiosulfate, pamidronate, penicillin and hyperbaric oxygen therapies but she ultimately decompensated with the onset of acute mitral regurgitation attributed to rupture of a previously calcified chordae tendineae. This case highlights an unusual case of calciphylaxis without clear precipitant as well as a novel manifestation of the disease. PMID:24789150

Gallimore, Grant Gardner; Curtis, Blair; Smith, Andria; Benca, Michael

2014-01-01

222

[Redo double valve replacement in a patient with bioprosthetic valve malfunction by pannus formation;report of a case].  

PubMed

A 76-year-old female, who had received Carpentier-Edwards perimount (CEP) pericardial bioprostheses for aortic and mitral valves 6 years before, was diagnosed with reduced mobility of the valvular cusps by echocardiogram 2 years after the surgery. The symptoms of heart failure gradually aggravated. Significant stenosis and regurgitation were observed of the prosthetic valves, and a second surgery was performed. Calcification and severe pannnus formation were observed of both CEP valves that were excised. PMID:25292380

Hiranuma, Susumu; Nabuchi, Akihiro; Okuyama, Hiroshi; Muto, Yasuji; Endo, Masahiro

2014-10-01

223

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

224

Balloon aortic valvuloplasty as a bridge to aortic valve replacement in a patient with severe calcific aortic stenosis  

PubMed Central

This case report describes a patient with severe calcific aortic stenosis who was initially considered inoperable because of a very poor left ventricular function and severe pulmonary hypertension. After balloon aortic valvuloplasty, the clinical and haemodynamic status of the patient improved to such an extent that subsequent aortic valve replacement was considered possible and eventually proved to be successful. Balloon aortic valvuloplasty has value as a potential bridge to aortic valve replacement when the risks for surgery are considered to be too high. ImagesFigure 1

Swinkels, B.M.; Jaarsma, W.; Wely, L. Relik-van; van Swieten, H.A.; Ernst, J.M.P.G.; Plokker, H.W.M.

2003-01-01

225

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

PubMed

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

Boronyak, Steven M; Merryman, W David

2012-09-01

226

Comparison of Transesophageal Echocardiographic Analysis and Circulating Biomarker Expression Profile in Calcific Aortic Valve Disease  

PubMed Central

Background and aim of the study Aortic valve sclerosis (AVSc), the early asymptomatic stage of calcific aortic valve disease (CAVD), is characterized by a progressive thickening of the aortic cusps without obstruction of the left ventricular outflow. In spite of its high prevalence, there are no molecular markers to characterize the early stages of CAVD before it progresses to a severe, symptomatic stage of aortic valve stenosis (AVS). The study aim was to identify any correlation between circulating biomarkers and transesophageal echocardiography (TEE) evaluation. Methods A total of 330 patients with various degrees of CAVD was enrolled into the study. Blood was collected from each patient prior to surgery, and analyzed using ELISA kits following the manufacturers' instructions. Results Significantly higher plasma osteopontin (OPN) levels were observed in AVSc patients (72.7 ± 1.8 ng/ml; p <0.001) and AVS patients (64.3 ± 5.1 ng/ml; p <0.001) when compared to controls (30.3 ± 1.8 ng/ml). Parathyroid hormone (PTH) levels in AVSc and AVS patients (164.1 ± 16.5 and 134.3 ± 14.6 pg/ml; p <0.001 and p = 0.04, respectively) were also significantly higher than in controls (61.8 ± 4.92 pg/ml). Upon further analysis, plasma levels of OPN (p <0.001) and PTH (p <0.001) were found to be significantly higher in asymptomatic AVSc patients, even before calcium deposition was detected on TEE evaluation. Fetuin-A levels were lower at all stages of CAVD when compared to controls (p <0.001 and p ?0.05, respectively), but were comparable among the patient groups. NT-levels were significantly higher in AVS patients than in controls (p ?0.01). Conclusion Serum levels of OPN, PTH, and fetuin-A showed a significant association with different stages of CAVD, with variations in their levels occurring before calcium nodules are visualized during TEE evaluation. The study results may help not only to provide a better understanding of the progression of CAVD but also to develop new tools that can be used to stage these patients. PMID:23798203

Sainger, Rachana; Grau, Juan B.; Branchetti, Emanuela; Poggio, Paolo; Lai, Eric; Koka, Erblina; Vernick, William J.; Gorman, Robert C.; Bavaria, Joseph E.; Ferrari, Giovanni

2014-01-01

227

Pre-existing endothelial cell activation predicts vasoplegia after mitral valve surgery†  

PubMed Central

OBJECTIVES Post-cardiac surgery vasoplegia is a common complication of cardiac surgery, characterized by profound loss of systemic vascular resistance. This results in severe hypotension, high cardiac output and metabolic acidosis reflecting inadequate tissue perfusion. The pathophysiological mechanisms underlying this syndrome remain unknown. We hypothesized that this vasoplegia reflects endothelial dysfunction, either as pre-existing condition or as a consequence of the surgical procedure. METHODS To examine these mechanisms, six established and distinct markers of endothelial cell activation were measured pre- and perioperatively in patients undergoing mitral valve surgery. Arterial (radial artery) and myocardial venous blood samples (coronary sinus) were collected simultaneously over the reperfused heart at various time points during the first hour after reperfusion. Additional samples were collected at baseline (brachial vein) and 1 day post-reperfusion (radial artery). Post-cardiac surgery vasoplegia was defined as a mean arterial blood pressure of <60 mmHg, with a cardiac index of ?2.2 l/min/m2 treated with continuous intravenous administration of norepinephrine. RESULTS No myocardial release of endothelial cell activation markers was observed upon reperfusion in patients with vasoplegia (n = 15; mean age 71 years, 73% male). In contrast, in patients without vasoplegia (n = 24; mean age 64 years, 54% male), reperfusion was characterized by a myocardial release of three endothelial cell activation markers. Myocardial von Willebrand Factor propeptide, osteoprotegerin and interleukin-8 were increased 107% (P < 0.001), 106% (P = 0.02) and 116% (P = 0.009), respectively, compared with arterial levels upon reperfusion. Similar systemic levels of all markers were found upon reperfusion in both groups, except for 120% increased soluble P-selectin (sP-selectin) levels in vasoplegia patients (P = 0.03). Remarkably, postoperative vasoplegia was identified with baseline von Willebrand Factor propeptide levels with a cut-off value of 11.9 nM as well as with baseline sP-selectin levels with a cut-off value of 64.4 ng/ml. CONCLUSIONS Pre-existing endothelial cell activation, reflected by higher baseline von Willebrand Factor propeptide and sP-selectin levels, is a predisposing factor for post-cardiac surgery vasoplegia. The pre-existing endothelial cell activation may have resulted in desensibilization of endothelium in patients who develop vasoplegic syndrome, resulting in no myocardial release of endothelial cell activation markers upon reperfusion. PMID:23736659

Kortekaas, Kirsten A.; Lindeman, Jan H.N.; Reinders, Marlies E.J.; Palmen, Meindert; Klautz, Robert J.M.; de Groot, Philip G.; Roest, Mark

2013-01-01

228

Calcific left atrium: A rare consequence of endocarditis  

PubMed Central

Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium (usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. Although we haven’t data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.

Dattilo, Giuseppe; Anfuso, Carmelo; Casale, Matteo; Giugno, Vincenza; Camarda, Lorenzo; Lagana, Natascia; Di Bella, Gianluca

2014-01-01

229

Calcified Rheumatic Valve Neoangiogenesis Is Associated With Vascular Endothelial Growth Factor Expression and Osteoblast-Like Bone Formation  

PubMed Central

Background Rheumatic heart disease is the most common cause of valvular disease in developing countries. Despite the high prevalence of this disease, the cellular mechanisms are not well known. We hypothesized that rheumatic valve calcification is associated with an osteoblast bone formation and neoangiogenesis. Methods and Results To test this hypothesis, we examined human rheumatic valves replaced at surgery (n=23), normal human valves (n=20) removed at cardiac transplantation, and degenerative mitral valve leaflets removed during surgical valve repair (n=15). Microcomputed tomography was used to assess mineralization fronts to reconstruct the extents of mineralization. Immunohistochemistry was used to localize osteopontin protein, ?-actin, osteocalcin, vascular endothelial growth factor, von Willebrand factor, and CD68 (human macrophage). Microcomputed tomography demonstrated complex calcification developing within the heavily calcified rheumatic valves, not in the degenerative mitral valves and control valves. Immunohistochemistry localized osteopontin and osteocalcin to areas of smooth muscle cells within microvessels and proliferating myofibroblasts. Vascular endothelial growth factor was present in areas of inflammation and colocalized with the CD68 stain primarily in the calcified rheumatic valves. Alizarin red, osteopontin, and osteocalcin protein expression was upregulated in the calcified rheumatic valves and was present at low levels in the degenerative mitral valves. Conclusions These findings support the concept that rheumatic valve calcification is not a random passive process but a regulated, inflammatory cellular process associated with the expression of osteoblast markers and neoangiogenesis. PMID:15956138

Rajamannan, Nalini M.; Nealis, Thomas B.; Subramaniam, Malayannan; Pandya, Sanjay; Stock, Stuart R.; Ignatiev, Constatine I.; Sebo, Thomas J.; Rosengart, Todd K.; Edwards, William D.; McCarthy, Patrick M.; Bonow, Robert O.; Spelsberg, Thomas C.

2014-01-01

230

35th Annual Meeting — American College of Angiology Orlando, Florida — October, 1988 Symposium ProceedingsNeurologic Aspects of Mitral Valve Prolapse  

Microsoft Academic Search

Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications

Albert F. Heck

1989-01-01

231

Effect of varying ventricular function by extrasystolic potentiation on closure of the mitral valve.  

NASA Technical Reports Server (NTRS)

Mitral regurgitant indexes were measured by roentgen videodensitometry in anesthetized dogs without thoracotomy before, during and after extrasystolic potentiation of ventricular contraction while the atria and ventricles were driven in normal temporal sequence simultaneously or in such a way as to induce atrial fibrillation. Small amounts of mitral reflux were observed with simultaneous atrial and ventricular driving and with atrial fibrillation in the control measurements before initiation of extrasystolic potentiation. Reflux became negligible during extrasystolic potentiation and increased beyond control levels after termination of extrasystolic potentiation.

Vandenberg, R. A.; Williams, J. C. P.; Sturm, R. E.; Wood , E. H.

1971-01-01

232

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

PubMed Central

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

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

2011-01-01

233

The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet  

SciTech Connect

We have recently demonstrated that the mitral valve anterior leaflet (MVAL) exhibited minimal hysteresis, no strain rate sensitivity, stress relaxation but not creep (Grashow et al., 2006, Ann Biomed Eng., 34(2), pp. 315-325; Grashow et al., 2006, Ann Biomed. Eng., 34(10), pp. 1509-1518). However, the underlying structural basis for this unique quasi-elastic mechanical behavior is presently unknown. As collagen is the major structural component of the MVAL, we investigated the relation between collagen fibril kinematics (rotation and stretch) and tissue-level mechanical properties in the MVAL under biaxial loading using small angle X-ray scattering. A novel device was developed and utilized to perform simultaneous measurements of tissue level forces and strain under a planar biaxial loading state. Collagen fibril D-period strain ({epsilon}{sub D}) and the fibrillar angular distribution were measured under equibiaxial tension, creep, and stress relaxation to a peak tension of 90 N/m. Results indicated that, under equibiaxial tension, collagen fibril straining did not initiate until the end of the nonlinear region of the tissue-level stress-strain curve. At higher tissue tension levels, {epsilon}{sub D} increased linearly with increasing tension. Changes in the angular distribution of the collagen fibrils mainly occurred in the tissue toe region. Using {epsilon}{sub D}, the tangent modulus of collagen fibrils was estimated to be 95.5{+-}25.5 MPa, which was {approx}27 times higher than the tissue tensile tangent modulus of 3.58{+-}1.83 MPa. In creep tests performed at 90 N/m equibiaxial tension for 60 min, both tissue strain and D remained constant with no observable changes over the test length. In contrast, in stress relaxation tests performed for 90 min {epsilon}{sub D} was found to rapidly decrease in the first 10 min followed by a slower decay rate for the remainder of the test. Using a single exponential model, the time constant for the reduction in collagen fibril strain was 8.3 min, which was smaller than the tissue-level stress relaxation time constants of 22.0 and 16.9 min in the circumferential and radial directions, respectively. Moreover, there was no change in the fibril angular distribution under both creep and stress relaxation over the test period. Our results suggest that (1) the MVAL collagen fibrils do not exhibit intrinsic viscoelastic behavior, (2) tissue relaxation results from the removal of stress from the fibrils, possibly by a slipping mechanism modulated by noncollagenous components (e.g. proteoglycans), and (3) the lack of creep but the occurrence of stress relaxation suggests a 'load-locking' behavior under maintained loading conditions. These unique mechanical characteristics are likely necessary for normal valvular function.

Liao,J.; Yang, L.; Grashow, J.; Sacks, M.

2007-01-01

234

Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval  

PubMed Central

Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP. PMID:25232403

Yontar, Osman Can; Karaagac, Kemal; Tenekecioglu, Erhan; Tutuncu, Ahmet; Demir, Mehmet; Melek, Mehmet

2014-01-01

235

Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients.  

PubMed

The purpose of this study was to assess the value of electron beam computed tomography in the detection of cardiac calcifications in coronaries and valves of dialysis patients and to determine the rate at which calcification progresses. Forty-nine chronic hemodialysis patients aged 28 to 74 years were compared with 102 non-dialysis patients aged 32 to 73 years with documented or suspected coronary artery disease, all of whom underwent coronary angiography. We used high-resolution electron beam computed tomography scanning to make 30 axial slices with a distance of 3 mm between each slice. The number of calcifications, the surface area, and the average and highest density values were measured. We calculated a quantitative coronary artery calcium score and assessed calcification of mitral and aortic valves. In dialysis patients, the measurements were repeated after 12 months. The coronary artery calcium score was from 2.5-fold to fivefold higher in the dialysis patients than in the non-dialysis patients. Hypertensive dialysis patients had higher calcium scores than non-hypertensive dialysis patients (P < 0.05). A stepwise, multiple regression analysis confirmed the importance of age and hypertension. No correlation between calcium, phosphate, or parathyroid hormone values and the coronary calcium score was identified; however, the calcium score was inversely correlated with bone mass in the dialysis patients (r = 0.47, P < 0.05). The mitral valve was calcified in 59% of dialysis patients, while the aortic valve was calcified in 55%. The coronary artery calcium score was correlated with aortic valvular, but not mitral valvular calcification. A repeat examination of the dialysis patients at an interval of 1 year showed a disturbing tendency for progression. Our data under-score the frequency and severity of coronary and valvular calcifications in dialysis patients, and illustrate the rapid progression of this calcification. Finally, they draw attention to hypertension as an important risk factor in this process. PMID:8604709

Braun, J; Oldendorf, M; Moshage, W; Heidler, R; Zeitler, E; Luft, F C

1996-03-01

236

Association of neutrophil-lymphocyte ratio with the presence and severity of rheumatic mitral valve stenosis.  

PubMed

The aim of the study is to investigate the association between the severity of rheumatic mitral valvular disease (RMVD) and the neutrophil-lymphocyte ratio (NLR). A total of 227 patients were enrolled in the study and divided into 3 groups. Patients in group 1 had rheumatic mitral stenosis (RMS), those in group 2 had RMVD without stenosis, and those in group 3 served as the control group. Group 1 was further divided into 2 groups, severe mitral stenosis (MS) and mild to moderate MS. The NLR was significantly higher in patients with severe MS when compared to those with mild to moderate MS (P = .002) while lymphocyte count was lower (P = .034). Using a cutoff level of 2.56, the NLR predicted severe RMS with a sensitivity of 75% and specificity of 74%. In conclusion, as an inexpensive, simple, and accessible marker of inflammation, the NLR may be useful in predicting the presence and severity of MS in patients with RMVD. PMID:24335245

Polat, Nihat; Yildiz, Abdulkadir; Yuksel, Murat; Bilik, Mehmet Zihni; Aydin, Mesut; Acet, Halit; Akil, Mehmet Ata; Oylumlu, Mustafa; Kaya, Hasan; Ertas, Faruk; Cil, Habib

2014-11-01

237

Genetic Associations with Valvular Calcification and Aortic Stenosis  

PubMed Central

BACKGROUND Limited information is available regarding genetic contributions to valvular calcification, which is an important precursor of clinical valve disease. METHODS We determined genomewide associations with the presence of aorticvalve calcification (among 6942 participants) and mitral annular calcification (among 3795 participants), as detected by computed tomographic (CT) scanning; the study population for this analysis included persons of white European ancestry from three cohorts participating in the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (discovery population). Findings were replicated in independent cohorts of persons with either CT-detected valvular calcification or clinical aortic stenosis. RESULTS One SNP in the lipoprotein(a) (LPA) locus (rs10455872) reached genomewide significance for the presence of aorticvalve calcification (odds ratio per allele, 2.05; P = 9.0×10?10), a finding that was replicated in additional white European, African-American, and Hispanic-American cohorts (P<0.05 for all comparisons). Genetically determined Lp(a) levels, as predicted by LPA genotype, were also associated with aorticvalve calcification, supporting a causal role for Lp(a). In prospective analyses, LPA genotype was associated with incident aortic stenosis (hazard ratio per allele, 1.68; 95% confidence interval [CI], 1.32 to 2.15) and aortic-valve replacement (hazard ratio, 1.54; 95% CI, 1.05 to 2.27) in a large Swedish cohort; the association with incident aortic stenosis was also replicated in an independent Danish cohort. Two SNPs (rs17659543 and rs13415097) near the proinflammatory gene IL1F9 achieved genomewide significance for mitral annular calcification (P = 1.5×10?8 and P = 1.8×10?8, respectively), but the findings were not replicated consistently. CONCLUSIONS Genetic variation in the LPA locus, mediated by Lp(a) levels, is associated with aorticvalve calcification across multiple ethnic groups and with incident clinical aortic stenosis. (Funded by the National Heart, Lung, and Blood Institute and others.) PMID:23388002

Thanassoulis, George; Campbell, Catherine Y.; Owens, David S.; Smith, J. Gustav; Smith, Albert V.; Peloso, Gina M.; Kerr, Kathleen F.; Pechlivanis, Sonali; Budoff, Matthew J.; Harris, Tamara B.; Malhotra, Rajeev; O'Brien, Kevin D.; Kamstrup, Pia R.; Nordestgaard, B?rge G.; Tybjaerg-Hansen, Anne; Allison, Matthew A.; Aspelund, Thor; Criqui, Michael H.; Heckbert, Susan R.; Hwang, Shih-Jen; Liu, Yongmei; Sjogren, Marketa; van der Pals, Jesper; Kalsch, Hagen; Muhleisen, Thomas W.; Nothen, Markus M.; Cupples, L. Adrienne; Caslake, Muriel; Di Angelantonio, Emanuele; Danesh, John; Rotter, Jerome I.; Sigurdsson, Sigurdur; Wong, Quenna; Erbel, Raimund; Kathiresan, Sekar; Melander, Olle; Gudnason, Vilmundur; O'Donnell, Christopher J.; Post, Wendy S.

2013-01-01

238

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

PubMed Central

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

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

2014-01-01

239

[Doppler echocardiography in the functional evaluation of patients with pure mitral valve stenosis].  

PubMed

To evaluate the utility of echo-Doppler (ED; PW, CW and color), 67 patients affected by pure mitral stenosis (20 M, 47 F, mean age 52 years) were submitted to ED examination. Right and left cardiac catheterization were performed in 20 patients within 24 hours before ED. Mitral area obtained by Doppler method (Hatle's formula) correlated highly with both echo-2 dimensional and hemodynamic area (r = 0.93, p less than 0.001; r = 0.95, p less than 0.001 respectively). It was possible to calculate systolic pulmonary pressure, in patients with tricuspid incompetence, (43.9 +/- 14.9 mmHg, range 25-80) which correlated significantly (r = 0.95, p less than 0.001) with hemodynamic data (40.2 +/- 12.7 mmHg, range 20-70). The left atrial-left ventricular pressure gradient was 15.6 +/- 6.9 mmHg, range 6-32; the mean pressure gradient was 8.4 +/- 3.7 mmHg, range 3-17; the pressure half time 170.2 +/- 62.3 ms, range 83-330. We observed different types of direction of transmitral jets: centrally directed (n = 34); forward antero-lateral wall (n = 28); toward interventricular septum (n = 5). The transmitral jets presented 4 different appearances: scimitar-shaped (n = 28); candle flame (n = 24); mushroom (n = 9); double-jets (n = 6). No correlation was observed between the different types of transmitral jets (direction and appearance) and the parameters obtained by Doppler (PW and CW): velocities, pressure half-time, gradients. Thus, Doppler echocardiography permits a complete anatomic and functional evaluation of patients with pure mitral stenosis. We have not observed any correlation between the hemodynamic data and the different types of transmitral jets visualized by color Doppler. PMID:2208198

Tartarini, G; Balbarini, A; Baglini, R; Di Marco, S; Mengozzi, G; Passaglia, C; Mariotti, R; Mariani, M

1990-02-01

240

The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement  

PubMed Central

Background Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0–2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. Methods One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n?=?34), INR <2.0; group 2 (n?=?49), INR 2.0–2.5; and group 3 (n?=?52), INR >2.5. Results A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P?=?0.036). Conclusions This study showed that a target INRs of 2.0–2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR. PMID:24885719

2014-01-01

241

Late results of mitral valve replacement with Carpentier-Edwards high profile bioprosthesis in young adults  

Microsoft Academic Search

Carpentier-Edwards (C\\/E) high profile supra-annular porcine bioprostheses were implanted in 163 patients between September 1982–February 1987 in the mitral position due to rheumatic disease. The patients' ages ranged between 15 and 58 years (mean: 36.5 ± 11.5). One hundred-two of the patients (62.5%) were female. The hospital mortality was 9.8% (16\\/163). The total cumulative follow-up period was 1093 patient-years (p-y)

B. Yamak; E. Sener; U. Kiziltepe; B. Mavitas; O. Tasdemir; K. Bayazit

1995-01-01

242

Early recovery of left ventricle following coronary artery bypass grafting and mitral valve repair in a case of anomalous origin of left coronary artery from pulmonary artery  

Microsoft Academic Search

Anomalous origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) is a rare congenital malformation, which can result\\u000a in myocardial infarction, congestive heart failure and sudden death if left untreated. Reports of myocardial revascularization\\u000a and Mitral Valve (MV) repair following ALCAPA repair in infants are uncommon. We report a critically ill infant with ALCAPA\\u000a needing myocardial revascularization and MV repair

Raj Gopal Menon; Salim Maskari; John Valliattu; Taha Al Delamie

2009-01-01

243

Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction  

Microsoft Academic Search

BackgroundMeasurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low

Caroline Cueff; Jean-Michel Serfaty; Claire Cimadevilla; Jean-Pierre Laissy; Dominique Himbert; Florence Tubach; Xavier Duval; Bernard Iung; Maurice Enriquez-Sarano; Alec Vahanian; David Messika-Zeitoun

2010-01-01

244

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

245

Determinants of the Doppler flow velocity profile through the mitral valve of the human fetus  

Microsoft Academic Search

OBJECTIVE--A normal fetal flow velocity profile through the atrioventricular valves early in gestation is characterised by a higher late peak (A) than early peak (E) velocity waveform, whereas the E\\/A ratio is known to increase throughout pregnancy. This study aims firstly to identify which of the two variables, E or A, is the contributory factor to the increased E\\/A ratio

A M Carceller-Blanchard; J C Fouron

1993-01-01

246

Limitations of Doppler ultrasound in the assessment of the function of prosthetic mitral valves.  

PubMed Central

Pressure half time has been assumed to be a relatively flow-independent measure of orifice area, but it may also be influenced by atrial and ventricular factors. Pressure half time and peak left ventricular inflow velocity were measured by continuous wave Doppler ultrasound in 164 patients with normally functioning Carpentier-Edwards, Björk-Shiley, and Starr-Edwards mitral prostheses. Pressure half time was shorter in the Björk-Shiley than in the other value types and peak transmitral velocity was highest in the Starr-Edwards prostheses. These differences, however, were partly explained by coexistent differences in transmitral flow. Filling time accounted for 19% and stroke volume for 15% of the variance in pressure half time compared with only 5.6% for prosthetic design and 0.4% for annulus diameter when each of these variables was considered alone. The design of the prosthesis explained 18% of the variance in peak transmitral velocity, while cardiac output and annulus diameter did not contribute significantly. With Doppler ultrasound it is impossible to define reliable normal ranges for prosthetic function independently of atrial and ventricular function. Formulas for orifice area based on peak transmitral velocity and flow seem more likely to reflect the behaviour of normally functioning prostheses than those based on pressure half time. Images PMID:2183860

Chambers, J; Jackson, G; Jewitt, D

1990-01-01

247

Late leaflet fracture and embolization of a Duromedics mitral prosthesis  

Microsoft Academic Search

A case of leaflet fracture and embolization of a mitral prosthetic valve is described. A 54-year-old man had received mitral\\u000a valve replacement with an Edwards-Duromedics 29M prosthetic valve, at 10 years ago. Emergency mitral valve replacement was\\u000a performed because the patient had severe congestive left heart failure with severe acute mitral regurgitation caused by a\\u000a fracture in one of the

Kenichi Sudo; Naru Sasagawa; Hirofumi Ide; Masao Nunokawa; Tatsuo Fujiki; Kunihiko Tonari

2000-01-01

248

Percutaneous balloon dilatation in congenital mitral stenosis.  

PubMed Central

A three year old girl with severe congenital mitral stenosis was successfully treated by percutaneous balloon dilatation of the mitral valve. Cardiac catheterisation and cross sectional and Doppler echocardiography indicated that the orifice of the mitral valve had doubled in area. A small atrial septal defect was found at follow up cardiac catheterisation and angiography. Balloon dilatation of the mitral valve is a reasonable alternative to surgical treatment for typical congenital mitral stenosis even in young children. Images Fig 1 Fig 2 PMID:3593619

Alday, L E; Juaneda, E

1987-01-01

249

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

250

The anti-calcification potential of a silsesquioxane nanocomposite polymer under in vitro conditions: potential material for synthetic leaflet heart valve.  

PubMed

Calcification currently represents a major cause of failure of biological tissue heart valves. It is a complex phenomenon influenced by a number of biochemical and mechanical factors. Recent advances in material science offer new polymers with improved properties, potentially suitable for synthetic leaflets heart valves manufacturing. In this study, the calcification-resistance efficacy and mechanical and surface properties of a new nanocomposite polymeric material (polyhedral oligomeric silsesquioxane-poly(carbonate-urea)urethane; POSS-PCU) which has been developed by our group are assessed by means of in vitro testing. In particular, thin sheets of nanocomposite, glutaraldehyde-fixed bovine pericardium (BP) and polyurethane (PU) were exposed to a calcium solution into a specially designed in vitro accelerated physiological pulsatile pressure system for a period of 31days and a total of 4×10(7) cycles. The samples were investigated for signs of calcification after exposure to calcium solution by means of X-ray, microscopic and chemical inspections. Mechanical and surface properties were also studied using stress-strain behaviour and surface morphology and hydrophobicity. Comparison shows that, in the experimental conditions, the level of calcification for the nanocomposite is considerably lower than for the fixed BP (p=0.008) and PU samples (p=0.015). Also, mechanical properties were unchanged in POSS-PCU, while there was a significant deterioration in PU samples (p<0.05). Hydrophobicity was significantly reduced in both the POSS-PCU and PU samples (p<0.0001). However, the POSS-PCU nanocomposite remained more hydrophobic than the PU sample (p<0.0001). Less platelet adhered to the POSS-PCU compared to the PU (p<0.0001). These results indicate that the use of this nanocomposite in synthetic leaflets heart valves may lead to potential advantages in terms of long-term performances and durability. PMID:20601232

Ghanbari, Hossein; Kidane, Asmeret G; Burriesci, Gaetano; Ramesh, Bala; Darbyshire, Arnold; Seifalian, Alexander M

2010-11-01

251

JAMA Patient Page: Heart Valve Infections  

MedlinePLUS

Cross Section of Heart With Valve Replacement Prosthetic Aortic Valve Right Atrium Right Ventricle Tricuspid Valve Left Atrium Mitral Valve Left Ventricle Aorta Vegetations Complications Associated With Heart Valve Infections Emboli Abscess Regurgitation ...

252

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

253

The effect of neonatal gene therapy with a gamma retroviral vector on cardiac valve disease in mucopolysaccharidosis VII dogs after a decade.  

PubMed

Mucopolysaccharidosis VII (MPS VII) is due to deficient activity of the lysosomal enzyme ?-glucuronidase (GUSB) and results in the accumulation of glycosaminoglycans (GAGs). This study determined the long-term effect of neonatal intravenous injection of a gamma retroviral vector (RV) on cardiac valve disease in MPS VII dogs. Transduced hepatocytes secreted GUSB into the blood for up to 11 years at levels similar to or greater than those achieved with enzyme replacement therapy (ERT). Valve regurgitation and thickening were scored from 0 (normal) to +4 (severely abnormal). At 1 year, untreated MPS VII dogs had mitral regurgitation, mitral valve thickening, aortic regurgitation, and aortic valve thickening scores of 2.3 ± 0.7, 2.3 ± 0.6, 1.8 ± 0.5, and 1.6 ± 0.7, respectively, which were higher than the values of 0.6 ± 0.1, 0.1 ± 0.4, 0.3 ± 0.8, and 0.1 ± 0.4, respectively, in treated MPS VII dogs. Treated MPS VII dogs maintained low aortic regurgitation and aortic valve thickening scores in their lifetime. Although mitral regurgitation and mitral valve thickening scores increased to 2.0 at ? 8 years of age in the treated MPS VII dogs, older normal dogs from the colony had similar scores, making it difficult to assess mitral valve disease. Older treated dogs had calcification within the mitral and the aortic valve annulus, while GUSB staining demonstrated enzyme activity within the mitral valve. We conclude that neonatal RV-mediated gene therapy reduced cardiac valve disease in MPS VII dogs for up to 11 years, and propose that neonatal initiation of ERT should have a similar effect. PMID:23860311

Bigg, Paul W; Sleeper, Meg M; O'Donnell, Patricia A; Liu, Yuli; Wu, Susan; Casal, Margret L; Haskins, Mark E; Ponder, Katherine P

2013-11-01

254

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

255

Mitral Valve Replacement  

MedlinePLUS

... from the left atrium to the heart's main pumping chamber called the left ventricle. It then closes ... from the left atrium to the heart's main pumping chamber called the left ventricle. (Click on the ...

256

Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence.  

PubMed

A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event. PMID:17026749

Agarwala, Sandeep; Kumar, Sanjay; Berridge, John; McLenachan, Jim; O'Regan, David J

2006-01-01

257

Mitral Annulus Segmentation From 3D Ultrasound Using Graph Cuts  

E-print Network

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

Schneider, Robert J.

258

C-reactive protein as a marker of severe calcification among patients with bicuspid aortic valve disease  

Microsoft Academic Search

Background. Bicuspid aortic valve (BAV) may be associated with aneurysmal dilatation of the ascending aorta, even after successful aortic valve replacement. There are as yet no biomarkers that correlate with the progression of such disease. Elevated levels of C-reactive protein (CRP), a marker of acute inflammation, are seen in chronic rheumatic valve disease, especially those with multivalvular disease, and have

M. Yagubyan; G. Sarkar; R. A. Nishimura; T. M. Sundt

2004-01-01

259

Agenesis of the mitral posterior leaflet in elderly.  

PubMed

Congenital mitral valve regurgitation is a rare disease that is found in infancy and childhood, and sometimes in elderly people. In the case presented, mitral regurgitation that was tolerated well until the sixth decade of life is reported. A 62-year-old male suffering from dyspnea was referred to our hospital. Transthoracic echocardiographic examination demonstrated severe mitral regurgitation with suspicion of agenesis of the posterior leaflet with a long, mobile anterior leaflet. A transesophageal echocardiogram and surgical evaluation verified agenesis of the posterior mitral valve. The patient was successfully treated using mitral valve replacement, and no complications occurred. PMID:24384183

Ozkan, Hakan; Tiryakioglu, Osman; Cetinkaya, Ahmet Seckin; Uyanik, Elif Ceylan; Bozat, Tahsin

2014-01-01

260

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

261

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

262

High Expression of the Pi-Transporter SLC20A1/Pit1 in Calcific Aortic Valve Disease Promotes Mineralization through Regulation of Akt-1  

PubMed Central

The regulation of phosphate (Pi) handling is crucial during calcification of the aortic valve. Gene profiling of Pi transporters revealed that VIC culture expresses SLC201A1/Pit1 and SLC20A2/Pit2. On exposure to a mineralizing medium (2 mM Pi), the expression of Pi transporters in VIC culture is increased several folds, with the highest magnitude for SLC20A1. By using siRNAs, we established that silencing SLC20A1 significantly reduced Pi-induced mineralization of VICs. In human pathological specimens, we found that the expression of SCL20A1 was increased in CAVD tissues compared to control non-mineralized aortic valves. Treatment of VIC culture with Pi promoted the loss of mitochondrial membrane potential (??m) and cytochrome c release within the cytosol, leading to apoptosis. Inhibition of Pi transporters with phosphonoformic acid (PFA) prevented Pi-mediated apoptosis of VICs. Moreover, we discovered that the level of the Akt-1 transcript is diminished in CAVD tissues compared with control valves. Accordingly, treatment with Pi caused a reduction of the Akt-1 transcript in VIC culture, and treatment with PFA or siRNA against SLC20A1 restored the level of Akt-1. Overexpression of Akt-1 (pCMVAkt-1) prevented both Pi-induced apoptosis and mineralization of VIC culture. These results strongly suggest that overexpression of SLC20A1 promotes apoptosis and mineralization by altering the level of Akt-1. PMID:23308213

El Husseini, Diala; Boulanger, Marie-Chloe; Fournier, Dominique; Mahmut, Ablajan; Bosse, Yohan; Pibarot, Philippe; Mathieu, Patrick

2013-01-01

263

Evolving Bioprosthetic Tissue Calcification Can Be Quantified Using Serial Multislice CT Scanning  

PubMed Central

Background. We investigated the value of serial multislice CT scanning for in vivo determination of evolving tissue calcification in three separate experimental settings. Materials and Methods. Bioprosthetic valve tissue was implanted in three different conditions: (1) glutaraldehyde-fixed porcine stentless conduits in pulmonary position (n = 6); (2) glutaraldehyde-fixed stented pericardial valves in mitral position (n = 3); and (3) glutaraldehyde-fixed pericardial tissue as patch in the jugular vein and carotid artery (n = 16). Multislice CT scanning was performed at various time intervals. Results. In stentless conduits, the distribution of wall calcification can be reliably quantified with CT. After 20 weeks, the CT-determined mean calcium volume was 1831 ± 581?mm³, with a mean wall calcium content of 89.8 ± 44.4??g/mg (r2 = 0.68). In stented pericardial valves implanted in mitral position, reliable determination of tissue mineralization is disturbed by scattering caused by the (continuously moving) alloy of the stent material. Pericardial patches in the neck vessels revealed progressive mineralization, with a significant increase in mean HU and calcium volume at 8 weeks after implantation, rising up to a level of 131.1 ± 39.6?mm³ (mean calcium volume score) and a mean calcium content of 19.1 ± 12.3??g/mg. Conclusion. The process of bioprosthetic tissue mineralization can be visualized and quantified in vivo using multislice CT scanning. This allows determination of the kinetics of tissue mineralization with intermediate in vivo evaluations. PMID:24089616

Meuris, B.; De Praetere, H.; Coudyzer, W.; Flameng, W.

2013-01-01

264

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

265

Balloon mitral valvotomy in pregnancy: maternal and fetal outcomes  

Microsoft Academic Search

Background: Rheumatic mitral valve stenosis contributes to significant morbidity in pregnancy. Surgical commissurotomy has been performed during pregnancy in patients with severe mitral stenosis for several decades, but the efficacy and safety of percutaneous balloon mitral valvotomy (BMV) in this subset has not been clearly defined.Study Design: In 1996 and 1997, 40 pregnant women aged 24 ± 5 years underwent

Anup Gupta; Yash Y Lokhandwala; Purnima R Satoskar; Vinita S Salvi

1998-01-01

266

Intracardiac calcification is a marker of generalized atherosclerosis.  

PubMed

Aortic valve calcification (AVC) and carotid artery calcification (CAC) are considered to be markers of generalized atherosclerosis. However, the role of intracardiac calcification (ICC) (valvular and perivalvular calcification) is unclear. The objective of this retrospective study was to analyze the relationship between ICC and CAC, risk factors, and clinical atherosclerotic disease. Risk factors included age, sex, diabetes mellitus, hypercholesterolemia, and hypertension; clinical atherosclerosis comprised stroke, coronary artery disease, and peripheral artery disease. Between January 1, 2001, and January 1, 2004, all consecutive patients were enrolled into the study who underwent both carotid ultrasonography and transthoracic echocardiography examinations within 2 months. Patients with renal failure, substantial aortic stenosis, and carotid artery occlusion were excluded. There were 320 patients (104 men; mean +/- SEM age, 66.6 +/- 0.76 years). Positive results on carotid ultrasonography are defined as any CAC. Patients were categorized as having mild, moderate, or severe CAC. Positive results on transthoracic echocardiography were defined as any ICC; AVC was defined as mitral anulus calcification (MAC) or both. Intracardiac calcification was found in 181 patients, AVC in 51 patients, MAC in 48 patients, and calcification of both structures in 82 patients. Using multiple logistic regression analysis, ICC (odds ratio, 1.9), age (10-year periods) (odds ratio, 2.0), and the presence of peripheral artery disease (odds ratio, 1.7) were independent predictors of CAC. Carotid ultrasonography results were positive in 227 patients. For CAC, the sensitivities of AVC, MAC, both, and any ICC were 52.4%, 52.0%, 33.5%, and 71.2%, respectively, and the specificities were 84.9%, 87.1%, 92.5%, and 78.5%, respectively. The extension of ICC as 0, 1 location (AVC or MAC) , or 2 locations (AVC and MAC) was associated with the severity of CAC (P < .001, tau = 0.42). There was no difference between patients with AVC vs patients with MAC in the presence of different stages of CAC (P = .62). Intracardiac calcification (MAC or AVC) is an independent predictor of CAC as a marker of atherosclerosis, although the lack of ICC does not rule out atherosclerosis. Intracardiac calcification is related to CAC, with high specificity. The extension of ICC is related to the severity of atherosclerosis. Based on our results, antiatherothrombotic therapy should be considered in patients with ICC even before obtaining a positive carotid ultrasonography result. PMID:17875954

Nemcsik, János; Farkas, Katalin; Kolossváry, Endre; Járai, Zoltán; Egresits, József; Borgulya, Gábor; Kiss, István; Lengyel, Mária

2007-01-01

267

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

268

Slope of the anterior mitral valve leaflet: a new measurement of left ventricular unloading for left ventricular assist devices and systolic dysfunction.  

PubMed

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

Martinez, Sara C; Bradley, Elisa A; Novak, Eric L; Rasalingam, Ravi; Cedars, Ari M; Ewald, Gregory A; Silvestry, Scott C; Joseph, Susan M

2014-06-01

269

The Unusual Suspect: Anemia-induced Systolic Anterior Motion of the Mitral Valve and Intraventricular Dynamic Obstruction in a Hyperdynamic Heart as Unexpected Causes of Exertional Dyspnea after Cardiac Surgery  

PubMed Central

Dynamic left ventricular (LV) outflow tract obstruction is a characteristic feature of hypertrophic cardiomyopathy; however, it can also occur in association with hyperdynamic LV contraction and/or changes in the cardiac loading condition, even in a structurally normal or near-normal heart. Here, we report a case of anemia-induced systolic anterior motion of the mitral valve and the resultant intraventricular obstruction in a patient who underwent coronary artery bypass grafting and suffered from anemia associated with recurrent gastrointestinal bleeding. PMID:24368973

Mun, Jeong-Beom; Oh, Ah-Reum; Park, Hwa-Sun; Park, Chul-Hyun; Park, Kook-Yang

2013-01-01

270

Implantation of a new mitral ring, adjustable during follow-up: a simplified technique  

PubMed Central

Mitral valve repair for ischaemic mitral incompetence has a 10% rate of failure at ten year follow-up. Progressive annular dilation could play an important role. We have implanted the enCorSQTM mitral valve repair system. This system can be downsized during follow-up with the appropriate activation via the lead passed through the left atrium suture line, in order to restore mitral leaflet coaptation. PMID:22761123

Caradonna, Eugenio; Testa, Nicola; De Filippo, Carlo Maria; Calvo, Eugenio; Di Giannuario, Giovanna; Spatuzza, Paola; Rossi, Marco; Alessandrini, Francesco

2012-01-01

271

Systolic arterial blood pressure in small-breed dogs with degenerative mitral valve disease: a prospective study of 103 cases (2007-2012).  

PubMed

The objective of this prospective observational study was to assess systolic arterial blood pressure (SABP) in small-breed dogs with degenerative mitral valve disease (MVD) from different International Small Animal Cardiac Health Council (ISACHC) heart failure classes. For this purpose, 103 client-owned dogs weighing <20 kg (mean ± standard deviation, 8.5 ± 3.0 kg; aged 9.8 ± 2.9 years) and presenting with MVD diagnosed by echo-Doppler examination were enrolled. Nineteen healthy dogs (9.9 ± 2.3 years; 8.7 ± 4.2 kg) were concurrently recruited as controls. SABP was measured in unsedated dogs using the Doppler method according to the recommendations in the American College of Veterinary Medicine consensus statement. SABP was significantly increased in dogs in ISACHC class 1 (n=53; median, interquartile range 140 mmHg, 130-150 mmHg) and class 2 (n=21; 140 mmHg, 130-150 mmHg), compared to the control group (n=19; 130 mmHg, 120-140 mmHg; P<0.01 and P<0.05, respectively), but remained within the reference interval (? 160 mmHg). Conversely, dogs in ISACHC class 3 showed a significantly lower SABP (n=29, 120 mmHg, 110-130 mmHg) than those from all other ISACHC classes (P<0.001) and the controls (P<0.05). Additionally, SABP<120 mmHg was recorded in 13/103 dogs (13%). The 13 dogs were all ISACHC class 3 (3a or 3b) and were under medical treatment for heart failure. In conclusion, MVD was often associated with SABP values that were within the reference interval, but at its upper end. However, a significant decrease in SABP was observed in dogs with ISACHC heart failure class 3. Whether such low SABP values resulted from an MVD-related decrease in cardiac output, an afterload reduction owing to cardiac treatment, or both, remains to be determined. PMID:23838208

Petit, A M; Gouni, V; Tissier, R; Trehiou-Sechi, E; Misbach, C; Pouchelon, J-L; Lefebvre, H P; Chetboul, V

2013-09-01

272

Risks for Heart Valve Problems  

MedlinePLUS

... a more common problem. As we age, our heart valves can become lined with calcium deposits that cause the valve flaps to thicken and become stiffer. ... increase a persons’ risk for sudden death or cause rapid development of problems in ... like a bicuspid aortic valve, mitral valve prolapse or a mild form of ...

273

Valve  

DOEpatents

A positive acting valve suitable for operation in a corrosive environment is provided. The valve includes a hollow valve body defining an open-ended bore for receiving two, axially aligned, spaced-apart, cylindrical inserts. One insert, designated the seat insert, terminates inside the valve body in an annular face which lies within plane normal to the axis of the two inserts. An elastomeric O-ring seal is disposed in a groove extending about the annular face. The other insert, designated the wedge insert, terminates inside the valve body in at least two surfaces oppositely inclined with respect to each other and with respect to a plane normal to the axis of the two inserts. An elongated reciprocable gate, movable between the two inserts along a path normal to the axis of the two inserts, has a first flat face portion disposed adjacent and parallel to the annular face of the seat insert. The gate has a second face portion opposite to the first face portion provided with at least two oppositely inclined surfaces for mating with respective inclined surfaces of the wedge insert. An opening is provided through the gate which registers with a flow passage through the two inserts when the valve is open. Interaction of the respective inclined surfaces of the gate and wedge insert act to force the first flat face portion of the gate against the O-ring seal in the seat insert at the limits of gate displacement where it reaches its respective fully open and fully closed positions.

Cho, Nakwon (Knoxville, TN)

1980-01-01

274

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.

Hamirani, Yasmin S.; Hnatiuk, Oleh; Pett, Stuart; Roldan, Carlos A.

2014-01-01

275

Pathogenesis of acute ischemic mitral regurgitation in three dimensions  

Microsoft Academic Search

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

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

1995-01-01

276

Chordal reconstruction with polytetrafluoroethylene (PTFE) sutures for mitral regurgitation  

Microsoft Academic Search

Chordal reconstruction of the mitral valve using CV4 or CV5 polytetrafluoroethylene (PTFE) (GoreTex, Flagstaff, AZ, USA) sutures was performed in seven patients with mitral regurgitation (MR) to ascertain its efficacy. The MR had been caused by prolapse of the anterior leaflet in three patients, the posterior leaflet in two, and both leaflets in two; five of the patients had an

Hajime Maeta; Setsuro Imawaki; Yasushi Shiraishi; Ichiro Arioka; Satoshi Tanaka

1994-01-01

277

Bisphosphonate derivatized polyurethanes resist calcification.  

PubMed

Calcification of polyurethane cardiovascular implants is an important disease process that has the potential to compromise the long-term function of devices such as polymer heart valves and ventricular assist systems. In this study we report the successful formulation and characterization of bisphosphonate-derivatized polyurethanes, hypothesized to resist implant calcification based on the pharmacologic activity of the immobilized bisphosphonate. Fully polymerized polyurethanes (a polyurea-polyurethane and a polycarbonate polyurethane) were modified (post-polymerization) with bromoalkylation of the hard segments followed by attachment of a bisphosphonate group at the bromine site. These bisphosphonate-polyurethanes resisted calcification in rat 60 day subdermal implants compared to nonmodified control polyurethane implants, that calcify. Bisphosphonates-modified polyurethanes were also studied in circulatory implants using a pulmonary valve cusp replacement model in sheep. Polyurethane cusps modified with bisphosphonate did not calcify in 90 day implants. compared to control polyurethane cusps implants, that demonstrated nodular surface oriented calcific deposits. It is concluded that bisphosphonate modified polyurethanes resist calcification both in subdermal implants and in the circulation. This novel biomaterial approach offers great promise for long-term blood stream implantation with calcification resistance. PMID:11519788

Alferiev, I; Vyavahare, N; Song, C; Connolly, J; Hinson, J T; Lu, Z; Tallapragada, S; Bianco, R; Levy, R

2001-10-01

278

Percutaneous transarterial balloon mitral valvuloplasty: 30 months experience.  

PubMed

Between February, 1985, and August, 1987, 76 patients with mitral stenosis underwent percutaneous transarterial mitral balloon valvuloplasty (MVP). There were 58 females and 18 males aged from 15 to 69 years (mean 39 +/- 11). In 31 patients the mitral valve was pliable (40%) and in 45 patients (60%) the valve was nonpliable. Calcified mitral stenosis was found in 24 patients (31%). Transseptal catheterization was used to place one or two 0.035" (350 cm long) exchange wires into the ascending aorta in order to be snared, retrieved and exteriorized, each one through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for mitral dilation. Single (25 mm in diameter, trefoil 3 x 12 mm, bifoil 2 x 19 mm) and double (18 and 15 mm, 18 and 18 mm, 18 and 20 mm) balloons were used in 24 and 52 patients respectively. Transarterial mitral valvuloplasty produced immediate improvement of mitral valve area (MVA = 1.1 +/- 0.3 to 2.4 +/- 0.4 cm2, p less than 0.001), mitral valve gradient (19 +/- 4 to 8 +/- 6 mmHg, p less than 0.001), echocardiographic left atrial diameter (LAD = 58 +/- 6 to 54 +/- 5 mm, p greater than 0.05) and echo-MVA (0.9 +/- 0.4 to 2.1 +/- 0.7, p less than 0.001). In three patients no MVA enlargement was achieved. A significant mitral regurgitation was produced in two patients. A stroke occurred in three patients (3.9%), one of these patients subsequently died (1.3%), one recovered and one remained hemiplegic. No atrial septal defect was found after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3378724

Babic, U U; Pejcic, P; Djurisic, Z; Vucinic, M; Grujicic, S N

1988-04-01

279

Mammogram - calcifications  

MedlinePLUS

... placed on the skin Large, rounded calcifications (macrocalcifications) are common in women over age 50. They appear as ... in size or shape, or tightly clustered together, are called ... a stereotactic core biopsy . This is a needle biopsy that uses ...

280

Mechanics of the Mitral Annulus in Chronic Ischemic Cardiomyopathy  

PubMed Central

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

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

2013-01-01

281

Vascular Calcification: an Update on Mechanisms and Challenges in Treatment  

PubMed Central

Vascular calcification is highly associated with cardiovascular disease mortality, particularly in high risk patients with diabetes and chronic kidney diseases (CKD). In blood vessels, intimal calcification is associated with atherosclerosis, whereas medial calcification is a non-occlusive process which leads to increased vascular stiffness and reduced vascular compliance. In the valves, calcification of the leaflets can change the mechanical properties of the tissue and result in stenosis. For many decades, vascular calcification has been noted as a consequence of aging. Studies now confirm that vascular calcification is an actively regulated process and shares many features with bone development and metabolism. This review provides an update on the mechanisms of vascular calcification including the emerging roles of the RANK/RANKL/OPG triad, osteoclasts and microRNAs. Potential treatments adapted from osteoporosis and CKD treatments that are under investigation for preventing and/or regressing vascular calcification will also be reviewed. PMID:23456027

Wu, Meiting; Rementer, Cameron; Giachelli, Cecilia M.

2013-01-01

282

Survival and echocardiographic data in dogs with congestive heart failure caused by mitral valve disease and treated by multiple drugs: A retrospective study of 21 cases  

PubMed Central

This retrospective study reports the survival time [onset of congestive heart failure (CHF) to death from any cause] of 21 dogs with mitral regurgitation (MR) and CHF treated with a combination of furosemide, angiotensin-converting enzyme inhibitor (ACEI, benazepril, or enalapril), pimobendan, spironolactone, and amlodipine. Baseline echocardiographic data: end-systolic and end-diastolic volume indices (ESVI and EDVI), left atrium to aorta ratio (LA/Ao), and regurgitant fraction (RF) are reported. Median survival time (MST) was 430 d. Initial dosage of furosemide (P = 0.0081) and LA/Ao (P = 0.042) were negatively associated with survival. Baseline echocardiographic indices (mean ± standard deviation) were 40.24 ± 16.76 for ESVI, 161.48 ± 44.49 mL/m2 for EDVI, 2.11 ± 0.75 for LA/Ao, and 64.71 ± 16.85% for RF. Combining furosemide, ACEI, pimobendan, spironolactone, and amlodipine may result in long survival times in dogs with MR and CHF. Severity of MR at onset of CHF is at least moderate. PMID:22547843

de Madron, Eric; King, Jonathan N.; Strehlau, Gunther; White, Regina Valle

2011-01-01

283

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

PubMed Central

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

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

2014-01-01

284

Biological valve prosthesis replacement--experiences and considerations.  

PubMed

Between 1976 and 1991. 1.017 tissue valve prostheses were implanted in 801 patients. During the same period 1876 mechanical valve prostheses were replaced. The hospital mortality was 8.1%. Till 1991 230 bioprostheses (22.6%) in the case of 166 patients (20.7%) had to be removed and replaced by other valve prostheses. There are no significant differences concerning the mortality between the first (8.1%) and the second operations (9.1%), and the durability of the various types of bioprostheses used, however, calcification, degeneration and other complications occurred more frequently and earlier in the case of mitral (24.5%) than in aortic (18.9%) bioprostheses, and in younger patients than in the older ones, as well. The mean age of patients was 46 years at the time of the first and 49 years at the time of the second operation. The incidence of reoperations was the highest in the seventh year after the first surgical intervention. In general, one size smaller prostheses were used in valve replacements after the removal of the first bioprostheses. PMID:1842481

Szabó, Z; Bodor, E; György, T; Moravcsik, E; Papp, L; Szabolcs, Z; Bartha, E

1991-01-01

285

Mechanisms and Clinical Consequences of Vascular Calcification  

PubMed Central

Vascular calcification has severe clinical consequences and is considered an accurate predictor of future adverse cardiovascular events, including myocardial infarction and stroke. Previously vascular calcification was thought to be a passive process which involved the deposition of calcium and phosphate in arteries and cardiac valves. However, recent studies have shown that vascular calcification is a highly regulated, cell-mediated process similar to bone formation. In this article, we outline the current understanding of key mechanisms governing vascular calcification and highlight the clinical consequences. By understanding better the molecular pathways and genetic circuitry responsible for the pathological mineralization process novel drug targets may be identified and exploited to combat and reduce the detrimental effects of vascular calcification on human health. PMID:22888324

Zhu, Dongxing; Mackenzie, Neil C. W.; Farquharson, Colin; MacRae, Vicky E.

2012-01-01

286

Vascular Calcification  

PubMed Central

Summary Clinically, vascular calcification is now accepted as a valuable predictor of coronary heart disease.153 Achieving control over this process requires understanding mechanisms in the context of a tightly controlled regulatory network, with multiple, nested feedback loops and cross talk between organ systems, in the realm of control theory. Thus, treatments for osteoporosis such as calcitriol, estradiol, bisphosphonates, calcium supplements, and intermittent PTH are likely to affect vascular calcification, and, conversely, many treatments for cardiovascular disease such as statins, antioxidants, hormone replacement therapy, angiotensin-converting enzyme inhibitors, fish oils, and calcium channel blockers may affect bone health. As we develop and use treatments for cardiovascular and skeletal diseases, we must give serious consideration to the implications for the organ at the other end of the bone-vascular axis. PMID:11602487

Demer, Linda L.; Tintut, Yin

2009-01-01

287

Saving a Life: Heart Valve Replacement  

NSDL National Science Digital Library

Students use their knowledge about how healthy heart valves function to design, construct and implant prototype replacement mitral valves for hypothetical patients' hearts. Building on what they learned in the associated lesson about artificial heart valves, combined with the testing and scoring of their prototype heart valve designs in this activity, students discover the pros and cons of different types of artificial heart valves based on materials, surgery requirements, and lifespan.

Integrated Teaching And Learning Program

288

The effect of mitral annuloplasty shape in ischemic mitral regurgitation: a finite element simulation  

PubMed Central

Background Undersized mitral annuloplasty (MA) is the preferred surgical treatment for chronic ischemic mitral regurgitation (CIMR). However, the preferred shape of undersized MA is unclear. Methods A previously described finite element (FE) model of the LV with mitral valve based on magnetic resonance images of a sheep with CIMR after postero-lateral MI was used. Saddle shape (Edwards Physio II) and asymmetric (IMR ETlogix) MA rings were digitized and meshed. Virtual annuloplasty was performed using virtual sutures to attach the MA ring. LV diastole and systole were performed before and after virtual MA of each type. Results Both types of MA reduced the septo-lateral dimension of the mitral annulus and abolished mitral regurgitation. The asymmetric MA was associated with lower virtual suture force in the P2 region but higher force in P1 and P3 regions. Although both types of MA reduced fiber stress at the LV base, fiber stress reduction after asymmetric MA was slightly greater. Neither type of MA affected fiber stress at the LV equator or apex. Although both types of MA increased leaflet curvature and reduced leaflet stress, stress reduction with saddle shape MA was slightly greater. Both MA types reduced stress on the mitral chordae. Conclusions The effects of saddle shaped and asymmetric MA rings are similar. FE simulations are a powerful tool that may reduce the need for animal and clinical trials. PMID:22245588

Wong, Vincent M.; Wenk, Jonathan F.; Zhang, Zhihong; Cheng, Guangming; Acevedo-Bolton, Gabriel; Burger, Mike; Saloner, David A.; Wallace, Arthur W.; Guccione, Julius M.; Ratcliffe, Mark B.; Ge, Liang

2012-01-01

289

Idiopathic infantile arterial calcification in two siblings: failure of treatment with diphosphonate.  

PubMed Central

Two siblings with idiopathic infantile arterial calcification are reported. The fetal and postnatal echocardiographic features were a large pericardial effusion, thickened pulmonary and aortic valves, poor pulsation of the descending aorta, and calcification of the great vessels. In one patient calcification was first detected at 33 weeks' gestation. Despite treatment with disodium etidronate both children died. Images PMID:2118367

Stuart, G; Wren, C; Bain, H

1990-01-01

290

The relief of mitral stenosis. An historic step in cardiac surgery.  

PubMed Central

Significant progress has been achieved in cardiac surgery in the last 50 years. Mitral valve surgery (especially for the relief of mitral stenosis) has paralleled the innovations and trends of cardiac surgery and often has served as the benchmark of the latest procedures and techniques. A chronological survey of mitral valve surgery is presented, with emphasis on parallels to cardiac surgery in general and with highlights of key figures and events that have conclusively altered the surgeon's approach to and success with cardiac dysfunction. A few surgeons promulgated the idea of cardiac surgery in the late 19th century, but mitral valve surgeries were not performed in earnest until Souttar's and Cutler's initial attempts in the 1920s and were not successful on large groups of patients until Bailey and Harken made independent breakthroughs in the 1940s, finally laying to rest the idea of the "inviolable heart." Cardiopulmonary bypass provided cardiac surgeons with the time to implant mechanical and bioprosthetic valves for palliative benefit to patients. The "perfect" valve has yet to be found, but the Starr-Edwards mechanical valve since its inception in 1961 has been one of the most successful and widely used prosthetic valves. Gradual improvement in surgical technique and growing knowledge of valve function enabled the re-emergence of mitral valve repair in the 1980s as the preferred surgical method of treating mitral stenosis. In the last 10 years, mitral valve balloon dilation has provided a nonsurgical technique for relief of stenosis and represents the broader trend towards interventional techniques. Images PMID:8969024

Khan, M N

1996-01-01

291

Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.  

PubMed Central

Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:3620253

Commeau, P; Grollier, G; Huret, B; Foucault, J P; Potier, J C

1987-01-01

292

Automated coronary artery calcification detection on low-dose chest CT images  

NASA Astrophysics Data System (ADS)

Coronary artery calcification (CAC) measurement from low-dose CT images can be used to assess the risk of coronary artery disease. A fully automatic algorithm to detect and measure CAC from low-dose non-contrast, non-ECG-gated chest CT scans is presented. Based on the automatically detected CAC, the Agatston score (AS), mass score and volume score were computed. These were compared with scores obtained manually from standard-dose ECG-gated scans and low-dose un-gated scans of the same patient. The automatic algorithm segments the heart region based on other pre-segmented organs to provide a coronary region mask. The mitral valve and aortic valve calcification is identified and excluded. All remaining voxels greater than 180HU within the mask region are considered as CAC candidates. The heart segmentation algorithm was evaluated on 400 non-contrast cases with both low-dose and regular dose CT scans. By visual inspection, 371 (92.8%) of the segmentations were acceptable. The automated CAC detection algorithm was evaluated on 41 low-dose non-contrast CT scans. Manual markings were performed on both low-dose and standard-dose scans for these cases. Using linear regression, the correlation of the automatic AS with the standard-dose manual scores was 0.86; with the low-dose manual scores the correlation was 0.91. Standard risk categories were also computed. The automated method risk category agreed with manual markings of gated scans for 24 cases while 15 cases were 1 category off. For low-dose scans, the automatic method agreed with 33 cases while 7 cases were 1 category off.

Xie, Yiting; Cham, Matthew D.; Henschke, Claudia; Yankelevitz, David; Reeves, Anthony P.

2014-03-01

293

Novel mitral clipping technique overcoming extreme atrial dilatation.  

PubMed

The mitral clipping technique is emerging as a promising new treatment option for severe mitral regurgitation. The device was designed and assessed in intermediate risk populations, which is in contrast to the real world, where most patients are deemed to be at very high risk for open heart surgery. The cardiac anatomy of these patients often challenges the freedom grades of the current mitral clip device. In this case presentation, we describe a novel technique overcoming extreme atrial dilation in a patient with severe mitral regurgitation despite previous implantation of two mitral clips. Based on a low/anterior trans-septal puncture, this procedure relied on a counter clock-wise 90° turn of the steerable sheath and alignment of the clip delivery system to the mitral valve, thereby gaining additional longitudinal freedom. This resulted in the successful implantation of two additional clips with achievement of a mild to moderate mitral regurgitation without relevant gradient and dramatic and sustained clinical improvement of the patient. © 2013 Wiley Periodicals, Inc. PMID:24167092

Tiroch, Klaus; Vorpahl, Marc; Seyfarth, Melchior

2014-10-01

294

Patient-Specific Mitral Leaflet Segmentation from 4D Ultrasound  

E-print Network

by generating models from three-dimensional ultrasound (3DUS) [3]. The advantages of generating models from the automatically segmented meshes to expert manual tracings for both a normal and diseased mitral valve, and found with model generation from 3DUS is that a limited number of methods exist that are able to accurately

295

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

NASA Astrophysics Data System (ADS)

Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves. During reconstructive surgery the judgement of mitral valve geometry and subvalvular apparatus is mandatory in order to choose for the appropriate repair strategy. To date, intraoperative analysis of mitral valve is merely based on visual assessment and inaccurate sizer devices, which do not allow for any accurate and standardized measurement of the complex three-dimensional anatomy. We propose a new intraoperative computer-assisted method for mitral valve measurements using a pointing instrument together with an optical tracking system. Sixteen anatomical points were defined on the mitral apparatus. The feasibility and the reproducibility of the measurements have been tested on a rapid prototyping (RP) heart model and a freshly exercised porcine heart. Four heart surgeons repeated the measurements three times on each heart. Morphologically important distances between the measured points are calculated. We achieved an interexpert variability mean of 2.28 +/- 1:13 mm for the 3D-printed heart and 2.45 +/- 0:75 mm for the porcine heart. The overall time to perform a complete measurement is 1-2 minutes, which makes the method viable for virtual annuloplasty during an intervention.

Engelhardt, Sandy; De Simone, Raffaele; Wald, Diana; Zimmermann, Norbert; Al Maisary, Sameer; Beller, Carsten J.; Karck, Matthias; Meinzer, Hans-Peter; Wolf, Ivo

2014-03-01

296

Myocardial fibre calcification  

Microsoft Academic Search

Three cases of myocardial fibre calcification found at post-mortem examination are described. In one case there was antemortem hypercalcaemia and hyperphosphataemia and the case was clearly an example of metastatic calcification. In the other two cases there was ischaemic myocardial necrosis and calcification was seen in fibres which were not overtly necrotic, but which were both in proximity to (the

J McClure; A S Pieterse; D J Pounder; P S Smith

1981-01-01

297

Mitral prolapse. A heart anomaly in a clinical neuroendocrine context.  

PubMed

Mitral valve prolapse was identified as a separate nosological entity by Barlow in 1963. A characteristic of this cardiac anomaly is blood reflux into the left atrium during the systole owing to the lack of adhesion between valve flaps. The presence of symptoms linked to neuroendocrine dysfunctions or to the autonomic nervous system lead to the onset of the pathology known as mitral valve prolapse syndrome (MVPs). It is usually diagnosed by chance in asymptomatic patients during routine tests. MVPs includes complex alterations to the neurovegetative system and a high clinical incidence of neuropsychiatric symptoms, like anxiety and panic attacks. A neuroendocrine mechanism thought to underlie panic attacks was recently proposed based on a biological model. In general, the cardiovascular anomaly manifested by patients with MVPs could be defined in neuroendocrine-constitutional terms. PMID:11048469

Parlapiano, C; Paoletti, V; Alessandri, N; Campana, E; Giovanniello, T; Pantone, P; Califano, F; Borgia, M C

2000-06-01

298

Pericardial patch augmentation for repair of incompetent bicuspid aortic valves at midterm  

Microsoft Academic Search

Objective: Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves. Methods: Autologous pericardium is sutured to the free edge of the prolapsing bicuspid leaflet. A large coaptation surface is created

Mirko Doss; Sami Sirat; Petar Risteski; Sven Martens; Anton Moritz

2008-01-01

299

Fracture embolization of a Duromedics mitral prosthesis.  

PubMed Central

The Duromedics bileaflet pyrolitic carbon mechanical prosthesis was introduced by Hemex in 1982 and subsequently acquired by Baxter. This communication documents a case of sudden leaflet fracture of a Duromedics mitral valve 48 months after implantation, which was managed successfully by replacement with a St. Jude Medical mechanical prosthesis. The patient presented in acute distress with paroxysmal atrial tachycardia and pulmonary edema. Transesophageal echocardiography was used to diagnose the leaflet fracture. The fracture had occurred transversely, with the fragments embolizing bilaterally to the iliofemoral arteries. These were removed at a subsequent operation. Cases of such fractures of the Duromedics prosthesis have been reported, with cavitation damage being the postulated mechanism. PMID:9205987

Baumgartner, F J; Munro, A I; Jamieson, W R

1997-01-01

300

Update of transcatheter valve treatment  

PubMed Central

Transcatheter valve implantation or repair has been a very promising approach for the treatment of valvular heart diseases since transcatheter aortic valve implantation (TAVI) was successfully performed in 2002. Great achievements have been made in this field (especially TAVI and transcatheter mitral valve repair—MitraClip system) in recent years. Evidence from clinical trials or registry studies has proved that transcatheter valve treatment for valvular heart diseases is safe and effective in surgical high-risk or inoperable patients. As the evidence accumulates, transcatheter valve treatment might be an alterative surgery for younger patients with surgically low or intermediate risk valvular heart diseases in the near future. In this paper, the updates on transcatheter valve treatment are reviewed. PMID:23897785

Liu, Xian-bao; Wang, Jian-an

2013-01-01

301

[Usefulness of Echocardiography for Detecting Prosthetic valve Dysfunction;Report of a Case].  

PubMed

A 78-year-old woman with a history of mitral valve stenosis underwent open mitral commissurotomy in 1976. In 1990, she underwent mitral valve replacement (Medtronic-Hall 29 mm), tricuspid annuloplasty(DeVega method), and pacemaker implantation for bradycardiac atrial fibrillation. However, in June 2012, she developed anemia of unknown cause. Prosthetic valve dysfunction was suspected, because intermittent changes in the left ventricular inflow was detected by echocardiography. Fluoroscopy actually confirmed the presence of prosthetic valve dysfunction. Therefore mitral valve re-replacement(ATS Medical, Inc. 29 mm) and tricuspid annuloplasty (Cosgrove ring 30 mm) were performed. Monitoring the changes in the left ventricular inflow is recommended when prosthetic valve dysfunction in a single leaflet is suspected. PMID:25292382

Oyama, Shogo; Ohuchi, Shingo; Okubo, Tadashi; Kumagai, Kazuya

2014-10-01

302

Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy  

NASA Technical Reports Server (NTRS)

Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.

2002-01-01

303

Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients  

PubMed Central

Background Mitral stenosis, one of the grave consequences of rheumatic heart disease, was generally considered to take decades to evolve. However, several studies from the developing countries have shown that mitral stenosis follows a different course from that seen in the developed countries. This study reports the prevalence, severity and common complications of mitral stenosis in the first and early second decades of life among children referred to a tertiary center for intervention. Methods Medical records of 365 patients aged less than 16 and diagnosed with rheumatic heart disease were reviewed. Mitral stenosis was graded as severe (mitral valve area?mitral valve area 1.0-1.5 cm2) and mild (mitral valve area?>?1.5 cm2). Results Mean age at diagnosis was 10.1?±?2.5 (range 3–15) years. Of the 365 patients, 126 (34.5%) were found to have mitral stenosis by echocardiographic criteria. Among children between 6–10 years, the prevalence of mitral stenosis was 26.5%. Mean mitral valve area (n?=?126) was 1.1?±?0.5 cm2 (range 0.4-2.0 cm2). Pure mitral stenosis was present in 35 children. Overall, multi-valvular involvement was present in 330 (90.4%). NYHA functional class was II in 76% and class III or IV in 22%. Only 25% of patients remember having symptoms of acute rheumatic fever. Complications at the time of referral include 16 cases of atrial fibrillation, 8 cases of spontaneous echo contrast in the left atrium, 2 cases of left atrial thrombus, 4 cases of thrombo-embolic events, 2 cases of septic emboli and 3 cases of airway compression by a giant left atrium. Conclusion Rheumatic mitral stenosis is common in the first and early second decades of life in Ethiopia. The course appeared to be accelerated resulting in complications and disability early in life. Echocardiography-based screening programs are needed to estimate the prevalence and to provide support for strengthening primary and secondary prevention programs. PMID:24180350

2013-01-01

304

Exploring the biology of vascular calcification in chronic kidney disease: What's circulating?  

Microsoft Academic Search

Chronic kidney disease (CKD) is associated with fatal cardiovascular consequences in part due to ectopic calcification of soft tissues particularly arteries, capillaries, and cardiac valves. An increasing body of evidence from experimental studies and in vivo data suggest that (I) a mineral imbalance with hyperphosphatemia and high-circulating calcium × phosphate product, (II) a deficiency of systemic or local calcification inhibitors,

M Schoppet; R C Shroff; L C Hofbauer; C M Shanahan

2008-01-01

305

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

PubMed

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

Martin, Randolph P

2013-11-01

306

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

PubMed Central

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

2013-01-01

307

Role of Circulating Osteogenic Progenitor Cells in Calcific Aortic Stenosis  

PubMed Central

Objectives The purpose of this study was to determine the role of circulating endothelial progenitor cells with osteoblastic phenotype (EPC-OCN) in human aortic valve calcification (AVC). Background Recent evidence suggests that rather than passive mineralization, AVC is an active atherosclerotic process with an osteoblastic component resembling coronary calcification. We have recently identified circulating EPCs with osteogenic properties carrying both endothelial progenitor (CD34, KDR) and osteoblastic (osteocalcin [OCN]) cell surface markers. Methods Blood samples from controls (n = 22) and patients with mild to moderate calcific aortic stenosis (mi-moAS, n = 17), severe calcific AS (sAS, n = 26), and both sAS and severe coronary artery disease (sCAD) (n = 33) were collected during diagnostic coronary angiography. By using flow cytometry, peripheral blood mononuclear cells were analyzed for CD34, KDR, and OCN. Resected normal and calcified aortic valves were analyzed histologically. Results Patients with mi-moAS and patients with sAS/sCAD had significantly less EPCs (CD34+/KDR+/OCN?) than controls. Patients with sAS showed significantly higher numbers of EPC-OCN (CD34+/KDR+/OCN+) than controls. In addition, the percentage of EPC costaining for OCN was higher in all disease groups compared with controls. A subgroup analysis of younger patients with bicuspid sAS showed a similar pattern of significantly lower EPCs but a high percentage of coexpression of OCN. Immunofluorescence showed colocalization of nuclear factor kappa-B and OCN in diseased and normal valves. CD34+/OCN+ cells were abundant in the endothelial and deeper cell layers of calcific aortic valve tissue but not in normal aortic valve tissue. Conclusions Circulating EPC-OCN may play a significant role in the pathogenesis and as markers of prognostication of calcific AS. PMID:23062532

Gossl, Mario; Khosla, Sundeep; Zhang, Xin; Higano, Nara; Jordan, Kyra L.; Loeffler, Darrell; Enriquez-Sarano, Maurice; Lennon, Ryan J.; Lerman, Lilach O.; Lerman, Amir

2014-01-01

308

Current Management of Calcific Aortic Stenosis  

PubMed Central

Calcific aortic stenosis (AS) is a progressive disease with no effective medical therapy that ultimately requires aortic valve replacement (AVR) for severe valve obstruction. Echocardiography is the primary diagnostic approach to define valve anatomy, measure AS severity and evaluate the left ventricular (LV) response to chronic pressure overload. In asymptomatic patients, markers of disease progression include the degree of leaflet calcification, hemodynamic severity of stenosis, adverse LV remodeling, reduced LV longitudinal strain, myocardial fibrosis and pulmonary hypertension. The onset of symptoms portends a predictably high mortality rate unless AVR is performed. In symptomatic patients, AVR improves symptoms, improves survival and, in patients with LV dysfunction, improves systolic function. Poor outcomes after AVR are associated with low-flow low-gradient AS, severe ventricular fibrosis, oxygen dependent lung disease, frailty, advanced renal dysfunction and a high comorbidity score. However, in most patients with severe symptoms, AVR is lifesaving. Bioprosthetic valves are recommended for patients over the age of 65 years. Transcatheter AVR is now available for patients with severe comorbidities, is recommended in patients who are deemed inoperable and is a reasonable alternative to surgical AVR in high risk patients. PMID:23833296

Lindman, Brian R.; Bonow, Robert O.; Otto, Catherine M.

2014-01-01

309

Percutaneous and off-pump treatments for functional mitral regurgitation.  

PubMed

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

Fukamachi, Kiyotaka

2008-01-01

310

Cerebellar calcification and lead  

Microsoft Academic Search

In elderly subjects who were brought up in a known high lead environment in Queensland, Australia, childhood residence and occupational status provide circumstantial evidence of a relationship between excessive lead intake and cerebellar calcification as seen on computed tomography. This supports experimental and neuropathological studies demonstrating an association between exposure to lead and perivascular cerebellar calcification.

M D Benson; J Price

1985-01-01

311

Juvenile intervertebral disc calcification  

Microsoft Academic Search

Juvenile intervertebral disc calcification is a rare but well described disorder of childhood. The syndrome consists of specific roentgenologic changes: calcification of nucleus pulposus in the intervertebral discs and occasional flattening and anterior wedging of the adjacent vertebral bodies. These changes can be accompanied by clinical symptoms such as neck pain, torticollis, general malaise and slight fever. The etiology and

Lisbet Rosenkrantz Grage; Mogens Egeblad

1992-01-01

312

Particle Image Velocimetry studies of bicuspid aortic valve hemodynamics  

Microsoft Academic Search

Bicuspid aortic valves (BAVs) are a congenital anomaly of the aortic valve with two fused leaflets, affecting about 1-2% of the population. BAV patients have much higher incidence of valve calcification & aortic dilatation, which may be related to altered mechanical forces from BAV hemodynamics. This study aims to characterize BAV hemodynamics using Particle Image Velocimetry(PIV). BAV models are constructed

Neelakantan Saikrishnan; Choon-Hwai Yap; Ajit P. Yoganathan

2010-01-01

313

Percutaneous transvenous mitral commissurotomy in a patient with situs inversus and dextrocardia: a case report  

PubMed Central

BACKGROUND Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy-guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia. CASE REPORT A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricularejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS). CONCLUSION Mirror-image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy. PMID:22577444

Tavassoli, Aliakbar; Emami, Mahmood; Mousavizadeh, Mostafa; Emami Meybodi, Tohid

2011-01-01

314

Sonographic Detectability Of Breast Calcifications  

NASA Astrophysics Data System (ADS)

Sonographic detectability of mammographically demonstrable breast calcifications depends primarily on the size of the calcific particles. Calcifications smaller than 2 mm in size are detected in fewer than 10% of cases, with equally low detection rates for benign and malignant particles. The inability of sonography to routinely identify malignant breast calcifications will severely restrict its use as a screening tool for cancer detection.

Sickles, Edward A.

1983-12-01

315

Durability of pyrolytic carbon-containing heart valve prostheses.  

PubMed

To assess abrasive wear of mechanical valve prostheses containing pyrolytic carbon components, we recovered at necropsy or surgery and analyzed by scanning electron microscopy and surface profilometry eight prostheses. Seven were implanted for 30-85 (mean 50 months. Valves included DeBakey aortic (2), DeBakey mitral (1), Beall mitral (2), Bjork-Shiley aortic (1), Cooley-Cutter mitral (1), and Lillehei-Kaster (L-K) tricuspid (1). All carbon occluders had undetectable wear. Carbon cage struts had a superficial burnish. Metallic struts had insignificant wear marks. In contrast, a Teflon Beall Model 104 valve implanted for 34 days and similarly analyzed had considerable material loss from the cage struts. This study suggests that clinically important abrasive wear will not be a late complication of cardiac valve replacement with pyrolytic carbon prostheses. PMID:7130212

Schoen, F J; Titus, J L; Lawrie, G M

1982-09-01

316

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

PubMed

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

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

2014-01-01

317

Native valve Escherichia coli endocarditis following urosepsis  

PubMed Central

Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure. PMID:23814428

Rangarajan, D.; Ramakrishnan, S.; Patro, K. C.; Devaraj, S.; Krishnamurthy, V.; Kothari, Y.; Satyaki, N.

2013-01-01

318

Transatrial transcatheter tricuspid valve-in-valve implantation of balloon expandable bioprosthesis.  

PubMed

Transcatheter valve-in-valve implantation into failing mitral and aortic bioprosthetic valves have been reported. This strategy avoids performing high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. Tricuspid valve-in-valve implantation has not been described. We report a case of failing bioprosthetic tricuspid valve in a 48-year-old woman with carcinoid syndrome. We attempted a transatrial transcatheter approach and we successfully deployed a 26-mm Edwards Sapien balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA) into a severely stenotic tricuspid bioprosthesis. This case demonstrates the technical feasibility and safety of this approach. Therefore, tricuspid valve-in-valve implantation may be a viable treatment alternative in carefully selected patients. PMID:20971296

Hon, Jimmy Kim Fatt; Cheung, Anson; Ye, Jian; Carere, Ronald G; Munt, Brad; Josan, Kiranbir; Lichtenstein, Samuel V; Webb, John

2010-11-01

319

Frequency by Decades of Unicuspid, Bicuspid, and Tricuspid Aortic Valves in Adults Having Isolated Aortic Valve Replacement for Aortic Stenosis, With or Without Associated Aortic Regurgitation  

Microsoft Academic Search

Background—Aortic valve stenosis (with or without aortic regurgitation and without associated mitral stenosis) in adults in the Western world has been considered in recent years to most commonly be the result of degenerative or atherosclerotic disease. Methods and Results—We examined operatively excised, stenotic aortic valves from 932 patients aged 26 to 91 years (meanSD, 7012), and none had associated mitral

William C. Roberts; Jong M. Ko

320

Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated stenotic Sapien heart valve prosthesis.  

PubMed

Treatment options for re-stenotic aortic valve prosthesis implanted by transcatheter technique have not been evaluated systematically. We describe the case of a 75-year-old dialysis patient who was treated by transcatheter aortic valve implantation 3.5 years ago and now presented with severe stenosis of the percutaneous heart valve. The patient was initially treated with a trans-apical implantation of an Edwards Sapien 26 mm balloon expandable valve. The patient remained asymptomatic for 3 years when he presented with increasing shortness of breath and significant calcification of the valve prosthesis on transesophageal echocardiography. Valve-in-valve percutaneous heart valve implantation using a 26-mm CoreValve prosthesis was performed under local anesthesia. The prosthesis was implanted without prior valvuloplasty. Pacing with a frequency of 140/min was applied during placement of the valve prosthesis. Positioning was done with great care using only fluoroscopic guidance with the aim to have the ventricular strut end of the CoreValve prosthesis 5 mm higher than the ventricular strut end of the Edwards Sapien prosthesis. After placement of the CoreValve prosthesis within the Edwards Sapien valve additional valvuloplasty with rapid pacing was performed in order to further expand the CoreValve prosthesis. The final result was associated with a remaining mean gradient of 5 mm Hg and no aortic regurgitation. In conclusion, implantation of a CoreValve prosthesis for treatment of a restenotic Edwards Sapien prosthesis is feasible and is associated with a good functional result. PMID:22707435

Hoffmann, Rainer; Möllmann, Helge; Lotfi, Shahram

2013-12-01

321

Sizing for mitral annuloplasty: where does science stop and voodoo begin?  

PubMed

The implantation of an improperly sized annuloplasty ring may result in an incompetent valve after surgical mitral valve repair. Consequently, the procedure of ring size selection is considered critical. Although a plethora of sizing strategies are described, the opinions on how to select the appropriate ring size differ widely and often appear arbitrary (ie, without scientific justification). These inconsistencies raise the question where, with respect to ring sizing, science stops and voodoo begins. PMID:23481703

Bothe, Wolfgang; Miller, D Craig; Doenst, Torsten

2013-04-01

322

Nuclear factor of activated T cells mediates oxidised LDL-induced calcification of vascular smooth muscle cells  

Microsoft Academic Search

Aims\\/hypothesis  Vascular calcification is a prominent feature of both atherosclerosis and diabetes, and is clinically associated with osteoporosis.\\u000a The expression of bone-regulatory factors and the impact of oxidative stress in aortic calcification are well-documented.\\u000a Recently, nuclear factor of activated T cells (NFAT) cytoplasmic, calcineurin-dependent 1 (NFATc1) was identified in calcified\\u000a aortic valves and has been implicated in vascular calcification. Therefore, we

C. Goettsch; M. Rauner; C. Hamann; K. Sinningen; U. Hempel; S. R. Bornstein; L. C. Hofbauer

323

Safety valve  

DOEpatents

The safety valve contains a resilient gland to be held between a valve seat and a valve member and is secured to the valve member by a sleeve surrounding the end of the valve member adjacent to the valve seat. The sleeve is movable relative to the valve member through a limited axial distance and a gap exists between said valve member and said sleeve.

Bergman, Ulf C. (Malmoe, SE)

1984-01-01

324

Impact of Mitral Stenosis and Aortic Atresia on Survival in Hypoplastic Left Heart Syndrome  

Microsoft Academic Search

Background. Aortic atresia has been implicated as a risk factor for decreased survival after stage 1 palliation. Prior studies evaluating the association of anatomic sub- types and mortality report conflicting results. Our objec- tive was to determine if mitral valve patency with aortic atresia is associated with increased mortality in hypo- plastic left heart syndrome (HLHS). Methods. All patients (n

Jenifer A. Glatz; Raymond T. Fedderly; Nancy S. Ghanayem; James S. Tweddell

325

Percutaneous mitral valvuloplasty: retrograde, transarterial double-balloon technique utilizing the transseptal approach.  

PubMed

Between February 1985 and May 1987, 72 patients with mitral stenosis (MS) underwent percutaneous transluminal mitral valvuloplasty (PTMV). The retrograde transarterial double-balloon technique was used on 54/72 patients (75%); 16 males, 38 females; mean age: 39 +/- 11 years. Transseptal catheterization was used to place two 0.035", 350-cm exchange wires into the ascending aorta in order to be snared, retrieved, and exteriorized, each through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for PTMV. The transmitral mean gradient fell [18 +/- 4 to 9 +/- 5 mmHg (P less than 0.001)]; the cardiac output increased [5.1 +/- 0.8 6.1 +/- 0.8 L/min (P less than 0.001)]; the hemodynamically calculated valve area increased [1.2 +/- 0.2 to 2.3 +/- 0.6 cm2 (P less than 0.001)]; and the short axis two-dimensional echocardiographic valve area increased [1.1 +/- 0.3 to 2.2 +/- 0.7 (P less than 0.001)]. PTMV was unsuccessful in two patients (4%), due to the inability to maintain the inflated balloons in the mitral position. Significant complications were encountered in two patients: two strokes (3.7%) and one mortality from the stroke (1.4%). Significant mitral regurgitation occurred in two patients (3.7%); no post-PTMV hemodynamically significant atrial septal defects were detected. Follow-up (mean time: 11 +/- 6 months) of 43 patients showed a persistent improvement in echocardiographic findings in 27 (63%) and hemodynamically measured mitral valve area in the 16 patients in which cardiac catheterization was repeated. The retrograde, transarterial double-balloon technique can successfully accomplish PTMV with good results and an acceptable low morbidity and mortality. PMID:3396065

Babic, U U; Dorros, G; Pejcic, P; Djurisic, Z; Vucinic, M; Lewin, R F; Grujicic, S N

1988-01-01

326

Calcific uremic arteriolopathy  

PubMed Central

Calcific uremic arteriolopathy (CUA)/calciphylaxis is an important cause of morbidity and mortality in patients with chronic kidney disease requiring renal replacement. Once thought to be rare, it is being increasingly recognized and reported on a global scale. The uremic milieu predisposes to multiple metabolic toxicities including increased levels of reactive oxygen species and inflammation. Increased oxidative stress and inflammation promote this arteriolopathy by adversely affecting endothelial function resulting in a prothrombotic milieu and significant remodeling effects on vascular smooth muscle cells. These arteriolar pathological effects include intimal hyperplasia, inflammation, endovascular fibrosis and vascular smooth muscle cell apoptosis and differentiation into bone forming osteoblast-like cells resulting in medial calcification. Systemic factors promoting this vascular condition include elevated calcium, parathyroid hormone and hyperphosphatemia with consequent increases in the calcium × phosphate product. The uremic milieu contributes to a marked increased in upstream reactive oxygen species—oxidative stress and subsequent downstream increased inflammation, in part, via activation of the nuclear transcription factor NF?B and associated downstream cytokine pathways. Consitutive anti-calcification proteins such as Fetuin-A and matrix GLA proteins and their signaling pathways may be decreased, which further contributes to medial vascular calcification. The resulting clinical entity is painful, debilitating and contributes to the excess morbidity and mortality associated with chronic kidney disease and end stage renal disease. These same histopathologic conditions also occur in patients without uremia and therefore, the term calcific obliterative arteriolopathy could be utilized in these conditions. PMID:20716935

Sowers, Kurt M

2010-01-01

327

Isolated tricuspid valve repair after metastatic tumor resection.  

PubMed

Isolated tricuspid valve repairs are performed in adults most commonly as a result of infective endocarditis, traumatic injury, rheumatic involvement, and ischemia. The use of neochordae made from polytetrafluoroethylene, being widespread in mitral valve operations, is gaining ground in tricuspid valve repair. We report a very rare case that describes isolated tricuspid valve repair using neochordae after resection of a right ventricular tumor involving the tricuspid valve. The tumor isolated was metastatic teratoma in a patient with growing teratoma syndrome. We further describe our technique of tricuspid neochord implantation and the rationale behind the repair. PMID:25282209

Roubelakis, Apostolos; Modi, Amit; Ohri, Sunil K

2014-10-01

328

Beat-rate dependent mitral flow patterns for in vitro hemodynamic applications.  

PubMed

The conservative surgery approach for restoring the functionality of heart valves has predominated during the last two decades, particularly for the mitral valve. In vitro pulsatile testing is a key methodology for the investigation of heart valve hemodynamics, and particularly for the ideation, validation and optimization of novel techniques in heart valve surgery. Traditionally, however, pulsatile mock loops have been developed for the study of aortic valve substitutes, and scarce attention has been paid in replicating the mitral flow patterns with due hemodynamic fidelity. In this work we provide detailed analytical expressions to produce beat-rate dependent, physiologic-like mitral flow patterns for in vitro applications. The approach we propose is based on a biomechanical analysis of the factors which govern hemodynamic changes in the mitral flow pattern, namely in terms of E and A wave contours and E/A peaks ratio, when switching from rest to mild exercise conditions. The patterns from the model we obtained were in good agreement with clinical literature data in terms of i) gradual superimposition of the E and A wave, which yielded a single peak at 96 bpm; ii) decrease in the E/A ratio with increasing heart rate; iii) amount of flow delivered by each of the two waves. The proposed method provides a physiologically representative, beat-rate dependent analytical expression of the mitral flow pattern, which can be used in in vitro hydrodynamic investigations to accurately replicate the changes that the flow waves experience when the heart rate shifts from rest to mild exercise conditions. PMID:21186468

Vismara, Riccardo; Fiore, Gianfranco B

2010-12-01

329

Acute mitral regurgitation caused by penetrating chest injury.  

PubMed

A 22-year-old male patient with penetrating cardiac injury was admitted to general surgery, where he underwent an immediate, life saving operation. Subsequent cardiological evaluation established the presence of a well tolerated mitral regurgitation without the need for urgent cardiac surgical intervention. One month later the patient was re-admitted in cardiac failure. Transesophageal echocardiography suggested the detachment of the posterior leaflet, which was not previously demonstrated by transthoracic echocardiography. Emergency surgery confirmed the diagnosis and the mitral valve was successfully repaired. The postoperative course was uneventful. This case history suggests that transesophageal echocardiography is mandatory after penetrating cardiac injury even in the case of good clinical condition and negative transthoracic echocardiographic findings. In the presence of valvular injury, early surgical intervention is recommended. PMID:7655693

Rywik, T; Sitkowski, W; Cichocki, J; Rajecka, A; Suwalski, K

1995-05-01

330

Three-dimensional echocardiography in valve disease  

PubMed Central

This review covers the role of three-dimensional (3D) echocardiography in the diagnosis of heart valve disease. Several factors have contributed to the evolution of this technique, which is currently a simple and routine method: rapid evolution in probe and computer technologies, demonstration that 3D data sets allowed more complete and accurate evaluation of cardiac structures, emerging clinical experience indicating the strong potential particularly in valve diseases, volume and function of the two ventricle measurements and several other fields. This report will review current and future applications of 3D echocardiography in mitral, aortic and tricuspid valve diseases underlying both qualitative (morphologic) and quantitative advantages of this technique. PMID:21977273

COLOMBO, CHIARA; TAMBORINI, GLORIA; PEPI, MAURO; ALIMENTO, MARINA; FIORENTINI, CESARE

2007-01-01

331

Robotic Posterior Mitral Leaflet Repair: Neochordal versus Resectional Techniques  

PubMed Central

Background Resectional techniques are the established method of posterior mitral valve leaflet repair for degenerative disease; however, use of neochordae in a robotically assisted approach is gaining acceptance because of its versatility for difficult multi-segment disease. The purposes of this study were to compare the versatility, safety, and effectiveness of neochordal vs. resectional techniques for robotic posterior mitral leaflet repair. Methods From 12/2007 to 7/2010, 334 patients underwent robotic posterior mitral leaflet repair for degenerative disease by a resectional (n=248) or neochordal (n=86) technique. Outcomes were compared unadjusted and after propensity score matching. Results Neochordae were more likely to be used than resection in patients with two (28% vs. 13%, P=.002) or three (3.7% vs. 0.87%, P=.08) diseased posterior leaflet segments. Three resection patients (0.98%) but no neochordal patient required reoperation for hemodynamically significant systolic anterior motion (SAM). Residual mitral regurgitation (MR) at hospital discharge was similar for matched neochordal vs. resection patients (P=.14) (MR 0+, 82% vs. 89%; MR 1+, 14% vs. 8.2%; MR 2+, 2.3% vs. 2.6%; one neochordal patient had 4+ MR and was reoperated). Among matched patients, postoperative mortality and morbidity were similarly low. Conclusion Compared with a resectional technique, robotic posterior mitral leaflet repair with neochordae is associated with shorter operative times and no occurrence of SAM. The versatility, effectiveness, and safety of this repair make it a good choice for patients with advanced multi-segment disease. PMID:23103008

Mihaljevic, Tomislav; Pattakos, Gregory; Gillinov, A. Marc; Bajwa, Gurjyot; Planinc, Mislav; Williams, Sarah J.; Blackstone, Eugene H.

2013-01-01

332

Alkaptonuria and intramedullary calcification.  

PubMed

Alkaptonuria is a rare disorder of metabolism caused by deficiency of homogentisic acid oxidase enzyme and characterized by triad of homogentisic aciduria (dark urine), relentlessly progressive arthritis and ochronosis. We have documented a case with typical features of alkaptonuria along with intramedullary calcification which has not been reported in the literature before. PMID:18846913

Raina, S; Mahesh, D M; Kaushal, S S; Gupta, D; Dhiman, D S; Negi, A; Sharma, S

2008-07-01

333

Calcific retropharyngeal tendinitis  

Microsoft Academic Search

Calcific retropharyngeal tendinitis is an imflammation of the longus colli muscle tendon which is located on the anterior surface of the verterbral column extending from the atlas to the third thoracic vertebra. The acute inflammatory condition is selflimiting with symptoms consisting of a gradually increasing neck pain often associated with throat pain and difficulty swallowing. The pain is aggravated by

David Karasick; Stephen Karasick

1981-01-01

334

Regulation of the sodium-phosphate cotransporter Pit-1 and its role in vascular calcification.  

PubMed

Vascular calcification is caused by the deposition of basic calcium phosphate crystals in blood vessels, myocardium, and/or cardiac valves. Calcification decreases artery wall compliance, and arterial calcification is associated to mortality in hyperphosphatemic renal failure and diabetes mellitus. The calcification of the tunica media characterizes the arteriosclerosis observed with age, diabetes and end stage-renal disease, and it can develop independently from intima calcification. As part of the vascular calcification mechanism, vascular smooth muscle cells (VSMC) experience a transition from a contractile to an osteochondrogenic phenotype and a sequence of molecular events that are typical of endochondral ossification. The current evidence indicates a key role of increased phosphate uptake by VSMC for calcification, which supplies the substrate for hydroxyapatite formation and could trigger or potentiate VSMC transdiferentiation. The present review analyzes the sodium-phosphate cotransporter Pit-1, which is implicated in calcification. On the basis of the available data obtained in the study of vascular and osteoblastic experimental models, we discuss potential regulatory mechanisms that could lead to increased sodium-dependent phosphate uptake in vascular calcification. PMID:19485893

Gonzalez, Magdalena; Martínez, Rafael; Amador, Cristián; Michea, Luis

2009-10-01

335

A Quantitative Study of Simulated Bicuspid Aortic Valves  

Microsoft Academic Search

Previous studies have shown that congentially bicuspid aortic valves develop degenerative diseases earlier than the standard trileaflet, but the causes are not well understood. It has been hypothesized that the asymmetrical flow patterns and turbulence found in the bileaflet valves together with abnormally high levels of strain may result in an early thickening and eventually calcification and stenosis. Central to

Kai Szeto; Tran Nguyen; Javier Rodriguez; Peter Pastuszko; Vishal Nigam; Juan Lasheras

2010-01-01

336

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

PubMed Central

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

2014-01-01

337

[Visualization and characterization of the transvalvular jet in mitral stenosis using color-coded Doppler].  

PubMed

Two-dimensional Color Doppler flow imaging is a new non-invasive technique which allows real-time visualization of intracardiac blood flow and provides informations about its direction, velocity and presence of turbulence. As a consequence the identification of jets configuration across stenotic valve orifices is now possible by Color flow imaging. This non invasive tool may be particularly helpful in patients with rheumatic mitral valve disease in whom distortion of mitral valve apparatus is often present, determining a non uniform and variable appearance of jets. Therefore the aim of this study was to describe our initial experience with color flow imaging in the visualization of transtenotic mitral jets in order to characterize different spatial configurations. We studied 45 patients with clinical and echocardiographic diagnosis of mitral stenosis. The mean age of these patients was 59 years (range from 36 to 72 years), 34 were women and 11 men. The different types of transmitral jets were characterized by real time and frame by frame analysis. The following characteristics of transmitral jets have been evaluated: A) appearance ("Candle flame", "Mushroom", "Scimitar"-shaped, "Double-jets"); B) direction (centrally directed or eccentric); C) extension into the left ventricle (basal, mid-ventricular and apical); D) persistence of turbulent flow during diastole (early-, mid-, late diastole). Mitral valve area was calculated from the velocity tracings obtained by continuous wave Doppler, applying the pressure half-time method. Color flow imaging of good quality for analysis was obtained in 41 of 45 patients (91%). In the other 4 patients the quality of color flow images was suboptimal however the direction and configuration of the jets could still be visualised.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3436493

Moro, E; Nicolosi, G L; Pignoni, P; Pavan, D; Dall'Aglio, V; D'Angelo, G; Lestuzzi, C; Zanuttini, D

1987-10-01

338

Childhood intervertebral disc calcification  

Microsoft Academic Search

Two cases of intervertebral disc calcification in children are reported. A 13-year-old boy presented with right subscapular pain radiating into the axilla with radiographic demonstration of multiple calcified intervertebral discs and a herniated fragment of calcified nucleus pulposus at T2–3. His condition improved with conservative therapy, and follow-up radiographic evaluation revealed resolution of the herniated calcified disc material. A second

B. Theo Mellion; John P. Laurent; William C. Watters

1993-01-01

339

Three-dimensional echocardiographic delineation of an acquired aorto-left atrial fistula complicating native aortic valve endocarditis - "advantage of three dimensions".  

PubMed

Aorto-atrial fistulas are rare, but important complications resulting from aortic valve infective endocarditis, aortic valve surgery, or aortic dissection. We hereby report a case of a 20-year male, referred to us with infective endocarditis of the native aortic valve with severe aortic regurgitation and symptoms of heart failure. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed aorto-left atrial fistula secondary to the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) region. The patient underwent successful removal of the vegetations, closure of the defect along with aortic valve replacement, and mitral valve repair. PMID:23931072

Chandra, Sharad; Ameta, Deepak; Kharwar, Rajiv Bharat; Goyal, Mukesh; Kumar, Devesh; Dwivedi, Sudhanshu Kumar; Saran, Ram Kirti

2013-11-01

340

Aortic Valve  

MedlinePLUS

... in this category include " xenograft " valves made from animal tissues (most often pig aortic valves), " homograft " or " allograft " valves retrieved from human cadavers, and " pulmonary autograft " valves moved from the patient's pulmonary artery on the right side of the heart to the aortic position ...

341

Plug valve  

DOEpatents

An improved plug valve wherein a novel shape for the valve plug and valve chamber provide mating surfaces for improved wear characteristics. The novel shape of the valve plug is a frustum of a body of revolution of a curved known as a tractrix, a solid shape otherwise known as a peudosphere.

Wordin, John J. (Shelley, ID)

1989-01-01

342

Tremolite whitewashing and pleural calcifications.  

PubMed

Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material ("luto" soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate vicinity, where "luto" had never been used, pleural calcifications were not observed. Results suggest that Metsovo tremolite may have caused pleural calcifications to all individuals born in Metsovo before 1940. This is the first study indicating that environmental asbestos exposure can cause abnormalities in everyone exposed to it. PMID:2820656

Constantopoulos, S H; Saratzis, N A; Kontogiannis, D; Karantanas, A; Goudevenos, J A; Katsiotis, P

1987-10-01

343

Tremolite whitewashing and pleural calcifications  

SciTech Connect

Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material (luto soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate vicinity, where luto had never been used, pleural calcifications were not observed. Results suggest that Metsovo tremolite may have caused pleural calcifications to all individuals born in Metsovo before 1940. This is the first study indicating that environmental asbestos exposure can cause abnormalities in everyone exposed to it.

Constantopoulos, S.H.; Saratzis, N.A.; Kontogiannis, D.; Karantanas, A.; Goudevenos, J.A.; Katsiotis, P.

1987-10-01

344

Tremolite whitewashing and pleural calcifications  

Microsoft Academic Search

Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material (luto soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate

S. H. Constantopoulos; N. A. Saratzis; D. Kontogiannis; A. Karantanas; J. A. Goudevenos; P. Katsiotis

1987-01-01

345

Analysis of interobserver and intraobserver variation of interpretation of the echocardiographic and Doppler flow determination of cardiac output by the mitral orifice method.  

PubMed Central

The variability of the interpretation by two individuals of a combined echocardiographic and Doppler method of calculating output was studied in 30 normal adults. In each subject three separate cardiac cycles were recorded to calculate maximal mitral valve orifice, the ratio of mean to maximal mitral valve leaflet separation, and the mean flow velocity through the mitral valve. The recordings were digitised twice by two independent observers. Estimates of cardiac output ranged from 3.2 to 8.11 1/min. Analysis of variance showed that interobserver and intraobserver variability for these measurements was 5.8% and 6.1% respectively. It is concluded that the reproducibility for interpreting this non-invasive method is adequate for clinical use in adults with cardiac outputs within the normal range. PMID:3707784

Nicolosi, G L; Pungercic, E; Cervesato, E; Modena, L; Zanuttini, D

1986-01-01

346

Check valve  

DOEpatents

A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion. 5 figs.

Upton, H.A.; Garcia, P.

1999-08-24

347

Check valve  

DOEpatents

A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion.

Upton, Hubert Allen (Morgan Hill, CA); Garcia, Pablo (Stanford, CA)

1999-08-24

348

Hemodynamic Environments from Opposing Sides of Human Aortic Valve Leaflets Evoke Distinct Endothelial Phenotypes In Vitro  

E-print Network

The regulation of valvular endothelial phenotypes by the hemodynamic environments of the human aortic valve is poorly understood. The nodular lesions of calcific aortic stenosis (CAS) develop predominantly beneath the ...

Weinberg, Eli J.

349

Cryosolenoid valve  

Microsoft Academic Search

An internally piloted shut-off valve is described for use with cryogenic fluids incorporates a short valve housing with normally closed valve closure means incorporated therein and fluid passages with ports for fluid flow therethrough including an elongated extended stem protruding therefrom on top of which a solenoid operator is received in the stem end opening so as to define a

Pauliukonis

1980-01-01

350

Fast valve  

DOEpatents

A fast valve is disclosed that can close on the order of 7 milliseconds. It is closed by the force of a compressed air spring with the moving parts of the valve designed to be of very light weight and the valve gate being of wedge shaped with O-ring sealed faces to provide sealing contact without metal to metal contact. The combination of the O-ring seal and an air cushion create a soft final movement of the valve closure to prevent the fast air acting valve from having a harsh closing. 4 figs.

Van Dyke, W.J.

1992-04-07

351

Heart valve surgery  

MedlinePLUS

Valve replacement; Valve repair; Heart valve prosthesis; Mechanical valves, Prosthetic valves ... place. The main types of new valves are: Mechanical -- made of man-made materials, such as metal ( ...

352

Idiopathic arterial calcification in infancy  

Microsoft Academic Search

An infant with idiopathic arterial calcification is presented. The disease was diagnosed during the life of the patient as an aortogram demonstrated a stenosis of the left coronary artery and complete occlusion of the right coronary artery.

J. M. Retbi; A. Casasoprana; J. C. Gabilan; M. Dehan; J. Rosenstein-Retbi

1978-01-01

353

Vascularization of bioprosthetic valve material  

NASA Astrophysics Data System (ADS)

Cell membrane remnants represent a probable nucleation site for calcium deposition in bioprosthetic heart valves. Calcification is a primary failure mode of both bovine pericardial and porcine aortic heterograft bioprosthesis but the nonuniform pattern of calcium distribution within the tissue remains unexplained. Searching for a likely cellular source, we considered the possibility of a previously overlooked small blood vessel network. Using a videomicroscopy technique, we examined 5 matched pairs of porcine aortic and pulmonary valves and 14 samples from 6 bovine pericardia. Tissue was placed on a Leitz Metallux microscope and transilluminated with a 75 watt mercury lamp. Video images were obtained using a silicon intensified target camera equipped with a 431 nm interference filter to maximize contrast of red cells trapped in a capillary microvasculature. Video images were recorded for analysis on a Silicon Graphics Image Analysis work station equipped with a video frame grabber. For porcine valves, the technique demonstrated a vascular bed in the central spongiosa at cusp bases with vessel sizes from 6-80 micrometers . Bovine pericardium differed with a more uniform distribution of 7-100 micrometers vessels residing centrally. Thus, small blood vessel endothelial cells provide a potential explanation patterns of bioprosthetic calcification.

Boughner, Derek R.; Dunmore-Buyze, Joy; Heenatigala, Dino; Lohmann, Tara; Ellis, Chris G.

1999-04-01

354

Antioxidant Enzymes Reduce DNA Damage and Early Activation of Valvular Interstitial Cells in Aortic Valve Sclerosis  

PubMed Central

Objective Accumulation of reactive oxygen species (ROS) and remodeling of the microstructure of the cusp characterize aortic valve sclerosis, the early phase of calcific aortic valve disease. These events are associated with activation of valvular interstitial cells (VICs) toward an osteogenic-like phenotype. Because ROS cause DNA damage and transcriptional activation we investigated the relationship between ROS, DNA damage response, and transdifferentiation of VICs. Methods and Results Human aortic valve cusps and patient-matched VICs were collected from 39 patients both with and without calcific aortic valve disease. VICs were exposed to hydrogen peroxide (0.1–1 mmol/L) after cell transduction with extracellular superoxide dismutase/catalase adenoviruses and characterized for DNA-damage response, osteogenic transdifferentiation, and calcification. ROS induce relocalization of phosphorylated ?H2AX, MRE11, and XRCC1 proteins with expression of osteogenic signaling molecule RUNX2 via AKT. We report a sustained activation of ?H2AX in aortic valve sclerosis-derived VICs suggesting their impaired ability to repair DNA damage. Adenovirus superoxide dismutase/catalase transduction decreases ROS-induced DNA damage and VIC transdifferentiation in aortic valve sclerosis-derived cells. Finally, adenoviral transduction with catalase reverts ROS-mediated calcification and cellular transdifferentiation. Conclusion We conclude that the ROS-induced DNA damage response is dysfunctional in early asymptomatic stages of calcific aortic valve disease. We unveiled an association among ROS, DNA-damage response, and cellular transdifferentiation, reversible by antioxidant enzymes delivery. PMID:23241403

Branchetti, Emanuela; Sainger, Rachana; Poggio, Paolo; Grau, Juan B.; Patterson-Fortin, Jeffrey; Bavaria, Joseph E.; Chorny, Michael; Lai, Eric; Gorman, Robert C.; Levy, Robert J.; Ferrari, Giovanni

2014-01-01

355

Balloon valvoplasty of mitral bioprosthesis.  

PubMed

We describe a case of percutaneous balloon valvoplasty of a stenotic Ionescu-Shiley mitral bioprosthesis with the help of an original emboli-protecting device. The procedure reduced diastolic gradient from 29 to 9 mmHg. The calculated area of the orifice increased from 0.7 to 1.7 cm2. At 10 months follow-up examination there was no change of hemodynamic parameters. PMID:2010248

Babic, U U; Grujicic, S; Vucinic, M

1991-02-01

356

A Study on the Mechanism for Cavitation in the Mechanical Heart Valves with an Electrohydraulic Total Artificial Heart  

NASA Astrophysics Data System (ADS)

It has been conceived that the mechanical heart valves mounted in an artificial heart close much faster than in vivo use, resulting in cavitation bubbles formation. In this study, the mechanisms for cavitation in mechanical heart valves (MHVs) is investigated with monoleaflet and bileaflet valves in the mitral position with an electrohydraulic total artificial heart (EHTAH). The valve-closing velocity and pressure-drop through the valve were done, and a high-speed video camera was employed to investigate the mechanism for MHVs cavitation. The valve-closing velocity and pressure-drop of the bileaflet valves were less than that of the monoleaflet valves. Most of the cavitation bubbles in the monoleaflet valves were observed next to the edge of the valve stop and the inner side of the leaflet. With the bileaflet valves, cavitation bubbles were concentrated along the leaflet tip. Also, the number density of cavitation bubbles in the bileaflet valves was less than that of the monoleaflet valves. The number density of cavitation bubbles increased with an increase in the valve-closing velocity and the valve stop area. It is established that squeeze flow holds the key to cavitation in the mechanical heart valve. In a viewpoint of squeeze flow, the bileaflet valve with slow valve-closing velocity and small valve stop area, is safer to prevent of blood cell damage than the monoleaflet valves.

Lee, Hwansung; Tsukiya, Tomonori; Homma, Akihiko; Kamimura, Tadayuki; Tatsumi, Eisuke; Taenaka, Yoshiyuki; Kitamura, Soichiro

357

Intraoperative echocardiographic detection of regurgitant jets after valve replacement  

NASA Technical Reports Server (NTRS)

BACKGROUND: Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. METHODS: Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. RESULTS: Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. CONCLUSIONS: Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.

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

2000-01-01

358

Fibrocalcific aortic valve disease: Opportunity to understand disease mechanisms using mouse models  

PubMed Central

Studies in vitro and in vivo continue to identify complex regulated mechanisms leading to overt fibrocalcific aortic valve disease (FCAVD). Assessment of the functional impact of those processes requires careful studies of models of FCAVD in vivo. Although the genetic basis for FCVAD is unknown for most patients with FCAVD, several disease-associated genes have been identified in humans and mice. Some gene products which regulate valve development in utero also protect against fibro-calcific disease during postnatal aging. Valve calcification can occur via processes that resemble bone formation. But valve calcification can also occur by non-osteogenic mechanisms, such as formation of calcific apoptotic nodules. Anti-calcific interventions might preferentially target either osteogenic or non-osteogenic calcification. Although FCAVD and atherosclerosis share several risk factors and mechanisms, there are fundamental differences between arteries and the aortic valve, with respect to disease mechanisms and responses to therapeutic interventions. Both innate and acquired immunity are likely to contribute to FCAVD. Angiogenesis is a feature of inflammation, but may also contribute independently to progression of FCAVD, possibly by actions of pericytes that are associated with new blood vessels. Several therapeutic interventions appear to be effective in attenuating development of FCAVD in mice. Therapies which are effective early in the course of FCAVD, however, are not necessarily effective in established disease. PMID:23833295

Weiss, Robert M.; Miller, Jordan D.; Heistad, Donald D.

2013-01-01

359

The development of the Starr-Edwards heart valve.  

PubMed Central

Development of the Starr-Edwards heart valve marked a new era in the treatment of valvular heart disease. Until the development of the Starr-Edwards valve, there were no published reports of patients who had lived longer than 3 months with a prosthetic valve in the mitral position. This valve was the result of a unique partnership between a young surgeon, Dr. Albert Starr, and an experienced engineer, Mr. Lowell Edwards. Working as a team, these 2 men developed and successfully implanted the 1st Starr-Edwards valve within less than 2 years of their 1st meeting. Their key to success was their willingness and ability to make repeated modifications to their design to solve each clinical problem as it arose. Their constant focus on the clinical goal aided the rapid transformation of their design from a leaflet valve to a shielded ball valve, and finally to an unshielded ball valve suitable for implantation in a human being. Along the way, they abandoned the idea of imitating the appearance of native valves, in favor of developing valves that would be clinically successful. Their work has provided help and hope for patients who otherwise would have died from the complications of rheumatic heart disease and other valvular disorders for which valve replacement is the only treatment. Images PMID:9885105

Matthews, A M

1998-01-01

360

Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study  

NASA Technical Reports Server (NTRS)

BACKGROUND: This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aalpha; posterior, Palpha) were measured. In ICM-MR, Aalpha measured in the medial and central planes was significantly larger than that in the lateral plane (39+/-5 degrees, 34+/-6 degrees, and 27+/-5 degrees, respectively; P<0.01), whereas Palpha showed no significant difference in any of the 3 AP planes (61+/-7 degrees, 57+/-7 degrees, and 56+/-7 degrees, P>0.05). In DCM-MR, both Aalpha (38+/-8 degrees, 37+/-9 degrees, and 36+/-7 degrees, P>0.05) and Palpha (59+/-6 degrees, 58+/-5 degrees, and 57+/-6 degrees, P>0.05) revealed no significant differences in the 3 planes. CONCLUSIONS: The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.

Kwan, Jun; Shiota, Takahiro; Agler, Deborah A.; Popovic, Zoran B.; Qin, Jian Xin; Gillinov, Marc A.; Stewart, William J.; Cosgrove, Delos M.; McCarthy, Patrick M.; Thomas, James D.

2003-01-01

361

Coracoclavicular and coracoacromial ligament calcification and ossification.  

PubMed

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification. PMID:2112784

Chen, Y M; Bohrer, S P

1990-01-01

362

Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case.  

PubMed

We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist (VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was re-hospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors. PMID:24527429

Rosa, Gian Marco; Parodi, Antonello; Dorighi, Ulrico; Carbone, Federico; Mach, François; Quercioli, Alessandra; Montecucco, Fabrizio; Vuilleumier, Nicolas; Balbi, Manrico; Brunelli, Claudio

2014-01-16

363

Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case  

PubMed Central

We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist (VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was re-hospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors. PMID:24527429

Rosa, Gian Marco; Parodi, Antonello; Dorighi, Ulrico; Carbone, Federico; Mach, Francois; Quercioli, Alessandra; Montecucco, Fabrizio; Vuilleumier, Nicolas; Balbi, Manrico; Brunelli, Claudio

2014-01-01

364

Deficient Signaling via Alk2 (Acvr1) Leads to Bicuspid Aortic Valve Development  

Microsoft Academic Search

Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly in humans. Despite recent advances, the molecular basis of BAV development is poorly understood. Previously it has been shown that mutations in the Notch1 gene lead to BAV and valve calcification both in human and mice, and mice deficient in Gata5 or its downstream target Nos3 have been shown

Penny S. Thomas; Somyoth Sridurongrit; Pilar Ruiz-Lozano; Vesa Kaartinen

2012-01-01

365

Altered Micrornas in Bicuspid Aortic Valve: A Comparison between Stenotic and Insufficient Valves  

PubMed Central

Background Bicuspid aortic valve (BAV), the most common form of congenital heart disease, is a leading cause of aortic stenosis (AS) and aortic insufficiency (AI). AS is typically due to calcific valve disease. Recently, microRNAs (miRNAs) have been shown to modulate gene expression. This study examined miRNAs that were altered in aortic valve leaflets of patients with AS compared to patients with AI. Additionally, in vitro experiments were performed to examine if these miRNAs modulate calcification-related genes. Materials and Methods Aortic valve samples (fused or unfused leaflets) were collected from 9 patients (mean age 44.9±13.8 years) undergoing aortic valve replacement. PIQOR™ miRXplore Microarrays containing 1421 miRNAs were used and hybridized to fused leaflet samples labeled with Cy5; unfused samples were used as control and labeled with Cy3. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to validate the miRNA array results. Cultured human aortic valve cells (AVICs) were treated with miRNA mimics and qRT-PCR was performed to determine changes in mRNAs. Results Seven miRNAs were statistically different between the AS and AI patients by microarray. MiR-26a and miR-195 levels were reduced by 65% and 59% respectively with p<0.05 in the stenotic samples by qRT-PCR. MiR-30b was reduced by 62% (p<0.06) in the stenotic samples by qRT-PCR. Human AVICs treated with miR-26a or miR-30b mimics had decreased mRNA levels of calcification-related genes. MiR-26a repressed BMP2 by 36%, ALKALINE PHOSPHATASE (ALPL) by 38%, and SMAD1 by 26%. MiR-30b reduced expression of SMAD1 by 18% and SMAD3 by 12%. Whereas miR-195 treated AVICs had increased mRNA levels of calcification-related genes such as BMP2 by 68% and RUNX2 by 11%. Conclusions MiR-26a, miR-30b, and miR-195 were decreased in the aortic valves of patients requiring valve replacement due to AS compared to those being replaced due to AI. These miRNAs appear to modulate calcification related genes in vitro. PMID:20845893

Nigam, Vishal; Sievers, Hans H.; Jensen, Brian C.; Sier, Holger A.; Simpson, Paul C.; Srivastava, Deepak; Mohamed, Salah A.

2011-01-01

366

Neomycin and carbodiimide crosslinking as an alternative to glutaraldehyde for enhanced durability of bioprosthetic heart valves.  

PubMed

Glutaraldehyde cross-linked porcine aortic valves, referred to as bioprosthetic heart valves (BHVs), are often used in heart valve replacements. Glutaraldehyde does not stabilize glycosaminoglycans (GAGs) and they are lost during preparation, in vivo implantation, cyclic fatigue, and storage. We report that binding of neomycin, a hyaluronidase inhibitor, to the tissues with carbodiimide cross-linking improves GAG retention without reducing collagen and elastin stability. It also led to improved biomechanical properties. Neomycin carbodiimide cross-linking did not significantly reduce calcification in a rat subdermal implantation model when they were stored in formaldehyde after cross-linking. Removal of formaldehyde storage significantly reduced calcification. PMID:22207605

Leong, Joshua; Munnelly, Amy; Liberio, Brianna; Cochrane, Leonard; Vyavahare, Naren

2013-05-01

367

Valve Disease  

MedlinePLUS

... Heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close them tightly to prevent a ...

368

Observation of cavitation in a mechanical heart valve in a total artificial heart.  

PubMed

Recently, cavitation on the surface of mechanical heart valves has been studied as a cause of fractures occurring in implanted mechanical heart valves. The cause of cavitation in mechanical heart valves was investigated using the 25 mm Medtronic Hall valve and the 23 mm Omnicarbon valve. Closing of these valves in the mitral position was simulated in an electrohydraulic totally artificial heart. Tests were conducted under physiologic pressures at heart rates from 60 to 100 beats per minute with cardiac outputs from 4.8 to 7.7 L/min. The disk closing motion was measured by a laser displacement sensor. A high-speed video camera was used to observe the cavitation bubbles in the mechanical heart valves. The maximum closing velocity of the Omnicarbon valve was faster than that of the Medtronic Hall valve. In both valves, the closing velocity of the leaflet, used as the cavitation threshold, was approximately 1.3-1.5 m/s. In the case of the Medtronic Hall valve, cavitation bubbles were generated by the squeeze flow and by the effects of the venturi and the water hammer. With the Omnicarbon valve, the cavitation bubbles were generated by the squeeze flow and the water hammer. The mechanism leading to the development of cavitation bubbles depended on the valve closing velocity and the valve stop geometry. Most of the cavitation bubbles were observed around the valve stop and were generated by the squeeze flow. PMID:15171470

Lee, Hwansung; Tsukiya, Tomonori; Homma, Akihiko; Kamimura, Tadayuki; Takewa, Yoshiaki; Nishinaka, Tomohiro; Tatsumi, Eisuke; Taenaka, Yoshiyuki; Takano, Hisateru; Kitamura, Soichiro

2004-01-01

369

Depressurization valve  

DOEpatents

A depressurization valve for use in relieving completely the pressure in a simplified boiling water reactor is disclosed. The normally closed and sealed valve is provided with a valve body defining a conduit from an outlet of a manifold from the reactor through a valve seat. A closing valve disk is configured for fitting to the valve seat to normally close the valve. The seat below the disk is provided with a radially extending annulus extending a short distance into the aperture defined by the seat. The disk is correspondingly provided with a longitudinally extending annulus that extends downwardly through the aperture defined by the seat towards the high pressure side of the valve body. A ring shaped membrane is endlessly welded to the seat annulus and to the disk annulus. The membrane is conformed over the confronted surface of the seat and disk in a C-sectioned configuration to seal the depressurization valve against the possibility of weeping. The disk is held to the closed position by an elongate stem extending away from the high pressure side of the valve body. The stem has a flange configured integrally to the stem for bias by two springs. The first spring acts from a portion of the housing overlying the disk on the stem flange adjacent the disk. This spring urges the stem and attached disk away from the seat and thus will cause the valve to open at any pressure. A second spring--preferably of the Belleville variety--acts on a latch plate surrounding and freely moving relative to the end of the stem. This second spring overcomes the bias of the first spring and any pressure acting upon the disk. This Belleville spring maintains through its spring force the valve in the closed position. At the same time, the latch plate with its freedom of movement relative to the stem allows the stem to thermally expand during valve temperature excursion. The latch plate in surrounding the stem is limited in its outward movement by a boss attached to the stem at the end of the stem remote from the disk. The latch plate is held normally closed by three radial latches spaced at 120.degree. around the periphery of the plate.

Skoda, George I. (Santa Clara, CA)

1989-01-01

370

Transcatheter Pulmonary Valve Replacement by Hybrid Approach Using a Novel Polymeric Prosthetic Heart Valve: Proof of Concept in Sheep  

PubMed Central

Background Since 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach. Methods We designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflets were made of 0.1-mm expanded polytetrafluoroethylene (ePTFE) coated with phosphorylcholine. We chose glutaraldehyde-treated bovine pericardium valves as control. Pulmonary valve stents were implanted in situ by a hybrid transapical approach in 10 healthy sheep (8 for polymeric valve and 2 for bovine pericardium valve), weighing an average of 22.5±2.0 kg. Angiography and cardiac catheter examination were performed after implantation to assess immediate valvular functionality. After 4-week follow-up, angiography, echocardiography, computed tomography, and cardiac catheter examination were used to assess early valvular function. One randomly selected sheep with polymeric valve was euthanized and the explanted valved stent was analyzed macroscopically and microscopically. Findings Implantation was successful in 9 sheep. Angiography at implantation showed all 9 prosthetic valves demonstrated orthotopic position and normal functionality. All 9 sheep survived at 4-week follow-up. Four-week follow-up revealed no evidence of valve stent dislocation or deformation and normal valvular and cardiac functionality. The cardiac catheter examination showed the peak-peak transvalvular pressure gradient of the polymeric valves was 11.9±5.0 mmHg, while that of two bovine pericardium valves were 11 and 17 mmHg. Gross morphology demonstrated good opening and closure characteristics. No thrombus or calcification was seen macroscopically. Conclusions This design of the novel ePTFE transcatheter pulmonary valve is safe and effective to deploy in sheep by hybrid approach, and the early valvular functionality is good. PMID:24926892

Xu, Tong-yi; Zhang, Zhi-gang; Li, Xin; Han, Lin; Xu, Zhi-yun

2014-01-01

371

The natural history of a non-stenotic bicuspid aortic valve  

Microsoft Academic Search

Forty-one patients in whom the diagnosis of a non-stenotic bicuspid aortic valve had been established by noninvasive techniques were followed up for a mean of 10.9 years. During this period, 2 patients required aortic valve replacement because of the development of calcific aortic valve stenosis at the ages of 52 and 64 and 5 others developed evidence of mild aortic

P Mills; G Leech; M Davies; A Leathan

1978-01-01

372

A rupture of both atrioventricular valves after blunt chest trauma: the usefulness of transesophageal echocardiography for a life-saving diagnosis.  

PubMed

Survival after the rupture of the both mitral and tricuspid valves in blunt thoracic trauma is uncommon and requires prompt diagnosis and treatment. We present a case in which transesophageal echocardiography performed in the operating room by the anesthesiologist identified the etiology of hemodynamic instability and facilitated successful emergency replacement of both valves. PMID:15845663

Petkov, Milen P; Napolitano, Charles A; Tobler, H Gareth; Ferrer, Thomas J; Palacios, J Mauricio; Wangler, Michael D

2005-05-01

373

Arthroscopic treatment of calcific tendonitis.  

PubMed

Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction. PMID:24904767

Barber, F Alan; Cowden, Courtney H

2014-04-01

374

Osteoprotegerin, vascular calcification and atherosclerosis  

PubMed Central

The association of bone pathologies with atherosclerosis has stimulated the search for common mediators linking the skeletal and the vascular system. Since its initial discovery as a key regulator in bone metabolism, osteoprotegerin (OPG) has become the subject of intense interest for its role in vascular disease and calcification. Studies in vitro and in animal models suggest that OPG inhibits vascular calcification. Paradoxically however, clinical studies suggest that serum OPG levels increase in association with vascular calcification, coronary artery disease, stroke and future cardiovascular events. This has led to extensive debate on the potential of OPG as a biomarker of vascular disease. However the exact significance and mechanisms by which this bone-regulatory protein influences cardiovascular pathophysiology is still unclear. The need for a more complete picture is being addressed in increasing valuable research indicating OPG as not only a marker but also a mediator of vascular pathology modulating osteogenic, inflammatory and apoptotic responses. By integrating the results of recent experimental research, animal models and clinical studies, this review summarises the present understanding of the role of OPG in vascular disease and calcification. PMID:19007931

Van Campenhout, Ann; Golledge, Jonathan

2009-01-01

375

VASCULAR CALCIFICATION IN DIALYSIS PATIENTS  

Microsoft Academic Search

A b s t r a c t: Renal osteodystrophy, vascular disease and mortality are believed to be linked in patients with chronic kidney disease (CKD), although to date most of the evidence is based only on statistical associations. The precise pathophysiology of vascu- lar calcification in end stagerenal disease (ESRD) is unknown, but risk factors include age, hypertension, time

376

Paravalvular mitral regurgitation treated with an amplatzer septal occluder device: a case report and review of the literature.  

PubMed

We describe a case of successful percutaneous closure of a moderate-sized paravalvular leak using the Amplatzer septal occluder device in a patient with excessive surgical risk. We were able to successfully close the paravalvular leak without interfering with normal prosthetic valve leaflet function. In patients with severe periprosthetic mitral regurgitation refractory to aggressive medical therapy who are not candidates for surgical intervention, use of the Amplatzer septal occluder device offers an attractive percutaneous treatment option. PMID:17268052

Momplaisir, Thierry; Matthews, Ray V

2007-02-01

377

A retrospective study of clinical signs and epidemiology of chronic valve disease in a group of 207 Dachshunds in Poland  

PubMed Central

Background Chronic mitral valve disease is frequently seen in the Dachshund. Dachshunds (n=207) made up 11.73% of the dogs admitted to the Cardiology Service at the Small Animal Clinic, Warsaw University of Life Sciences, Poland (first visits only). Results Of these, 35 dogs had no clinically detectable heart disease while 172 had chronic valve disease with the mitral valve affected most often (130 dogs), both mitral and tricuspid valves infrequently (39 dogs) and rarely the tricuspid valve (3 dogs). Males were affected more frequently than females and the average age of dogs with chronic valve disease was 11.9 years for females and 11.3 years for males. A majority of the diseased Dachshunds were classified as ISACHC 2 (79), followed by ISACHC 1 (60). Most frequent clinical signs noted by owners included coughing, exercise intolerance, dyspnea and tachypnea. Heart murmurs were generally louder with increased disease severity; however there were 20 dogs in the ISACHC 1 group with no audible heart murmurs. The most frequent electrocardiographic abnormalities included an increased P wave and QRS complex duration, increased R wave amplitude and tachycardia. With increased disease severity, echocardiography revealed an increase in heart size. A higher ISACHC class was related to increased heart size (based on echocardiography) and increased percentage of patients exhibiting enlargement of both left atrium and left ventricle (based on radiography). Conclusions The Dachshund is often affected by chronic mitral valvular disease with a late onset of associated clinical signs and few cardiac complications. PMID:23844824

2013-01-01

378

The Role of TNF-? and TNF Superfamily Members in the Pathogenesis of Calcific Aortic Valvular Disease  

PubMed Central

Calcific aortic valve disease (CAVD) represents a slowly progressive pathologic process associated with major morbidity and mortality. The process is characterized by multiple steps: inflammation, fibrosis, and calcification. Numerous studies focalized on its physiopathology highlighting different “actors” for the multiple “acts.” This paper focuses on the role of the tumor necrosis factor superfamily (TNFSF) members in the pathogenesis of CAVD. In particular, we discuss the clinical and experimental studies providing evidence of the involvement of tumor necrosis factor-alpha (TNF-?), receptor activator of nuclear factor-kappa B (NF-?B) ligand (RANKL), its membrane receptor RANK and its decoy receptor osteoprotegerin (OPG), and TNF-related apoptosis-inducing ligand (TRAIL) in valvular calcification. PMID:24307884

Galeone, Antonella; Paparella, Domenico; Colucci, Silvia; Grano, Maria; Brunetti, Giacomina

2013-01-01

379

The degeneration of biological cardiovascular prostheses under pro-calcific metabolic conditions in a small animal model.  

PubMed

In order to allow for a comparative evaluation of the in vivo degeneration of biological and tissue-engineered heart valves and vascular grafts, a small animal model of accelerated cardiovascular calcification is desired. Wistar rats (n = 102; 6 groups) were fed ad libitum with regular chow and 5 different regimens of pro-calcific diet supplemented with combinations of vitamin D (VD), cholesterol (CH) and dicalcium phosphate (PH). Moreover, cryopreserved (n = 7) or detergent-decellularized rat aortic conduit grafts (n = 6) were infrarenally implanted in Wistar rats under severely pro-calcific conditions. The follow-up lasted up to 12 weeks. High-dose application of VD (300,000 IU/kg), CH (2%) and PH (1.5%) resulted in elevated serum calcium and cholesterol levels as well as LDL/HDL ratio. It increased the tissue MMP activity visualized by in situ zymography and caused significantly aggravated calcification of the native aortic valve as well as the aortic wall as assessed by histology and micro-computed tomography. (Immuno)histology and quantitative real-time PCR revealed chondro-osteogenic cell transformation, lipid deposition, nitrosative stress and low-level inflammation to be involved in the formation of calcific lesions. Despite pro-calcific in vivo conditions, decellularization significantly reduced calcification, inflammation and intimal hyperplasia in aortic conduit implants. A well balanced dietary trigger for pathologic metabolic conditions may represent an appropriate mid-term treatment to induce calcifying degeneration of aortic valves as well as vascular structures in the systemic circulation in rats. With respect to experimental investigation focusing on calcifying degeneration of native or prosthetic tissue, this regimen may serve as a valuable tool with a rapid onset and multi-facetted character of cardiovascular degeneration. PMID:24917029

Assmann, Alexander; Zwirnmann, Kai; Heidelberg, Friederike; Schiffer, Franziska; Horstkötter, Kim; Munakata, Hiroshi; Gremse, Felix; Barth, Mareike; Lichtenberg, Artur; Akhyari, Payam

2014-08-01

380

Ras-Related Signaling Pathways in Valve Development: Ebb and Flow  

NSDL National Science Digital Library

Congenital heart defects affect ~1 in every 100 live births, and deficits in the formation of the mitral, tricuspid, and outflow tract valves account for 20ÃÂ25% of all cardiac malformations. Mutations in genes that affect Ras signaling have been identified in individuals with congenital valve disease associated with Noonan syndrome and neurofibromatosis type 1. Dissection of Ras-related signaling pathways during valvulogenesis provides seminal insight into cellular and molecular mechanisms that contribute to congenital heart disease.

Katherine E. Yutzey (Cincinnati ChildrenÃÂs Hospital Research Foundation Division of Molecular Cardiovascular Biology); Melissa Colbert (Cincinnati ChildrenÃÂs Hospital Research Foundation Division of Molecular Cardiovascular Biology); Jeffrey Robbins (Cincinnati ChildrenÃÂs Hospital Research Foundation Division of Molecular Cardiovascular Biology)

2005-12-01

381

Evidence of Adaptive Mitral Leaflet Growth  

PubMed Central

Ischemic mitral regurgitation is mitral insuffciency caused by myocardial infarction. Recent studies suggest that mitral leaflets have the potential to grow and reduce the degree of regurgitation. Leaflet growth has been associated with papillary muscle displacement, but role of annular dilation in leaflet growth is unclear. We tested the hypothesis that chronic leaflet stretch, induced by papillary muscle tethering and annular dilation, triggers chronic leaflet growth. To decipher the mechanisms that drive the growth process, we further quantified regional and directional variations of growth. Five adult sheep underwent coronary snare and marker placement on the left ventricle, papillary muscles, mitral annulus, and mitral leaflet. After eight days, we tightened the snares to create inferior myocardial infarction. We recorded marker coordinates at baseline, acutely (immediately post infarction), and chronically (five weeks post infarction). From these coordinates, we calculated acute and chronic changes in ventricular, papillary muscle, and annular geometry along with acute and chronic leaflet strains. Chronic left ventricular dilation of 17.15% (p<0.001) induced chronic posterior papillary muscle displacement of 13.49mm (p=0.07). Chronic mitral annular area, commissural and septal-lateral distances increased by 32.50% (p=0.010), 14.11% (p=0.007), and 10.84% (p=0.010). Chronic area, circumferential, and radial growth were 15.57%, 5.91%, and 3.58%, with non-significant regional variations (p=0.868). Our study demonstrates that mechanical stretch, induced by annular dilation and papillary muscle tethering, triggers mitral leaflet growth. Understanding the mechanisms of leaflet adaptation may open new avenues to pharmacologically or surgically manipulate mechanotransduction pathways to augment mitral leaflet area and reduce the degree of regurgitation. PMID:23159489

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

2012-01-01

382

[Experience with surgical treatment of prosthetic valve endocarditis].  

PubMed

Prosthetic valve endocarditis (PVE) is a rare but dangerous complication that may occur after the implantation. The authors retrospectively summarize their 11-year experience in treating PVE. 2357 prosthetic valve (PV) implantations were performed over 11 years at the Department of Cardiovascular Surgery, Semmelweis University, Budapest, PVE was found to be the indication for operation in 1.8% of the cases (43/2357). 43 surgical interventions were carried out on 38 patients (mean age: 52.5 yrs, male/female ratio: 25/13). Blood cultures were positive in 86% and negative in 14% of the cases. The infected PV-s were replaced emergently (14%), urgently (79%) or electively (7%). The explanted valves were aortic in 55% and mitral 45% of the cases, 63% were mechanical and 37% biological. PVE followed the primary PV implantation in less than a year in 39.5%. Infected environment during the primary PV implantation was found to be a predisposing factor for the late endocarditis episodes. The mean age of the infected and explanted aortic bioprosthetic valves was significantly higher than that of explanted mechanical valves (p < 0.05). No such difference could be found at the mitral valves. The explanted valves were replaced by mechanical (75.5%) or biological (22.5%) devices. Homograft was implanted once. Early postoperative mortality of the primary PV replacements was 10.5%) devices. Homograft was implanted once. Early postoperative mortality of the primary PV replacements was 10.5%. Endocarditis reoccurred in 20% of the cases. Means follow-up duration was 45.5 months. Two-, five- an 10-year survival were 75%, 64% and 51% respectively. In conclusion in the surgical treatment of PVE, bioprosthetic and mechanical valves are suitable alternatives as opposed to homografts and freestyle stentless valves. PMID:11601178

Szabolcs, Z; Bartha, E; Gellér, L; Hartyánszky, I; Minorics, C; Moravcsik, E; Hüttl, T; Szabó, T; Bodor, E

2001-09-01

383

Ascending aorta dissection associated with bicuspid aortic valve  

Microsoft Academic Search

Aortic dissection etiology involve many factors that are difficult to identify clearly. We report a 47-year-old man who underwent\\u000a a Bentall operation with reattachment of bypass grafts for a dissecting aneurysm (De Bakey type II) 4 years after combined\\u000a triple coronary artery bypass grafting and mitral valve replacement. This case appeared to be associated with factors leading\\u000a to dissecting aneurysm

Atsushi Morishita; Tadayuki Shimakura; Masaki Nonoyama; Taiichi Takasaki; Masataka Yoda

2001-01-01

384

Mechanism of a musical systolic murmur caused by a degenerated porcine bioprosthetic valve.  

PubMed

The cause of a musical (cooing) murmur produced by a degenerated bioprosthetic valve in the mitral position was investigated. Spectral analysis of the murmur recorded at the chest wall at the site of the maximum palpable impulse showed virtually all sound in a narrow frequency band around the dominant frequency of 158 hertz. The same valve, surgically removed and mounted in the mitral position in a pulse duplicating system, produced an audible musical murmur detected by a phonocatheter in the atrial chamber. Nearly all of the sound-pressure occurred in a narrow band of frequency around 145 hertz. High speed motion pictures (500 frames/s) showed systolic flutter of a flail leaflet. The frequency of this leaflet flutter was 142 hertz. Hot film anemometry showed minimal turbulence, all located near the margin of the regurgitant leaflet. The intensity of the murmur was unrelated to the intensity of turbulence. A second degenerated bioprosthetic valve that produced in vivo a typical blowing holosystolic mitral regurgitant murmur produced in vitro a murmur with a broad range of frequencies (20 to 500 hertz). With this valve, the intensity of the murmur was related to the intensity of the turbulence. Motion pictures showed no leaflet flutter. Flutter of an insufficient valve leaflet causing uniform and periodic high frequency fluctuating pressures therefore appeared to be the cause of the musical quality of the systolic murmur in a degenerated bioprosthetic valve. PMID:7081071

Stein, P D; Sabbah, H N; Magilligan, D J; Lakier, J B

1982-06-01

385

Valve replacement in children: a challenge for a whole life.  

PubMed

Valvular pathology in infants and children poses numerous challenges to the paediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. Homograft and bioprosthetic valves achieve superior haemodynamic results initially but at the cost of accelerated degeneration. Small patient size and the risk of thromboembolism limit the usefulness of mechanical valves, and somatic outgrowth is an universal problem with all available prostheses. The goal of this article is to address valve replacement options for all four valve positions within the paediatric population. We review current literature and our practice to support our preferences. To summarize, a multitude of opinions and surgical experiences exist. Today, the valve choices that seem without controversy are bioprosthetic replacement of the tricuspid valve and Ross or Ross-Konno procedures when necessary for the aortic valve. On the other hand, bioprostheses may be implanted when annular pulmonary diameter is adequate; if not or in case of right ventricular outflow tract discontinuity, it is better to use a pulmonary homograft with the Ross procedure. Otherwise, a valved conduit. Mitral valve replacement remains the most problematic; the mechanical prosthesis must be placed in the annular position, avoiding oversizing. Future advances with tissue-engineered heart valves for all positions and new anticoagulants may change the landscape for valve replacement in the paediatric population. PMID:23062483

Henaine, Roland; Roubertie, François; Vergnat, Mathieu; Ninet, Jean

2012-10-01

386

Thymoma calcification: Is it clinically meaningful?  

PubMed Central

Among anterior mediastinal lesions, thymoma is the most common. Thymomas are tumors of thymic epithelial cell origin that are distinguished by inconsistent histological and biologic behavior. Chest imaging studies typically show a round or lobulated tumor in the anterior mediastinum. Calcifications in thymomas are classically punctuate or amorphous, positioned within the lesion. Chest computed tomography (CT) features suggesting higher risk thymoma consist of tumor heterogeneity, vascular involvement, lobulation, pulmonary nodules, lymphadenopathy, and pleural manifestations. Imaging findings have an imperfect ability to predict stage and prognosis for thymoma patients. Our objective is to highlight the clinical implications of thymoma calcifications on the diagnosis, clinical manifestation and prognosis. A pubmed and google search was performed using the following words: thymoma calcification, calcified thymus, mediastinal calcification, anterior mediastinal calcification, and calcified thymoma. After reviewing 370 articles, 32 eligible articles describing thymoma calcifications were found and included in this review. Although the presence of thymus calcifications was more common in patients with invasive thymomas, they were present in significant portion of non-invasive thymomas. The presence of calcifications was not a significant factor in differentiating between benign and malignant thymoma. As a result, the type, location, size or other characteristics of thymus gland calcifications were not relevant features in clinical and radiologic diagnosis of thymoma. The histopathological diagnosis is still the only possible way to confirm the neoplastic nature of thymoma. All types of thymomas should be evaluated and managed independently of the presence of calcifications. PMID:21861913

2011-01-01

387

Calcific retropharyngeal tendinitis. [Radiological findings  

SciTech Connect

Calcific retropharyngeal tendinitis is an imflammation of the longus colli muscle tendon which is located on the anterior surface of the verterbral column extending from the atlas to the third thoracic vertebra. The acute inflammatory condition is selflimiting with symptoms consisting of a gradually increasing neck pain often associated with throat pain and difficulty swallowing. The pain is aggravated by head and neck movement. Clinically the condition can be confused with retropharyngeal absecess, meningitis, infectious spondylitis, and post-traumatic muscle spasm. The radiographic features of this condition consist of pre-vertebral soft tissue swelling from C1 to C4 and amorphous calcific density in the longus colli tendon anterior to the body of C2 and inferior to the anterior arch of C1.

Karasick, D.; Karasick, S.

1981-12-01

388

Deficiencies of physiologic calcification inhibitors and low-grade inflammation in arterial calcification: lessons for cartilage calcification.  

PubMed

Apart from clinical parallels, similarities in the pathogenesis of arterial and articular cartilage calcification have come to light in recent years. These include the roles of aging, of chronic low-grade inflammation and of genetic and acquired dysregulation of inorganic pyrophosphate (PP(i)) metabolism. This review focuses on recent developments in understanding the pathogenesis of artery calcification pertinent to interpretation of the mechanistic basis for articular cartilage calcification in aging and osteoarthritis. PMID:15797489

Rutsch, Frank; Terkeltaub, Robert

2005-03-01

389

Mechanisms of mechanical heart valve cavitation in an electrohydraulic total artificial heart.  

PubMed

Until now, we have estimated cavitation for mechanical heart valves (MHV) mounted in an electrohydraulic total artificial heart (EHTAH) with tap water as a working fluid. However, tap water at room temperature is not a proper substitute for blood at 37 degrees C. We therefore investigated MHV cavitation using a glycerin solution that was identical in viscosity and vapor pressure to blood at body temperature. In this study, six different kinds of monoleaflet and bileaflet valves were mounted in the mitral position in an EHTAH, and we investigated the mechanisms for MHV cavitation. The valve closing velocity, pressure drop measurements, and a high-speed video camera were used to investigate the mechanism for MHV cavitation and to select the best MHV for our EHTAH. The closing velocity of the bileaflet valves was slower than that of the monoleaflet valves. Cavitation bubbles were concentrated on the edge of the valve stop and along the leaflet tip. It was established that squeeze flow holds the key to MHV cavitation in our study. Cavitation intensity increased with an increase in the valve closing velocity and the valve stop area. With regard to squeeze flow, the Björk-Shiley valve, because it is associated with slow squeeze flow, and the bileaflet valve with low valve closing velocity and small valve stop areas are better able to prevent blood cell damage than the monoleaflet valves. PMID:15968949

Lee, Hwansung; Taenaka, Yoshiyuki; Kitamura, Soichiro

2005-01-01

390

Evidence for active regulation of pro-osteogenic signaling in advanced aortic valve disease  

PubMed Central

Objective This study tested the hypothesis that valvular calcium deposition, pro-osteogenic signaling, and function can be altered in mice with advanced aortic valve disease. Methods/Results “Reversa” mice were placed on a Western-type diet for 12 months and screened for the presence of aortic valve stenosis. Mice with advanced valve disease were assigned to two groups: 1) continued progression for 2 months, and 2) “regression” for 2 months, in which lipid lowering was accomplished by a “genetic switch”. Control mice were normocholesterolemic for 14 months. Mice with advanced valve disease had massive valvular calcification that was associated with increases in bone morphogenetic protein signaling, Wnt/?-catenin signaling, and markers of osteoblast-like cell differentiation. Remarkably, reducing plasma lipids with a “genetic switch” dramatically reduced markers of pro-osteogenic signaling and significantly reduced valvular calcium deposition. Nevertheless, despite a marked reduction in valvular calcium deposition, valve function remained markedly impaired. Phospho-Smad2 levels and myofibroblast activation (indices of pro-fibrotic signaling) remained elevated. Conclusion Molecular processes that contribute to valvular calcification and osteogenesis remain remarkably labile during end stages of aortic valve stenosis. While reductions in valvular calcium deposition were not sufficient to improve valvular function in our animals, these findings demonstrate that aortic valve calcification is a remarkably dynamic process that can be modified therapeutically even in the presence of advanced aortic valve disease. PMID:20864669

Miller, Jordan D.; Weiss, Robert M.; Serrano, Kristine M.; Castaneda, Lauren E.; Brooks, Robert M.; Zimmerman, Kathy; Heistad, Donald D.

2010-01-01

391

Idiopathic isolated annular dilatation causing congenital mitral regurgitation  

PubMed Central

Isolated annular dilatation is an extremely uncommon cause of congenital mitral regurgitation. We report a case of a 5-year-old child with idiopathic isolated annular dilatation causing severe congenital mitral regurgitation. PMID:23129915

Malik, Lalitaditya; Gupta, Anubhav; Nath, Ranjit Kumar; Grover, Vijay; Gupta, Vijay Kumar

2012-01-01

392

Piezoelectric valve  

DOEpatents

A motorized valve has a housing having an inlet and an outlet to be connected to a pipeline, a saddle connected with the housing, a turn plug having a rod, the turn plug cooperating with the saddle, and a drive for turning the valve body and formed as a piezoelectric drive, the piezoelectric drive including a piezoelectric generator of radially directed standing acoustic waves, which is connected with the housing and is connectable with a pulse current source, and a rotor operatively connected with the piezoelectric generator and kinematically connected with the rod of the turn plug so as to turn the turn plug when the rotor is actuated by the piezoelectric generator.

Petrenko, Serhiy Fedorovich

2013-01-15

393

Percutaneous balloon mitral valvulotomy and coexisting left atrial hemangioma: case report and long-term follow-up.  

PubMed

Hemangiomas of the heart are extremely rare. The prognosis is quite variable, because this benign tumor may grow, involute, or stop growing; therefore, resection is usually the treatment of choice. In patients with tumors of the left atrium, percutaneous balloon mitral valvulotomy is generally contraindicated. Yet for patients with moderate-to-severe mitral valve stenosis, balloon valvulotomy is an established therapy. Herein, we present the case of a 73-year-old woman who was referred to our department in 1995 with severe mitral valve stenosis. Echocardiography showed a valve orifice area of 0.9 cm2, according to Gorlin's formula, and a mean pressure gradient of 11 mmHg. Surgical therapy was declined by the patient. There were no signs of coronary artery disease. The injection of contrast medium into the left coronary artery showed a hemangioma at the posterior wall of the left atrium. Magnetic resonance imaging and transesophageal echocardiography confirmed the diagnosis. Despite the incr