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Sample records for mitral valve calcification

  1. Modified Surgical Intervention for Extensive Mitral Valve Endocarditis and Posterior Mitral Annular Calcification

    PubMed Central

    Kim, Gwan Sic; Beom, Min Sun; Kim, Sung Ryong; Kim, Na Rae; Jang, Ji Wook; Jang, Mi Hee; Ryu, Sang Wan

    2016-01-01

    The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification. PMID:26889447

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

    PubMed

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

    2014-12-01

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

  3. Sapien XT Transcatheter Mitral Valve Replacement Under Direct Vision in the Setting of Significant Mitral Annular Calcification.

    PubMed

    Murashita, Takashi; Suri, Rakesh M; Daly, Richard C

    2016-03-01

    Mitral valve replacement carries a high risk in patients with extensive mitral annular calcification. We report the case of a 71-year-old woman with severely calcified mitral valve stenosis and extensive annular calcification. We approached the mitral valve through a left atriotomy using cardiopulmonary bypass and cardiac arrest. We successfully deployed a 29-mm Sapien XT valve under direct visualization with satisfactory positioning. We further balloon-expanded the device to diminish the likelihood of periprosthetic regurgitation. Open mitral valve replacement with a transcatheter valve can be performed without the need for decalcification of the mitral annulus and is a good alternative to conventional mitral valve replacement. PMID:26897200

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

    PubMed Central

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

    2013-01-01

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

  5. Mitral Annulus Calcification.

    PubMed

    Abramowitz, Yigal; Jilaihawi, Hasan; Chakravarty, Tarun; Mack, Michael J; Makkar, Raj R

    2015-10-27

    Mitral annulus calcification (MAC) is a chronic, degenerative process in the fibrous base of the mitral valve. Although MAC was initially thought to be an age-related degenerative process, there is accumulating evidence that other mechanisms, such as atherosclerosis and abnormal calcium-phosphorus metabolism, also contribute to the development of MAC. Despite its frequency, the clinical relevance of MAC is grossly underappreciated. Indeed, MAC is associated with an increased incidence of cardiovascular disease, mitral valve disease, arrhythmias, and mortality. MAC also influences the outcomes of cardiac surgery and interventions, and its clinical relevance may well increase substantially in the forthcoming era of transcatheter mitral valve replacement. In this paper, we review the available published data to provide a consistent, clinically relevant description of MAC on the basis of contemporary imaging. We describe the pathophysiological mechanisms contributing to the formation of MAC and the clinical implications of this disease entity. PMID:26493666

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

    PubMed

    Takami, Yoshiyuki; Tajima, Kazuyoshi

    2016-02-01

    Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010. Before AVR, CT scans were performed to identify MAC, whose severity was graded on a scale of 0-4, with grade 0 denoting no MAC and grade 4 indicating severe MAC. Echocardiography was performed before AVR and at follow-up over 2years after AVR. MAC was identified in 56 patients with grade 1 (30%), 2 (39%), 3 (18%), and 4 (13%), respectively. Patients with MAC presented older age (728 versus 6611years), higher rate of dialysis-dependent renal failure (43 versus 4%), and less frequency of bicuspid aortic valve (9 versus 36%), when compared to those without MAC. No significant differences were seen in short- and mid-term mortality after AVR between the groups. In patients with MAC, progression of neither mitral regurgitation nor stenosis was observed at follow-up of 5323months for 102 survivors, although the transmitral flow velocities were higher than in those without MAC. In conclusion, MAC represented 53% of the patients undergoing isolated AVR for AVS, usually appeared in dialysis-dependent elder patients with tricuspid AVS. MAC does not affect adversely upon the survival, without progression of mitral valve disease, at least within 2years after AVR. PMID:25252778

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

    PubMed

    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

    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

  8. Native Mitral Stenosis Treated With Transcatheter Mitral Valve Replacement.

    PubMed

    Jain, Renuka; Algahim, Mohamed F; Bajwa, Tanvir K; Khandheria, Bijoy K; O'Hair, Daniel P

    2016-03-01

    Surgical treatment of mitral stenosis with extreme calcification remains a challenge. Recently, the balloon-expandable valve prosthesis, anchored by radial force, offers a new option for these patients. We present 2 cases of transcatheter mitral valve replacement in patients with severe native mitral valve stenosis and annular calcification deemed too extensive for conventional surgical techniques. PMID:26897235

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

    PubMed Central

    Jernimo, Teresa; Fragoso, Andr; Silva, Claudia; Guilherme, Patrcia; Santos, Nlio; Fasca, Marlia; Neves, Pedro

    2015-01-01

    Background. Mitral valve calcification and intima media thickness (IMT) are common complications of chronic kidney disease (CKD) implicated with high cardiovascular mortality. Objective. To investigate the implication of magnesium and fibroblast growth factor-23 (FGF-23) levels with mitral valve calcification and IMT in CKD diabetic patients. Methods. Observational, prospective study involving 150 diabetic patients with mild to moderate CKD, divided according to Wilkins Score. Carotid-echodoppler and transthoracic echocardiography were used to assess calcification. Statistical tests used to establish comparisons between groups, to identify risk factors, and to establish cut-off points for prediction of mitral valve calcification. Results. FGF-23 values continually increased with higher values for both IMT and calcification whereas the opposite trend was observed for magnesium. FGF-23 and magnesium were found to independently predict mitral valve calcification and IMT (P < 0.05). Using Kaplan-Meier analysis, the number of deaths was higher in patients with lower magnesium levels and poorer Wilkins score. The mean cut-off value for FGF-23 was 117?RU/mL and for magnesium 1.7?mg/dL. Conclusions. Hypomagnesemia and high FGF-23 levels are independent predictors of mitral valve calcification and IMT and are risk factors for cardiovascular mortality in this population. They might be used as diagnostic/therapeutic targets in order to better manage the high cardiovascular risk in CKD patients. PMID:26089881

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

    PubMed

    Silva, Ana Paula; Gundlach, Kristina; Bchel, Janine; Jernimo, Teresa; Fragoso, Andr; Silva, Claudia; Guilherme, Patrcia; Santos, Nlio; Fasca, Marlia; Neves, Pedro

    2015-01-01

    Background. Mitral valve calcification and intima media thickness (IMT) are common complications of chronic kidney disease (CKD) implicated with high cardiovascular mortality. Objective. To investigate the implication of magnesium and fibroblast growth factor-23 (FGF-23) levels with mitral valve calcification and IMT in CKD diabetic patients. Methods. Observational, prospective study involving 150 diabetic patients with mild to moderate CKD, divided according to Wilkins Score. Carotid-echodoppler and transthoracic echocardiography were used to assess calcification. Statistical tests used to establish comparisons between groups, to identify risk factors, and to establish cut-off points for prediction of mitral valve calcification. Results. FGF-23 values continually increased with higher values for both IMT and calcification whereas the opposite trend was observed for magnesium. FGF-23 and magnesium were found to independently predict mitral valve calcification and IMT (P < 0.05). Using Kaplan-Meier analysis, the number of deaths was higher in patients with lower magnesium levels and poorer Wilkins score. The mean cut-off value for FGF-23 was 117?RU/mL and for magnesium 1.7?mg/dL. Conclusions. Hypomagnesemia and high FGF-23 levels are independent predictors of mitral valve calcification and IMT and are risk factors for cardiovascular mortality in this population. They might be used as diagnostic/therapeutic targets in order to better manage the high cardiovascular risk in CKD patients. PMID:26089881

  11. Mitral Valve Prolapse

    MedlinePLUS

    ... mitral Some kids and many grown-ups have something called mitral valve prolapse (say: MY-trul VALV PRO-laps). For most people, it's a heart problem that isn't much to worry about. What Is the Mitral Valve? The mitral valve ...

  12. Mitral valve surgery - open

    MedlinePLUS

    Mitral valve replacement - open; Mitral valve repair - open; Mitral valvuloplasty ... your heart function. You are having open-heart surgery for another reason and your doctor may want to replace or repair your mitral valve at the same time. Your heart valve has ...

  13. Mitral Valve Prolapse

    MedlinePLUS

    ... People with an abnormal mitral valve may need mitral valve repair or replacement if: • Symptoms are getting worse • The ... Loved One? Order AHA Brochures Your Heart Valve Surgery Your Mitral Valve Prolapse Innocent Heart Murmurs If Your Child Has ...

  14. Caseous calcification of the mitral annulus

    PubMed Central

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

    2013-01-01

    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

  15. The effects of decellularization and cross-linking techniques on the fatigue life and calcification of mitral valve chordae tendineae.

    PubMed

    Gunning, Gillian M; Murphy, Bruce P

    2016-04-01

    In cases of severely diseased mitral valves (MV), the required treatment is often valve replacement. Bioprosthetic and stentless replacement valves are usually either fully or partially composed of animal derived tissue treated with a decellularization process, a cross-linking process, or both. In this study, we analysed the effects of these treatments on the fatigue properties of porcine MV chordae tendineae (CT), as well as on the calcification of the CT using an in vitro technique. CT were tested in 4 groups; (1) native, (2) decellularized (DC), (3) decellularized and cross-linked with glutaraldehyde (DC-GTH), and (4) decellularized and cross-linked with 1-ehtyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)(DC-EDC). CT were tested in both uniaxial tension, and in fatigue at 10MPa peak stress (1Hz). The cycles to failure (mean±SD) for the four groups are as follows; Native- 53,397±55,798, DC- 28,013±30,634, DC-GTH- 97,665±133,556, DC-EDC- 318,601±322,358. DC-EDC CT were found to have a slightly longer fatigue life than the native and DC groups. The DC-EDC group also had a marginally lower dynamic creep rate, meaning those CT elongate more slowly. After in vitro calcification, X-ray microtomography was used to determine relative levels of calcification. The DC-EDC and DC-GTH groups had the lowest volume of calcific deposits. Under uniaxial testing, the ultimate tensile strength (UTS) of the DC-GTH CT was statistically significantly reduced after calcification, while the UTS was relatively unchanged for the DC-EDC group. Overall, these results indicate that a treatment of decellularization plus cross-linking with EDC may improve the fatigue life of porcine CT, reduce the rate of elongation, and help the CT resist the negative effects of calcification. This may be a preferable treatment in the preparation of porcine MVs for the replacement of diseased MVs. PMID:26875146

  16. Mitral Valve Repair

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Mitral Valve Replacement Aortic Valve Mitral Valve Repair Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

  17. Surgical Management of Caseous Calcification of the Mitral Annulus.

    PubMed

    Wehman, Brody; Dawood, Murtaza; Ghoreishi, Mehrdad; Cheema, Faisal; Jones, Jace W; Kane, Maureen A; Ward, Christopher W; Gammie, James S

    2015-06-01

    Caseous calcification of the mitral annulus is a rare variant of mitral annular calcification where liquefaction and caseation result in formation of a mass at the border of the calcified annulus. Limited reports of operative therapy for caseous calcification of the mitral annulus describe wide excision and gross dbridement of the mass, a technique that can cause perioperative stroke. We present a strategy of limited incision and drainage of the liquid material, closure of the incision, and subsequent suture obliteration of the cavity and mitral valve repair or replacement. In our experience, this technique is safe and has not been associated with perioperative stroke. PMID:26046892

  18. [Modern mitral valve surgery].

    PubMed

    Bothe, W; Beyersdorf, F

    2016-04-01

    At the beginning of the 20th century, Cutler and Levine performed the first successful surgical treatment of a stenotic mitral valve, which was the only treatable heart valve defect at that time. Mitral valve surgery has evolved significantly since then. The introduction of the heart-lung machine in 1954 not only reduced the surgical risk, but also allowed the treatment of different mitral valve pathologies. Nowadays, mitral valve insufficiency has become the most common underlying pathomechanism of mitral valve disease and can be classified into primary and secondary mitral insufficiency. Primary mitral valve insufficiency is mainly caused by alterations of the valve (leaflets and primary order chords) itself, whereas left ventricular dilatation leading to papillary muscle displacement and leaflet tethering via second order chords is the main underlying pathomechanism for secondary mitral valve regurgitation. Valve reconstruction using the "loop technique" plus annuloplasty is the surgical strategy of choice and normalizes life expectancy in patients with primary mitral regurgitation. In patients with secondary mitral regurgitation, implanting an annuloplasty is not superior to valve replacement and results in high rates of valve re-insufficiency (up to 30 % after 3 months) due to ongoing ventricular dilatation. In order to improve repair results in these patients, we add a novel subvalvular technique (ring-noose-string) to the annuloplasty that aims to prevent ongoing ventricular remodeling and re-insufficiency. In modern mitral surgery, a right lateral thoracotomy is the approach of choice with excellent repair and cosmetic results. PMID:26907868

  19. Mitral Valve Disease

    MedlinePLUS

    ... need to be replaced in the future. Like mitral valve repair, replacement can be done minimally invasively or with traditional open heart surgery. Your medical team will discuss the advantages and ...

  20. Mitral Valve Prolapse

    MedlinePLUS

    ... people to feel tired or short of breath. Mitral regurgitation can usually be treated with medicines, but some people need surgery to repair or replace the defective valve. How is MVP treated? Most of the time, ...

  1. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    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)

  2. Mitral valve prolapse.

    PubMed

    Guy, T Sloane; Hill, Arthur C

    2012-01-01

    Mitral valve prolapse is defined as abnormal bulging of the mitral valve leaflets into the left atrium during ventricular systole. Mitral valve prolapse is a common condition that is a risk factor for mitral regurgitation, congestive heart failure, arrhythmia, and endocarditis. Myxomatous degeneration is the most common cause of mitral prolapse in the United States and Europe, and progression of myxomatous mitral prolapse is the most common cause of mitral regurgitation that requires surgical treatment. Myxomatous degeneration appears to have genetic etiology. The genetics of myxomatous degeneration is complex and not fully worked out; it appears to be heterogeneous with multi-gene, multi-chromosomal autosomal dominance with incomplete penetrance. The molecular disorder of myxomatous degeneration appears to consist of a connective tissue disorder with altered extracellular matrix status and involves the action of matrix metalloproteinase, cysteine endoproteases, and tenomodulin. Treatment of mitral prolapse with regurgitation is complex, and the technological advances that are currently in development will be challenging and controversial. PMID:22248324

  3. Mitral valve repair for ischemic mitral regurgitation

    PubMed Central

    Mohebali, Jahan

    2015-01-01

    Mitral valve repair for ischemic mitral valve regurgitation remains controversial. In moderate mitral regurgitation (MR), controversy exists whether revascularization alone will be adequate to restore native valve geometry or whether intervention on the valve (repair) should be performed concomitantly. When MR is severe, the need for valve intervention is not disputed. Rather, the controversy is whether repair versus replacement should be undertaken. In contrast to degenerative or myxomatous disease that directly affects leaflet integrity and morphology, ischemic FMR results from a distortion and dilation of native ventricular geometry that normally supports normal leaflet coaptation. To address this, the first and most crucial step in successful valve repair is placement of an undersized, complete remodeling annuloplasty ring to restore the annulus to its native geometry. The following article outlines the steps for repair of ischemic mitral regurgitation. PMID:26309832

  4. Mitral Valve Prolapse

    MedlinePLUS

    ... or prevent complications. Very few people will need surgery to repair or replace the mitral valve. MVP puts you at risk for infective endocarditis, a kind of heart infection. To prevent it, doctors used to prescribe ... work or certain surgeries. Now, only people at high risk of endocarditis ...

  5. Genetic predisposition to calcific aortic stenosis and mitral annular calcification.

    PubMed

    Kutikhin, Anton G; Yuzhalin, Arseniy E; Brusina, Elena B; Ponasenko, Anastasia V; Golovkin, Alexey S; Barbarash, Olga L

    2014-09-01

    Valvular calcification precedes the development of valvular stenosis and may represent an important early phenotype for valvular heart disease. It is known that development of valvular calcification is likely to occur among members of a family. However, the knowledge about the role of genomic predictive markers in valvular calcification is still elusive. Aims of this review are to assess the impact of gene polymorphisms on risk and severity of aortic stenosis and mitral annular calcification. According to the results of the investigations carried out, all polymorphisms may be divided into the three groups conferring the level of evidence of their association with valvular stenosis. It is possible to conclude that apoB (XbaI, rs1042031, and rs6725189), ACE (rs4340), IL10 (rs1800896 and rs1800872), and LPA (rs10455872) gene polymorphisms may be associated with valvular calcific stenosis with a relatively high level of evidence. A number of other polymorphisms, such as PvuII polymorphism within the OR? gene, rs1042636 polymorphism within the CaSR gene, rs3024491, rs3021094, rs1554286, and rs3024498 polymorphisms within the IL10 gene, rs662 polymorphism within the PON1 gene, rs2276288 polymorphism within the MYO7A gene, rs5194 polymorphism within the AGTR1 gene, rs2071307 polymorphism within the ELN gene, rs17659543 and rs13415097 polymorphisms within the IL1F9 gene may correlate with a risk of calcific valve stenosis with moderate level of evidence. Finally, rs1544410 polymorphism within the VDR gene, E2 and E4 alleles within the apoE gene, rs6254 polymorphism within the PTH gene, and rs1800871 polymorphism within the IL10 gene may be associated with aortic stenosis with low level of evidence. PMID:24903972

  6. Life-saving PTMC for critical calcific mitral stenosis in cardiogenic shock with balloon impasse.

    PubMed

    Dugal, J S; Jetley, V; Sabharwal, J S; Sofat, S; Singh, Charanjit

    2003-01-01

    A 32-year-old male patient, a case of critical calcific mitral stenosis (following closed mitral valvotomy in 1989) was admitted for mitral valve replacement in September 2001. In hospital, he developed cardiogenic shock, pulmonary oedema and oliguria precluding surgery. An emergency percutaneous transatrial balloon mitral commissurotomy as a life-saving procedure in a valve with unfavourable morphology and 'balloon impasse' is discussed. PMID:12959736

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

    ClinicalTrials.gov

    2016-03-09

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

  8. Lipomatous hamartoma of mitral valve.

    PubMed

    Bhat, Seetharama Ps; Gowda Sl, Girish; Chikkatur, Raghavendra; Nanjappa, Manjunath C

    2016-01-01

    Primary cardiac tumors are very rare, and tumors arising from cardiac valves are extremely rare. We present a case of lipomatous hamartoma of the mitral valve in a young female. This is the 6th case of lipomatous hamartoma of the mitral valve to be reported. We discuss the operative and histopathological findings. PMID:24821963

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

    PubMed Central

    Sadee, A S; Becker, A E

    1991-01-01

    To investigate the mechanism that increases the orifice area of the mitral valve during balloon dilatation 43 surgically excised intact rheumatic mitral valves were studied. The main pathological features were (a) fibrosis of mitral valve leaflets and commissures (10 valves); (b) fibrosis with calcification of one commissure (eight anterolateral, seven posteromedial); (c) fibrosis with calcification of both commissures (seven valves); and (d) predominant involvement of the subvalvar apparatus (11 valves). The valves were assessed by photography and radiography before and after balloon dilatation (balloons up to 38 mm (bifoil 2 x 19 mm) and pressures up to 4 atmospheres). The valve was dilated in stages under direct visual control by balloons of increasing diameter. Splitting of the fused commissures was the most common mode of widening the orifice. However, the mitral valve leaflets were torn in two fibrotic valves and in six valves with extensive involvement of the subvalvar apparatus. In the fibrotic valves (group (a] the tear originated near the valve perimeter, at the thinnest part of the remaining valve leaflet. In the valves with subvalvar involvement splitting started at the apex of spaces between the fused chordal columns and proceeded upward. Where there is extensive involvement of the subvalvar apparatus in rheumatic mitral valve disease the risk of tearing of the valve leaflets by balloon dilatation is increased and this is likely to predispose to the development of acute valvar insufficiency. Images PMID:2039673

  10. Mitral Valve Prolapse (For Parents)

    MedlinePLUS

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

  11. Mechanics of the mitral valve

    PubMed Central

    Rausch, Manuel K.; Famaey, Nele; Shultz, Tyler OBrien; Bothe, Wolfgang; Miller, D. Craig

    2013-01-01

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

  12. Finite Element Modeling of Mitral Valve Repair.

    PubMed

    Morgan, Ashley E; Pantoja, Joe Luis; Weinsaft, Jonathan; Grossi, Eugene; Guccione, Julius M; Ge, Liang; Ratcliffe, Mark

    2016-02-01

    The mitral valve is a complex structure regulating forward flow of blood between the left atrium and left ventricle (LV). Multiple disease processes can affect its proper function, and when these diseases cause severe mitral regurgitation (MR), optimal treatment is repair of the native valve. The mitral valve (MV) is a dynamic structure with multiple components that have complex interactions. Computational modeling through finite element (FE) analysis is a valuable tool to delineate the biomechanical properties of the mitral valve and understand its diseases and their repairs. In this review, we present an overview of relevant mitral valve diseases, and describe the evolution of FE models of surgical valve repair techniques. PMID:26632260

  13. Superior septal approach for mitral valve surgery.

    PubMed

    Garcia-Villarreal, Ovidio A

    2016-02-01

    Superior septal approach is a very useful technique to address the mitral valve surgery. Since this approach virtually divides the left atrium in two parts between the ascending aorta and the superior vena cava, mitral valve exposure becomes quite easy. We present a case of mitral valve repair by means of this approach. PMID:26534911

  14. Current challenges in interventional mitral valve treatment

    PubMed Central

    Candreva, Alessandro; Pozzoli, Alberto; Guidotti, Andrea; Gaemperli, Oliver; Nietlispach, Fabian; Barthelmes, Jens; Emmert, Maximilian Y.; Weber, Alberto; Benussi, Stefano; Alfieri, Ottavio; Maisano, Francesco

    2015-01-01

    Transcatheter mitral valve therapies have emerged as an alternative option in high surgical risk or inoperable patients with severe and symptomatic mitral regurgitation (MR). As multiple technologies and different approaches will become available in the field of mitral valve interventions, different challenges are emerging, both patient- (clinical challenges) and procedure-related (technical challenges). This review will briefly explore the current open challenges in the evolving fields of interventional mitral valve treatment. PMID:26543599

  15. Mitral valve disease--current management and future challenges.

    PubMed

    Nishimura, Rick A; Vahanian, Alec; Eleid, Mackram F; Mack, Michael J

    2016-03-26

    The field of mitral valve disease diagnosis and management is rapidly changing. New understanding of disease pathology and progression, with improvements in and increased use of sophisticated imaging modalities, have led to early diagnosis and complex treatment. In primary mitral regurgitation, surgical repair is the standard of care. Treatment of asymptomatic patients with severe mitral regurgitation in valve reference centres, in which successful repair is more than 95% and surgical mortality is less than 1%, should be the expectation for the next 5 years. Transcatheter mitral valve repair with a MitraClip device is also producing good outcomes in patients with primary mitral regurgitation who are at high surgical risk. Findings from clinical trials of MitraClip versus surgery in patients of intermediate surgical risk are expected to be initiated in the next few years. In patients with secondary mitral regurgitation, mainly a disease of the left ventricle, the vision for the next 5 years is not nearly as clear. Outcomes from ongoing clinical trials will greatly inform this field. Use of transcatheter techniques, both repair and replacement, is expected to substantially expand. Mitral annular calcification is an increasing problem in elderly people, causing both mitral stenosis and regurgitation which are difficult to treat. There is anecdotal experience with use of transcatheter valves by either a catheter-based approach or as a hybrid technique with open surgery, which is being studied in early feasibility trials. PMID:27025438

  16. [Cardiac valves calcifications in dialysis patients].

    PubMed

    Klari?, Dragan; Klari?, Vera; Kristi?, Ivica

    2011-10-01

    Chronic kidney disease (CKD) patients, especially those with end-stage renal disease (ESRD), are at much higher risk of cardiovascular disease (CVD) than the general population. High serum phosphorus (P) level play important role in pathogenesis of cardiovascular calcifications and is a frequent and important cardiovascular risk factor in patients with CKD. We aimed to investigate the association of serum levels of C-reactive protein (CRP), parathyroid hormon (PTH). calcium phosphorus product (CaxP) with cardiac valves calcifications (VC) in patients on hemodialysis (HD). We investigated for VC using colour Doppler echocardiography. VC were considered present if mitral annular calcifications and/or aortic annular calcifications were visualized. We divided patients in two groups. VC negative group (VC-) were patients with absence of VC. Patients with presence of VC were VC positive (VC+). CRP mean levels in two samples were higher in VC+ group than in VC- group (17.0 vs 3.4mg/L) and (17.1 vs 4.0 mg/L) p<0.0001. CaxP mean level in both samples was higher in VC+ group than in VC- group, 4.8 vs 4.2 (p=0.0219) and 5.0 vs 4.3 (p=0.0078). We also made analysis of absolute highest levels of three samples of CRP (CRPmax) between groups. CRPmax was higher in VC+ group than in VC- group, 19.5 vs 9.7 mg/L, (p=0.0045). We made analysis of absolute higher levels of two samples of Ca x P (CaxPmax) between groups. CaxPmax was higher in VC+ group than in VC- group, 5.2 vs 4.4 (p=0.0014). We found cardiac valve calcifications in 40 percent of patients on hemodialysis. We found that patients with correlation between PTH level, CRP level, CaxP product and cardiac valve calcifications have higher serum levels of PTH and CRP. We also found that CaxP product is higher in patients with cardiac valve calcifications. We didn't find correlation between age, dialysis duration, BMI and cardiac valve calcifications. These findings support careful monitoring of calcium metabolisum in end stage renal disease to reduce valvular cacifications and the risk of cardiovascular disease. PMID:23120808

  17. Mitral Valve Prolapse

    MedlinePLUS

    ... may not close tightly. These flaps normally help seal or open the valve. Much of the time, ... and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the ...

  18. Mitral Valve Replacement

    MedlinePLUS

    ... Disease Diseases of the arteries, valves, and aorta, as well as cardiac rhythm disturbances Aortic Valve Disease Coronary Artery ... abnormalities that are present at birth in children, as well as in adults Atrial Septal Defect Ventricular ...

  19. In vivo identification of mitral valve fibrosis and calcium by real-time quantitative ultrasonic analysis.

    PubMed

    Lattanzi, F; Picano, E; Landini, L; Mazzarisi, A; Pelosi, G; Benassi, A; Salvatore, L; Distante, A; L'Abbate, A

    1990-02-01

    Conventional echocardiography provides fundamental information about mitral valve morphology and function but has a relatively low specificity in evaluating valve calcific deposits, which is critical information for the preoperative decision to perform commisurotomy or replacement. In vitro radiofrequency ultrasonic quantitative analysis of the mitral valve has been demonstrated to be a reliable tool in identifying normal, fibrotic and calcific valves. This study evaluates quantitative ultrasound characterization of the mitral valve in vivo. Thirty-three patients, scheduled to undergo mitral valve replacement, and 20 normal subjects (10 young and 10 older control subjects) were studied with a 2.25-MHz transducer. Radiofrequency signal was analyzed by a microprocessor system (used with an M-mode commercially available echocardiograph) for on-line evaluation of ultrasonic backscatter with 8 bits of amplitude resolution, 40-MHz sampling rate and a 1-microsecond acquisition gate. The integrated value of the rectified radiofrequency signal amplitude was deemed the integrated backscatter index. The highest value recorded with the ultrasonic analysis from each valve was taken as representative and expressed as the percent value with respect to the pericardial integrated backscatter index value of that subject. The 33 excised mitral valves underwent histologic examination. Four groups were identified: young controls (group I, n = 10); older controls age-matched with patients (group II, n = 10); patients with fibrotic mitral valves (group III, n = 13); and patients with calcific mitral valves (group IV, n = 20).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2301264

  20. Bioprosthetic mitral valve dysfunction due to native valve preserving procedure.

    PubMed

    Matsuno, Yukihiro; Mori, Yoshio; Umeda, Yukio; Takiya, Hiroshi

    2016-03-01

    Mitral valve replacement with preservation of the mitral leaflets and subvalvular apparatus is considered to maintain left ventricular geometry and function and reduce the risk of myocardial rupture. However, the routine use of this technique may lead to early complications such as left ventricular outflow tract obstruction and even mitral inflow obstruction, requiring reoperation. We describe a rare case of bioprosthetic mitral valve dysfunction caused by a native valve preserving procedure. PMID:25392048

  1. Recent developments in percutaneous mitral valve treatment.

    PubMed

    La Canna, Giovanni; Denti, Paolo; Buzzatti, Nicola; Alfieri, Ottavio

    2016-02-01

    In recent years, various percutaneous techniques have been introduced for the treatment of mitral regurgitation (MR), including direct leaflet repair, annuloplasty and left ventricular remodeling. Percutaneous mitral repair targets both primary degenerative and secondary mitral valve regurgitation and may be considered in selected high-surgical-risk patients. The assessment of mitral functional anatomy by echocardiography and computed tomography is crucial when selecting the appropriate repair strategy, according to the regurgitant valve lesion and the surrounding anatomy. The ongoing clinical use of new devices in annuloplasty and percutaneous mitral valve replacement is a promising new scenario in the treatment of MR that goes beyond the conventional surgical approach. PMID:26560529

  2. Alternative approaches for mitral valve repair

    PubMed Central

    Goldstone, Andrew B.

    2015-01-01

    Unique situations arise in which alternative exposures for mitral valve surgery offer distinct advantages over traditional approaches. Each exposure facilitates both mitral valve repair and replacement, although the standard repair procedures must be modified to accommodate these non-traditional exposures. Here, we detail the technical considerations required to perform transventricular and transaortic mitral valve repair as well as discuss the advantages for employing these less conventional approaches. PMID:26539353

  3. Mitral valve disease—morphology and mechanisms

    PubMed Central

    Levine, Robert A.; Hagége, Albert A.; Judge, Daniel P.; Padala, Muralidhar; Dal-Bianco, Jacob P.; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T.; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H.; Clusel, Catherine; Delling, Francesca N.; Dietz, Harry C.; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D.; Jensen, Morten O.; Jeunemaitre, Xavier P.; Le Marec, Hervé; Le Tourneau, Thierry; Markwald, Roger R.; Mérot, Jean; Messas, Emmanuel; Milan, David P.; Neri, Tui; Norris, Russell A.; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucéat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A.; Song, Jae-Kwan; Yacoub, Magdi H.

    2016-01-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but—even in adult life—remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular–ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease. PMID:26483167

  4. Mitral valve disease-morphology and mechanisms.

    PubMed

    Levine, Robert A; Hagge, Albert A; Judge, Daniel P; Padala, Muralidhar; Dal-Bianco, Jacob P; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H; Clusel, Catherine; Delling, Francesca N; Dietz, Harry C; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D; Jensen, Morten O; Jeunemaitre, Xavier P; Marec, Herv Le; Tourneau, Thierry Le; Markwald, Roger R; Mrot, Jean; Messas, Emmanuel; Milan, David P; Neri, Tui; Norris, Russell A; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A; Song, Jae-Kwan; Yacoub, Magdi H

    2015-12-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but-even in adult life-remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular-ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease. PMID:26483167

  5. Prosthetic valve thrombosis in a patient with mitral valve replacement.

    PubMed

    Bilal, Muhammad; Khan, Muhammad Shahzeb; Haseeb, Abdul; Khan, Abdul Bari

    2015-07-01

    Prosthetic valve thrombosis within one year after mitral valve replacement is rarely seen in patients on warfarin therapy and without any risk factor. Here, we describe a case of a 39-year- old female, who presented with dyspnoea and shortness of breath 11 months after mitral valve replacement. The echocardiogram revealed severe valvular stenosis due to presence of clots on the mitral valve and restricted motion of the mitral leaflets. As a result of deterioration of general condition and haemodynamic un-stability, plan was made to re-operate for her valve replacement surgery. This case report highlights the diagnosis, prevention and management of patients with prosthetic valve thrombosis following mitral valve replacement. PMID:26160099

  6. Multiple angiomatous mitral valve cysts leading to floppy mitral valve syndrome.

    PubMed

    Gltekin, Nazmi; Kkate?, Emine; Ersanli, Murat; Kansiz, Erhan

    2008-06-01

    We report an extremely rare case of cystic-tumor like formations that originated from the mitral valve tissue affected by verrucous endocarditis, leading to floppy mitral valve syndrome. These cystic tumoral formations were discovered during two-dimensional echocardiographic examination of a 46 year-old woman with cardiac symptoms of palpitation, dyspnea, and exertional angina pectoris. Multiple cysts were attached to the anterior mitral leaflet, resulting in pansystolic pseudoparachute-like floppy mitral valve prolapse, and severe mitral regurgitation. The patient underwent prosthetic mitral valve replacement following removal of the mitral valve and multiple cystic-tumoral formations. She had an uneventful postoperative course. Histological diagnosis was diffuse angiomatous cystic development of vasculatory tumor-like structures due to verrucous endocarditis. PMID:18765969

  7. Quantitative mitral valve anatomy and pathology.

    PubMed

    Garbi, Madalina; Monaghan, Mark J

    2015-09-01

    Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications. PMID:26693344

  8. Quantitative mitral valve anatomy and pathology

    PubMed Central

    Monaghan, Mark J

    2015-01-01

    Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications.

  9. Recurrent stuck mitral valve: eosinophilia an unusual pathology.

    PubMed

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

    2015-03-01

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

  10. Severe bioprosthetic mitral valve stenosis in pregnancy.

    PubMed

    Munoz-Mendoza, Jerson; Pinto Miranda, Veronica; Tanawuttiwat, Tanyanan; Badiye, Amit; Chaparro, Sandra V

    2016-01-01

    A 21-year-old woman in the 16th week of pregnancy was admitted due to acute presentation of severe exertional dyspnea. She had undergone mitral valve replacement (MVR) with bioprosthetic valve for infective endocarditis 2years ago. She developed congestive heart failure from mitral bioprosthetic valve stenosis due to early structural valve deterioration. She also had severe pulmonary hypertension and underwent a redo MVR using a mechanical valve prosthesis with good maternal outcome but fetal demise. This report brings up the debate about what type of valve should be used in women in reproductive age, and discusses the management of severe mitral stenosis and stenosis of a bioprosthetic valve during pregnancy. Surgical options can almost always be delayed until fetal maturity is achieved and a simultaneous cesarean section can be performed. However, under certain circumstances when the maternal welfare is in jeopardy the surgical intervention is mandatory even before the fetus reaches viability. PMID:24374988

  11. Valvuloplasty of a stenosed mitral valve bioprothesis.

    PubMed

    Bekeredjian, Raffi; Katus, Hugo A; Rottbauer, Wolfgang

    2010-06-01

    An 86-year-old female patient was admitted to our hospital with a stenosed biological mitral valve prothesis (orifice area 0.75 cm(2)). Additional cardiac surgery was refused by the patient and her physician. Therefore, balloon valvuloplasty of the mitral valve bioprothesis was planned. Valvulopasty was successfully and safely performed using a standard mitral valve valvuloplasty protocol. Positioning of the Inoue-balloon was facilitated using a wire that was inserted into the left ventricle and simultaneous transthoracic echocardiography. The Inoue balloon was inflated twice (26 mm). After valvuloplasty, echocardiography was repeated, showing a reduction in mean pressure gradient (5 mmHg) and increased orifice area (1.2 cm(2)) without relevant mitral valve regurgitation. PMID:20516519

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

    PubMed Central

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

    1976-01-01

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

  13. Late Calcific Mitral Stenosis After MitraClip Procedure in a Dialysis-Dependent Patient

    PubMed Central

    Pope, Nicolas H.; Lim, Scott; Ailawadi, Gorav

    2016-01-01

    The EVEREST II trial investigated the MitraClip (Abbott Vascular, Menlo Park, CA) in patients with severe mitral regurgitation (MR) undergoing surgical procedures. Although mitral stenosis was not reported in this cohort, this trial excluded patients receiving dialysis. We report a case of a 43-year-old HIV-positive, dialysis-dependent patient with nonischemic cardiomyopathy and severe MR, who was considered at high operative risk because of frailty. She was treated with a MitraClip as part of the REALISM high-risk registry. Her symptomatic MR improved but severe symptomatic mitral stenosis developed 28 months after the MitraClip procedure. At that point, she was felt to be a better operative candidate but required open mitral valve replacement. Pathologic examination demonstrated significant calcification of the leaflets around the MitraClip devices. PMID:23608290

  14. Marfan syndrome and mitral valve prolapse

    PubMed Central

    Weyman, Arthur E.; Scherrer-Crosbie, Marielle

    2004-01-01

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

  15. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

    PubMed Central

    2015-01-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process. PMID:26539345

  16. Acute Renal Infarction Secondary to Calcific Embolus from Mitral Annular Calcification

    SciTech Connect

    Bande, Dinesh; Abbara, Suhny; Kalva, Sanjeeva P.

    2011-06-15

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

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

    PubMed

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

    2014-10-01

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

  18. Mitral valve surgery - minimally invasive

    MedlinePLUS

    ... 19782846 . Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet . 2009;374:1271-83. Epub 2009 Sep 9. ... Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet . 2009;373:1382-94. PMID: 19356795 www.ncbi. ...

  19. Calcifications in benfluorex-induced valve heart disease: a misknown association.

    PubMed

    Plurien, Franois; Bruneval, Patrick; Jobic, Yannick; Iung, Bernard; Ennezat, Pierre-Vladimir

    2015-01-01

    Benfluorex, an anorexigenic agent, is recognized to induce noncalcified restrictive valvular regurgitation. We report a well-documented case of a 73-year-old patient who developed heart failure with aortic and mitral regurgitation following benfluorex intake. Echocardiography and peroperative analysis found large mitral annular calcifications and aortic subvalvular calcifications. Pathology confirmed drug-induced valve heart disease (DIVHD). The presence of valvular apparatus calcification should not lead to diagnosis of degenerative valvular disease and a priori preclude the diagnosis of DIVHD. PMID:25614032

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

    PubMed Central

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

    1994-01-01

    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

  1. In vitro identification of different degrees of mitral valve disease by online evaluation of radiofrequency ultrasound signal.

    PubMed

    Lattanzi, F; Picano, E; Mazzarisi, A; Aratari, C; Pelosi, G; Pozzolini, A; Salvatore, L; Landini, L; Distante, A; L'Abbate, A

    1987-11-01

    Sixty five mitral valves were studied in vitro with a 2.25 MHz transducer. Radiofrequency signals were analysed by a microprocessor system (implemented on an M-mode commercially available echocardiography) for online evaluation of ultrasonic backscatter (8 bits of amplitude resolution, 40 MHz sampling rate, 1 microsecond acquisition gate). The integrated value of the rectified signal amplitude was expressed as the integrated backscatter index (in db). The highest value recorded with ultrasonic scanning of each sample was taken as representative of that specimen. Calcification of mitral valves was assessed by radiography (24 mitral valves). Non-calcified mitral calves underwent pathological examination, and fibrotic valves (22 mitral valves) were differentiated from normal valves (19 mitral valves). A statistically significant (p less than 0.005) difference was recorded among the three groups for the index maximal value: calcific -7.4(3.1) db (mean(SD)), fibrotic -18.9(4.9) db, and normal -37.9(7.6) db. In conclusion, a microprocessor based system for online evaluation of radiofrequency ultrasonic signals, which may also be feasible for in vivo studies, provided a clear differentiation in vitro of calcific, fibrotic, and normal mitral valves. PMID:3286003

  2. Mitral valve replacement with the Biocor stentless mitral valve: early results.

    PubMed

    Morea, M; De Paulis, R; Galloni, M; Gastaldi, L; di Summa, M

    1994-09-01

    Chordal preservation during mitral valve replacement is thought to greatly preserve left ventricular function. Recently a stentless mitral valve (Biocor) became available for clinical use. It is a porcine mitral valve with the entire chordal apparatus, the sewing ring being reinforced by a bovine pericardial ring and the chordae being sutured together onto two pericardial patches. During a six months period, seven patients undergoing mitral valve replacement for mitral insufficiency (four cases), mitral stenosis (two cases) or mixed lesions (one case) received a stentless mitral valve. Their mean age was 66.3 +/- 4.8. The valve was implanted by suturing the pericardial patches onto the papillary muscles and the sewing ring onto the mitral annulus. Echocardiography control immediately after surgery showed good valve function. Three valves failed after a period of seven days, seven and 12 months respectively. The valve lesions were similar and consistent with an excessive tension on the chordae and on the valvular tissue. There were tears along the posterior annulus and at the level of the commissures, often accompanied by chordal rupture. Histology and scanning electron microscopy showed good integration of the prosthesis with the patients own tissues. There were areas of overgrowing tissue without endothelial cells especially in the area of papillary muscle -pericardial patch interaction. The remaining four patients continue to do well after a mean follow up of two years. The apparent excessive tension on the valve tissues leading to the premature failure of the prosthesis could be due to the variability in the distance between mitral annulus and papillary muscles.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8000580

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

    PubMed

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

    2016-01-01

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

  4. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

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

  5. Evolution of the concept and practice of mitral valve repair.

    PubMed

    Cohn, Lawrence H; Tchantchaleishvili, Vakhtang; Rajab, Taufiek K

    2015-07-01

    The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women's Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, cardiologists and cardiac anesthesiologists has resulted in excellent outcomes. In spite of this, the etiology of mitral valve pathology ultimately determines the outcome of mitral valve repair. PMID:26309840

  6. Minimally invasive transaortic mitral valve repair during aortic valve replacement.

    PubMed

    Santana, Orlando; Lamelas, Joseph

    2011-01-01

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

  7. Nanobacteria-associated calcific aortic valve stenosis.

    PubMed

    Jelic, Tomislav M; Chang, Ho-Huang; Roque, Rod; Malas, Amer M; Warren, Stafford G; Sommer, Andrei P

    2007-01-01

    Calcific aortic valve stenosis is the most common valvular disease in developed countries, and the major reason for operative valve replacement. In the US, the current annual cost of this surgery is approximately 1 billion dollars. Despite increasing morbidity and mortality, little is known of the cellular basis of the calcifications, which occur in high-perfusion zones of the heart. The case is presented of a patient with calcific aortic valve stenosis and colonies of progressively mineralized nanobacteria in the fibrocalcific nodules of the aortic cusps, as revealed by transmission electron microscopy. Consistent with their outstanding bioadhesivity, nanobacteria might serve as causative agents in the development of calcific aortic valve stenosis. PMID:17315391

  8. Mitral valve plasty for a hammock mitral valve in an adult patient.

    PubMed

    Ito, Toshiaki; Tokoro, Masayoshi; Yanagisawa, Jyunji

    2015-09-01

    A 50-year old woman presented with arterial thrombosis in the right leg. Echocardiography revealed a mobile left atrial thrombus and severe mitral stenosis. She underwent a left atrial thrombectomy, the maze procedure and mitral valve plasty. Anterior and posterior mitral leaflets arose directly from the anterior papillary muscle, and from the posterior papillary muscle intervened by short chordae. This suggested a hammock mitral valve. A posterior papillary muscle division and commissurotomy were performed. The anterior leaflet was divided off the anterior papillary muscle, then extended by a triangular-shaped autologous pericardial patch and apically reattached. The postoperative mean pressure gradient of the mitral valve was 2.2 mmHg, and there was no regurgitation. The patient was in NYHA Class 1 and in sinus rhythm, 14 months after the operation. PMID:26034223

  9. Mitral Valve Prolapse in Young Patients.

    ERIC Educational Resources Information Center

    McFaul, Richard C.

    1987-01-01

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

  10. Material Properties of Aged Human Mitral Valve Leaflets

    PubMed Central

    Pham, Thuy; Sun, Wei

    2014-01-01

    Objective To characterize the mechanical properties of aged human anterior (AML) and posterior (PML) mitral leaflets. Materials and Methods The AML and PML samples from explanted human hearts (n = 21, mean age of 82.62 ± 8.77 years old) were subjected to planar biaxial mechanical tests. The material stiffness, extensibility and degree of anisotropy of the leaflet samples were quantified. The microstructure of the samples was assessed through histology. Results Both the AML and PML samples exhibited a nonlinear and anisotropic behavior with the circumferential direction being stiffer than the radial direction. The AML samples were significantly stiffer than the PML samples in both directions, suggesting that they should be modeled with separate sets of material properties in computational studies. Histological analysis indicated the changes in the tissue elastic constituents, including the fragmented and disorganized elastin network, the presence of fibrosis and proteoglycan/glycosaminoglycan infiltration and calcification, suggesting possible valvular degenerative characteristics in the aged human leaflet samples. Overall, stiffness increased and areal strain decreased with calcification severity. In addition, leaflet tissues from hypertensive individuals also exhibited a higher stiffness and low areal strain than normotensive individuals. Conclusion There are significant differences in the mechanical properties of the two human mitral valve leaflets from this advanced age group. The morphologic changes in the tissue composition and structure also infer the structural and functional difference between aged human valves and those of animals. PMID:24039052

  11. Papillary fibroelastoma of the mitral valve 12 years after mitral valve commissurotomy.

    PubMed

    Cesena, F H; Pereira, A N; Dallan, L A; Aiello, V D; Mansur, A J

    1999-10-01

    A 63 year-old woman who had had mitral valve commissurotomy 12 years earlier was seen because of rheumatic mitral stenosis and left brachial paresis due to cerebral embolism. On clinical evaluation, a diastolic rumble was heard over the mitral area, and the echocardiogram revealed a mass attached to the mitral subvalvular apparatus. The patient was operated on, and both the surgical and histologic findings depicted papillary fibroelastoma. This tumor may occur as an isolated lesion or be associated with mitral valve stenosis or other cardiac abnormalities, and it is an important source of emboli. Early echocardiographic diagnosis, followed by surgical excision, may avoid serious complications such as stroke, myocardial infarction, and sudden death. PMID:10548180

  12. Mitral valve repair over five decades

    PubMed Central

    2015-01-01

    It has become evident that mitral valve (MV) repair is the preferable treatment for the majority of patients presenting with severe mitral regurgitation (MR). This success clearly testifies that the surgical procedure is accessible, reproducible and is carrying excellent long-lasting results. From the pre-extracorporeal circulation’s era to the last percutaneous approaches, a large variety of techniques have been proposed to address the different features of MV diseases. This article aimed at reviewing chronologically the development of these dedicated techniques through their origins and the debates that they generated in the literature. PMID:26309841

  13. Left Atrial Wall Dissection after Mitral Valve Replacement

    PubMed Central

    Kim, Kyung Woo; Park, Se Hyeok; Lee, Sang-Il; Kim, Ji Yeon; Kim, Kyung-Tae; Choe, Won Joo; Park, Jang Su; Kim, Jung Won

    2013-01-01

    Left atrial dissection does occur, though rarely, after mitral valve surgery. A 68-year-old Korean female presented with moderate mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation. She was scheduled for mitral valve replacement and tricuspid annuloplasty. We experienced a left atrial dissection after weaning from cardiopulmonary bypass and decided not to repair it. The patient recovered uneventfully. We suggest that a specific type of left atrial dissection can be treated conservatively. PMID:24198922

  14. [Left Ventricular Rupture following Mitral Valve Replacement].

    PubMed

    Yamaguchi, Atsushi

    2015-07-01

    Left ventricular rupture is a rare but lethal complication after mitral valve replacement (MVR). Between 1989 and 2014, of 850 patients who underwent MVR, 6 developed left ventricular rupture in Saitama Medical Center, Jichi Medical University. Treasure type I rupture occurred in 5 patients and Miller type III in 1. Four cases developed ventricular rupture right after declamping of the ascending aorta, and the remaining 2 after the transfer to the intensive care unit( ICU). Prompt surgical therapy was achieved for the instant closure of the muscular wall defect under the cardiopulmonary bypass and cardiac arrest, however, leading to the disappointing result of 66.7% of hospital death. It is the most important to relieving the stress of the posterior wall of the left ventricle during mitral surgery by using the modification techniques with the preservation of posterior mitral leaflet and avoiding pre and afterload of the left ventricle right after the MVR. PMID:26197900

  15. Mitral valve-in-valve with the lotus mechanically expanding platform.

    PubMed

    Feldman, Ted; Reardon, Michael J

    2015-12-01

    Disadvantages of existing balloon expandable or self-expanding transcatheter platforms for mitral valve-in-valve include the potential for malposition during deployment and for LV outflow tract obstruction Controlled mechanical valve expansion, the option to reposition, and stable hemodynamics throughout the procedure make the LOTUS valve an attractive option for mitral valve-in-valve Correct sizing remains a critical aspect of all trancatheter valve implant procedures, including valve-in-valve implants. PMID:26582326

  16. Robotically assisted minimally invasive mitral valve surgery

    PubMed Central

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

    2013-01-01

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

  17. Evolution of the concept and practice of mitral valve repair

    PubMed Central

    Tchantchaleishvili, Vakhtang; Rajab, Taufiek K.

    2015-01-01

    The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, cardiologists and cardiac anesthesiologists has resulted in excellent outcomes. In spite of this, the etiology of mitral valve pathology ultimately determines the outcome of mitral valve repair. PMID:26309840

  18. Normal joint mobility in mitral valve prolapse

    PubMed Central

    Marks, J. S.; Sharp, J.; Brear, S. G.; Edwards, J. D.

    1983-01-01

    Thirty-seven adults (19 male, 18 female) with mitral valve prolapse (MVP) were examined for evidence of joint hypermobility scored on a 0-9 scale. None of the patients had hypermobility scores exceeding 3, and comparison with 37 healthy age and sex matched controls recruited from hospital staff failed to show an increased prevalence of hypermobility in MVP. There was no evidence that the MVP syndrome is a forme fruste of a heritable disorder of connective tissue. PMID:6830324

  19. Echocardiographic restenosis after successful balloon dilatation of the mitral valve with the Inoue balloon: experience of a United Kingdom centre.

    PubMed Central

    Thomas, M R; Monaghan, M J; Michalis, L K; Jewitt, D E

    1993-01-01

    OBJECTIVES--(a) To assess the echocardiographic incidence of restenosis after successful balloon dilatation of the mitral valve at a mid-term follow up of one year among a population of predominantly United Kingdom patients. (b) To identify any factors, assessed before or during dilatation, which may predict the development of restenosis. DESIGN--Successful dilatation of the mitral valve was defined as an increase in mitral valve area of > 25% and a final valve area of at least 1.5 cm2. Echocardiographic restenosis was defined at follow up as a loss of 50% of initial gain and a valve area of less than 1.5 cm2. Mitral valve area was assessed by transthoracic echocardiography before, during, 48 hours after, and one year after successful balloon dilatation of the mitral valve. Echo score before dilatation (an assessment of valvar and subvalvar calcification, thickening, and mobility), age, rhythm, echocardiographic mitral valve area before and after dilatation, left atrial pressure before and after dilatation, and end diastolic mitral valve gradient before and after dilatation were compared in those patients with and without echocardiographic restenosis at one year. SETTING--A regional cardiothoracic centre in the United Kingdom that performs 20-30 balloon dilatations of mitral valves each year. PATIENTS--39 patients, with symptomatic dominant mitral stenosis, who had undergone successful balloon dilatation of the mitral valve, and in whom echocardiographic assessment of mitral valve area was available at one year. 92% of patients were citizens of the United Kingdom. INTERVENTIONS--Balloon dilatation of the mitral valve by the Inoue technique. MAIN OUTCOME MEASURES--Mitral valve area and patient symptom class (New York Heart Association) one year after successful dilatation of the mitral valve. RESULTS--The incidence of echocardiographic restenosis was eight of 39 patients (21%). Of the eight patients with restenosis four underwent mitral valve replacement, two had repeat dilatation of the mitral valve, and two remained on medical treatment. With univariant analysis, factors associated with restenosis were increased age, higher echo score before dilatation, and a lower mitral valve area immediately after the operation. The only independent risk factor for restenosis, shown by multivariant analysis, was a high echo score before dilatation. There was no significant fall in mitral valve area at one year in those patients without restenosis. Most (28/31) of these patients had echocardiographic evidence of splitting of at least one commissure after dilatation compared with only two of eight patients who developed restenosis. Of 10 patients with an echo score before dilatation > or = 10 only two had an initially successful operation and no restenosis at one year. CONCLUSIONS--The echocardiographic incidence of restenosis after dilatation of the mitral valve by the Inoue technique in patients of the United Kingdom is 21%. The principal factor associated with restenosis is a high echo score before dilatation. Increases in mitral valve area are maintained in those patients without restenosis and it is likely that the mechanism of initial increase in valve area is different in the two groups, being commissural splitting in those patients who do not get restenosis and valve stretching in those that do. In patients with an echo score > or = 10 dilatation of the mitral valve should be considered only as a palliative procedure. PMID:8518065

  20. Effect of the mitral valve on diastolic flow patterns

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  1. Effect of the mitral valve on diastolic flow patterns

    SciTech Connect

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

    2014-12-15

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

  2. Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement.

    PubMed

    Zarrini, Parham; Elboudwarej, Omeed; Luthringer, Daniel; Siegel, Robert

    2015-09-01

    Mycotic aneurysms can be a rare, but serious complication of infectious endocarditis. We report the case of a 20-year-old woman who presented with fever and malaise from streptococcal bacteremia and found to have vegetation on the anterior leaflet of the mitral valve. On follow-up visit, the patient was noted to have a mycotic aneurysm of the anterior mitral valve without aortic involvement. Her clinical course was complicated by mitral valve chordal rupture, severe mitral regurgitation, and dyspnea from severe mitral regurgitation for which she underwent successful surgical repair of the mitral valve. PMID:25881967

  3. Transaortic Repair as Bailout Procedure for Left Atrial Tear in Redo Mitral Valve Surgery via Superior Transseptal Approach.

    PubMed

    Ohira, Suguru; Doi, Kiyoshi; Yamazaki, Sachiko; Yaku, Hitoshi

    2016-01-01

    We encountered a tear of the left atrium with severe calcification during redo mitral surgery, and report a technique for its repair. An 82-year-old woman underwent redo mitral valve replacement. The mitral valve was performed via a superior transseptal approach. The atriotomy was closed directly. The roof of the left atrium was found to be torn after aortic de-clamping. There was no remaining intact left atrial tissue on the aortic side. Patch closure was performed using transaortic stitches passing through the subaortic curtain to fix the patch. The left atrial roof and atrial septum were closed with the same patch. PMID:26496880

  4. Senile Calcification of the Trachea, Aortic Arch, and Mitral Annulus: An Incidental Finding on Chest X-Ray.

    PubMed

    Hosseinzadeh Maleki, Mahmood; Kazemi, Toba; Davoody, Navid

    2015-10-27

    A 94-year-old woman presented with dizziness and hypotension of 2 days' duration. She denied any syncope, presyncope, or angina. She had received a permanent pacemaker 12 years previously for the management of complete heart block (CHB), but she failed to program it. Twelve-lead electrocardiography revealed CHB with ventricular escape rhythm (40/min), so we inserted a temporary pacemaker. Anteroposterior chest X-ray showed trachea, aortic arch, and severe mitral valve calcification. Tracheal calcification is usually seen after 40 years old without clinical importance. However, it is seen in patients with renal failure, metastases, and prolonged use of warfarin as well as in pregnancy.(1) (-) (3). PMID:26985213

  5. Tissue-engineered mitral valve chordae tendineae: Biomechanical and biological characterization of decellularized porcine chordae.

    PubMed

    Gong, Wenhui; Li, Sen; Lei, Dong; Huang, Peng; Yuan, Zhize; You, Zhengwei; Ye, Xiaofeng; Zhao, Qiang

    2016-03-01

    Chordae tendineae are essential for maintaining mitral valve function. Chordae replacement is one of the valve repair procedures commonly used to treat mitral valve regurgitation. But current chordae alternatives (polytetrafluoroethylene, ePTFE) do not have the elastic and self-regenerative properties. Moreover, the ePTFE sutures sometimes fail due to degeneration, calcification and rupture. Tissue-engineered chordae tendineae may overcome these problems. The utility of xenogeneic chordae for tissue-engineered chordae tendineae has not yet been adequately explored. In this study, polyelectrolyte multilayers (PEM) film modified decellularized porcine mitral valve chordae (PEM-DPC) were developed to explore tissue-engineered chordae tendineae as neochordae substitutes. Fresh porcine mitral chordae were decellularized and reserved the major elastic fiber and collagen components. Decellularized chordae with a PEM film were produced with chitosan-heparin by a lay-by-lay technique. Mesenchymal stem cells and vascular endothelial cells could grow well on the surface of the PEM-DPC. The superior biomechanical properties of PEM-DPC were proved with good flexibility and strength both in vitro and in vivo. PEM-DPC can be developed for potential alternative mitral valve chordae graft. PMID:26708255

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  7. Cor Triatriatum with Mitral Valve Disease in Adults

    PubMed Central

    Fuster-Siebert, M.; Llorens, R.; Arcas-Meca, R.; Rubio-Alvarez, J.; Prieto-Galn, F.; Garca-Bengochea, J.B.

    1982-01-01

    One 16-year-old boy with cor triatriatum and congenital mitral regurgitation and two women, 35- and 54-years-old, with cor triatriatum and rheumatic mitral stenosis are reported. The regurgitant mitral valve in the boy had three papillary muscles and short chordae tendineae. One of the patients with rheumatic mitral stenosis had a subtotal cor triatriatum with enlargement of the left atrial appendage and without asymmetry in the signs of pulmonary congestion. The mitral regurgitation facilitated the angiographic diagnosis of cor triatriatum. However, neither of the two patients associated with rheumatic mitral stenosis were correctly diagnosed preoperatively. All three patients were operated on with satisfactory results. Images PMID:15226941

  8. Trans-catheter mitral valve implantation for mitral regurgitation: clinical case description and literature review.

    PubMed

    Romeo, Francesco; Cammalleri, Valeria; Ruvolo, Giovanni; Quadri, Arshad; De Vico, Pasquale; Muscoli, Saverio; Marchei, Massimo; Meloni, Sabrina; Conti, Fabio; Ussia, Gian Paolo

    2016-02-01

    Trans-catheter mitral valve implantation (TMVI) is actually the most attractive technique for treating patients with severe mitral regurgitation, who are denied surgical therapy. Recently, trans-catheter implantation of aortic biological prosthesis in mitral position has been done in compassionate cases, and very few experiences of TMVI in native non-calcified valves have been recently reported in very-high-risk patients, mainly with functional mitral regurgitation.Here, we report our case of TMVI using the second-generation CardiAQ prostheisis (CardiAQ Valve Technologies, Irvine, California, USA), reviewing the current state of the art. PMID:26556446

  9. Left ventricular post-infraction pseudoaneurysm mimicking mitral valve endocarditis.

    PubMed

    Dedeilias, Panagiotis; Koukis, Ioannis; Roussakis, Antonios; Tsipas, Pantelis; Rouska, Effie

    2013-01-01

    In this report we present a patient who was initially diagnosed as suffering from mitral valve endocarditis. The proper use of diagnostic modalities revealed a pseudo aneurysm of the left ventricle which was mimicking mitral valve vegetations. This allowed better planning of the subsequent operation. The optimal preoperative diagnostic studies are discussed along with the proper surgical treatment. PMID:24228621

  10. Finite element analysis to model complex mitral valve repair.

    PubMed

    Labrosse, Michel; Mesana, Thierry; Baxter, Ian; Chan, Vincent

    2016-01-01

    Although finite element analysis has been used to model simple mitral repair, it has not been used to model complex repair. A virtual mitral valve model was successful in simulating normal and abnormal valve function. Models were then developed to simulate an edge-to-edge repair and repair employing quadrangular resection. Stress contour plots demonstrated increased stresses along the mitral annulus, corresponding to the annuloplasty. The role of finite element analysis in guiding clinical practice remains undetermined. PMID:24904177

  11. Review of the endovascular approach to mitral valve disease.

    PubMed

    Bergsland, Jacob; Mirtaheri, Peyman; Hiorth, Nikolai; Fosse, Erik

    2015-01-01

    The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be briefly described. PMID:26201541

  12. Lifting posterior mitral annuloplasty for enhancing leaflet coaptation in mitral valve repair: midterm outcomes

    PubMed Central

    Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok; Yang, Hyun Suk

    2015-01-01

    Background We evaluated the midterm outcomes of lifting posterior mitral annuloplasty for enhancing leaflet coaptation in mitral valve repair. Methods Between October 2007 and December 2012, 341 consecutive patients with significant mitral regurgitation underwent lifting posterior mitral annuloplasty using a specially designed fabric annuloplasty strip that lifts the middle portion of the posterior annulus. Associated procedures for mitral valve repairs, such as patch valvuloplasty for posterior leaflet prolapse (n=80), new chord placement for anterior leaflet prolapse (n=33), commissurotomy (n=29), and posterior leaflet extension (n=23), were performed in 141 patients (41.3%). Results Thirty-day mortality was 0.9%. Nine late deaths (2.6%) occurred. Mean overall survival at 5 years was 96.0%1.1%. During the mean follow-up period of 3817 months, six patients (1.8%) underwent valve-related reoperation (5-year freedom from valve-related reoperation, 98.1%0.8%). At 5 years, mean freedom from recurrence of mitral regurgitation grade 3+ to 4+ (moderate to severe) was 95.1%1.6%. The mean valve pressure gradient (PG) was 3.21.5 mmHg across all strip sizes at the time of follow-up. Conclusions Lifting posterior mitral annuloplasty using an innovative annuloplasty strip in mitral valve repair has a low rate of recurrent regurgitation or valve-related reoperation with rare relevant complications. PMID:26309826

  13. Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

    PubMed Central

    2010-01-01

    Background This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement. Methods A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses. Results No statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%). Conclusion Mitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients. PMID:21059216

  14. The transseptal approach for mitral valve replacement revisited.

    PubMed Central

    Santibez Escobar, F; Serrano Gallardo, G; Ramirez Marroquin, S; Lopez Soriano, F; Barragn Garca, R

    1997-01-01

    We describe our experience with the transseptal approach for mitral valve replacement, a technique that we applied especially in cases of 3rd and 4th operations wherein numerous adhesions made the usual left atrial approach difficult. We report 39 cases of mitral procedures in which we used 3 slightly different transseptal approaches, depending on the cardiac anatomy and the preferences of the surgeon. There were no complications associated with any of these approaches. Indeed they made the mitral valve procedure easier, because they enabled full exposure of the mitral valvular and subvalvular apparatus. We also propose the transseptal approach as a very safe and reproducible technique for use in patients with friable tissues, heavily calcified mitral valves, or small left atria- and in patients who must undergo combined tricuspid and mitral procedures. In this series, there were no conduction abnormalities secondary to the approach, nor were there any procedure-related deaths. PMID:9339510

  15. Mitral Valve Clip for Treatment of Mitral Regurgitation: An Evidence-Based Analysis

    PubMed Central

    Ansari, Mohammed T.; Ahmadzai, Nadera; Coyle, Kathryn; Coyle, Doug; Moher, David

    2015-01-01

    Background Many of the 500,000 North American patients with chronic mitral regurgitation may be poor candidates for mitral valve surgery. Objective The objective of this study was to investigate the comparative effectiveness, harms, and cost-effectiveness of percutaneous mitral valve repair using mitral valve clips in candidates at prohibitive risk for surgery. Data Sources We searched articles in MEDLINE, Embase, and the Cochrane Library published from 1994 to February 2014 for evidence of effectiveness and harms; for economic literature we also searched NHS EED and Tufts CEA registry. Grey literature was also searched. Review Methods Primary studies were sought from existing systematic reviews that had employed reliable search and screening methods. Newer studies were sought by searching the period subsequent to the last search date of the review. Two reviewers screened records and assessed study validity. We used the Cochrane risk of bias tool for randomized, generic assessment for non-randomized studies, and the Phillips checklist for economic studies. Results Ten studies including 1 randomized trial were included. The majority of the direct comparative evidence compared the mitral valve clip repair with surgery in patients not particularly at prohibitive surgical risk. Irrespective of degenerative or functional chronic mitral regurgitation etiology, evidence of effectiveness and harms is inconclusive and of very low quality. Very-low-quality evidence indicates that percutaneous mitral valve clip repair may provide a survival advantage, at least during the first 1 to 2 years, particularly in medically managed chronic functional mitral regurgitation. Because of limitations in the design of studies, the cost-effectiveness of mitral valve clips in patients at prohibitive risk for surgery also could not be established. Limitations Because of serious concerns of risk of bias, indirectness, and imprecision, evidence is of very low quality. Conclusions No meaningful conclusions can be drawn about the comparative effectiveness, harms, and cost-effectiveness of mitral valve clips in the population with chronic mitral regurgitation who are at prohibitive risk for surgery. PMID:26379810

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

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

    2014-09-01

    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

  18. Reoperative minimally invasive mitral valve replacement for bovine pericardial valve thrombosis secondary to idiopathic hypereosinophilic syndrome.

    PubMed

    Chu, Michael W A; Adams, Corey; Yared, Kibar; Ball, Warren; Dhingra, Sanjay; Rosenbloom, Andrea

    2011-01-01

    Bioprosthetic mitral valves rarely obstruct. We present an older woman who presented with rapidly progressive dyspnea 4 years after bovine mitral replacement. Investigations demonstrated severe mitral stenosis with large, obstructive masses within the previous mitral prosthesis and an elevated eosinophil count. She underwent urgent reoperative mitral replacement and tricuspid valve repair through a 4-cm right minithoracotomy under hypothermic, fibrillatory arrest. Pathologic analysis revealed eosinophilic infiltrates in the obstructive masses and normal endomyocardial biopsies. She made an uneventful recovery and was discharged on steroids to suppress the eosinophilia. Repeat echocardiography demonstrated a well-functioning porcine valve without leaflet restriction or obstruction. PMID:21664795

  19. Left ventricular pseudoaneurysm after mitral valve replacement: Review of pseudoaneurysms late after mitral valve replacement.

    PubMed

    ?ahan, Ekrem; ?ahan, Suzan; Karamanl?o?lu, Murat; Gl, Murat; Tfekio?lu, Omac

    2015-08-01

    Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is a rare condition but can be life threatening if it develops into perdicardial tamponade. LVPA may develop de novo after the surgical procedure or may be a sequela of an earlier rupture. Clinical presentation includes shortness of breath, heart failure, chest pain, endocarditis, and pericardial tamponade. However, it can also have an asymptomatic course. The recommended treatment for LVPA is surgical repair. Conservative follow-up is an alternative for patients who refuse surgical treatment or are considered high risk for re-operation. We conducted a review of all the available literature on cases of LVPA after mitral valve replacement and present the findings here. PMID:25939434

  20. Transcatheter Aortic and Mitral Valve Implantation (TAMVI) in Native Rheumatic Valves.

    PubMed

    Akujuo, Adanna C; Dellis, Sophia L; Britton, Lewis W; Bennett, Edward V

    2015-11-01

    A 68-year-old female with moderate to severe aortic stenosis and severe mitral stenosis, deemed too high risk for surgery (STS mortality risk?=?12.3%) with a porcelain aorta, was successfully treated with a transcatheter aortic and mitral valve implantation (TAMVI) via a transapical approach. A 23?mm Sapien valve (Edwards Lifesciences, Irvine, CA, USA) was placed in the aortic position and a 29?mm inverted Sapien valve (Edwards Lifesciences) in the mitral position. PMID:26347492

  1. Mass attached to mechanical mitral valve mimicking a thrombus.

    PubMed

    Calvo-Taracido, Manuel; Bustamante, Sergio; Adasme, scar; Kara, Sergio; Merino, Jaime; Pivetta, Rodolfo; Macedo, Matas; Marrero, Roberto; Fernndez, Ricardo; Puccio, Jos Miguel

    2015-12-15

    Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function. This advantage has been demonstrated in functional mitral valve regurgitation as well as mitral valve regurgitation due to rheumatic disease. Regarding complications of this technique, several of them have been reported, papillary muscle rupture being one of them. We describe a clinical case of this weird but possible kind of complication. PMID:26298382

  2. Development of a Severe Mitral Valve Stenosis Secondary to the Treatment of Mitral Regurgitation with a Single MitraClip.

    PubMed

    Osswald, Anja; Al Jabbari, Odeaa; Abu Saleh, Walid K; Barker, Colin; Ruhparwar, Arjang; Karmonik, Christof; Loebe, Matthias

    2016-03-01

    We report a patient with class III heart failure symptoms due to mitral regurgitation (MR) subsequent to nonischemic cardiomyopathy. The patient underwent percutaneous transcatheter mitral valve repair using a single MitraClip, which reduced the MR; however it created mild-to-moderate mitral stenosis, which progressed to severe mitral stenosis. Subsequently the patient underwent mitral valve replacement surgery. doi: 10.1111/jocs.12692 (J Card Surg 2016;31:153-155). PMID:26805917

  3. [Intracardiac mass: Why not a liquefaction necrosis of a mitral annulus calcification?].

    PubMed

    Leddet, P; Couppi, P; De Poli, F; Uhry, S; Hanssen, M

    2015-11-01

    We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication. PMID:26482628

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

    PubMed Central

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

    2014-01-01

    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

  5. Iatrogenic mitral stenosis following transcatheter aortic valve replacement (TAVR)

    PubMed Central

    Harries, Iwan; Chandrasekaran, Badrinathan; Barnes, Edward; Ramcharitar, Steve

    2015-01-01

    A 57 year old female underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Mild iatrogenic mitral stenosis was noted intraoperatively. Attempts to reposition the device were hampered by aortic angulation. One year later, severe mitral stenosis was confirmed on transoesophageal echocardiography. It is important to recognise that iatorgenic mitral stenosis due to TAVR may progress over time. Care should be taken to minimise the risk of this rare complication PMID:25820053

  6. Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation-new devices and emerging outcomes.

    PubMed

    Shamoun, Fadi E; Craner, Ryan C; Seggern, Rita Von; Makar, Gerges; Ramakrishna, Harish

    2015-01-01

    Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education. PMID:26440239

  7. Dissecting intramyocardial hematoma after robotic mitral valve repair.

    PubMed

    McGrath, Tory; Ushukumari, Deepu; Canale, Leonardo; Gillinov, Marc

    2015-03-01

    We report the first case of a dissecting intramyocardial hematoma discovered intraoperatively after robotic mitral valve repair, potential etiologies relevant to robotic surgery, and its successful management. PMID:25742825

  8. Transcatheter mitral valve replacement: design implications, potential pitfalls and outcomes assessment.

    PubMed

    Tang, Gilbert H L; George, Isaac; Hahn, Rebecca T; Bapat, Vinayak; Szeto, Wilson Y; Kodali, Susheel K

    2015-01-01

    Transcatheter mitral valve replacement (TMVR) is an emerging new treatment option in patients with advanced mitral valve disease deemed a high or prohibitive risk for surgery. Designing an ideal TMVR device requires a detailed understanding of different mitral valve pathologies and the complex, dynamic anatomy and physiology of the mitral apparatus. This review aims to critically evaluate design implications in TMVR in the context of mitral valve disease, imaging prerequisites, procedural approaches, potential complications, and outcomes assessment. PMID:26274537

  9. Transcatheter Aortic Valve Replacement in a Patient With a Previous Bioprosthetic Mitral Valve Replacement: Report of a Delayed Fatal Interaction.

    PubMed

    Poulin, Frdric; Lamarche, Yoan; Le, Van Hoai Viet; Doucet, Michel; Romo, Philippe; Gnreux, Philippe

    2016-02-01

    We report on a man with bioprosthetic mitral valve perforation who presented late after transcatheter aortic valve replacement with a balloon-expandable transcatheter heart valve (THV). The protrusion of the commissural strut of the bioprosthetic mitral valve coupled with the low implanted THV resulted in repetitive trauma leading to rupture of a mitral leaflet. Potential preventive strategies are discussed. This case illustrates the importance of preprocedural imaging screening and cautious THV deployment in patients with a bioprosthetic mitral valve. PMID:26319966

  10. Iatrogenic mitral valve chordal rupture during placement of an inflatable and repositionable percutaneous aortic valve prosthesis.

    PubMed

    D'Ancona, Giuseppe; Ince, Hseyin; Ortak, Jasmin; Stoeckicht, Yannik; Kische, Stephan

    2015-03-01

    A case is reported of iatrogenic mitral valve chordal rupture occurring during transcatheter aortic valve implantation (TAVI) with an inflatable and repositionable valve (Direct Flow; Direct Flow Medical, Santa Rosa, CA, USA). The specific implantation technique requires initial valve advancement into the left ventricular cavity, valve inflation within the ventricular cavity, and a final finely tuned valve upward pulling through the left ventricular outflow tract until contact with the aortic annulus is achieved. During this phase of the procedure, entangling with the mitral subvalvular apparatus should be excluded, to avoid inadvertent tissue tearing and consequent mitral valve malfunction. The present patient underwent TAVI but then developed symptomatic severe mitral valve regurgitation resulting from chordal rupture. The condition was successfully treated percutaneously by implanting a Mitra-Clip. PMID:26204679

  11. How to start a minimal access mitral valve program.

    PubMed

    Hunter, Steven

    2013-11-01

    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

  12. Right coronary cusp perforation after mitral valve replacement

    PubMed Central

    Al Yamani, Mohammed I.; Frapier, Jean-Marc; Battistella, Pascal D.; Albat, Bernard

    2013-01-01

    Secondary to leaflet injury, which is a well-known technical mistake, aortic regurgitation can occur during mitral valve replacement or repair. In most cases, the left or the non-coronary cusps are affected. For the first time, we report the case of a patient who had severe aortic regurgitation due to right coronary cusp perforation after mitral valve replacement. This complication was not identified until reoperation. Had transoesophageal echocardiography (TOE) been used during the first procedure, a delayed reoperation could have been avoided. During mitral surgery, every aortic cusp is at risk and peroperative TOE should be a mandatory procedure. PMID:23243033

  13. Mitral Valve Replacement and Limited Myectomy for Hypertrophic Obstructive Cardiomyopathy

    PubMed Central

    Stassano, Paolo; Di Tommaso, Luigi; Triggiani, Donato; Contaldo, Antonio; Gagliardi, Cesare; Spampinato, Nicola

    2004-01-01

    Hypertrophic obstructive cardiomyopathy is a dynamic obstruction of the left ventricular outflow tract caused by septal hypertrophy and systolic anterior motion of the mitral valve. When the condition cannot be controlled by medical therapy, the most frequently used surgical approach is left ventricular myotomy-myectomy. Mitral valve replacement (to correct another mechanism of obstruction) is another surgical option; however, its use for this condition is controversial. We review the long-term results of patients who underwent limited left ventricular myotomy-myectomy and mitral valve replacement at our institution. Eighteen patients who had hypertrophic obstructive cardiomyopathy and severe mitral insufficiency underwent surgery between 1978 and 1983: 7 were men and 11 were women (mean age, 41.8 10.5 years). Preoperatively, most of the patients (78.8%) were in New York Heart Association functional class III or IV. The operation consisted of a shallow myectomy of the hypertrophied septum and mitral valve replacement. One patient died in the hospital (5.5%); 3 patients died later during follow-up. The remaining 14 patients are alive and in good condition (mean follow-up, 21.9 1.7 years). Functional class improved postoperatively in all surviving patients. The mean left ventricular outflow tract gradient fell from 78.1 20.9 mmHg preoperatively to 9.4 5.2 mmHg postoperatively (P < 0.001). At present, surgical treatment of hypertrophic obstructive cardiomyopathy does not include mitral valve replacement. However, our long-term results show that limited ventricular myectomy and mitral valve replacement predictably and consistently lower the left ventricular outflow tract gradient and resolve the mitral valve insufficiency. PMID:15212123

  14. Fibroblast growth factor 23 and parathyroid hormone predict extent of aortic valve calcifications in patients with mild to moderate chronic kidney disease

    PubMed Central

    Di Lullo, Luca; Gorini, Antonio; Bellasi, Antonio; Morrone, Luigi F.; Rivera, Rodolfo; Russo, Luigi; Santoboni, Alberto; Russo, Domenico

    2015-01-01

    Background Cardiac valve calcifications are present in dialysis patients and regarded as dependent on a deranged mineral metabolism. Few data are available for patients with chronic kidney disease (CKD) not on dialysis. This study evaluates the potential association between the extent of cardiac valve calcification and levels of intact parathyroid hormone (i-PTH), phosphorus, calcium, 25-OH vitamin D, fibroblast growth factor 23 (FGF-23), Klotho and C-reactive protein (CRP) simultaneously measured in patients with mild to moderate CKD. Methods Consecutive non-hospitalized patients referring to five nephrology units were evaluated. Inclusion criteria were age >18 years, CKD Stages 34, and the presence of aortic and/or mitral valve calcification assessed by echocardiography as routinely clinical evaluation. Patients underwent clinical examination and routine biochemistry. Baseline i-PTH, phosphorus, calcium, 25-OH vitamin D, FGF-23, Klotho and CRP were simultaneously ascertained. Results Extent of aortic valve calcification (n = 100 patients) was moderate in 68 patients and mild in the remaining patients. Mitral valve calcification (n = 96 patients) score was 1, 2 and 3 in 61, 34 and 1 patients, respectively. In univariate analysis, no association was found between extent of mitral valve calcification and markers of mineral metabolism and CRP; aortic valve extent of calcification was positively associated with i-PTH (r2 = 0.212; P = 0.03) and FGF-23 (r2 = 0.272; P = 0.01), and negatively with Klotho (r2 = ?0.208; P = 0.04). In multivariable analysis, extent of aortic valve calcification was associated with FGF-23 (P = 0.01) and PTH (P = 0.01) levels. Conclusions Extent of aortic valve calcification is associated to FGF-23 and PTH in nave CKD patients with mild to moderate CKD. Further studies should examine whether FGF-23 assay should be included in routine clinical evaluation of CKD as part of cardiovascular risk stratification. PMID:26613033

  15. Gene expression profiling of human calcific aortic valve disease

    PubMed Central

    Rysä, Jaana

    2015-01-01

    Calcific aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening (i.e. aortic sclerosis) to severe calcification of valves (i.e. aortic stenosis). Gene expression profiling analysis of non-calcified controls, sclerotic, and calcified aortic valves was performed to better understand the progression of calcific aortic valve disease. The complementary information related to processing and statistical analysis of the DNA microarray data is provided in this article. Interpretation of this data can be found in a research article entitled “MicroRNA-125b and chemokine CCL4 expression are associated with calcific aortic valve disease” [1]. The microarray data complies with MIAME guidelines and is deposited in the Gene Expression Omnibus (GEO) database under accession number GSE51472.

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

    PubMed Central

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

    2012-01-01

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

  17. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study

    PubMed Central

    Santana, Orlando

    2016-01-01

    Approximately 30% to 50% of patients will develop ischemic mitral regurgitation (MR) after a myocardial infarction, which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus, and portends a poor long-term prognosis. Surgical treatment is centered on mitral valve repair utilizing a restrictive annuloplasty, or valve replacement with preservation of the subvalvular apparatus. In the recent Cardiothoracic Surgical Trials Network (CSTN) study, patients with severe ischemic MR were randomized to mitral valve repair with a restrictive annuloplasty versus chordal-sparing valve replacement, and concomitant coronary artery bypass grafting, if indicated. At 2-year follow-up, mitral valve repair was associated with a significantly higher incidence of moderate or greater recurrent MR and heart failure, with no difference in the indices of left ventricular reverse remodeling, as compared with valve replacement. The current appraisal aims to provide insight into the CSTN trial results, and discusses the evidence supporting a pathophysiologic-guided repair strategy incorporating combined annuloplasty and subvalvular repair techniques to optimize the outcomes of mitral valve repair in ischemic MR. PMID:26904260

  18. Dissection of the atrial wall after mitral valve replacement.

    PubMed Central

    Lukcs, L; Kassai, I; Lengyel, M

    1996-01-01

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

  19. Evaluation of mitral valve replacement anchoring in a phantom

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  20. Open-Heart Surgery for Mitral Valve Disease

    PubMed Central

    Gerein, Alfred N.; Gourlay, Robert H.; Kavanagh-Gray, Doris

    1965-01-01

    The findings in and experiences with 19 consecutive patients subjected to open mitral valve surgery are described. All patients underwent a right-heart catheterization. In order to exclude multivalvular heart disease, a left-heart catheterization was performed in 10 patients and angiographic studies of the aortic valve area in 12. Pulmonary function studies were performed on 11 patients. The FEV (0.75 sec.) and the MMFR were found to correlate well with existing pulmonary reserves. Fourteen of the 19 patients subjected to open mitral valve surgery survived the operation and have been followed up for three months to 2 years. Four patients had a mitral valvuloplasty. Three of these four have deteriorated and will require a valvular replacement. Ten of 15 patients subjected to a mitral valve replacement are alive; five of these 10 have had signs and symptoms indicating peripheral embolization. Mitral valvuloplasty is preferable to a valvular replacement as far as embolic complications are concerned, while valvular replacements result in a more perfect and lasting hemodynamic repair. The high incidence of peripheral embolization following valvular replacements focuses attention on the need for improved mitral valve prostheses. PMID:14346463

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

    PubMed Central

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

    1988-01-01

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

  2. Mutations in DCHS1 cause mitral valve prolapse.

    PubMed

    Durst, Ronen; Sauls, Kimberly; Peal, David S; deVlaming, Annemarieke; Toomer, Katelynn; Leyne, Maire; Salani, Monica; Talkowski, Michael E; Brand, Harrison; Perrocheau, Maëlle; Simpson, Charles; Jett, Christopher; Stone, Matthew R; Charles, Florie; Chiang, Colby; Lynch, Stacey N; Bouatia-Naji, Nabila; Delling, Francesca N; Freed, Lisa A; Tribouilloy, Christophe; Le Tourneau, Thierry; LeMarec, Hervé; Fernandez-Friera, Leticia; Solis, Jorge; Trujillano, Daniel; Ossowski, Stephan; Estivill, Xavier; Dina, Christian; Bruneval, Patrick; Chester, Adrian; Schott, Jean-Jacques; Irvine, Kenneth D; Mao, Yaopan; Wessels, Andy; Motiwala, Tahirali; Puceat, Michel; Tsukasaki, Yoshikazu; Menick, Donald R; Kasiganesan, Harinath; Nie, Xingju; Broome, Ann-Marie; Williams, Katherine; Johnson, Amanda; Markwald, Roger R; Jeunemaitre, Xavier; Hagege, Albert; Levine, Robert A; Milan, David J; Norris, Russell A; Slaugenhaupt, Susan A

    2015-09-01

    Mitral valve prolapse (MVP) is a common cardiac valve disease that affects nearly 1 in 40 individuals. It can manifest as mitral regurgitation and is the leading indication for mitral valve surgery. Despite a clear heritable component, the genetic aetiology leading to non-syndromic MVP has remained elusive. Four affected individuals from a large multigenerational family segregating non-syndromic MVP underwent capture sequencing of the linked interval on chromosome 11. We report a missense mutation in the DCHS1 gene, the human homologue of the Drosophila cell polarity gene dachsous (ds), that segregates with MVP in the family. Morpholino knockdown of the zebrafish homologue dachsous1b resulted in a cardiac atrioventricular canal defect that could be rescued by wild-type human DCHS1, but not by DCHS1 messenger RNA with the familial mutation. Further genetic studies identified two additional families in which a second deleterious DCHS1 mutation segregates with MVP. Both DCHS1 mutations reduce protein stability as demonstrated in zebrafish, cultured cells and, notably, in mitral valve interstitial cells (MVICs) obtained during mitral valve repair surgery of a proband. Dchs1(+/-) mice had prolapse of thickened mitral leaflets, which could be traced back to developmental errors in valve morphogenesis. DCHS1 deficiency in MVP patient MVICs, as well as in Dchs1(+/-) mouse MVICs, result in altered migration and cellular patterning, supporting these processes as aetiological underpinnings for the disease. Understanding the role of DCHS1 in mitral valve development and MVP pathogenesis holds potential for therapeutic insights for this very common disease. PMID:26258302

  3. Mutations in DCHS1 Cause Mitral Valve Prolapse

    PubMed Central

    Durst, Ronen; Sauls, Kimberly; Peal, David S; deVlaming, Annemarieke; Toomer, Katelynn; Leyne, Maire; Salani, Monica; Talkowski, Michael E.; Brand, Harrison; Perrocheau, Malle; Simpson, Charles; Jett, Christopher; Stone, Matthew R.; Charles, Florie; Chiang, Colby; Lynch, Stacey N.; Bouatia-Naji, Nabila; Delling, Francesca N.; Freed, Lisa A.; Tribouilloy, Christophe; Le Tourneau, Thierry; LeMarec, Herv; Fernandez-Friera, Leticia; Solis, Jorge; Trujillano, Daniel; Ossowski, Stephan; Estivill, Xavier; Dina, Christian; Bruneval, Patrick; Chester, Adrian; Schott, Jean-Jacques; Irvine, Kenneth D.; Mao, Yaopan; Wessels, Andy; Motiwala, Tahirali; Puceat, Michel; Tsukasaki, Yoshikazu; Menick, Donald R.; Kasiganesan, Harinath; Nie, Xingju; Broome, Ann-Marie; Williams, Katherine; Johnson, Amanda; Markwald, Roger R.; Jeunemaitre, Xavier; Hagege, Albert; Levine, Robert A.; Milan, David J.; Norris, Russell A.; Slaugenhaupt, Susan A.

    2015-01-01

    SUMMARY Mitral valve prolapse (MVP) is a common cardiac valve disease that affects nearly 1 in 40 individuals13. It can manifest as mitral regurgitation and is the leading indication for mitral valve surgery4,5. Despite a clear heritable component, the genetic etiology leading to non-syndromic MVP has remained elusive. Four affected individuals from a large multigenerational family segregating non-syndromic MVP underwent capture sequencing of the linked interval on chromosome 11. We report a missense mutation in the DCHS1 gene, the human homologue of the Drosophila cell polarity gene dachsous (ds) that segregates with MVP in the family. Morpholino knockdown of the zebrafish homolog dachsous1b resulted in a cardiac atrioventricular canal defect that could be rescued by wild-type human DCHS1, but not by DCHS1 mRNA with the familial mutation. Further genetic studies identified two additional families in which a second deleterious DCHS1 mutation segregates with MVP. Both DCHS1 mutations reduce protein stability as demonstrated in zebrafish, cultured cells, and, notably, in mitral valve interstitial cells (MVICs) obtained during mitral valve repair surgery of a proband. Dchs1+/? mice had prolapse of thickened mitral leaflets, which could be traced back to developmental errors in valve morphogenesis. DCHS1 deficiency in MVP patient MVICs as well as in Dchs1+/? mouse MVICs result in altered migration and cellular patterning, supporting these processes as etiological underpinnings for the disease. Understanding the role of DCHS1 in mitral valve development and MVP pathogenesis holds potential for therapeutic insights for this very common disease. PMID:26258302

  4. Cardiogenic shock due to Gemella morbillorum native mitral valve endocarditis.

    PubMed

    Rosa, Regis Goulart; Rosa, Maria Doroti; Ascoli, Aline Maria; Mattioni, Mariana; Barth, Jose Herve; Teixeira, Cassiano

    2015-06-01

    Gemella morbillorum is a rare cause of infective endocarditis. Consequently, little is known about the natural course of endocarditis secondary to this pathogen. Herein, we report a case of cardiogenic shock as a complication of acute mitral valve regurgitation following Gemella morbillorum native valve endocarditis. PMID:26185624

  5. Animal Models of Calcific Aortic Valve Disease

    PubMed Central

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

    2011-01-01

    Calcific aortic valve disease (CAVD), once thought to be a degenerative disease, is now recognized to be an active pathobiological process, with chronic inflammation emerging as a predominant, and possibly driving, factor. However, many details of the pathobiological mechanisms of CAVD remain to be described, and new approaches to treat CAVD need to be identified. Animal models are emerging as vital tools to this end, facilitated by the advent of new models and improved understanding of the utility of existing models. In this paper, we summarize and critically appraise current small and large animal models of CAVD, discuss the utility of animal models for priority CAVD research areas, and provide recommendations for future animal model studies of CAVD. PMID:21826258

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

    PubMed

    Cozzarin, Alberto; Cianciulli, Toms F; Guidoin, Robert; Zhang, Ze; Lax, Jorge A; Saccheri, Mara C; Garca Escudero, Alejandro; Estrada, Jorge E

    2014-09-01

    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

  7. Effects of hydration on mitral valve prolapse.

    PubMed

    Lax, D; Eicher, M; Goldberg, S J

    1993-08-01

    We investigated the effect of hydration on mitral valve prolapse (MVP). Ten subjects with documented diagnosis of MVP were studied before and after oral hydration with 1 L of fluid. Increased weight and cardiac output were present after hydration. Results showed that all 10 subjects with diagnosis of MVP before hydration continued to have MVP after hydration; however, subtle changes were detected, especially on auscultation. Seven of 9 subjects (with cardiac examination recorded before and after hydration) had auscultatory findings of MVP before hydration. No detectable auscultatory change after hydration was present in one subject; in six subjects a loss of either a click or a murmur was detected after hydration. All subjects had echocardiographically detected MVP before hydration; evidence of MVP on two-dimensional or M-mode examination persisted after hydration in all 10 subjects. Minor changes in the echocardiographic examination (M-mode n = 2, Doppler n = 1) were detected in three subjects. Thus we found that hydration of subjects with MVP did not alter the overall diagnosis; however, changes occurred, especially on auscultation. This suggests that alterations in hydration may affect auscultatory expression of MVP and could explain, in part, the variable auscultatory findings in patients with MVP. PMID:8338013

  8. Imaging in Minimally Invasive Mitral Valve Repair.

    PubMed

    Mangold, Stefanie; Castillo-Sang, Mario; Schoepf, U Joseph; Leipsic, Jonathon A; Fuller, Stephen R; Wichmann, Julian L; Muscogiuri, Giuseppe; De Cecco, Carlo N

    2015-11-01

    Minimally invasive mitral valve (MV) repair and replacement techniques have evolved as increasingly used alternatives to open heart surgery especially in patients unsuitable for surgery or at high perioperative risk. The vast majority of these techniques are still under development, and only a limited number of devices are approved for clinical use; however, they do show promising results in terms of minimizing complications and improving clinical outcome. The complex anatomy of the MV and the annulus complicates not only the development of devices for minimally invasive MV repair or replacement but also complicates preprocedural planning, which is mandatory for minimization of postprocedural complications. Although echocardiography still plays a crucial clinical role, cross-sectional imaging modalities such as coronary computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) are increasingly gaining importance for preprocedural planning. Specifically, CCT seems to be more practicable for preinterventional planning and device sizing, whereas CMR has been shown useful in detecting increased risk for adverse clinical outcomes through delayed gadolinium enhancement and the monitoring of cardiac morphology and function in the framework of follow-up examinations. This article describes recent techniques currently available or under development for minimally invasive repair or replacement of the MV and reviews the current state of CCT and CMR imaging for preinterventional and postinterventional diagnostic workup. PMID:26258600

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

    PubMed Central

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

    2010-01-01

    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 4584 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

  10. [Left Ventricular Rupture during Both Mitral and Aortic Valve Replacements].

    PubMed

    Kurumisawa, Soki; Aizawa, Kei; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Ohki, Shinnichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation. PMID:25963782

  11. Mitral valve operations at a high-volume pediatric heart center: Evolving techniques and improved survival with mitral valve repair versus replacement

    PubMed Central

    Baird, Christopher W; Myers, Patrick O; Marx, Gerald; del Nido, Pedro J

    2012-01-01

    Mitral valve disease is quite variable and can occur as an isolated defect or in association with other complex left sided lesions. These lesions are often best described with detailed pre-operative imaging studies to define the valve anatomy and to access associated left heart disease. Depending on the type of mitral valve disease, various surgical repair techniques have led to improved survival in the recent era. We describe lesion specific approach to mitral valve repair and results. PMID:22529595

  12. Senile Calcification of the Trachea, Aortic Arch, and Mitral Annulus: An Incidental Finding on Chest X-Ray

    PubMed Central

    Hosseinzadeh Maleki, Mahmood; Kazemi, Toba; Davoody, Navid

    2015-01-01

    A 94-year-old woman presented with dizziness and hypotension of 2 days’ duration. She denied any syncope, presyncope, or angina. She had received a permanent pacemaker 12 years previously for the management of complete heart block (CHB), but she failed to program it. Twelve-lead electrocardiography revealed CHB with ventricular escape rhythm (40/min), so we inserted a temporary pacemaker. Anteroposterior chest X-ray showed trachea, aortic arch, and severe mitral valve calcification. Tracheal calcification is usually seen after 40 years old without clinical importance. However, it is seen in patients with renal failure, metastases, and prolonged use of warfarin as well as in pregnancy.1-3 PMID:26985213

  13. Genetic association analyses highlight biological pathways underlying mitral valve prolapse.

    PubMed

    Dina, Christian; Bouatia-Naji, Nabila; Tucker, Nathan; Delling, Francesca N; Toomer, Katelynn; Durst, Ronen; Perrocheau, Maelle; Fernandez-Friera, Leticia; Solis, Jorge; Le Tourneau, Thierry; Chen, Ming-Huei; Probst, Vincent; Bosse, Yohan; Pibarot, Philippe; Zelenika, Diana; Lathrop, Mark; Hercberg, Serge; Roussel, Ronan; Benjamin, Emelia J; Bonnet, Fabrice; Lo, Su Hao; Dolmatova, Elena; Simonet, Floriane; Lecointe, Simon; Kyndt, Florence; Redon, Richard; Le Marec, Hervé; Froguel, Philippe; Ellinor, Patrick T; Vasan, Ramachandran S; Bruneval, Patrick; Markwald, Roger R; Norris, Russell A; Milan, David J; Slaugenhaupt, Susan A; Levine, Robert A; Schott, Jean-Jacques; Hagege, Albert A; Jeunemaitre, Xavier

    2015-10-01

    Nonsyndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown etiology that predisposes to mitral regurgitation, heart failure and sudden death. Previous family and pathophysiological studies suggest a complex pattern of inheritance. We performed a meta-analysis of 2 genome-wide association studies in 1,412 MVP cases and 2,439 controls. We identified 6 loci, which we replicated in 1,422 cases and 6,779 controls, and provide functional evidence for candidate genes. We highlight LMCD1 (LIM and cysteine-rich domains 1), which encodes a transcription factor and for which morpholino knockdown of the ortholog in zebrafish resulted in atrioventricular valve regurgitation. A similar zebrafish phenotype was obtained with knockdown of the ortholog of TNS1, which encodes tensin 1, a focal adhesion protein involved in cytoskeleton organization. We also showed expression of tensin 1 during valve morphogenesis and describe enlarged posterior mitral leaflets in Tns1(-/-) mice. This study identifies the first risk loci for MVP and suggests new mechanisms involved in mitral valve regurgitation, the most common indication for mitral valve repair. PMID:26301497

  14. Percutaneous transluminal balloon dilatation of the mitral valve in pregnancy.

    PubMed Central

    Smith, R; Brender, D; McCredie, M

    1989-01-01

    Pregnancy can cause life threatening complications in women with mitral stenosis, and there is a substantial risk of fetal death if valvotomy under cardiopulmonary bypass is required. A patient is described in whom pulmonary oedema developed after delivery of her first child by caesarean section 13 months previously. Subsequent cardiac catheterisation showed severe mitral stenosis (valve area 0.96 cm2, valve gradient 12 mm Hg, pulmonary artery pressure 30/16 mm Hg). Before valvotomy could be performed the patient again became pregnant and presented in pulmonary oedema at twenty two weeks' gestation. Medical treatment was unsuccessful and she underwent percutaneous transluminal balloon dilatation of the mitral valve. This increased the valve area to 1.78 cm2 and reduced the transmitral gradient to 6 mm Hg. The procedure was uncomplicated, and she remained symptom free on no medication. She delivered vaginally at 37 weeks' gestation. Percutaneous transluminal balloon dilatation of the mitral valve is a safe and effective alternative to mitral valvotomy in pregnancy. PMID:2757867

  15. Acute massive mitral regurgitation from prosthetic valve dysfunction.

    PubMed Central

    Cooper, D K; Sturridge, M F

    1976-01-01

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

  16. Neochordameter: A New Technology in Mitral Valve Repair

    PubMed Central

    Alizadeh-Ghavidel, Alireza; Samiei, Niloofar; Javadikasgari, Hoda; Bashirpour, Kamiar

    2013-01-01

    Background: Mitral valve repair has shown superior results compared to mitral valve replacement in patients with mitral valve prolapse. Using premeasured neochordae (the loop technique) has been proposed for both anterior and posterior leaflet repairs. However, there are two major problems that are usually experienced using this method. One is deciding the length of the neo-chordae, and the other is tying the knot at the intended length. Objectives: This study introduced a new technology in mitral valve repair that reduces the complexity of making neo-chordae loops, especially in minimally invasive surgeries. Patients and Methods: Neochordameter is a new device which utilizes preoperative transthoracic echocardiography to determine the exact length of required neochordae and enable surgeons to make neochordae loops before starting the cardiopulmonary bypass. In this study, we applied this technique in mitral valve repair of three patients. Results: Two of these patients were male and the other one was female. All of them had severe mitral regurgitation requiring anterior leaflet repair. Total eight neochordae loops were used in these patients. No change in the length of neochordae was required after saline test and all of these patients had none or trivial mitral regurgitation by intraoperative and follow up transesophageal echocardiography. No complication was seen in six-month follow up. Conclusions: The ability of this technology in developing premeasured neo-chordae loops with accurate sizes and not needing the post-implantation length adjustment which is efficient in reducing the complexity of both minimally invasive and conventional surgeries are the issues which is going to be regarded . PMID:25478522

  17. Transfemoral aortic valve implantation in severe aortic stenosis patients with prior mitral valve prosthesis

    PubMed Central

    Sar?, Cenk; Ba?tu?, Serdal; Kasapkara, Hac? Ahmet; Durmaz, Tahir; Kele?, Telat; Akay, Murat; Aslan, Abdullah Nabi; Bayram, Nihal Akar; Bozkurt, Engin

    2015-01-01

    Introduction Transcatheter aortic valve implantation for severe symptomatic aortic stenosis in patients with a previous mitral valve prosthesis is technically challenging, and pre-procedural comprehensive assessment of these patients before transcatheter aortic valve implantation is vital for an uncomplicated and successful procedure. Aim We want to share our experience with transcatheter aortic valve implantation in patients with a preexisting functional mitral valve prosthesis and describe a series of important technical and pre-procedural details. Material and methods At our center, 135 patients with symptomatic severe aortic stenosis were treated with transcatheter aortic valve implantation. Six of them with a preexisting mitral valve prosthesis received an Edwards SAPIEN XT valve through the transfemoral route. Results Transcatheter aortic valve implantation was performed successfully in all 6 patients without any deformation of the cobalt-chromium/steel stents of the aortic valve bioprosthesis. Also no distortion or malfunction in the mitral valve prosthesis was observed after the procedure. There were no complications during the hospitalization period. Post-procedural echocardiography revealed no or mild aortic paravalvular regurgitation and normal valve function in all the patients. In addition, serial echocardiographic examination demonstrated that both the stability and function of the aortic and mitral prosthetic valves were normal without any deterioration in the gradients and the degree of the regurgitation at long-term follow-ups. Conclusions Our experience confirms that transcatheter aortic valve implantation is technically feasible in patients with previous mitral valve replacement but comprehensive evaluation of patients by multimodal imaging techniques such as transesophageal echocardiography and multislice computed tomography is mandatory for a successful and safe procedure. PMID:26677380

  18. Minimally invasive valve sparing mitral valve repair—the loop technique—how we do it

    PubMed Central

    Jacobs, Stephan

    2013-01-01

    Mitral valve insufficiency is the second most common heart valve disease, with untreated regurgitation leading to enlargement of the left atrium (LA), atrial fibrillation and heart failure. Besides functional regurgitation, the main cause is degenerative valve disease with elongation of the chordae tendineae and prolapsing of the leaflets. Surgical repair is the gold standard therapy for mitral valve insufficiency today. Recently, the implantation of neochordae (the “loop-technique”) has been established and is the preferred technique in many centres including ours. Results of surgical mitral valve repair are good with low rates of re-intervention and mortality. With minimally invasive techniques, patient satisfaction is high and hospital stay is short. In conclusion, mitral valve repair should be the preferred strategy in patients with symptomatic mitral valve insufficiency or with asymptomatic mitral valve insufficiency in accordance with the guidelines. Modern repair techniques like neo-chord implantation with the loop-technique combined with minimally invasive access routes result in low mortality and morbidity and short hospital stay as well as high patient satisfaction. PMID:24349988

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

    PubMed Central

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

    2012-01-01

    Background: Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. Materials and Methods: We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants’ samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. Results: The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8). Conclusion: We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement. PMID:23439740

  20. Subvalvular pannus and thrombosis in a mitral valve prosthesis.

    PubMed

    Kim, Gun Ha; Yang, Dong Hyun; Kang, Joon-Won; Kim, Dae-Hee; Jung, Sung-Ho; Lim, Tae-Hwan

    2016-01-01

    A 69-year-old female underwent cardiac CT to evaluate prosthetic valve (PHV) dysfunction detected on echocardiography. A CT coronal and en face views of the mitral annular plane showed a low-density, mass-like lesion on the left atrial side of the PHV and a high-density, plate-like lesion on the left ventricular side of PHV. A repeat of the mitral valve replacement was performed, and preoperative CT findings of both the thrombus on the left atrial side and pannus formation on the LV side were confirmed in the operative findings. PMID:26452593

  1. Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

    PubMed Central

    Doolub, Gemina

    2015-01-01

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

  2. En bloc aortic and mitral valve replacement and left ventricular outflow tract enlargement using a combined transaortic and trans-septal atrial approach.

    PubMed

    Hassan, Mohammed; Windsor, Jimmy; Ricci, Marco

    2015-12-01

    Aortic and mitral valve replacement with division and reconstruction of the inter-valvular fibrous body has been described in clinical situations involving infective endocarditis, extensive annular calcifications and diminutive valve annuli. Herein, we describe a combined transaortic and trans-septal approach with division of the inter-valvular fibrosa for combined aortic and mitral valve replacement. The reconstruction of the inter-valvular fibrous body, atrial walls and aortic root was carried out using a 'three-patch' technique with bovine pericardium. PMID:26409564

  3. Echocardiography in congenital mitral valve regurgitationthe liaison between cardiologist and surgeon

    PubMed Central

    Vl?daia, A; Ghiorghiu, I; ?erban, M; Popescu, BA; Jurcu?, R

    2009-01-01

    Congenital heart diseases are broadly defined as those cardiac anomalies that are present at birth. By their very nature, such defects have their origin in embryonic development. Congenital mitral valve regurgitation is a rare disease occurring in infancy or childhood. In up to 60% of cases, congenital anomalies of the mitral valve occur in association with other cardiac lesions, and often more than one component of the mitral apparatus is involved. The true incidence of congenital mitral valve regurgitation (MVR) is difficult to determine accurately (0.210.42% from total mitral valve regurgitations); isolated congenital mitral regurgitation is uncommon. The Carpentier classification of congenital mitral valve disease is the most commonly used nomenclature based on a functional analysis of the mitral valve leaflet. The contemporary anatomic classification has the advantage of minimizing observer variability in the diagnosis and it offers a much better liaison between the cardiologist and surgeon. PMID:20108755

  4. Mitral Valve Repair Using ePTFE Sutures for Ruptured Mitral Chordae Tendineae: A Computational Simulation Study

    PubMed Central

    Rim, Yonghoon; Laing, Susan T.; McPherson, David D.; Kim, Hyunggun

    2013-01-01

    Mitral valve repair using expanded polytetrafluoroethylene (ePTFE) sutures is an established and preferred interventional method to resolve the complex pathophysiologic problems associated with chordal rupture. We developed a novel computational evaluation protocol to determine the effect of the artificial sutures on restoring mitral valve function following valve repair. A virtual mitral valve was created using three-dimensional echocardiographic data in a patient with ruptured mitral chordae tendineae. Virtual repairs were designed by adding artificial sutures between the papillary muscles and the posterior leaflet where the native chordae were ruptured. Dynamic finite element simulations were performed to evaluate pre- and post-repair mitral valve function. Abnormal posterior leaflet prolapse and mitral regurgitation was clearly demonstrated in the mitral valve with ruptured chordae. Following virtual repair to reconstruct ruptured chordae, the severity of the posterior leaflet prolapse decreased and stress concentration was markedly reduced both in the leaflet tissue and the intact native chordae. Complete leaflet coaptation was restored when four or six sutures were utilized. Computational simulations provided quantitative information of functional improvement following mitral valve repair. This novel simulation strategy may provide a powerful tool for evaluation and prediction of interventional treatment for ruptured mitral chordae tendineae. PMID:24072489

  5. Rate of repair in minimally invasive mitral valve surgery

    PubMed Central

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

    2013-01-01

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

  6. Beating heart mitral valve repair with integrated ultrasound imaging

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  7. State of the mitral valve in rabbits with hypokinesia

    NASA Technical Reports Server (NTRS)

    Strelkovska, V. Y.

    1979-01-01

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

  8. Surgical phantom for off-pump mitral valve replacement

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  9. Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair

    PubMed Central

    Guedes, Marco Antnio Vieira; Pomerantzeff, Pablo Maria Alberto; Brando, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Tarasoutchi, Flvio; Spinola, Pablo da Cunha; Jatene, Fbio Biscegli

    2015-01-01

    Introduction Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce. Objective To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Methods Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05. Results There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study. Conclusion Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study. PMID:26313723

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

    PubMed Central

    Liao, Jun

    2015-01-01

    There are very compelling reasons to develop a tissue engineered mitral valve, but this endeavor has not received the same attention as tissue engineering strategies for the semilunar valves. Challenges in regenerating a mitral valve include recapitulating the complex heterogeneity in terms of anatomy (differently sized leaflets, numerous chordae), extracellular matrix composition, biomechanical behavior, valvular interstitial cell and endothelial cell phenotypes, and interior vasculature and innervation. It will also be essential to restore the functional relationships between the native mitral valve and left ventricle. A growing amount of information relevant to tissue engineering a mitral valve has been recently collected through investigations of cell mechanobiology and collagen organization. It is hoped that the development of tissue engineered mitral valves can build on knowledge derived from engineering semilunar valves, but the mitral valve will presents its own unique challenges as investigators move towards a first generation prototype. PMID:21221857

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

    PubMed

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

    1989-10-01

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

  12. Percutaneous mitral heart valve repair--MitraClip.

    PubMed

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

    2014-01-01

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

  13. [Necrotising endocarditis of mitral valve due to Staphylococcus lugdunensis].

    PubMed

    Celebi, Gven; Bykate?, Mustafa; Do?an, Sait Mesut; Pi?kin, Nihal; Aydemir, Hande; Oztoprak, Nefise; Akta?, Elif; Bekta?, Sibel; Keskin, Ay?egl; Akduman, Deniz

    2009-04-01

    Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis. PMID:19621620

  14. Coronary Revascularization Alone or with Mitral Valve Repair

    PubMed Central

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

    2009-01-01

    We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr). A total of 83 patients had a reduced left ventricular ejection fraction and moderate mitral regurgitation: 28 patients underwent CABG+MVr, and 55 underwent CABG alone. Changes in mitral regurgitation, functional class, and left ventricular ejection fraction were compared in both groups. The mean follow-up was 5.1 3.6 years (range, 0.115.1 yr). Reduction of 2 mitral-regurgitation grades was found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P < 0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively (P = 0.1), as well as improvements in left ventricular ejection fraction and functional class. One- and 5-year survival rates were similar in the CABG+MVr and CABG-only groups: 96% 3% versus 96% 4%, and 87% 5% versus 81% 8%, respectively (P = NS). Propensity analysis showed similar results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and 47% at late follow-up, respectively. In patients with moderate ischemic mitral regurgitation, either surgical approach led to an improvement in functional class. Early and intermediate-term mortality rates were low with either CABG or CABG+MVr. However, an increased rate of late recurrent mitral regurgitation in the CABG+MVr group was observed. PMID:19876417

  15. Double orifice mitral valve and bicuspid aortic valve: pieces of the same single puzzle?

    PubMed

    ?ayl?k, Faysal; Mutluer, Ferit Onur; Tosu, Ayd?n; Seluk, Murat

    2015-01-01

    Double orifice mitral valve is a very rare congenital abnormality. Well known associations of this pathology with other congenital lesions point to a complex and central pathophysiological mechanism leading to a sequence of pathologies. These associations have long been realized and arbitrarily defined as Shone complex. We would like to present a 21-year-old patient with double orifice mitral valve associated with bicuspid aortic valve, with a brief review of the literature on possible central mechanisms leading to different subsets of congenital abnormalities involving these two. PMID:25949830

  16. Double Orifice Mitral Valve and Bicuspid Aortic Valve: Pieces of the Same Single Puzzle?

    PubMed Central

    ?ayl?k, Faysal; Mutluer, Ferit Onur; Tosu, Ayd?n; Seluk, Murat

    2015-01-01

    Double orifice mitral valve is a very rare congenital abnormality. Well known associations of this pathology with other congenital lesions point to a complex and central pathophysiological mechanism leading to a sequence of pathologies. These associations have long been realized and arbitrarily defined as Shone complex. We would like to present a 21-year-old patient with double orifice mitral valve associated with bicuspid aortic valve, with a brief review of the literature on possible central mechanisms leading to different subsets of congenital abnormalities involving these two. PMID:25949830

  17. Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs.

    PubMed

    Vrs, Kroly; Szilvsi, Viktria; Manczur, Ferenc; Mth, kos; Reiczigel, Jen?; Nolte, Ingo; Hungerbhler, Stephan

    2015-12-01

    Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 2.3 years, which was significantly different from that of dogs without MVI (5.1 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 2.8 kg) and those without MVI (12.8 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature. PMID:26599093

  18. Review of mitral valve insufficiency: repair or replacement

    PubMed Central

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

    2014-01-01

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

  19. [Catheter based mitral valve repair for severe mitral regurgitation: patient selection].

    PubMed

    Naegeli, Barbara; Franzen, Olaf

    2015-09-01

    The catheter-based mitral valve repair is a novel technology for the treatment of severe mitral regurgitation (MR). This technique is suitable for elderly patients with pronounced co-morbidities who are deemed to be high risk for conventional heart surgery. A meaningful reduction of mitral regurgitation leads to improvement of symptoms and quality of life. Studies also demonstrate reverse remodeling of the left ventricle. In heart failure patients with severe MR percutaneous repair reduces re-hospitalization rates>50% in comparison to optimal medical treatment. For degenerative MR conventional surgery is the gold standard, whereas for high surgical risk patients and for severe functional MR percutaneous repair is an alternative. PMID:26331203

  20. Damage to the circumflex coronary artery during mitral valve repair with sliding leaflet technique.

    PubMed

    Tavilla, G; Pacini, D

    1998-12-01

    We report a case of damage to the circumflex coronary artery during mitral valve repair using sliding leaflet technique in a patient with a posterior mitral leaflet prolapse and coronary artery disease who underwent mitral valve reconstruction using Carpentier's technique and coronary artery bypass grafting. This case underscores the risk of circumflex coronary artery injury during mitral valve reconstruction, especially in patients with left coronary dominance or codominance, and therefore emphasizes the importance of knowing the coronary artery anatomy preoperatively. The use of intraoperative transesophageal echocardiography is mandatory for the evaluation of mitral valvuloplasty. PMID:9930500

  1. How Is Mitral Valve Prolapse Treated?

    MedlinePLUS

    ... surgery. If you’ve had valve repair or replacement, you may need antibiotics before dental work and surgery. These procedures can allow bacteria to enter your bloodstream. Antibiotics can help prevent infective endocarditis, a serious heart valve infection. Discuss with your doctor whether you need ...

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

    PubMed Central

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

    2015-01-01

    A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy. PMID:25883896

  3. Left atrial ball valve thrombus in restrictive cardiomyopathy and normal mitral valve: Loose cannon in heart.

    PubMed

    Karim, Fazal; Sharma, Prafull; Bahl, Ajay

    2015-12-01

    Left atrial ball valve thrombus is an unusual condition, especially in patients with normal mitral valve. In the present case, we describe a 61-year-old female with restrictive cardiomyopathy who presented with a large left atrial ball valve thrombus, which subsequently embolized to right carotid artery and was treated with intravenous thrombolysis. This case provides useful insight into the genesis of such thrombi and highlights management dilemmas of a rare clinical problem. PMID:26688155

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

    NASA Astrophysics Data System (ADS)

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

    2012-06-01

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

  5. Robotic tissue tracking for beating heart mitral valve surgery.

    PubMed

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

    2013-12-01

    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

  6. "Adjustable" artificial chordal replacement for repair of mitral valve prolapse.

    PubMed

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

    2006-04-01

    Achieving a stable repair of mitral valve prolapse can be difficult in complex pathologies, and a 5% to 20% late reoperation rate exists with leaflet resection and reconstruction. During an 8-year period, prolapse was managed uniformly with "adjustable" Gortex (W. L. Gore & Associates Inc, Flagstaff, AZ) artificial chordal replacement and Carpentier ring annuloplasty (Edwards Lifesciences LLC, Irvine, CA), without leaflet resection. Artificial chords were placed initially in the papillary muscles, and then after ring annuloplasty they were adjusted to optimize length to the prolapsing segment(s). Of 52 patients with prolapse, 100% were repaired successfully with artificial chords. Operative mortality was 1.9%, and 4, 6, and 8-year survivals were 87%, 81%, and 71%, respectively. Only 1 of 52 patients (1.9%) experienced late failure, and this patient was re-repaired with artificial chords. Thus, "adjustable" artificial chordal replacement facilitates uniform repair of mitral valve prolapse with a low late failure rate. PMID:16564319

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

    PubMed

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

    2013-08-01

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

  8. Fabrication of mitral valve chordae by directed collagen gel shrinkage.

    PubMed

    Shi, Yaling; Vesely, Ivan

    2003-12-01

    The principles of tissue engineering are being used to explore numerous applications in reconstructive surgery. Mitral valve chordae are one such potential area, as mitral valve repair is increasing in popularity and synthetic materials have not been used widely. The use of cells, combined with reconstituted type I collagen, is an attractive option for fabricating materials for the replacement of thin tendonous structures such as mitral valve chordae. We have been using the principle of directed collagen gel shrinkage to fabricate tendinous structures with good mechanical properties. In this study, our objective was to maximize the strength of the collagen constructs by choosing cell type and optimizing cell-seeding density, culture time, and initial collagen concentration. A collagen-cell suspension was cast into silicone rubber wells with microporous anchors at the ends and cultured in an incubator. The anchors allowed shrinkage to occur only transverse to the long axis of the wells, thus creating highly aligned collagenous constructs. Collagen gel contraction increased with higher cell-seeding density. The optimal value was 10(6) cells/mL. The rate of gel contraction decreased with the initial collagen concentration. Fibril density increased with culture time, as the gel contracted. After the system was optimized, the mechanical strength of the constructs increased to 1.1 MPa, a value at least an order of magnitude greater than previously published results with similar systems. This study has demonstrated that collagen-cell constructs, with material properties similar to those of native mitral valve chordae, can be developed using the principle of directed collagen gel shrinkage. These structures may have application in other areas that require small-diameter tendons. PMID:14670111

  9. Maze permutations during minimally invasive mitral valve surgery

    PubMed Central

    2015-01-01

    Surgical ablation for atrial fibrillation is most frequently done in the concomitant setting, and most commonly with mitral valve surgery. Minimally invasive surgical techniques for the treatment of atrial fibrillation have developed contemporaneously with techniques for minimally invasive mitral valve surgery. As in traditional surgery for atrial fibrillation, there are many different permutations of ablations for the less invasive approaches. Lesion sets can vary from simple pulmonary vein isolation (PVI) to full bi-atrial lesions that completely reproduce the traditional cut-and-sew Cox Maze III procedure with variable efficacy in restoring sinus rhythm. Additionally, treatment of the atrial appendage can be done through minimally invasive approaches without any ablation at all in an attempt to mitigate the risk of stroke. Finally, hybrid procedures combining minimally invasive surgery and catheter-based ablation are being developed that might augment surgical treatment of atrial fibrillation at the time of minimally invasive mitral valve repair. These various permutations and their results are reviewed. PMID:26539352

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

    PubMed Central

    Gmez, Ricardo; Verduras, Mara Jos; Lopez-Quintana, Alfonso; Riera, Luis; Zerolo, Ignacio; Martinez-Bordiu, Cristbal

    1981-01-01

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

  11. [Association of anorexia nervosa and mitral valve prolapse].

    PubMed

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

    1986-01-01

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

  12. Caseous Necrosis of Mitral Annulus

    PubMed Central

    Balci, Sinan; Akkaya, Selcuk; Ardali, Selin; Hazirolan, Tuncay

    2015-01-01

    Masses or mass-like lesions located in proximity to mitral valve encompass a wide range of differential diagnoses including neoplasias, abscesses, thrombi, and rarely caseous calcification of mitral annulus. Due to asymptomatic presentation, its diagnosis is usually incidental. Echocardiography is the first choice of imaging in evaluation. Cardiac computed tomography (CT) is helpful in establishing diagnosis by showing dense calcifications while cardiac magnetic resonance imaging (MRI) is used primarily as a problem solving tool. Imaging in evaluation of mitral annulus caseous calcification is essential in order to prevent unnecessary operations. PMID:26355421

  13. Reduced size of liquefaction necrosis of mitral annular calcification in chronic renal failure by using low calcium concentration hemodialysis.

    PubMed

    Koito, H; Nakamura, C; Suzuki, J; Takahashi, H; Iwasaka, T

    1999-06-01

    A report is presented of a liquefaction necrosis of mitral annular calcification in a patient with chronic renal failure and secondary hyperparathyroidism who had been managed by hemodialysis for 11 years. The mass was echogenic with an echo-lucent area inside, high density on computed tomography and low intensity on magnetic resonance imaging. The uptake of gallium-67 (67Ga)-citrate and the bone agent technetium-99m-methylene diphosphate (99mTc-MDP) was seen in the mass. These findings were compatible with liquefaction necrosis of the mitral annular calcification. After treatment with low calcium concentration hemodialysis, the size of the mass reduced with disappearance of the echo-lucent area on the echocardiography and there was no uptake of 67Ga-citrate or 99mTc-MDP. Liquefaction necrosis might be the early and reversible form of mitral annular calcification. When a tumorlike echogenic mass at the base of mitral leaflets is seen in patients with predisposing factors for mitral annular calcification, consider the possibility of this specific form of mitral annular calcification in order to avoid any unnecessary surgical intervention. PMID:10406591

  14. Parachute mitral valve in a young adult with recurrent pulmonary oedema.

    PubMed

    Rybicka, Justyna; Dobrowolski, Piotr; Ku?mierczyk, Mariusz; Rza?ski, Jacek; Kowalski, Miros?aw; Hoffman, Piotr

    2011-06-01

    A parachute mitral valve is a rare congenital malformation resulting from fusion of the mitral chordae tendineae and their attachment to the one prominent papillary muscle. It can be found either as an isolated lesion or, more often, associated with left heart obstructive lesions, patent ductus arteriosus or ventricular septal defect. Congenital mitral stenosis usually presents with severe symptoms in early childhood, otherwise remains stable and hardly ever requires surgical intervention. We present a case of a young adult with severe stenosis of a parachute mitral valve and history of recurrent pulmonary oedema treated by mitral commissurotomy. PMID:21744717

  15. Hemodynamics and Mechanobiology of Aortic Valve Inflammation and Calcification

    PubMed Central

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

    2011-01-01

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

  16. Bacterial endocarditis, mitral regurgitation, and intra-atrial thrombosis following mitral valve replacement

    PubMed Central

    Windsor, Harry M.; Fagan, Paul; Shanahan, Mark X.

    1968-01-01

    Bacterial endocarditis with positive blood culture occurred on six occasions in a series of 140 mitral valve replacements. In three of these, extensive detachment of the prosthesis with severe mitral incompetence resulted. Re-operation was undertaken in two of these cases. Intra-atrial thrombosis occurred twice. In three other cases, in which intra-atrial thrombosis occurred, infection was strongly suspected to have been the responsible factor. Mitral regurgitation presented no difficulty in diagnosis, as all patients had severe congestive cardiac failure and typical physical signs. Confirmation was established by cinangiography. Intra-atrial thrombosis presented difficulty in diagnosis. A persistently positive blood culture, continued pyrexia, and a history of sepsis were the most consistent and significant findings in the cases reported. The antibiotic regime described by Amoury and his colleagues has been used for the past year. There has not been a single case of bacterial endocarditis, intra-atrial thrombosis, or wound infection in 120 consecutive valve replacements on this regime. Because of the high mortality associated with intra-atrial thrombosis, and the close association between endocarditis and thrombosis, the presence of endocarditis with or without regurgitation might well be a compelling reason for re-operation. The mortality from these complications could, we believe, be reduced by the use of a more extensive antibiotic cover and a more vigorous attitude to surgical intervention. We have not had to consider re-operation since adopting the policy outlined, as these complications have not occurred. Images PMID:5637494

  17. Fenfluramine Disrupts the Mitral Valve Interstitial Cell Response to Serotonin

    PubMed Central

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

    2009-01-01

    Serotonin (5HT) receptor signaling and 5HT-related agents, such as the anorexogen fenfluramine (Fen), have been associated with heart valve disease. We investigated the hypothesis that Fen may disrupt mitral valve interstitial cell (MVIC) homeostasis through its effects on mitogenesis and extracellular matrix biosynthesis. Normal and myxomatous mitral valves, both human and canine, were harvested, and primary MVIC cultures were established. 5HT caused increased phosphorylation of extracellular signal-related kinase in MVIC; Fen alone did not. However, Fen combined with 5HT increased the level of MVIC extracellular signal-related kinase, when compared with 5HT alone. In addition, MVIC mitogenesis per 3H-thymidine (3HTdR) demonstrated a 5HT dose-dependent increase, with no effect of Fen alone. In contrast, Fen combined with 5HT inhibited the MVIC 3HTdR response when compared with 5HT alone. Furthermore, fluoxetine, a 5HT transporter inhibitor, while having no effect alone, suppressed Fen-5HT 3HTdR inhibition when administered with Fen plus 5HT. Finally, MVIC incorporations of 3H-proline and 3H-glucosamine, measures of extracellular matrix collagen and glycosaminoglycan respectively, were increased with 5HT alone; however, Fen did not affect MVIC glycosaminoglycan or collagen either alone or in combination with 5HT. Taken together, the ratios of 3H-proline or 3H-glycosaminoglycan to 3HTdR in MVIC, normalized to 5HT alone, demonstrated a significant imbalance of extracellular matrix production versus proliferation in MVIC cultures with Fen plus 5HT exposure. This imbalance may explain in part the pathophysiology of Fen-related mitral valve disease. PMID:19679875

  18. Innate and Adaptive Immunity in Calcific Aortic Valve Disease

    PubMed Central

    Mathieu, Patrick; Bouchareb, Rihab

    2015-01-01

    Calcific aortic valve disease (CAVD) is the most common heart valve disorder. CAVD is a chronic process characterized by a pathologic mineralization of valve leaflets. Ectopic mineralization of the aortic valve involves complex relationships with immunity. Studies have highlighted that both innate and adaptive immunity play a role in the development of CAVD. In this regard, accumulating evidence indicates that fibrocalcific remodelling of the aortic valve is associated with activation of the NF-?B pathway. The expression of TNF-? and IL-6 is increased in human mineralized aortic valves and promotes an osteogenic program as well as the mineralization of valve interstitial cells (VICs), the main cellular component of the aortic valve. Different factors, including oxidized lipid species, activate the innate immune response through the Toll-like receptors. Moreover, VICs express 5-lipoxygenase and therefore produce leukotrienes, which may amplify the inflammatory response in the aortic valve. More recently, studies have emphasized that an adaptive immune response is triggered during CAVD. Herein, we are reviewing the link between the immune response and the development of CAVD and we have tried, whenever possible, to keep a translational approach. PMID:26065007

  19. Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.

    PubMed

    Patel, Hetain; Antoine, Steve M; Funk, Michael; Santana, Orlando

    2011-01-01

    A 79-year-old woman with a history of bioprosthetic aortic and mitral valve replacement with coronary artery bypass graft surgery presented with pulmonary edema 4 years after surgery. Transthoracic echocardiography and transesophageal echocardiography revealed an obstruction of the left ventricular outflow tract caused by the bioprosthetic mitral valve. We present this case, accompanied by a review of the literature. PMID:21546891

  20. Starr-Edwards valves at the aortic and mitral positions implanted for 39 years.

    PubMed

    Misawa, Shun-ichi; Aizawa, Kei; Kaminishi, Yuichiro; Muraoka, Arata; Misawa, Yoshio

    2011-06-01

    Cloth-covered Starr-Edwards caged ball valves implanted in the aortic and mitral valve positions for 39 years were extracted. Both showed valve dysfunction resulting from pannus overgrowth. The metal cages of the Starr-Edwards valves were covered with worn cloth. This case indicates the extended durability of Starr-Edwards valves and the importance of the design and materials of prosthetic heart valves to avoid pannus overgrowth and prosthetic valve abrasion. PMID:21674313

  1. Transcatheter implantation of a CoreValve aortic prosthesis in a patient with a ball-cage mechanical mitral valve.

    PubMed

    Gedikli, Omer; Kutlu, Merih; Civelek, Ali; Ince, Huseyin

    2013-09-01

    Although transcatheter aortic valve implantation (TAVI) has been performed successfully in patients with aortic stenosis and a mechanical mitral valve, to the present authors' knowledge only one report has been made of this being achieved in a patient with a ball-cage-type mechanical mitral valve. In the present case, as the cage section of the mechanical valve was inclined towards the left ventricular outflow tract (LVOT), there was a risk of interaction between the prosthesis and mechanical valve during the TAVI procedure. The successful implementation is described of a self-expandable aortic prosthesis in a patient with a ball-cage-type mechanical valve inclined towards the LVOT. PMID:24383383

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

    PubMed Central

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

    1990-01-01

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

  3. Artificial chordae for degenerative mitral valve disease: critical analysis of current techniques

    PubMed Central

    Ibrahim, Michael; Rao, Christopher; Athanasiou, Thanos

    2012-01-01

    The surgical repair of degenerative mitral valve disease involves a number of technical points of importance. The use of artificial chordae for the repair of degenerative disease has increased as a part of the move from mitral valve replacement to repair of the mitral valve. The use of artificial chordae provides an alternative to the techniques pioneered by Carpentier (including the quadrangular resection, transfer of native chordae and papillary muscle shortening/plasty), which can be more technically difficult. Despite a growth in their uptake and the indications for their use, a number of challenges remain for the use of artificial chordae in mitral valve repair, particularly in the determination of the correct length to ensure optimal leaflet coaptation. Here, we analyse over 40 techniques described for artificial chordae mitral valve repair in the setting of degenerative disease. PMID:22962321

  4. Predicting Acute Kidney Injury Following Mitral Valve Repair

    PubMed Central

    Chang, Chih-Hsiang; Lee, Cheng-Chia; Chen, Shao-Wei; Fan, Pei-Chun; Chen, Yung-Chang; Chang, Su-Wei; Chen, Tien-Hsing; Wu, Victor Chien-Chia; Lin, Pyng-Jing; Tsai, Feng-Chun

    2016-01-01

    Background: Acute kidney injury (AKI) after cardiac surgery is associated with short-term and long-term adverse outcomes. Novel biomarkers have been identified for the early detection of AKI; however, examining these in every patient who undergoes cardiac surgery is prohibitively expensive. Society of Thoracic Surgeons (STS) and Age, Creatinine, and Ejection Fraction (ACEF) scores have been proven to predict mortality in bypass surgery. The aim of this study was to determine whether these scores can be used to predict AKI after mitral valve repair. Materials and Methods: Between January 2010 and December 2013, 196 patients who underwent mitral valve repair were enrolled. The clinical characteristics, outcomes, and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined using the Kidney Disease Improving Global Outcome 2012 clinical practice guidelines for AKI. Results: A total of 76 patients (38.7%) developed postoperative AKI. The STS renal failure (AUROC: 0.797, P < .001) and ACEF scores (AUROC: 0.758, P < .001) are both satisfactory tools for predicting all AKI. The STS renal failure score exhibited superior accuracy compared with the ACEF score in predicting AKI stage 2 and 3. The overall accuracy of both scores was similar for all AKI and AKI stage 2 and 3 when the cut-off points of the STS renal failure and ACEF scores were 2.2 and 1.1, respectively. Conclusion: In conclusion, the STS renal failure score can be used to accurately predict stage 2 and 3 AKI after mitral valve repair. The ACEF score is a simple tool with satisfactory power in screening patients at risk of all AKI stages. Additional studies can aim to determine the clinical implications of combining preoperative risk stratification and novel biomarkers. PMID:26816491

  5. Placement of Neochords in Mitral Valve Repair: Enhanced Exposure of the Papillary Muscles Using a Standard Valve Sizer.

    PubMed

    Erlebach, Magdalena; Lange, Ruediger; Mazzitelli, Domenico

    2016-01-01

    Minimally invasive mitral valve repair with placement of artificial chordae for mitral valve regurgitation has become the standard of care. In some cases, such as Barlow's disease or bileaflet prolapse, papillary muscle exposure may be difficult. By using a valve sizer to retract both leaflets, visualization can be optimized, thus simplifying suture placement and thereby minimizing cross-clamp and cardiopulmonary bypass times. This technique is simple, is cost effective, and can be applied quickly. PMID:26694289

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

    SciTech Connect

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

    2007-08-29

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

  7. Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery

    PubMed Central

    Gillinov, A. Marc; Gelijns, Annetine C.; Parides, Michael K.; DeRose, Joseph J.; Moskowitz, Alan J.; Voisine, Pierre; Ailawadi, Gorav; Bouchard, Denis; Smith, Peter K.; Mack, Michael J.; Acker, Michael A.; Mullen, John C.; Rose, Eric A.; Chang, Helena L.; Puskas, John D.; Couderc, Jean-Philippe; Gardner, Timothy J.; Varghese, Robin; Horvath, Keith A.; Bolling, Steven F.; Michler, Robert E.; Geller, Nancy L.; Ascheim, Deborah D.; Miller, Marissa A.; Bagiella, Emilia; Moquete, Ellen G.; Williams, Paula; Taddei-Peters, Wendy C.; OGara, Patrick T.; Blackstone, Eugene H.; Argenziano, Michael

    2015-01-01

    Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.) PMID:25853744

  8. An Isolated Congenital Left Ventricular Diverticulum with Mitral Valve Endocarditis.

    PubMed

    Jiang, Bo; Yang, Yi-Feng; Wang, Xi; Xiong, Lian; Huang, Can; Gong, Liang-Hui

    2016-03-01

    Congenital left ventricular diverticulum is a rare cardiac malformation, which could result in rupture, thrombosis, congestive heart failure, infective endocarditis, ventricular arrhythmia and aortic insufficiency. Most authors propose that patients who are symptomatic and have a higher risk for major complications should undergo surgical treatment. We present a case of isolated congenital left ventricular diverticulum with mitral valve infective endocarditis and anomalous single coronary artery observed intra-operatively. The patient underwent successful surgical repair of the diverticulum by continuous suture of the internal opening inside the left ventricle. PMID:26572256

  9. In vitro Models of Aortic Valve Calcification: Solidifying a System

    PubMed Central

    Bowler, Meghan A.; Merryman, W. David

    2014-01-01

    Calcific aortic valve disease (CAVD) affects 25% of people over 65, and the late-stage stenotic state can only be treated with total valve replacement, requiring 85,000 surgeries annually in the US alone [1]. As CAVD is an age-related disease, many of the affected patients are unable to undergo the open-chest surgery that is its only current cure. This challenge motivates the elucidation of the mechanisms involved in calcification, with the eventual goal of alternative preventative and therapeutic strategies. There is no sufficient animal model of CAVD, so we turn to potential in vitro models. In general, in vitro models have the advantages of shortened experiment time and better control over multiple variables compared to in vivo models. As with all models, the hypothesis being tested dictates the most important characteristics of the in vivo physiology to recapitulate. Here, we collate the relevant pieces of designing and evaluating aortic valve calcification so that investigators can more effectively draw significant conclusions from their results. PMID:25249188

  10. Repair for mitral valve aneurysm using autologous pericardium: a case of our experience.

    PubMed

    Zhang, Hongqiang; Chen, Hao; Sun, Xiaoning; Yang, Shouguo; Wang, Chunsheng

    2014-01-01

    Mitral Valve Aneurysm (MVA) is rarely reported and occurs most in association with infective endocarditis of the aortic valve. In our case, the 46-yr-old Chinese man was referred to our hospital with dyspnea and orthopnea. Transesophageal echocardiography during operation revealed a localized, thin-walled saccular structure in the anterior leaflet that bulged into the left atrium, and severe mitral and aortic regurgitation. Aortic valve was replaced with mechanical prostheses and mitral valve was repaired with autologous pericardium. Transesophageal echocardiography during operation and transthoracic echocardiography 3 months later showed mild regurgitation. PMID:25230935

  11. Perinatal Changes in Mitral and Aortic Valve Structure and Composition

    PubMed Central

    Stephens, Elizabeth H.; Post, Allison D.; Laucirica, Daniel R.; Grande-Allen, K. Jane

    2015-01-01

    At birth, the mechanical environment of valves changes radically as fetal shunts close and pulmonary and systemic vascular resistances change. Given that valves are reported to be mechanosensitive, we investigated remodeling induced by perinatal changes by examining compositional and structural differences of aortic and mitral valves (AVs, MVs) between 2-day-old and 3rd fetal trimester porcine valves using immunohistochemistry and Movat pentachrome staining. Aortic valve composition changed more with birth than the MV, consistent with a greater change in AV hemodynamics. At 2 days, AV demonstrated a trend of greater versican and elastin (P = 0.055), as well as greater hyaluronan turnover (hyaluronan receptor for endocytosis, P = 0.049) compared with the 3rd-trimester samples. The AVs also demonstrated decreases in proteins related to collagen synthesis and fibrillogenesis with birth, including procollagen I, prolyl 4-hydroxylase, biglycan (all P ≤ 0.005), and decorin (P = 0.059, trend). Both AVs and MVs demonstrated greater delineation between the leaflet layers in 2-day-old compared with 3rd-trimester samples, and AVs demonstrated greater saffron-staining collagen intensity, suggesting more mature collagen in 2-day-old compared with 3rd-trimester samples (each P < 0.05). The proportion of saffron-staining collagen also increased in AV with birth (P < 0.05). The compositional and structural changes that occur with birth, as noted in this study, likely are important to proper neonatal valve function. Furthermore, normal perinatal changes in hemodynamics often do not occur in congenital valve disease; the corresponding perinatal matrix maturation may also be lacking and could contribute to poor function of congenitally malformed valves. PMID:20536360

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

    PubMed

    De Bonis, Michele; Bolling, Steven F

    2013-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement

    PubMed Central

    Priye, Shio; Sathyanarayan, J; Shivaprakash, S; Reddy, Durgaprasad

    2015-01-01

    Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5th post-operative day. PMID:26903676

  16. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. Accurate assessment of mitral valve area in patients with mitral stenosis by three-dimensional echocardiography.

    PubMed

    Chen, Q; Nosir, Y F; Vletter, W B; Kint, P P; Salustri, A; Roelandt, J R

    1997-03-01

    The accuracy of measurements of mitral valve orifice area (MVA) from three-dimensional echocardiographic (3DE) image data sets obtained by a transthoracic or transesophageal rotational imaging probe was studied in 15 patients with native mitral stenosis. The smallest MVA was identified from a set of eight parallel short-axis cut planes of the mitral valve between the anulus and the tips of leaflets (paraplane echocardiography) and measured by planimetry. In addition, MVA was measured from the two-dimensional short-axis view (2DE). Values of MVA measured by 3DE and 2DE were compared with those calculated from Doppler pressure half-time (PHT) as a gold standard. Observer variabilities were studied for 3DE. MVA measured from PHT ranged between 0.55 and 3.19 cm2 (mean +/- SD 1.57 +/- 0.73 cm2), from 3DE between 0.83 and 3.23 cm2 (mean +/- SD 1.55 +/- 0.67 cm2), and from 2DE between 1.27 and 4.08 cm2 (mean +/- SD 1.9 +/- 0.7 cm2). The variability of intraobserver and interobserver measurements for 3DE measurements was not significantly different (p = 0.79 and p = 0.68, respectively); for interobserver variability, standard error of the estimate = 0.25. There was excellent correlation, close limits of agreement (mean difference +/- 2 SD), and nonsignificant differences between 3DE and PHT for MVA measurements (r = 0.98 [0.02 +/- 0.3] and p = 0.6), respectively. There was moderate correlation, wider limits of agreement, and significant difference between 2DE and PHT for MVA measurements (r = 0.89 [0.32 +/- 0.66] and p = 0.002), respectively. This may be related to the difficulties in visualization of the smallest orifice in precordial short-axis views. This study suggests that three-dimensional image data sets, by providing the possibility of "computer slicing" to generate equidistant parallel cross sections of the mitral valve independently from physically dictated ultrasonic windows, allow accurate and reproducible measurement of the MVA. PMID:9083968

  20. Morphological and Chemical Study of Pathological Deposits in Human Aortic and Mitral Valve Stenosis: A Biomineralogical Contribution

    PubMed Central

    Cottignoli, Valentina; Salvador, Loris; Valfré, Carlo

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  2. Right lateral mini-thoracotomy for mitral valve surgery.

    PubMed

    Reser, Diana; Holubec, Tomas; Yilmaz, Murat; Guidotti, Andrea; Maisano, Francesco

    2015-01-01

    Since the 1990 s, minimally invasive cardiac surgery has gained wide acceptance due to patient and economic demand. The advantages are less trauma, less bleeding, less wound infections, less pain and faster recovery. Many studies showed that the outcomes are comparable with those of conventional sternotomy. Right lateral mini-thoracotomy evolved into a routine and safe access in specialized centres for minimally invasive mitral valve surgery. The 6-cm incision is performed over the fifth intercostal space in the inframammary groove. With a double-lumen tube, the right lung is deflated before entering the pleural cavity. A soft tissue retractor is used to minimize rib spreading. The stab incisions for the endoscopic camera and the transthoracic clamp are performed in the right anterior and posterior axillary line in the third intercostal space. Surgery on the mitral valve is performed in a standard fashion under a direct vision with video assistance. One chest tube is inserted. The intercostal space is adapted with braided sutures to prevent lung herniation. Ropivacaine is used for local infiltration. The pectoral muscle, subcutaneous tissue and skin are adapted with running sutures. Complications of a right lateral mini-thoracotomy are rare (conversion to sternotomy, rethoracotomy, phrenic nerve palsy, wound infection and thoracic wall hernia) and well manageable. PMID:26507363

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

    Pitcher, D; Grahame, R

    1982-01-01

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

  5. A tale of two pressures: a case of pseudo-prosthetic mitral valve stenosis.

    PubMed

    Bokhari, Syed S I; O'Neill, William W; Cohen, Mauricio G

    2011-12-01

    We present a case of an 83-year-old female with past medical history of rheumatic fever associated mitral stenosis for which she underwent mitral commissurotomy 25 years prior to presentation. Subsequently, she underwent coronary artery bypass grafting and mitral valve replacement with a bio-prosthetic valve 8 years prior to presentation. Presently, she started experiencing worsening dyspnea and heart failure symptoms. Echocardiography showed mildly reduced left ventricular ejection fraction with severe aortic stenosis and pulmonary hypertension. The bioprosthetic mitral valve was functioning normally. We performed right and left heart catheterization for evaluation. Peak aortic gradient was 50 mm Hg with a mean gradient of 39 mm Hg. Aortic valve area was calculated to be 0.31 cm(2). However, simultaneous measurement of left ventricular and wedge pressures showed a significant gradient of 11 mm Hg across the mitral valve with a calculated mitral valve area of 0.4 cm(2). Because of discordant information between echocardiographic and hemodynamic data, we proceeded with trans-septal puncture to directly measure left atrial pressures. Simultaneous left atrial and left ventricular pressure measurement demonstrated a mean gradient of 4 mm Hg across the mitral valve with an area calculated at 1.9 cm(2). We review the tracings in detail and discuss the pitfalls of using pulmonary capillary wedge pressure as a surrogate for left atrial pressure. PMID:22106062

  6. Design considerations and quantitative assessment for the development of percutaneous mitral valve stent.

    PubMed

    Kumar, Gideon Praveen; Cui, Fangsen; Phang, Hui Qun; Su, Boyang; Leo, Hwa Liang; Hon, Jimmy Kim Fatt

    2014-07-01

    Percutaneous heart valve replacement is gaining popularity, as more positive reports of satisfactory early clinical experiences are published. However this technique is mostly used for the replacement of pulmonary and aortic valves and less often for the repair and replacement of atrioventricular valves mainly due to their anatomical complexity. While the challenges posed by the complexity of the mitral annulus anatomy cannot be mitigated, it is possible to design mitral stents that could offer good anchorage and support to the valve prosthesis. This paper describes four new Nitinol based mitral valve designs with specific features intended to address migration and paravalvular leaks associated with mitral valve designs. The paper also describes maximum possible crimpability assessment of these mitral stent designs using a crimpability index formulation based on the various stent design parameters. The actual crimpability of the designs was further evaluated using finite element analysis (FEA). Furthermore, fatigue modeling and analysis was also done on these designs. One of the models was then coated with polytetrafluoroethylene (PTFE) with leaflets sutured and put to: (i) leaflet functional tests to check for proper coaptation of the leaflet and regurgitation leakages on a phantom model and (ii) anchorage test where the stented valve was deployed in an explanted pig heart. Simulations results showed that all the stents designs could be crimped to 18F without mechanical failure. Leaflet functional test results showed that the valve leaflets in the fabricated stented valve coapted properly and the regurgitation leakage being within acceptable limits. Deployment of the stented valve in the explanted heart showed that it anchors well in the mitral annulus. Based on these promising results of the one design tested, the other stent models proposed here were also considered to be promising for percutaneous replacement of mitral valves for the treatment of mitral regurgitation, by virtue of their key features as well as effective crimping. These models will be fabricated and put to all the aforementioned tests before being taken for animal trials. PMID:24746106

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

    PubMed Central

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

    2011-01-01

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

  8. Transcatheter ACURATE-TA Aortic Valve Implantation in a Patient With a Previous Mechanical Mitral Valve.

    PubMed

    Bagur, Rodrigo; Kiaii, Bob; Teefy, Patrick J; Diamantouros, Pantelis; Harle, Christopher; Goela, Aashish; Chan, Ian; Chu, Michael W A

    2015-11-01

    Transcatheter aortic valve implantation (TAVI) in the presence of a mechanical mitral valve (MMV) prosthesis is still challenging because of the rigid mitral frame within the aortomitral curtain. Moreover, low-lying coronary ostia represent a hazardous problem of coronary obstruction, especially in narrow or porcelain aortic roots. The present case demonstrates the successful management of 2 challenging anatomical issues, the rigid cage of the MMV and the low-lying left main coronary ostium (LMCO), with the implantation of the ACURATE-TA bioprosthesis (Symetis SA, Ecublens, Switzerland). It also highlights the importance of having multiple TAVI devices in order to choose the ideal transcatheter aortic bioprosthesis to fit the unique anatomical presentation of the patient. PMID:26522576

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

    PubMed

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

    2011-12-01

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

  10. Manipulation of valve composition to elucidate the role of collagen in aortic valve calcification

    PubMed Central

    2014-01-01

    Background Extracellular matrix (ECM) disarray is found in calcific aortic valvular disease (CAVD), yet much remains to be learned about the role of individual ECM components in valvular interstitial cell (VIC) function and dysfunction. Previous clinical analyses have shown that calcification is associated with decreased collagen content, while previous in vitro work has suggested that the presence of collagen attenuates the responsiveness of VICs to pro-calcific stimuli. The current study uses whole leaflet cultures to examine the contributions of endogenous collagen in regulating the phenotype and calcification of VICs. Methods A “top-down” approach was used to characterize changes in VIC phenotype in response to collagen alterations in the native 3D environment. Collagen-deficient leaflets were created via enzymatic treatment and cultured statically for six days in vitro. After culture, leaflets were harvested for analysis of DNA, proliferation, apoptosis, ECM composition, calcification, and gene/protein expression. Results In general, disruption of collagen was associated with increased expression of disease markers by VICs in whole organ leaflet culture. Compared to intact control leaflets, collagen-deficient leaflets demonstrated increased VIC proliferation and apoptosis, increased expression of disease-related markers such as alpha-smooth muscle actin, alkaline phosphatase, and osteocalcin, and an increase in calcification as evidenced by positive von Kossa staining. Conclusions These results indicate that disruption of the endogenous collagen structure in aortic valves is sufficient to stimulate pathological consequences in valve leaflet cultures, thereby highlighting the importance of collagen and the valve extracellular matrix in general in maintaining homeostasis of the valve phenotype. PMID:24581344

  11. Effect of obstructive sleep apnea on mitral valve tenting.

    PubMed

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

    2012-04-01

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

  12. Review of Congenital Mitral Valve Stenosis: Analysis, Repair Techniques and Outcomes.

    PubMed

    Baird, Christopher W; Marx, Gerald R; Borisuk, Michele; Emani, Sitram; Del Nido, Pedro J

    2015-06-01

    The spectrum of congenital mitral valve stenosis (MS) consists of a complex of defects that result in obstruction to left ventricular inflow. This spectrum includes patients with underdeveloped left heart structures (Fig.1) to those with isolated congenital MS. The specific mitral valve defects can further be divided into categories based on the relationship to the mitral valve annulus including valvar, supravalvar and subvalvar components. Clinically, these patients present based on the degree of obstruction, associated mitral regurgitation, secondary pulmonary hypertension, associated lung disease and/or associated cardiac lesions. There are a number of factors that contribute to the successful outcomes in these patients including pre-operative imaging, aggressive surgical techniques and peri-operative management. Figure1 (a) Image representing a parachute mitral valve with a small left ventricular cavity. Supra-mitral ring with a fibrous rim of tissue attaches to the mitral annulus and extends on the surfaces of the mitral leaflets. Stenosing mitral membranes or the thickened fribrotic rim of tissue grows on to the atrial aspects of the mitral leaflets restricting the effective orifice area. This thickened fibrous anterior leaflet tissue can extend down onto the chordae tendenae towards the papillary muscle creating an "arcade" like structure. Additional valvar components include commissural fusion and thickened fibrous leaflets that can lead to restricted leaflet motion. Note the sub-valvar or papillary muscle components of congenital MS including the shortened chordae tendenae, reduced inter-chordal space and tethering of the papillary muscles to the ventricle. (b) Pathologic specimen of a parachute mitral valve with a single papillary muscle. PMID:26577233

  13. Effects of pimobendan for mitral valve regurgitation in dogs.

    PubMed

    Kanno, Nobuyuki; Kuse, Hiroshi; Kawasaki, Masaya; Hara, Akashi; Kano, Rui; Sasaki, Yoshihide

    2007-04-01

    Pimobendan has a dual mechanism of action: it increases myocardial contractility by increasing calcium sensitization to troponin C and it promotes vasodilation by inhibiting PDEIII. This study examined the effects of pimobendan on cardiac function, hemodynamics, and neurohormonal factors in dogs with mild mitral regurgitation (MR). The dogs were given 0.25 mg/kg of pimobendan orally every 12 hr for 4 weeks. With pimobendan, the heart rate and stroke volume did not change, but the systolic blood pressure gradually decreased and the degree of mitral valve regurgitation tended to decrease. Renal blood flow was significantly increased and the glomerular filtration rate was slightly increased at 2 and 4 weeks. Furthermore, over the 4-week period, the plasma norepinephrine concentration decreased significantly, the systolic index increased slightly, the left atrial diameter and the left ventricular diameters decreased significantly, and the heart size improved. Given these results, pimobendan appears to be useful for treating MR in dogs. However, further long-term studies of pimobendan involving a larger number of dogs with mild and moderate MR are needed to establish the safety of pimobendan and document improvements in quality of life. PMID:17485924

  14. Simultaneous transapical aortic and mitral valve-in-valve implantation for double prostheses dysfunction: case report and technical insights.

    PubMed

    D'Onofrio, Augusto; Zucchetta, Fabio; Gerosa, Gino

    2014-09-01

    Transcatheter "Valve-in-Valve" implantation (ViV) has shown promising results in high-risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. We present a case of a 68-year-old woman with a history of three previous cardiac operations on the aortic and mitral valve. At the time of admission she was severely symptomatic due to a simultaneous SVD of a 23 mm aortic and of a 29 mm mitral St. Jude Biocor bioprosthesis. Because of the history of several cardiac operations and to her comorbidities, the patient was considered with an extremely high surgical risk profile and was therefore scheduled for double concomitant mitral and aortic ViV. Through a trans-apical approach, the patient underwent 23 and 29 mm Edwards Sapien XT implantation in the aortic and mitral bioprosthesis, respectively. The procedure was uneventful as well as the following hospital stay. At 6-months follow-up the patient is in NYHA class I. Echocardiography shows that the aortic bioprosthesis has no leak and the mean gradient is 20 mm Hg while the mitral valve has mild leak and maximum and mean gradients are 21 and 10 mm Hg, respectively. The three main technical aspects that should be carefully considered in double concomitant ViV are: sequence of valve deployment (whether to implant the mitral or the aortic valve first), choice of access and valve sizing. In conclusion, double simultaneous trans-apical mitral and aortic ViV is technically feasible. 2014 Wiley Periodicals, Inc. PMID:24677811

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

    PubMed Central

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

    1995-01-01

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

  16. Dynamic Heterogeneity of the Heart Valve Interstitial Cell Population in Mitral Valve Health and Disease

    PubMed Central

    Sauls, Kimberly; Koenig, Sara N.; Anstine, Lindsey J.; Garg, Vidu; Norris, Russell A.; Lincoln, Joy

    2015-01-01

    The heart valve interstitial cell (VIC) population is dynamic and thought to mediate lay down and maintenance of the tri-laminar extracellular matrix (ECM) structure within the developing and mature valve throughout life. Disturbances in the contribution and distribution of valve ECM components are detrimental to biomechanical function and associated with disease. This pathological process is associated with activation of resident VICs that in the absence of disease reside as quiescent cells. While these paradigms have been long standing, characterization of this abundant and ever-changing valve cell population is incomplete. Here we examine the expression pattern of Smooth muscle ?-actin, Periostin, Twist1 and Vimentin in cultured VICs, heart valves from healthy embryonic, postnatal and adult mice, as well as mature valves from human patients and established mouse models of disease. We show that the VIC population is highly heterogeneous and phenotypes are dependent on age, species, location, and disease state. Furthermore, we identify phenotypic diversity across common models of mitral valve disease. These studies significantly contribute to characterizing the VIC population in health and disease and provide insights into the cellular dynamics that maintain valve structure in healthy adults and mediate pathologic remodeling in disease states. PMID:26527432

  17. Repeat Minimally Invasive Mitral Valve Replacement for Recurrent Mitral Stenosis after OMC in Patients Who Decline Blood Product Transfusion for Religious Reasons

    PubMed Central

    Ito, Yujiro; Nakamura, Yoshitsugu; Tagusari, Osamu; Yoshida, Shigehiko

    2015-01-01

    Cardiac surgery for Jehovah's Witness (JW) patients is considered to be high risk because of patients' refusal to receive blood transfusion. We report a successful mitral valve replacement for recurrent mitral stenosis after OMC with minimally invasive right thoracotomy, without any transfusion of allogeneic blood or blood products. This minimally invasive mitral valve replacement through right thoracotomy was an excellent approach for JW patients. PMID:26618021

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

    PubMed

    Al-Sherbeeni, Nisreen M

    2009-08-01

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

  19. Designing innovative retractors and devices to facilitate mitral valve repair surgery

    PubMed Central

    Yozu, Ryohei

    2015-01-01

    Various devices have been developed to facilitate mitral valve surgery, including those that improve mitral valve exposure and assist surgeons with associated procedures. Choosing appropriate supporting devices when performing minimally invasive mitral valve surgery (MIMVS) through a minithoracotomy with endoscopic assistance is critical. Depending on the surgeons preference, trans-thoracic or trans-working-port left atrial retractors can be utilized. Although the trans-thoracic retractors provide a simple and orderly working space around the minithoracotomy working port, the positioning of the shaft is difficult and there is an implicit risk of chest wall bleeding. On the other hand, the trans-working-port type provides excellent exposure, is easily handled and manipulated, and facilitates surgeries involving various anatomical structures without special training. A great deal of understanding and knowledge about retractors is necessary to achieve the optimal exposure required to facilitate surgical techniques, and to maintain a reproducible and safe surgical system during mitral valve surgery. PMID:26309847

  20. The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs. replacement?

    PubMed

    Maisano, Francesco; Alfieri, Ottavio; Banai, Shmuel; Buchbinder, Maurice; Colombo, Antonio; Falk, Volkmar; Feldman, Ted; Franzen, Olaf; Herrmann, Howard; Kar, Saibal; Kuck, Karl-Heinz; Lutter, Georg; Mack, Michael; Nickenig, Georg; Piazza, Nicolo; Reisman, Mark; Ruiz, Carlos E; Schofer, Joachim; Søndergaard, Lars; Stone, Gregg W; Taramasso, Maurizio; Thomas, Martyn; Vahanian, Alec; Webb, John; Windecker, Stephan; Leon, Martin B

    2015-07-01

    Transcatheter mitral interventions has been developed to address an unmet clinical need and may be an alternative therapeutic option to surgery with the intent to provide symptomatic and prognostic benefit. Beyond MitraClip therapy, alternative repair technologies are being developed to expand the transcatheter intervention armamentarium. Recently, the feasibility of transcatheter mitral valve implantation in native non-calcified valves has been reported in very high-risk patients. Acknowledging the lack of scientific evidence to date, it is difficult to predict what the ultimate future role of transcatheter mitral valve interventions will be. The purpose of the present report is to review the current state-of-the-art of mitral valve intervention, and to identify the potential future scenarios, which might benefit most from the transcatheter repair and replacement devices under development. PMID:25870204

  1. Two melodies in concert: mitral and pulmonary valve replacement late in repaired tetralogy of Fallot.

    PubMed

    Fang, Zhi; Hu, Jia; Zhu, Xianglan; Lin, Ke

    2015-01-01

    Disruption of pulmonary valve integrity after Tetralogy of Fallot repair often results in a cascade of hemodynamic and electrophysiological abnormalities. Here we report an uncommon case of severe pulmonary regurgitation with concomitant rheumatic mitral stenosis diagnosed 25 years after primary Tetralogy of Fallot repair. A 33-year-old man presented with symptomatic palpitation and exercise intolerance and was treated successfully with pulmonary and mitral valve replacement, after which his symptoms improved dramatically. PMID:25887053

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

    PubMed

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

    2012-08-01

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

  3. Replacement of the mitral valve in an infant with group B streptococcal endocarditis.

    PubMed

    Walker, T A; Aru, G M; Ebeid, M R

    2001-01-01

    Endocarditis due to group B streptococcus is very rare in infants, and may be associated with significant morbidity and mortality. Review of the literature reveals only a single reported case of an infant with this type of streptococcal endocarditis involving the mitral valve. This infant had underlying congenital heart disease, and died shortly after catheterization. We now report group B streptococcal endocarditis occurring in an infant with a structurally normal heart who was treated successfully by replacement of the mitral valve. PMID:11233405

  4. Calcific aortic valve disease: A consensus summary from the Alliance of Investigators on Calcific Aortic Valve Disease

    PubMed Central

    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

    2014-01-01

    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

  5. Antiphospholipid Syndrome and Libman-Sacks Endocarditis in a Bioprosthetic Mitral Valve.

    PubMed

    Sladek, Eric H; Accola, Kevin D

    2016-02-01

    This report describes one the first cases of antiphospholipid syndrome and Libman-Sacks endocarditis in a bioprosthetic valve. A redo mitral valve replacement was carried out owing to early deterioration of the prior valve. Initially it was considered secondary to rheumatic heart disease; however, pathology analysis and autoimmune workup revealed antiphospholipid syndrome with Libman-Sacks endocarditis. We believe certain populations with mitral valve stenosis may have an underlying antiphospholipid syndrome. As a result, there needs to be a lower threshold for identifying this disease. PMID:26777966

  6. Ventricular Septal Perforation Caused by the Strut of a Mitral Valve Bioprosthesis.

    PubMed

    Dagnegård, Hanna H; Ugander, Martin; Liska, Jan; Källner, Göran G

    2016-03-01

    Ventricular rupture is a well-known complication of mitral valve replacement. We report a rare complication in which the strut of a recently implanted mitral bioprosthesis eroded through the ventricular septum. We present the strategy of the reoperation in which the sutures holding the repair patch were also used to support the new prosthesis. In addition to ventricular rupture and obstruction of the left ventricular outflow tract by a mitral bioprosthesis, the risk of iatrogenic ventricular septal defect (VSD) should be considered when choosing, sizing, and implanting a mitral bioprosthesis. PMID:26897197

  7. A Rare Association of Parachute Mitral Valve with Double Outlet Right Ventricle and Severe Pulmonary Hypertension in an Adult.

    PubMed

    Meenakshi, K; Chidambaram, Sundar; Dhandapani, V E; Rameshwar, R

    2014-11-01

    Congenital mitral stenosis (MS) is a rare congenital cardiac malformation and the obstruction to the flow across the mitral valve can be caused by supramitral ring, commissural fusion, short chordae, anomalous mitral arcade, anomalous position of the papillary muscles and the so-called'parachute mitral valve'. We describe here the case of a 47 year old male diagnosed to have a double outlet right ventricle (DORV), subaortic ventricular septal defect (VSD) with no pulmonary stenosis, severe pulmonary hypertension and congenital MS due to parachute mitral valve. PMID:26281483

  8. Mechanics of mitral valve edge-to-edge-repair and MitraClip procedure.

    PubMed

    Bhattacharya, Shamik; He, Zhaoming

    2015-01-01

    The edge-to-edge repair (ETER) technique has been used as a stand-alone procedure, or as a secondary procedure with ring annuloplasty for degenerative, functional mitral regurgitation, or for mitral regurgitation of other kinds of valvular etiologies. The percutaneous MitraClip technique based on ETER has been used in patients who are inoperable or at high surgical risk. However, adverse events such as residual mitral regurgitation, and clip detachment or fracture indicate that the mechanics underlying these procedures is not well understood. Therefore, current studies on mitral valve functionality and mechanics related to the ETER and MitraClip procedures are reviewed to improve the efficacy and safety of both procedures. Extensive in vivo, in vitro, and in silico studies related to ETER and MitraClip procedures along with MitraClip clinical trial results are presented and discussed herein. The ETER suture force and the mitral valve tissue mechanics and hemodynamics of each procedure are discussed. A quantitative understanding of the interplay of mitral valve components and as to biological response to the procedures remains challenging. Based on mitral valve mechanics, ETER or MitraClip therapy can be optimized to enhance repair efficacy and durability. PMID:25955011

  9. Multicenter Evaluation of High-Risk Mitral Valve Operations: Implications for Novel Transcatheter Valve Therapies

    PubMed Central

    LaPar, Damien J.; Isbell, James M.; Crosby, Ivan K.; Kern, John; Lim, D. Scott; Fonner, Edwin; Speir, Alan M.; Rich, Jeffrey B.; Kron, Irving L.; Ailawadi, Gorav

    2016-01-01

    Background The MitraClip REALISM (Abbott Vascular, Menlo Park, CA) trial included several inclusion criteria to identify patients at high risk for conventional mitral valve (MV) surgery. This study evaluated contemporary surgical outcomes for high-risk surgical patients who met these defined criteria to serve as a benchmark to evaluate appropriateness in treatment allocation between surgical and percutaneous MV repair. Methods A statewide Society for Thoracic Surgeons (STS) database was queried for patients undergoing isolated mitral valve surgery over a 12-year study period from 17 different hospitals. Patients were stratified into high-risk (HR) versus non-high-risk (non-HR) cohorts based upon clinical criteria similar to those utilized in the REALISM trial. Mixed effects multivariable regression modeling was used to evaluate study endpoints including mortality, morbidity, and resource utilization. Results Of 2,440 isolated mitral operations, 29% (n = 698) were HR per REALISM criteria. Median STS Predicted Risk of Mortality (PROM) for HR patients was 6.6% compared with 1.6% for non-HR patients (p < 0.001). The HR patients more commonly underwent MV replacement as well as urgent (30% vs 19%, p < 0.001) operations. High-risk patients incurred higher morbidity and mortality (7% vs 1.6%) with longer intensive care unit (48 vs 41 hours) and hospital stays (7 vs 6 days, all p < 0.001). Among REALISM criteria, STS PROM 12% or greater and high-risk STS criteria were the only criteria associated with mortality. Conclusions Select REALISM criteria, including reoperation with patent grafts and functional MR with ejection fraction less than 0.40, may not identify patients truly at high risk of death with surgery. In addition to conventional STS criteria, risk assessment by surgeons is essential to direct appropriate treatment allocation for high-risk mitral disease. PMID:25282165

  10. Percutaneous Mitral Valve Repair in Mitral Regurgitation Reduces Cell-Free Hemoglobin and Improves Endothelial Function

    PubMed Central

    Rammos, Christos; Zeus, Tobias; Balzer, Jan; Kubatz, Laura; Hendgen-Cotta, Ulrike B.; Veulemans, Verena; Hellhammer, Katharina; Totzeck, Matthias; Luedike, Peter; Kelm, Malte; Rassaf, Tienush

    2016-01-01

    Background and Objective Endothelial dysfunction is predictive for cardiovascular events and may be caused by decreased bioavailability of nitric oxide (NO). NO is scavenged by cell-free hemoglobin with reduction of bioavailable NO up to 70% subsequently deteriorating vascular function. While patients with mitral regurgitation (MR) suffer from an impaired prognosis, mechanisms relating to coexistent vascular dysfunctions have not been described yet. Therapy of MR using a percutaneous mitral valve repair (PMVR) approach has been shown to lead to significant clinical benefits. We here sought to investigate the role of endothelial function in MR and the potential impact of PMVR. Methods and Results Twenty-seven patients with moderate-to-severe MR treated with the MitraClip® device were enrolled in an open-label single-center observational study. Patients underwent clinical assessment, conventional echocardiography, and determination of endothelial function by measuring flow-mediated dilation (FMD) of the brachial artery using high-resolution ultrasound at baseline and at 3-month follow-up. Patients with MR demonstrated decompartmentalized hemoglobin and reduced endothelial function (cell-free plasma hemoglobin in heme 28.9±3.8 μM, FMD 3.9±0.9%). Three months post-procedure, PMVR improved ejection fraction (from 41±3% to 46±3%, p = 0.03) and NYHA functional class (from 3.0±0.1 to 1.9±1.7, p<0.001). PMVR was associated with a decrease in cell free plasma hemoglobin (22.3±2.4 μM, p = 0.02) and improved endothelial functions (FMD 4.8±1.0%, p<0.0001). Conclusion We demonstrate here that plasma from patients with MR contains significant amounts of cell-free hemoglobin, which is accompanied by endothelial dysfunction. PMVR therapy is associated with an improved hemoglobin decompartmentalization and vascular function. PMID:26986059

  11. Comparison of Percutaneous Mitral Valve Repair Versus Conservative Treatment in Severe Functional Mitral Regurgitation.

    PubMed

    Giannini, Cristina; Fiorelli, Francesca; De Carlo, Marco; Guarracino, Fabio; Faggioni, Michela; Giordano, Paolo; Spontoni, Paolo; Pieroni, Andrea; Petronio, Anna Sonia

    2016-01-15

    Percutaneous mitral valve repair (PMVR) using the MitraClip System is feasible and entails clinical improvement even in patients with high surgical risk and severe functional mitral regurgitation (MR). The aim of this study was to assess survival rates and clinical outcome of patients with severe, functional MR treated with optimal medical therapy (OMT) compared with those who received MitraClip device. Sixty patients treated with OMT were compared with a propensity-matched cohort of 60 patients who underwent PMVR. Baseline demographics and echocardiographic variables were similar between the 2 groups. The mean age of patients was 75years, and 67% were men. The median logistic EuroSCORE and EuroSCORE II were 17% and 6%, respectively, because of the presence of several co-morbidities. The mechanism of MR was functional in all cases with an ischemic etiology in 52% of patients. Median left ventricle ejection fraction was 34%. All the patients were symptomatic for dyspnea with 63% and 12% in the New York Heart Association class III and IV, respectively. In PMVR group, the procedure was associated with safety and very low incidence of procedural complications with no occurrence of procedural and inhospital mortality. After a median follow-up of 515days (248 to 828days), patients treated with PMVR demonstrated overall survival, survival freedom from cardiac death and survival free of readmission due to cardiac disease curves higher than patients treated conservatively (log-rank test p= 0.007, p= 0.002, and p= 0.04, respectively). In conclusion, PMVR offers a valid option for selected patients with high surgical risk and severe, functional MR and entails better survival outcomes compared with OMT. PMID:26651454

  12. Potential drug targets for calcific aortic valve disease

    PubMed Central

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

    2014-01-01

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

  13. Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography

    PubMed Central

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

    2013-01-01

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

  14. Patient-specific mitral valve closure prediction using 3D echocardiography.

    PubMed

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

    2013-05-01

    This article presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (TEE). Our approach uses physics-based modeling to solve for the stationary configuration of the closed valve structure from the patient-specific open valve structure, which is recovered using a user-in-the-loop, thin-tissue detector segmentation. The method uses a tensile shape-finding approach based on energy minimization. This method is employed to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using 10 intraoperative 3D TEE sequences by comparing the closed valve configuration predicted from the segmented open valve with the segmented closed valve, taken as ground truth. Experiments show promising results, with prediction errors on par with 3D TEE resolution and with good potential for applications in pre-operative planning. PMID:23497987

  15. Large Patent Ductus Arteriosus in a 44-Year-Old Woman Leading to Calcium Deposition in the Left Atrium and Mitral and Aortic Valves

    PubMed Central

    Roberts, Carey Camille

    2015-01-01

    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously. PMID:26175644

  16. Surface modification of polyurethane heart valves: effects on fatigue life and calcification.

    PubMed

    Bernacca, G M; Wheatley, D J

    1998-12-01

    Polyurethane heart valves can be functionally durable with minimal calcification, in vitro. In vivo, these characteristics will depend on the resistance of the polyurethane to thrombogenesis and biodegradation. Surface modification may improve the polyurethane in these respects, but may adversely affect calcification and durability. This study investigates the effects of surface modifications of two polyurethane heart valves (PEU and PEUE) on their in vitro fatigue and calcification behaviour. Modifications included heparin, taurine, 3-aminopropyltriethoxysilane and polyethylene oxide (PEO). Neither hydrodynamic function nor leaflet thickness distribution was significantly altered by surface modification. PEO-modification was detrimental to valve fatigue durability and calcification. Heparin, taurine or aminosilane modifications of PEU valves increased durability. Aminosilane modification of PEUE valves increased durability compared with PEO modification. Appropriate surface modification may be useful to improve blood compatibility of implantable polyurethanes, and may also be advantageous as regards fatigue durability of flexing materials in longterm applications. PMID:9988359

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

    PubMed

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

    2002-10-01

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

  18. 43.3-year durability of a Smeloff-Cutter ball-caged mitral valve.

    PubMed

    Head, Stuart J; Ko, Jamie; Singh, Rajeev; Roberts, William C; Mack, Michael J

    2011-02-01

    Extended durability of mechanical heart valves has been documented for many years. We describe a case of a ball-caged mechanical valve implanted 43.3 years previous to developing valve dysfunction. The patient presented with both prosthetic valve stenosis and insufficiency. This Smeloff-Cutter valve (Cutter Laboratories, Berkeley, CA) in the mitral position was dysfunctional due to lipid absorption, which resulted in ball variance and concomitant pannus growth prevented optimal seating of the ball in its cage. This is the longest length of time in which a Smeloff-Cutter mechanical valve has been originally implanted. PMID:21256329

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

    PubMed

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

    2014-12-01

    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

  20. Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement: Establishing Consensus Among Modalities and Disciplines.

    PubMed

    Blanke, Philipp; Naoum, Christopher; Webb, John; Dvir, Danny; Hahn, Rebecca T; Grayburn, Paul; Moss, Robert R; Reisman, Mark; Piazza, Nicolo; Leipsic, Jonathon

    2015-10-01

    Transcatheter mitral valve implantation (TMVI) represents a promising approach to treating mitral valve regurgitation in patients at increased risk of perioperative mortality. Similar to transcatheter aortic valve replacement (TAVR), TMVI relies on pre- and periprocedural noninvasive imaging. Although these imaging modalities, namely echocardiography, computed tomography, and fluoroscopy, are well established in TAVR, TMVI has entirely different requirements. Approaches and nomenclature need to be standardized given the multiple disciplines involved. Herein we provide an overview of anatomical principles and definitions, a methodology for anatomical quantification, and perioperative guidance. PMID:26481845

  1. [An emergent aortic and mitral valve replacement for active infective endocarditis preoperatively using extracorporeal ultrafiltration method].

    PubMed

    Sakahashi, H; Takazawa, A; Eishi, K; Aomi, S; Tsuchida, K; Harada, Y; Seino, R; Hashimoto, A; Koyanagi, H

    1991-03-01

    We reported a 29-year-old man with active endocarditis complicating aortic and mitral valve regurgitation. The echocardiogram showed a mycotic aneurysm at aortic valvular annulus and a aneurysm of mitral valve. Heart failure was progressive and caused anuria. Prior to emergent double valve replacement, 2,500 ml of water was removed. Then hemodynamics became stationary. Urination was good during and after operation. In this case, complicating acute renal failure, dehydration with extracorporeal ultrafiltration method was very effective for improvement of hemodynamics. PMID:2020151

  2. Molecular Imaging Insights into Early Inflammatory Stages of Arterial and Aortic Valve Calcification

    PubMed Central

    New, Sophie E. P.; Aikawa, Elena

    2011-01-01

    Traditional imaging modalities such as computed tomography, although perfectly adept at identifying and quantifying advanced calcification, cannot detect the early stages of this disorder and offer limited insight into the mechanisms of mineral dysregulation. This review presents optical molecular imaging as a promising tool that simultaneously detects pathobiological processes associated with inflammation and early stages of calcification in vivo at the (sub)cellular levels. Research into treatment of cardiovascular calcification is lacking, as shown by clinical trials that have failed to demonstrate the reduction of calcific aortic stenosis. Hence the need to elucidate the pathways that contribute to cardiovascular calcification and to develop new therapeutic strategies to prevent or reverse calcification has driven investigations into the use of molecular imaging. This review discusses studies that have used molecular imaging methods to advance knowledge of cardiovascular calcification, focusing in particular on the inflammation-dependent mechanisms of arterial and aortic valve calcification. PMID:21617135

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

    NASA Astrophysics Data System (ADS)

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

    1985-04-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    1985-01-01

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

  6. An uncommon case of isolated parachute-like asymmetric mitral valve in an adult.

    PubMed

    Mochizuki, Yasuhide; Tanaka, Hidekazu; Fukuda, Yuko; Hirata, Ken-Ichi

    2014-09-01

    A 31-year-old asymptomatic male was referred to hospital for an examination of right bundle brunch block. Both, transthoracic and transesophageal echocardiography revealed normal left ventricular function, and two different-sized papillary muscles; the anterolateral muscle was more pronounced, with almost major chordae tendineae inserted into this dominant muscle, whereas the immature, flat posteromedial papillary muscle had very short chordae tendineae and was located higher in the left ventricle, inserted directly into the mitral annulus. The mitral valve orifice was eccentrically located at the lateral side, but no significant mitral stenosis or regurgitation was observed. No other congenital heart anomalies were identified. Thus, the final diagnosis was isolated parachute-like asymmetric mitral valve (PLAMV), without any other congenital heart anomalies. The patient was followed up closely with periodic echocardiographic examinations. Parachute mitral valve is a rare congenital cardiac defect characterized by focalized attachment of the chordae tendineae of both leaflets to a single papillary muscle. In contrast to true parachute mitral valve, PLAMV has two separate papillary muscles, one of which is more pronounced and into which all chordae are inserted. PLAMV was highly associated with other congenital heart anomalies, and the involved dominant muscle was most frequently a posteromedial papillary muscle. Isolated PLAMV in an adult is even more rare, while the presence of an immature posteromedial papillary muscle--as in the present case--is extremely rare. PMID:25799716

  7. Postoperative Migration of an Edwards-SAPIEN XT Mitral Valve-in-Valve Treated With Direct Vision Implantation During Beating-Heart Bypass.

    PubMed

    Mick, Stephanie L; Roselli, Eric E; Kapadia, Samir; Tuzcu, E Murat; Krishnaswamy, Amar; Svensson, Lars G

    2016-03-01

    Transcatheter valve-in-valve mitral valve replacement provides treatment options to high-risk patients but is subject to its own complications. We present the migration of a transcatheter balloon-expandable Edwards-SAPIEN XT valve (Edwards Lifesciences, Irvine, CA) within a previously implanted surgical Carpentier-Edwards valve (Edwards Lifesciences) and our novel approach to its treatment. PMID:26897205

  8. Recent data on mitral valve prolapse and magnesium deficit.

    PubMed

    Zeana, C D

    1988-12-01

    Idiopathic mitral valve prolapse (IMVP) is a widespread disease. IMVP may be latent, but most patients describe a great variety of symptoms. The clinical pictures of IMVP and of latent tetany are superimposed with regard to Mg deficit. IMVP appears as a late complication of latent tetany due to magnesium deficit (LTMD). The Mg deficit has various causes: insufficient Mg intake (especially during slimming diets), and depletion of Mg provoked by stress, coffee excess, corticosteroids or catecholamine excess. The high prevalence in women is mainly due to the ovarian hormones. Constitutional factors such as the HLA Bw35 antigen and the behavioural type A favour Mg depletion. The HLA-Bw35-positive individuals show a lower level of tissue Mg. In the development of the valvular lesion there are some other associated factors apart from Mg deficit which alter collagen metabolism: ascorbic acid deficit, febrile illnesses, corticosteroid excess. Symptomatology is dominated by the latent tetany syndrome. Palpitations and precordial pain are the most frequent cardiac symptoms. The click and mid-late systolic murmer do not appear in all IMVP cases. In clinical investigation the following tests are indispensable: echocardiogram, electrocardiogram, evaluation of plasma and erythrocyte Mg, calcaemia and calciuria. In particular cases more sophisticated studies are necessary. Therapy based on Mg should be applied consistently and for long periods of time. Mg therapy results in the control of latent tetany as well as in morphologic recovery. The administration of Mg in LT prevents the development of IMVP. PMID:3079420

  9. Computational mitral valve evaluation and potential clinical applications.

    PubMed

    Chandran, Krishnan B; Kim, Hyunggun

    2015-06-01

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

  10. A case of the Starr-Edwards ball valve (Model 6120) in the mitral position for 45years.

    PubMed

    Azuma, Shuhei; Morita, Masafumi; Yoshii, Yasuhiro; Mieno, Shigetoshi

    2015-02-01

    A 59-year-old male who had undergone mitral valve replacement with the Starr-Edwards ball valve Model 6120 (S-E ball valve) 45years ago was admitted to our hospital for hemolytic anemia and heart failure. Echocardiography revealed that there was no valve dysfunction but paravalvular leakage between the annulus of P2 and the sewing ring of the Starr-Edwards ball valve. He underwent mitral valve replacement. The S-E ball valve was successfully replaced with bileaflet mechanical valve. The explanted S-E ball valve was free from signs of structural valve degeneration. This case shows one of the longest durability of the S-E ball valve in mitral position in the world. PMID:23868200

  11. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    Lpez-Pardo, Francisco; Urbano-Moral, Jose Angel; Gonzlez-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; Lpez-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly. PMID:26096823

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

    PubMed Central

    2015-01-01

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

  13. CC-chemokine receptor 7 and its ligand CCL19 promote mitral valve interstitial cell migration and repair

    PubMed Central

    Wang, Xiaozhi; Wang, Liang; Miao, Liping; Zhao, Rong; Wu, Yanhu; Kong, Xiangqing

    2015-01-01

    Abstract The effect of CC-chemokine receptor 7 (CCR7) and CC-chemokine ligand 19 (CCL19) on rheumatic mitral stenosis is unknown. This study aimed to explore the roles of CCR7 and CCL19 in rheumatic mitral stenosis by measuring the expression of CCR7 and CCL19 in human mitral valves from rheumatic mitral stenosis patients. Additionally, we examined their effects on human mitral valve interstitial cells (hMVICs) proliferation, apoptosis and wound repair. CCR7 and CCL19 expression was measured in the mitral valves from rheumatic mitral stenosis patients (n?=?10) and compared to normal mitral valves (n?=?5). CCR7 was measured in cultured hMVICs from rheumatic mitral stenosis patients and normal donors by RT-PCR and immunofluorescence. The cells were also treated with exogenous CCL19, and the effects on wound healing, proliferation and apoptosis were assayed. In the rheumatic mitral valves, valve interstitial cells expressed CCR7, while mononuclear cells and the endothelium expressed CCL19. Healthy mitral valves did not stain positive for CCR7 or CCL19. CCR7 was also detected in cultured rheumatic hMVICs or in normal hMVICs treated with CCL19. In a wound healing experiment, wound closure rates of both rheumatic and normal hMVICs were significantly accelerated by CCL19. These effects were abrogated by a CCR7 neutralizing antibody. The CCR7/CCL19 axis did not influence the proliferation or apoptosis of hMVICs, indicating that wound healing was due to increased migration rates rather than increased proliferation. In conclusion, CCR7 and CCL19 were expressed in rheumatic mitral valves. The CCR7/CCL19 axis may regulate remodeling of rheumatic valve injury through promoting migratory ability of hMVICs. PMID:26668580

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

    PubMed

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

    2006-12-01

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

  15. Myectomy as an alternative solution for systolic anterior motion in a patient who underwent mitral valve repair.

    PubMed

    Domoto, Satoru; Morita, Kozo; Koike, Hiroyuki; Iguchi, Atsushi; Uwabe, Kazuhiko; Niinami, Hiroshi

    2016-01-01

    Systolic anterior motion (SAM) of the mitral apparatus is a relatively frequent complication of mitral valve repair. When significant SAM persists despite intraoperative medical therapies, a second repair is generally required. We describe a rare case of SAM due to a hypertrophic septum in a patient who underwent mitral valve repair, with no preoperative obstruction of the left ventricular outflow tract. The present case of SAM was successfully treated only with transaortic septal myectomy. Therefore, myectomy might be considered as an alternative solution for SAM that is suspected to be caused by a hypertrophic septum after mitral valve repair. PMID:24297768

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

    PubMed Central

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

    2015-01-01

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

  17. Side-Specific Endothelial-Dependent Regulation of Aortic Valve Calcification

    PubMed Central

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

    2014-01-01

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

  18. Asymptotic Model of Fluid-Tissue Interaction for Mitral Valve Dynamics.

    PubMed

    Domenichini, Federico; Pedrizzetti, Gianni

    2015-06-01

    The vortex formation process inside the left ventricle is intrinsically connected to the dynamics of the mitral leaflets while they interact with the flow crossing the valve during diastole. The description of the dynamics of a natural mitral valve still represents a challenging issue, especially because its material properties are not measurable in vivo. Medical imaging can provide some indications about the geometry of the valve, but not about its mechanical properties. In this work, we introduce a parametric model of the mitral valve geometry, whose motion is described in the asymptotic limit under the assumption that it moves with the flow, without any additional resistance other than that given by its shape, and without the need to specify its material properties. The mitral valve model is coupled with a simple description of the left ventricle geometry, and their dynamics is solved numerically together with the equations ruling the blood flow. The intra-ventricular flow is analyzed in its relationship with the valvular motion. It is found that the initial valve opening anticipates the peak velocity of the Early filling wave with little influence of the specific geometry; while subsequent closure and re-opening are more dependent on the intraventricular vortex dynamics and thus on the leaflets' geometry itself. The limitations and potential applications of the proposed model are discussed. PMID:26577230

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

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

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

  20. [Left atrium thrombus after mitral valve replacement presented with syncope; report of a case].

    PubMed

    Kehara, Hiromu; Takano, Tamaki; Fujii, Taishi; Yamamoto, Takateru; Nakahara, Ko; Komatsu, Kazunori; Ohtsu, Yoshinori; Terasaki, Takamitsu; Wada, Yuko; Seto, Tatsuichirou; Fukui, Daisuke; Amano, Jun

    2014-12-01

    Left atrial free ball thrombus (LABT) after mitral valve replacement (MVR) is very rare, and sudden death may occur by thrombus impaction to the mitral valve orifice. A 81-year-old woman who underwent MVR and tricuspid annuloplasty ten years ago presented with syncope. She was admitted to a hospital, and echocardiography revealed a LABT. When she took sitting position, she fainted. The free ball thrombus possibly impacted mitral valve orifice. She was transferred to our hospital and an emergent operation was performed. There was a LABT of 4 cm in diameter, which was removed. Postoperative course was uneventful. There are 12case reports which described LABT after MVR, and anticoagulant therapy was insufficient in most of those cases. Strict anticoagulant therapy is important to prevent left atrial thrombus after MVR. PMID:25434546

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

    PubMed

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

    2015-04-01

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

  2. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement.

    PubMed

    Inoue, Takahiro; Hashimoto, Kazuhiro; Sakamoto, Yoshimasa; Nagahori, Ryuichi; Yoshitake, Michio; Matsumura, Yoko; Takagi, Tomomitsu; Kinami, Hiroo

    2014-09-16

    Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings. PMID:25224154

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

    PubMed Central

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

    2013-01-01

    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

  4. Percutaneous Transvenous Mitral Commissurotomy for Post-Surgical Mitral Restenosis: Acute Outcome and Analysis of Factors Influencing Results.

    PubMed

    Chandrasekar; Abraham; Rajagopal; Somanath; Sudarsana

    1998-05-01

    The present study examined the utility of percutaneous transvenous mitral commissurotomy (PTMC) for post-surgical mitral restenosis (Group I, n = 71 patients), and the factors influencing the outcome of the procedure. The results of PTMC were also compared with a group of patients (Group II, n = 70 patients), who underwent PTMC for de novo mitral stenosis. Both the groups were matched for age, pre-procedure mitral valve area and echocardiographic score. PTMC was successful in 60 patients (85%) in group I and in 68 patients (97%) in group II (p < 0.05). However, the final mitral valve area achieved was similar between the two groups (1.8 +/- 0.3 vs. 1.9 +/- 0.2 sq.cm, p = NS). Patients in group I had significantly greater mitral valve calcification (0.6 +/- 0.8 vs. 0.3 +/- 0.6, p < 0.05). Multiple regression analysis of results in patients with post-surgical restenosis revealed that only basal mean pulmonary artery pressure and basal cardiac index correlated significantly with increase in valve area. Mitral valve leaflet mobility, thickness and subvalvular deformity did not correlate significantly with the increase in mitral valve area. CONCLUSION: PTMC is a safe procedure for post-surgical mitral restenosis with negligible complication, with a higher success and significantly lower complication rate than that reported for repeat surgical commissurotomy. Although patients with surgical restenosis had a greater degree of calcification of mitral valve leaflets; only basal mean pulmonary artery pressure and cardiac index significantly influenced the increase in mitral valve area. Increased fibrosis of mitral leaflet following surgery probably adversely influences the results of PTMC for post-surgical mitral restenosis. PMID:10973342

  5. Transesophageal echocardiographic imaging of multiple complications following mitral valve replacement

    PubMed Central

    Brassard, Charles L; Viens, Claudia; Denault, André

    2015-01-01

    Summary We present a case of mitral valve (MV) replacement that resulted in multiple complications, as diagnosed by transesophageal echocardiography (TEE), including left ventricular outflow tract obstruction, aortic dissection and left ventricular rupture. We also describe that identification of bleeding originating from the posterior aspect of the heart by the surgical team should trigger a complete TEE evaluation for adequate diagnosis. An 84-year-old woman underwent a MV replacement. Weaning from cardiopulmonary bypass (CPB) revealed a late-peaking gradient of 44 mmHg over the left ventricular outflow tract caused by obstruction from a bioprosthetic strut. After proper surgical correction, TEE evaluation showed a type A aortic dissection that was subsequently repaired. After separation from CPB, the surgical team identified a major bleed that originated from the posterior aspect of the heart. Although the initial suspicion was injury to the atrioventricular groove, a complete TEE evaluation confirmed a left ventricular free wall rupture by showing the dissecting jet using colour-flow Doppler. TEE is an essential component in cardiac surgery for assessment of surgical repair and potential complications. Posterior bleeding should trigger a complete TEE examination with assessment of nearby structures to rule out a life-threatening pathology. Left ventricular free wall rupture can be identified using colour-flow Doppler. Learning points Multiple complications may occur after MVR.TEE is an essential component in the evaluation of surgical repair and its potential associated complications, including LVOT obstruction, aortic dissection and LV rupture.Posterior bleeding, from the region of AV groove, should trigger a complete TEE examination with assessment of nearby structures such as the atria, coronary sinus and myocardium to rule out a life threatening pathology.The diagnosis of a LV rupture can be confirmed with 2-D imaging and colour-flow Doppler demonstrating a dissecting jet through the myocardium. PMID:26796436

  6. [Mitral valve prolapse: do rhythm disorders have an electrophysiologic substratum?].

    PubMed

    Levy, S; Blanc, A; Clementy, J; Dallocchio, M; Bricaud, H

    1982-06-01

    The mechanism of arrhythmias in mitral valve prolapse (MVP) is still unclear. The aim of this study was to determine if there were electrophysiological features common to patients with MVP. Eighteen patients with MVP documented on echo and angiocardiography underwent electrophysiological investigation. The series comprised 5 patients with ventricular arrhythmias and 5 with supraventricular arrhythmias, two of whom had ECG appearances of the Wolff-Parkinson-White, syndrome, and one a short PR interval. The RR interval, PR interval, intraatrial conduction (PA), atrio-hisian conduction (AH), intraventricular conduction (HV) the effective refractory periods of the atrium, AV node and ventricle, and the corrected sinus node recovery time were measured in the MVP group and in 20 presumed normal control subjects. There was a significant increase in the PR interval (p less than 0,05) at the expense of nodal conduction (AH) in the MVP group. In addition the Wenckebach point was significantly lower in this group. The other electrophysiological parameters in spontaneous rhythm and the atrial, AV nodal and ventricular refractory periods were the same in both groups. Sinus node function was comparable in both groups. In two patients without paiviously documented tachycardia, junctional tachycardia was initiated by provocative stimulation. However, no ventricular arrhythmias could be induced by pacing. A large number of preexcitation syndromes was observed in the MVP group (4/18), including one case of a latent Kent bundle, in patients with paroxysmal supraventricular tachycardias. On the other hand, the value of electrophysiological investigation seems to be limited for clarifying the mechanisms of the ventricular arrhythmias, probably because of their endomyocardial origin. Nevertheless, hemodynamic investigation showed abnormalities of left ventricular contraction in 4 of the 5 patients with ventricular arrhythmias. PMID:6810796

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

    PubMed

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

    2015-02-01

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

  8. [Incidence and relevance of tricuspid-valve insufficiency in acquired mitral-valve defect. Analysis based on right ventricular angiograms].

    PubMed

    Simon, R; Lichtlen, P

    1976-08-01

    To detect tricuspid incompetence (TI) right ventricular angiography was performed in 167 patients suffering from moderate to severe mitral valve disease. Holosystolic reflux of contrast medium to the right atrium through the central part of the tricuspid valve was thought to represent true TI, whereas a jet of contrast medium following the injection catheter and originating from the region of its valve passage was assumed to reflect arteficial regurgitation. True TI was found in 35% of the total group (30% mild to moderate, 5% severe TI). TI was often accompanied by atrial fibrillation (91%), pulmonary hypertension (74%) and reduced contraction of the tricuspid annulus (55%). Since tricuspid regurgitation in mitral valve disease commonly represents "functional" incompetence surgical intervention may be recommandable only in case of severe TI or concomitant valvular stenosis. PMID:1086005

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

    PubMed Central

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

    2012-01-01

    Aims We hypothesized that the structure and function of the mature valves is largely dependent upon how these tissues are built during development, and defects in how the valves are built can lead to the pathological progression of a disease phenotype. Thus, we sought to uncover potential developmental origins and mechanistic underpinnings causal to myxomatous mitral valve disease. We focus on how filamin-A, a cytoskeletal binding protein with strong links to human myxomatous valve disease, can function as a regulatory interface to control proper mitral valve development. Methods and results Filamin-A-deficient mice exhibit abnormally enlarged mitral valves during foetal life, which progresses to a myxomatous phenotype by 2 months of age. Through expression studies, in silico modelling, 3D morphometry, biochemical studies, and 3D matrix assays, we demonstrate that the inception of the valve disease occurs during foetal life and can be attributed, in part, to a deficiency of interstitial cells to efficiently organize the extracellular matrix (ECM). This ECM organization during foetal valve gestation is due, in part, to molecular interactions between filamin-A, serotonin, and the cross-linking enzyme, transglutaminase-2 (TG2). Pharmacological and genetic perturbations that inhibit serotonin-TG2-filamin-A interactions lead to impaired ECM remodelling and engender progression to a myxomatous valve phenotype. Conclusions These findings illustrate a molecular mechanism by which valve interstitial cells, through a serotonin, TG, and filamin-A pathway, regulate matrix organization during foetal valve development. Additionally, these data indicate that disrupting key regulatory interactions during valve development can set the stage for the generation of postnatal myxomatous valve disease. PMID:22843703

  10. [Cardiac Amyloidosis Diagnosed Following Mitral Valve Repair; Report of a Case].

    PubMed

    Yoshitake, Shuichiro; Katayama, Yuji; Fumoto, Hideyuki; Yamamoto, Hiroaki

    2015-11-01

    We present a case of a 60-year-old female who underwent elective mitral valve repair for mitral valve regurgitation. Intra-aortic balloon pumping was necessary to wean her from cardiopulmonary bypass, and a sudden cardiac arrest happened on postoperative day 17. Due to such unexpected postoperative course, a right ventricular biopsy was done, and she was diagnosed with light chain amyloidosis (AL) type cardiac amyloidosis. Despite long percutaneous cardiopulmonary bypass support, she never recovered from severe heart failure. Cardiac surgeons should be aware of this fatal disease, and preoperative screening with various tests is required. PMID:26555921

  11. Rapid occurrence of giant left ventricular pseudoaneurysm after mitral valve replacement.

    PubMed

    Rekik, Sofiene; Trabelsi, Imen; Charfeddine, Hanene; Krichene, Salma; Hentati, Mourad; Kammoun, Samir

    2008-11-01

    Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively. PMID:19004077

  12. A simple method of making artificial chordal loops for mitral valve repair.

    PubMed

    Cagli, Kerim

    2010-02-01

    Artificial chordal replacement with expanded polytetrafluoroethylene is an established technique for mitral valve repair. This report describes a simple technique of using Hegar dilators for making premeasured artificial chordal loops, whether as a single set of loops or as two connected sets of loops arising from the same stem. This technique uses a simple and widely available tool, the Hegar dilator, for preparation of chordal loops and further establishes the repair of opposing two segments of mitral valve by securing only one stem of the neochordae to the papillary muscle. PMID:20103293

  13. Giant left Atrial Myxoma Induces Mitral Valve Obstruction and Pulmonary Hypertension

    PubMed Central

    Mashhadi, Mahpaekar; Peter, Sanjeeth

    2016-01-01

    Atrial myxomas are the commonest benign primary tumours of the heart. They are generally 2 to 6 cm in size. Depending on their size and site may result in mitral valve obstruction which may lead to pulmonary hypertension. Clinical symptoms may suggest the presence of a myxoma but echocardiography is the mainstay of diagnosis and confirmation is by histopathology. A well-formed, organized thrombus is a common differential. The report of an unusually large left atrial myxoma that occurred in a 54-year-old male causing mitral valve obstruction and pulmonary hypertension is presented here. PMID:26894077

  14. Aortic valve calcification in 499 consecutive patients referred for computed tomography

    PubMed Central

    Hryniewiecki, Tomasz; Micha?owska, Ilona; K?pka, Cezary; Abramczuk, El?bieta; Or?owska-Baranowska, Ewa; Ru?y??o, Witold

    2015-01-01

    Introduction Aortic valve calcification (AVC) is the most common cause of aortic stenosis. The aim of the study was to assess the prevalence of aortic valve, coronary artery and aortic calcifications and to evaluate the correlation between calcification of the aortic valve, coronary arteries and aorta. Material and methods The study included 499 patients aged 60 years and over who underwent coronary computed tomography because of chest pain. Beside coronary artery calcium score (CAC), we evaluated AVC and ascending aorta calcifications (AAC). Results Aortic valve calcification was found in 144 subjects (28.9% of the whole study population). Prevalence of CAC and AAC was higher than AVC and amounted to 73.8% and 54.0%. Prevalence of AVC, CAC and AAC was significantly lower in the group of patients ? 70 years than in the group of patients > 70 years of age (p = 0.0002, p < 0.0001, p < 0.0001). Aortic valve calcification was more often observed in men than women (34.7% vs. 25.4%, p = 0.02). Degree of aortic valve calcification was also significantly higher among men than women (median score 4 vs. 0, p = 0.01). Similar observations were true for CAC and AAC, where both prevalence and degree of calcification was higher among men than women. In the whole study population no correlation was noted between AVC and CAC or AAC (p = 0.34, p = 0.85). There was a significant correlation between AAC and CAC (p < 0.0001). Conclusions Despite some similarities in pathological mechanism and risk factors, a degenerative defect of the aortic valve could be independent of atheromatous lesions in the coronary arteries and aorta. PMID:26528335

  15. HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDIES OF ATHEROSCLEROTIC AND SENILE CALCIFIC AORTIC VALVE STENOSIS.

    PubMed

    Saladze, T; Gogiashvili, L; Tsagareli, Z; Bakhutashvili, Z; Kavtaradze, T

    2015-01-01

    THE GOAL OF THIS STUDY: description of morphogenesis aortic valve stenosis in the senile and vice atherosclerotic aortic valve and definition inflammatory processes in them, improving pathology-anatomic diagnostic, macro- and microscopic examination of the stage of development of atherosclerotic plaques in the operating material fragments of aortic valve on the basis of morphological (histochemical and immunohistochemical studies by using markers CD31, VEGF) and idiopathic characteristics of atherosclerotic plaques, the differential diagnosis of the degree of calcification of the aortic valve in the atherogenic and idiopathic aortic stenosis. Calcification in senile aortic stenosis is characterized by three main parameters: infiltration of inflammatory cells, while senile origin stenosis observed the potential growth of angiogenesis. In endothelial walls of the aortic valve imunnhistochemicaly revealed high expression of endothelial and panendothelial growth factors. We have investigated aortic valve leaflets which were obtained from patients undergoing aortic valve replacement. Total 65 Patients (there age were from 54-84 year), 35 male and 30 female. The results indicate that senile lesion of aortic valve leaflets have several features including: sclera-fibrosis, inflammatory cell infiltration, new vessels formation and calcification which also are present in clinically stenotic valves cased by atherosclerosis. As a result of overlap clinical factors within atherosclerosis and senile calcific disease may be determined such as factors contributing progress of obstruction and vice versa, morphological pre-conditions for occlusion of thrombosis and blood vessels that will become significant part of strategy on treatment of wall structure stability and post-operation treatment. PMID:26177142

  16. Percutaneous Transcatheter Mitral Valve Replacement: Patient-specific Three-dimensional Computer-based Heart Model and Prototyping.

    PubMed

    Vaquerizo, Beatriz; Theriault-Lauzier, Pascal; Piazza, Nicolo

    2015-12-01

    Mitral regurgitation is the most prevalent valvular heart disease worldwide. Despite the widespread availability of curative surgical intervention, a considerable proportion of patients with severe mitral regurgitation are not referred for treatment, largely due to the presence of left ventricular dysfunction, advanced age, and comorbid illnesses. Transcatheter mitral valve replacement is a promising therapeutic alternative to traditional surgical valve replacement. The complex anatomical and pathophysiological nature of the mitral valvular complex, however, presents significant challenges to the successful design and implementation of novel transcatheter mitral replacement devices. Patient-specific 3-dimensional computer-based models enable accurate assessment of the mitral valve anatomy and preprocedural simulations for transcatheter therapies. Such information may help refine the design features of novel transcatheter mitral devices and enhance procedural planning. Herein, we describe a novel medical image-based processing tool that facilitates accurate, noninvasive assessment of the mitral valvular complex, by creating precise three-dimensional heart models. The 3-dimensional computer reconstructions are then converted to a physical model using 3-dimensional printing technology, thereby enabling patient-specific assessment of the interaction between device and patient. It may provide new opportunities for a better understanding of the mitral anatomy-pathophysiology-device interaction, which is of critical importance for the advancement of transcatheter mitral valve replacement. PMID:26607029

  17. Mitral valve repair using ePTFE sutures for ruptured mitral chordae tendineae: a computational simulation study.

    PubMed

    Rim, Yonghoon; Laing, Susan T; McPherson, David D; Kim, Hyunggun

    2014-01-01

    Mitral valve (MV) repair using expanded polytetrafluoroethylene sutures is an established and preferred interventional method to resolve the complex pathophysiologic problems associated with chordal rupture. We developed a novel computational evaluation protocol to determine the effect of the artificial sutures on restoring MV function following valve repair. A virtual MV was created using three-dimensional echocardiographic data in a patient with ruptured mitral chordae tendineae (RMCT). Virtual repairs were designed by adding artificial sutures between the papillary muscles and the posterior leaflet where the native chordae were ruptured. Dynamic finite element simulations were performed to evaluate pre- and post-repair MV function. Abnormal posterior leaflet prolapse and mitral regurgitation was clearly demonstrated in the MV with ruptured chordae. Following virtual repair to reconstruct ruptured chordae, the severity of the posterior leaflet prolapse decreased and stress concentration was markedly reduced both in the leaflet tissue and the intact native chordae. Complete leaflet coaptation was restored when four or six sutures were utilized. Computational simulations provided quantitative information of functional improvement following MV repair. This novel simulation strategy may provide a powerful tool for evaluation and prediction of interventional treatment for RMCT. PMID:24072489

  18. Targeting the Papillary Muscles in Mitral Valve Repair for Ischemic Mitral Regurgitation.

    PubMed

    Mihos, Christos G; Pineda, Andres M; Santana, Orlando

    2015-01-01

    Ischemic mitral regurgitation due to left ventricular remodeling and leaflet tethering is associated with decreased survival, and the optimal management remains unknown. Restrictive mitral annuloplasty is the current treatment of choice, but it is associated with a 15% to 30% incidence of late recurrent mitral regurgitation, which confers a poor prognosis. A pathophysiology-guided approach to surgical repair is preferable, with a goal of alleviating leaflet tethering and restoring proper subvalvular mechanics. In patients with preoperative predictors of annuloplasty failure, combining a papillary muscle repositioning technique with conventional annuloplasty repair allows for complete geometric repair of the ventriculomitral unit. PMID:26451765

  19. A comparative study of the morphology of mammalian chordae tendineae of the mitral and tricuspid valves

    PubMed Central

    Hutchison, Jennifer; Rea, Paul

    2015-01-01

    It is assumed that the human heart is almost identical to domestic mammalian species, but with limited literature to support this. One such area that has been underinvestigated is that of the subvalvular apparatus level. The authors set out to examine the morphology of the subvalvular apparatus of the mammalian atrioventricular valves through gross dissection and microscopic analysis in a small-scale pilot study. The authors examined the chordae tendineae of the mitral and tricuspid valves in sheep, pig and bovine hearts, comparing the numbers of each of these structures within and between species. It was found that the number of chordae was up to twice as many for the tricuspid valve compared with the mitral valve. The counts for the chordae on the three valve leaflets of the tricuspid valve, as well as the two mitral valve leaflets, were almost identical between species. However, the chordae attaching onto the posterior papillary muscle were almost double compared with the septal and anterior papillary muscles. Histological analysis demonstrated an abrupt transitional zone. In conclusion, the authors have shown that there is no gross morphological difference between, or within, these species at the subvalvular apparatus level. PMID:26644912

  20. Reduced Sox9 function promotes heart valve calcification phenotypes in vivo

    PubMed Central

    Peacock, Jacqueline D; Levay, Agata K; Gillaspie, Devin B; Tao, Ge; Lincoln, Joy

    2010-01-01

    Rationale Calcification of heart valve structures is the most common form of valvular disease and is characterized by the appearance of bone-like phenotypes within affected structures. Despite the clinical significance, the underlying etiology of disease onset and progression is largely unknown and valve replacement remains the most effective treatment. The SRY-related transcription factor Sox9 is expressed in developing and mature heart valves, and its function is required for expression of cartilage-associated proteins, similar to its role in chondrogenesis. In addition to cartilage-associated defects, mice with reduced sox9 function develop skeletal bone prematurely, however the ability of sox9 deficiency to promote ectopic osteogenic phenotypes in heart valves has not been examined. Objective This study aims to determine the role of Sox9 in maintaining connective tissue homeostasis in mature heart valves using in vivo and in vitro approaches. Methods and Results Using histological and molecular analyses we report that Sox9fl/+;Col2a1-cre mice develop calcific lesions in heart valve leaflets from 3 months of age associated with increased expression of bone-related genes and activation of inflammation and matrix remodeling processes. Consistently, ectopic calcification is also observed following direct knockdown of Sox9 in heart valves in vitro. Further, we show that retinoic acid treatment in mature heart valves is sufficient to promote calcific processes in vitro, which can be attenuated by Sox9 overexpression. Conclusions This study provides insights into the molecular mechanisms of heart valve calcification and identifies reduced Sox9 function as a potential genetic basis for calcific valvular disease. PMID:20056916

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

    PubMed

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

    2011-12-01

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

  2. Changes in Left Ventricular Morphology and Function After Mitral Valve Surgery

    PubMed Central

    Shafii, Alexis E.; Gillinov, A. Marc; Mihaljevic, Tomislav; Stewart, William; Batizy, Lillian H.; Blackstone, Eugene H.

    2015-01-01

    Degenerative mitral valve disease is the leading cause of mitral regurgitation in North America. Surgical intervention has hinged on symptoms and ventricular changes that develop as compensatory ventricular remodeling takes place. In this study, we sought to characterize the temporal response of left ventricular (LV) morphology and function to mitral valve surgery for degenerative disease, and identify preoperative factors that influence reverse remodeling. From 19862007, 2,778 patients with isolated degenerative mitral valve disease underwent valve repair (n=2,607/94%) or replacement (n=171/6%) and had at least 1 postoperative transthoracic echocardiogram (TTE); 5,336 TTEs were available for analysis. Multivariable longitudinal repeated-measures analysis was performed to identify factors associated with reverse remodeling. LV dimensions decreased in the first year after surgery (end-diastolic from 5.70.80 to 4.91.4 cm; end-systolic from 3.40.71 to 3.11.4 cm). LV mass index decreased from 13944 to 11273 gm?2. Reduction of LV hypertrophy was less pronounced in patients with greater preoperative left heart enlargement (P<.0001) and greater preoperative LV mass (P<.0001). Postoperative LV ejection fraction initially decreased from 587.0 to 5320, increased slightly over the first postoperative year, and was negatively influenced by preoperative heart failure symptoms (P<.0001) and lower preoperative LV ejection fraction (P<.0001). Risk-adjusted response of LV morphology and function to valve repair and replacement was similar (P>.2). In conclusion, a positive response toward normalization of LV morphology and function after mitral valve surgery is greatest in the first year. The best response occurs when surgery is performed before left heart dilatation, LV hypertrophy, or LV dysfunction develop. PMID:22534055

  3. In Vivo Dynamic Deformation of the Mitral Valve Annulus

    PubMed Central

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

    2010-01-01

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

  4. In vivo dynamic deformation of the mitral valve annulus.

    PubMed

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

    2009-09-01

    Though mitral valve (MV) repair surgical procedures have increased in the United States [Gammie, J. S., et al. Ann. Thorac. Surg. 87(5):1431-1437, 2009; Nowicki, E. R., et al. Am. Heart J. 145(6):1058-1062, 2003], studies suggest that altering MV stress states may have an effect on tissue homeostasis, which could impact the long-term outcome [Accola, K. D., et al. Ann. Thorac. Surg. 79(4):1276-1283, 2005; Fasol, R., et al. Ann. Thorac. Surg. 77(6):1985-1988, 2004; Flameng, W., P. Herijgers, and K. Bogaerts. Circulation 107(12):1609-1613, 2003; Gillinov, A. M., et al. Ann. Thorac. Surg. 69(3):717-721, 2000]. Improved computational modeling that incorporates structural and geometrical data as well as cellular components has the potential to predict such changes; however, the absence of important boundary condition information limits current efforts. In this study, novel high definition in vivo annular kinematic data collected from surgically implanted sonocrystals in sheep was fit to a contiguous 3D spline based on quintic-order hermite shape functions with C(2) continuity. From the interpolated displacements, the annular axial strain and strain rate, bending, and twist along the entire annulus were calculated over the cardiac cycle. Axial strain was shown to be regionally and temporally variant with minimum and maximum values of -10 and 4%, respectively, observed. Similarly, regionally and temporally variant strain rate values, up to 100%/s contraction and 120%/s elongation, were observed. Both annular bend and twist data showed little deviation from unity with limited regional variations, indicating that most of the energy for deformation was associated with annular axial strain. The regionally and temporally variant strain/strain rate behavior of the annulus are related to the varied fibrous-muscle structure and contractile behavior of the annulus and surrounding ventricular structures, although specific details are still unavailable. With the high resolution shape and displacement information described in this work, high fidelity boundary conditions can be prescribed in future MV finite element models, leading to new insights into MV function and strategies for repair. PMID:19585241

  5. An improved method for determining the flow characteristics of prosthetic mitral heart valves

    PubMed Central

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

    1971-01-01

    The flow characteristics of most prosthetic mitral valves recommended for clinical use have not been adequately investigated. As a result vital information about their performance is lacking and, until this is published, comparisons between different prostheses cannot easily be made. In this paper the design and construction of a suitable rig for the testing of such valves is described. The results obtained will be presented in a subsequent paper. Images PMID:5543821

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

    SciTech Connect

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

    1986-01-01

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

  7. Could anterior papillary muscle partial necrosis explain early mitral valve repair failure?

    PubMed

    Pozzi, Matteo; Generali, Tommaso; Henaine, Roland; Mitchell, Julia; Lemaire, Anais; Chiari, Pascal; Fran, Jean; Obadia, Jean Franois

    2014-09-01

    Standardized techniques of mitral valve repair (MVR) have recently witnessed the introduction of a 'respect rather than resect' concept, the strategy of which involves the use of artificial chordae. MVR displays several advantages over mitral valve replacement in degenerative mitral regurgitation (MR), but the risk of reoperation for MVR failure must be taken into account. Different mechanisms could be advocated as the leading cause of MVR failure; procedure-related mechanisms are usually involved in early MVR failure, while valve-related mechanisms are common in late failure. Here, the case is reported of an early failure of MVR using artificial chordae that could be explained by an unusual procedure-related mechanism, namely anterior papillary muscle necrosis. MVR failure is a well-known complication after surgical repair of degenerative MR, but anterior papillary muscle partial necrosis might also be considered a possible mechanism of procedure-related MVR failure, especially when considering the increasing use of artificial chordae. Owing to the encouraging results obtained, mitral valve re-repair might be considered a viable solution, but must be selected after only a meticulous evaluation of the underlying mechanism of MVR failure. PMID:25799709

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

    PubMed Central

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

    1993-01-01

    OBJECTIVES--To determine whether biplane transoesophageal imaging offers advantages in the evaluation of mitral prostheses when compared with standard single transverse plane imaging or the precordial approach in suspected prosthetic dysfunction. DESIGN--Prospective mitral valve prosthesis in situ using precordial and biplane transoesophageal ultrasonography. SETTING--Tertiary cardiac referral centre. SUBJECTS--67 consecutive patients with suspected dysfunction of a mitral valve prosthesis (16 had bioprostheses and 51 mechanical prostheses) who underwent precordial, transverse plane, and biplane transoesophageal echocardiography. Correlative invasive confirmation from surgery or angiography, or both, was available in 44 patients. MAIN OUTCOME MEASURES--Number, type, and site of leak according to the three means of scanning. RESULTS--Transverse plane transoesophageal imaging alone identified all 31 medial/lateral paravalvar leaks but only 24/30 of the anterior/posterior leaks. Combining the information from both imaging planes confirmed that biplane scanning identified all paravalvar leaks. Five of the six patients with prosthetic valve endocarditis, all three with valvar thrombus or obstruction, and all three with mitral annulus rupture were diagnosed from transverse plane imaging alone. Longitudinal plane imaging alone enabled diagnosis of the remaining case of prosthetic endocarditis and a further case of subvalvar pannus formation. CONCLUSIONS--Transverse plane transoesophageal imaging was superior to the longitudinal imaging in identifying medial and lateral lesions around the sewing ring of a mitral valve prosthesis. Longitudinal plane imaging was superior in identifying anterior and posterior lesions. Biplane imaging is therefore an important development in the study of mitral prosthesis function. Images PMID:8398497

  9. Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study.

    PubMed Central

    Manning, W J; Reis, G J; Douglas, P S

    1992-01-01

    OBJECTIVE--Systemic emboli related to atrial thrombi are a well known complication of percutaneous balloon dilatation of the mitral valve. The presence of left atrial thrombi therefore, is believed to be a contraindication to balloon dilatation. The purpose of this study was to determine the frequency of left atrial thrombi in patients referred for balloon dilatation of the mitral valve, the added benefit of pre-procedural transoesophageal echocardiography, and to identify factors that predicted left atrial thrombi. DESIGN--Prospective study over a 14 month period of 20 consecutive patients by cross sectional transthoracic echocardiography 24-48 hours before balloon dilatation of the mitral valve and by transoesophageal echocardiography immediately before the procedure. RESULTS--One patient had a left atrial thrombus detected by transthoracic study. Two patients (10%) had left atrial thrombi identified by transoesophageal echocardiography. In both valve dilatation was not attempted and the thrombi were confirmed at surgery. The remaining 18 patients all underwent successful balloon dilatation of the mitral valve without clinical evidence of an embolic event. No association was found between patient age, mitral valve area, transmitral gradient, left atrial size, presence of atrial fibrillation, severity of mitral regurgitation, cardiac output, or the presence of left atrial swirling and an increased prevalence of atrial thrombi. CONCLUSION--Left atrial thrombi are often seen despite long term systemic anticoagulation in patients referred for balloon dilatation of the mitral valve. The frequency of unsuspected left atrial thrombi detected by transoesophageal echocardiography was similar to the reported frequency of embolic events after balloon dilatation of the mitral valve. Transoesophageal echocardiography for the identification of left atrial thrombi is strongly recommended in all patients before balloon dilatation of the mitral valve including those treated with systemic anticoagulation and those who have had a normal transthoracic echocardiographic study. Images PMID:1540437

  10. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: A consensus document from the Mitral Valve Academic Research Consortium.

    PubMed

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

    2015-08-01

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of trans- catheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26170468

  11. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part2: Endpoint Definitions: A Consensus Document From the Mitral Valve Academic Research Consortium.

    PubMed

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

    2015-07-21

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

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

    PubMed

    Adams, John; O'Rourke, Malachy J

    2015-07-01

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

  13. Hemodynamic rounds series: Left heart catheterization and mitral balloon valvuloplasty in a patient with a mechanical aortic valve.

    PubMed

    Kosmicki, Douglas; Michaels, Andrew D

    2008-02-15

    Patients with rheumatic heart disease and a history of mechanical aortic valve replacement will occasionally present with significant mitral stenosis for consideration of mitral balloon valvuloplasty. The conventional retrograde trans-aortic method for left heart catheterization cannot be done for patients with a mechanical aortic valve. We present a patient with a mechanical aortic valve who underwent successful left heart catheterization and mitral valvuloplasty via a transseptal approach. A 5 French pigtail catheter was advanced through the left atrial 8 French Mullins sheath into the left ventricle, for simultaneous pressure measurement across the mitral valve. This manuscript discusses the strengths and weaknesses of several approaches for left heart catheterization in patients with a mechanical aortic valve. PMID:18288758

  14. Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair.

    PubMed

    Taguchi, Takahiro; Dillon, Jeswant; Yakub, Mohd Azhari

    2016-01-01

    A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting. PMID:26913683

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  16. [The meaning of the systolic progression of the mitral valve for the outflow tract obstruction in hypertrophic obstructive cardiomyopathy (HOCM). Studies by means of a valve model].

    PubMed

    Lemke, R; Kaltenbach, M

    1979-10-01

    We constructed two valve models in order to investigate the cause of SAM of the mitral valve and the cause of the outflow tract obstruction in HOCM. With model 1 we were able to demonstrate that a subvalvular obstruction created a SAM of the mitral valve, there was also a pressure gradient distal to the obstruction, the valve itself did not create any obstruction. With model 2 we demonstrated that three causes were responsible for an outflow tract obstruction: 1. A narrow outflow tract even after removal of the mitral valve. 2. A position of the mitral valve close to a protruding septum and relatively short chordae tendineae. 3. A SAM of the mitral valve with apposition to the septum due to a Venturi effect. We were able to create a typical bisferiens poststenotic pressure curve in presence of a monophasic prestenotic curve. We conclude from our investigation that for the SAM of the mitral valve as well as for the outflow tract obstruction different anatomic structures may be responsible, which cause simular hemodynamic abnormalities. These abnormalities are most prominent in HOCM but not necessarily linked with this disease. PMID:574690

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

    NASA Astrophysics Data System (ADS)

    Ohri, Rachit

    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.

  18. [Caseous calcification of the mitral annulus, variable and revealing clinical picture, and the contribution of cardiac tomodensitometry to the diagnosis: report of two cases].

    PubMed

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

    2014-04-01

    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

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

    PubMed Central

    2010-01-01

    Myxomatous mitral regurgitation (type II Carpentier's functional classification) affects about 1-2% of the population. This represents a very common indication for valve surgery resulting in a low percentage of repairs compared to replacement which is actually performed. In the last decades, several methods for mitral valve repair have been developed, to make the surgical feasibility easier, improve the long-term follow-up thus avoiding the need for reoperations. A very interesting method is represented by the combination of various valve repair techniques, depending on the involvement of the anterior, posterior, or both leaflets, and the use of PTFE artificial chordae tendineae when excessive chordal elongation or rupture due to myxomatous degeneration co-exists. The aim of this review is to summarize the evolution of these techniques from the beginning till now. PMID:20377866

  20. A Case of Idiopathic Hypereosinophilic Syndrome Causing Mitral Valve Papillary Muscle Rupture

    PubMed Central

    Tamse, Tiffany; Rampersad, Avind; Jordan-Villegas, Alejandro; Ireland, Jill

    2015-01-01

    Idiopathic Hypereosinophilic Syndrome (IHES) is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO) as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses. PMID:26640733

  1. A Case of Idiopathic Hypereosinophilic Syndrome Causing Mitral Valve Papillary Muscle Rupture.

    PubMed

    Tamse, Tiffany; Rampersad, Avind; Jordan-Villegas, Alejandro; Ireland, Jill

    2015-01-01

    Idiopathic Hypereosinophilic Syndrome (IHES) is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO) as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses. PMID:26640733

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

    PubMed Central

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

    2013-01-01

    In certain populations, open heart surgery to replace a diseased mitral valve is not an option, leaving percutaneous delivery a viable alternative. However, a surgical transcatheter based delivery of a metallic support frame incorporating a tissue derived valve puts considerable constraints on device specifications. Expansion to a large diameter from the catheter diameter without mechanical fracture involves advanced device design and appropriate material processing and selection. In this study, a new frame concept is presented with a desirable feature that incorporates wings that protrude during expansion to establish adequate fixation. Expansion characteristics of the design in relation to annulus fixation were quantified through finite element analysis predictions of the frame wing span and angles. Computational modeling and simulation was used to identify many favorable design features for the transcatheter mitral valve frame and obtain desired expansion diameters (3545mm), acceptable radial stiffness (2.7N/mm), and ensure limited risk of failure based on predicted plastic deformations. PMID:23372624

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

    PubMed

    Sadowski, Jerzy; Myrdko, Tomasz; Sniezek-Maciejewska, Maria; Rudziński, Paweł; Traczyński, Marek

    2003-01-01

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

  4. Early failures of Ionescu-Shiley bioprosthesis after mitral valve replacement in children.

    PubMed

    Galioto, F m; Midgley, F M; Kapur, S; Perry, L W; Watson, D C; Shapiro, S R; Ruckman, R N; Scott, L P

    1982-02-01

    Two infants, 101/2 and 11 1/2 months of age, underwent mitral valve replacement with Ionescu-Shiley bovine bioprosthesis for congenital cardiac defects. Both patients had early valve failure, 19 months and 4 months after implantation, due to the growth of excessive collagen on the ventricular surface of the bioprosthesis with adherence of the collagen primarily to the sewing rings and struts of the valves. The cause of this excessive collagen reaction is unknown. Further study is needed to document the true incidence of this problem. PMID:7057671

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

    PubMed Central

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

    1972-01-01

    One each of 17 commercially available prosthetic mitral valves has been subjected to in vitro testing using a pulse duplicator. Measurements of mean diastolic pressure difference, incompetence, dimensions, mechanical movements, and turbulence were made, and the quality of manufacture was examined. Although most valves would be effective in the treatment of incompetence, only those with large orifice diameters produced no significant stenosis. All the valves tested were in clinical use at some time in the period 1966-71. Most of the prostheses were obtained in 1968 or 1969. Many of this group showed a manufacturing standard which was less than impeccable. Images PMID:5039443

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

    PubMed

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

    2013-10-01

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

  7. Trileaflet Mitral Valve with Three Papillary Muscles Associated with Hypertrophic Cardiomyopathy: A Novel Case.

    PubMed

    Rosanio, Salvatore; Simonsen, Cameron J; Starwalt, John; Keylani, Abdul M; Vitarelli, Antonio

    2015-09-01

    Congenital mitral valve (MV) malformations are uncommon, except for MV prolapse. Despite their infrequency, most of them are well-known and defined entities, such as congenital MV stenosis with two papillary muscles, parachute MV, supravalvular mitral ring, hypoplastic MV, isolated cleft in the anterior and/or posterior leaflets, and double-orifice MV. A trileaflet MV with three separate papillary muscles with concordant atrioventricular and ventricle-arterial connections is exceptionally rare. To the best of the authors' knowledge, it has been reported only once in association with subaortic valvular stenosis. We hereby describe a novel case associated with hypertrophic cardiomyopathy. PMID:25809503

  8. Mitral valve endocarditis due to Abiotrophia defectiva in a 14th week pregnant woman.

    PubMed

    Botta, Luca; Merati, Roberto; Vignati, Gabriele; Orcese, Carlo Andrea; De Chiara, Benedetta; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale

    2016-01-01

    Infective endocarditis during pregnancy carries a high mortality risk, both for the mother and for the foetus and requires a multidisciplinary team in the management of complicated cases. We report our experience with a 39-year old patient, affected by an acute active mitral endocarditis due to Abiotrophia defectiva at the 14th gestational week, strongly motivated to continue the pregnancy. Our patient successfully underwent mitral valve replacement with a normothermic high-flow cardiopulmonary bypass under continuous intraoperative foetal monitoring. Caesarean section occurred at the 38th gestational week. The delivery was uneventful and both the mother and child are doing well at the 16-month follow-up. PMID:26487436

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  10. [Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

    PubMed

    Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants. PMID:26197828

  11. Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure: a case report

    PubMed Central

    2010-01-01

    Occurrence of bioprosthetic valve thrombosis less than a year after replacement is very uncommon. Here, we describe a case of a 57 year old male, who presented 10 months after receiving a bioprosthetic mitral valve replacement with a two week history of dyspnea on exertion, worsening orthopnea and decreased exercise tolerance. Echocardiography revealed severe mitral regurgitation (MR), thrombosis of the posterior mitral leaflet, left atrial (LA) mural thrombus and a depressed left ventricular ejection fraction of twenty-five percent. Given severe clot burden and decompensated heart failure (New York Heart Association - NYHA class III) repeat sternotomy was done to replace the bioprosthetic mitral valve and remove LA mural thrombus. MR was resolved postoperatively. This brief report further reviews promoting factors, established guidelines and management strategies of bioprosthetic valve thrombosis. PMID:20350310

  12. Calcific deposits developing in a bovine pericardial bioprosthetic valve 3 days after implantation.

    PubMed

    Ishihara, T; Ferrans, V J; Jones, M; Cabin, H S; Roberts, W C

    1981-03-01

    Calcific deposits, localized in a thin layer of thrombus covering the cuspal surfaces, were present 3 days after implantation in a valved pulmonic conduit that contained an Ionescu-Shiley bovine pericardial valve and was placed in a 29-year-old man with double outlet right ventricle, valvular and infundibular pulmonic stenosis, and ventricular septal defect. Factors that may have contributed to such a rapid calcification were the relatively young age of the patient, the development of acute renal insufficiency postoperatively, and the administration of large amounts of calcium chloride intravenously during blood transfusions and during episodes of cardiac arrest. PMID:7460257

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

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

    2010-01-01

    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 (14mm) 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] 1.132.69: p=0.011) and VD (adjusted HR 1.53; 95%CI 1.092.15: p=0.015), but not IS (adjusted HR 1.34; 95%CI 0.872.05: 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 1.133.17: p=0.008) and VD (adjusted HR 1.81: 95%CI 1.212.72: p=0.002), and showing borderline association with IS (adjusted HR 1.59: 95%CI 0.952.67: 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

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

    PubMed

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

    2015-06-01

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

  16. Conservative approach to mitral valve replacement in hypertrophic cardiomyopathy with systolic anterior motion – a case report

    PubMed Central

    Suder, Bogdan; Szymoński, Krzysztof; Wasilewski, Grzegorz; Sadowski, Jerzy; Kapelak, Boguslaw

    2015-01-01

    The authors report the case of a 60-year-old patient with hypertrophic cardiomyopathy (HCM), systolic anterior motion (SAM), and high gradient in the left ventricular outflow tract (LVOT) who underwent surgical treatment. During the surgery, myomectomy of the septum was performed using the Morrow method: despite the persisting SAM and increased LVOT gradients, the mitral valve was not replaced. The case study presents a conservative approach to mitral valve replacement during HCM surgery. PMID:26855652

  17. [Surgical techniques in mitral valve diseases : Reconstruction and/or replacement].

    PubMed

    Noack, T; Mohr, F-W

    2016-02-01

    Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients. PMID:26659846

  18. Papillary fibroelastoma of the mitral valve. A rare cause of embolic events.

    PubMed Central

    Colucci, V; Alberti, A; Bonacina, E; Gordini, V

    1995-01-01

    A 66-year-old woman was admitted to our department with an 11-month history of multiple transient ischemic attacks and strokes. A 2-dimensional echocardiographic study revealed an intracardiac tumor attached both to the chordae and to the anterolateral papillary muscle of the mitral valve. The patient underwent excision of the tumor, which necessitated concomitant mitral valve replacement. She remains free of symptoms 1 year postoperatively, with no echocardiographic evidence of recurrence of the tumor. To date, 19 cases of surgically treated papillary fibroelastomas of the mitral valve have been reported in the English-language literature. We add the description of our case to emphasize the importance of this tumor as an identifiable and curable cause of cerebral and coronary embolization. The frequent occurrence of cardiac valve tumors suggests the use of 2-dimensional echocardiography in patients who are experiencing transient ischemic attacks or strokes, as well as in those who sustain a myocardial infarction despite normal coronary arteries at angiography. When papillary fibroelastoma is diagnosed, surgical treatment must be considered because of the high risk of embolization. Images PMID:8605435

  19. Repair of delayed left ventricular rupture after mitral valve replacement: report of a case.

    PubMed

    Terada, Hitoshi; Kazui, Teruhisa; Yamashita, Katsushi; Washiyama, Naoki; Suzuki, Takayasu; Suzuki, Kazuchika; Ohkura, Kazuhiro; Hasan Muhammad, Bashar Abul

    2004-01-01

    Rupture of the left ventricle (LV) after mitral valve replacement (MVR) is a devastating complication, associated with high mortality. A 64-year-old woman with a type I delayed LV rupture, which occurred after MVR with a 27-mm St. Jude Medical mitral prosthesis for mitral stenosis, was successfully treated by a combination of intracardiac and extracardiac surgical repair techniques. The extracardiac repair involved approximating the edges of myocardium around the tear with large sutures bolstered by strips of Teflon felt, then covering the epicardial hematoma with another porcine pericardial patch, using gelatin resorcinol formaldehyde glue and collagen sheets. The intracardiac repair involved suturing the edges of an oval piece of porcine pericardium to the endocardium around the laceration. No LV pseudoaneurysm was detected postoperatively on echocardiography or computed tomography scans. The patient is well 2 years after the operation. PMID:15526133

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

    NASA Astrophysics Data System (ADS)

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

    2008-03-01

    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.

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

    PubMed

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

    1997-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    SciTech Connect

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

    1982-01-01

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

  4. An unusual presentation of hemolytic anemia in a patient with prosthetic mitral valve.

    PubMed

    Najib, Mohammad Q; Vinales, Karyne L; Paripati, Harshita R; Kundranda, Madappa N; Valdez, Riccardo; Rihal, Charanjit S; Chaliki, Hari P

    2011-07-01

    Although rare, periprosthetic valvular regurgitation can cause hemolytic anemia. We present the case of a 63-year-old man who had an unusual presentation of hemolytic anemia due to periprosthetic mitral valve regurgitation (PMVR) in the presence of cold agglutinins. Due to high surgical risk, PMVR was percutaneously closed with three Amplatzer devices under the guidance of three-dimensional transesophageal echocardiography. PMID:21453302

  5. Left atrial high-grade undifferentiated pleomorphic sarcoma protruding through the mitral valve.

    PubMed

    Bgu, Celine; Barreda, Eleodoro; Hammoudi, Nadjib; Fouret, Pierre; Toledano, Dan; Isnard, Richard; Leprince, Pascal; Montalescot, Gilles; Barthlmy, Olivier

    2014-12-01

    Primary cardiac tumors are uncommon. Malignant neoplasms account for 25%, including 75% of cardiac sarcomas. A 53-year-old female complained of exertional dyspnea and orthopnea. Chest computed tomography revealed a mass within the left atrium. Echocardiography confirmed a bilobed left atrial mass protruding through the mitral valve orifice. The tumor was completely resected and was histologically diagnosed as a high-grade pleomorphic sarcoma. A 13-month follow-up was achieved without any recurrence on magnetic resonance imaging. PMID:25468101

  6. Ablation of Atrial Fibrillation in a Patient with a Mechanical Mitral Valve.

    PubMed

    Zipse, Matthew M; Nguyen, Duy Thai

    2016-03-01

    Clinicians must be mindful of the left ventricular lead when cannulating the coronary sinus with a decapolar catheter or an ablation catheter. Left atrial catheter ablation for the treatment of atrial fibrillation in patients with a mechanical mitral valve, when approached carefully, can be performed safely and effectively. Block across linear lines should be confirmed using differential activation and/or differential pacing to decrease risks of proarrhythmias. PMID:26920185

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

    NASA Astrophysics Data System (ADS)

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

    2010-04-01

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

  8. Quantitative Evaluation of Mitral Regurgitation Secondary to Mitral Valve Prolapse by Magnetic Resonance Imaging and Echocardiography.

    PubMed

    Le Goffic, Caroline; Toledano, Manuel; Ennezat, Pierre-Vladimir; Binda, Camille; Castel, Anne-Laure; Delelis, Franois; Graux, Pierre; Tribouilloy, Christophe; Marchaux, Sylvestre

    2015-11-01

    The present prospective study was designed to evaluate the accuracy of quantitative assessment of mitral regurgitant fraction (MRF) by echocardiography and cardiac magnetic resonance imaging (cMRI) in the modern era using as reference method the blinded multiparametric integrative assessment of mitral regurgitation (MR) severity. 2-Dimensional (2D) and 3-dimensional (3D) MRF by echocardiography (2D echo MRF and 3D echo MRF) were obtained by measuring the difference in left ventricular (LV) total stroke volume (obtained from either 2D or 3D acquisition) and aortic forward stroke volume normalized to LV total stroke volume. MRF was calculated by cMRI using either (1) (LVstroke volume- systolic aortic outflow volume by phase contrast)/LV stroke volume (cMRI MRF [volumetric]) or (2) (mitral inflow volume- systolic aortic outflow volume)/mitral inflow volume (cMRI MRF [phase contrast]). Six patients had 1+ MR, 6 patients had 2+ MR, 12 patients had 3+ MR, and 10 had 4+ MR. A significant correlation was observed between MR grading and 2D echo MRF (r= 0.60, p <0.0001) and 3D echo MRF (r= 0.79, p <0.0001), cMRI MRF (volumetric) (r= 0.87, p <0.0001), and cMRI MRF (phase contrast r= 0.72, p <0.001). The accuracy of MRF for the diagnosis of MR ?3+ or 4+ was the highest with cMRI MRF (volumetric) (area under the receiver-operating characteristic curve [AUC]= 0.98), followed by 3D echo MRF (AUC= 0.96), 2D echo MRF (AUC= 0.90), and cMRI MRF (phase contrast; AUC= 0.83). In conclusion, MRF by cMRI (volumetric method) and 3D echo MRF had the highest diagnostic value to detect significant MR, whereas the diagnostic value of 2D echo MRF and cMRI MRF (phase contrast) was lower. Hence, the present study suggests that both cMRI (volumetric method) and 3D echo represent best approaches for calculating MRF. PMID:26372213

  9. Early and Mid-Term Outcome of Pediatric Congenital Mitral Valve Surgery

    PubMed Central

    Baghaei, Ramin; Tabib, Avisa; Jalili, Farshad; Totonchi, Ziae; Mahdavi, Mohammad; Ghadrdoost, Behshid

    2015-01-01

    Background: Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. Objectives: The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. Patients and Methods: In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 38.18 months and 11.92 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgery Results: Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Conclusions: Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis. PMID:26446282

  10. Vortices formed on the mitral valve tips aid normal left ventricular filling

    NASA Astrophysics Data System (ADS)

    Vlachos, Pavlos

    2011-11-01

    For the left ventricle to function as an effective pump it must be able to fill from a low left atrial pressure. However, this ability is lost in patients with heart failure. We investigated the fluid dynamics of the left ventricle filling by imaging the blood flow in patients with healthy and impaired diastolic function, using 2D phase contrast magnetic resonance imaging and we quantified the intraventricular pressure gradients and the strength and location of the formed vortices. We found that during early filling in normal subjects, prior to the opening of the mitral valve the flow moves towards the apex and subsequently at the time of the opening of the valve the rapid movement of the mitral annulus away from the left ventricle apex enhances the formation of a vortex ring at the mitral valve tips. Instead of being a passive byproduct of the process as was previously believed, this vortex ring facilitates filling by reducing convective losses and enhancing the function of the left ventricle as a suction pump. Impairment of this mechanism contributes to diastolic dysfunction, with the left ventricle filling becoming dependent on left atrial pressure, and eventually leading to heart failure. John R. Jones Professor

  11. Canine degenerative myxomatous mitral valve disease: natural history, clinical presentation and therapy.

    PubMed

    Borgarelli, Michele; Haggstrom, Jens

    2010-07-01

    Myxomatous mitral valve disease is a common condition in geriatric dogs. Most dogs affected are clinically asymptomatic for a long time. However, about 30% of these animals present a progression to heart failure and eventually die as a consequence of the disease. Left atrial enlargement, and particularly a change in left atrial size, seems to be the most reliable predictor of progression in some studies, however further studies are needed to clarify how to recognize asymptomatic patients at higher risk of developing heart failure. According to the published data on the natural history of the disease and the results of published studies evaluating the effect of early therapy on delaying the progression of the disease, it seems that no currently available treatment delays the onset of clinical signs of congestive heart failure (CHF). Although the ideal treatment of more severely affected dogs is probably surgical mitral valve repair or mitral valve replacement, this is not a currently available option. The results of several clinical trials together with clinical experience suggest that dogs with overt CHF can be managed with acceptable quality of life for a relatively long time period with medical treatment including furosemide, an angiotensin-converting enzyme inhibitor, pimobendan, and spironolactone. PMID:20610017

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

    PubMed Central

    Hu, Xiang; Zhao, Qiang

    2011-01-01

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

  13. CTS Trials Network: Surgical ablation of atrial fibrillation during mitral valve surgery - many questions unanswered

    PubMed Central

    Afifi, Ahmed

    2015-01-01

    A disease that is associated with stroke and mortality, atrial fibrillation (AF) complicates 30 to 50% of mitral valve disease patients admitted for surgery.1 Since the introduction of the Cox maze III procedure in 1992 many efforts have been made to come up with modified lesion sets and/or energy sources to surgically treat AF. This lead to the recently published American Heart Association (AHA) American College of Cardiology (ACC)Heart Rhythm Society (HRS) guidelines2 stating that it is reasonable to perform atrial fibrillation ablation in selected patients undergoing other types of cardiac surgery. The effectiveness of different techniques in conversion to sinus rhythm and the clinical impact of freedom from AF remain a question. The CTS Trials Network have undertaken a trial to answer these questions. The first year results of their randomized trial comparing AF ablation at the time of mitral valve surgery with mitral valve surgery alone were published recently in The New England Journal of Medicine.3 PMID:26566527

  14. Secondary abdominal compartment syndrome required decompression laparotomy during minimally invasive mitral valve repair.

    PubMed

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Saito, Tetsuya; Sawa, Yoshiki

    2016-12-01

    We treated a 77-year-old patient with secondary abdominal compartment syndrome that caused failure to maintain cardiopulmonary bypass while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repair procedures. During the operation, a decompression laparotomy was needed to relieve elevated intraabdominal pressure that caused instability of the cardiopulmonary bypass. Due to poor oxygenation and the long cardiopulmonary bypass time, the patient required peripheral extracorporeal membrane oxygenation before recovery. We alert surgeons to this rare complication that can occur even in patients undergoing minimally invasive surgery with a right mini-thoracotomy. PMID:26943679

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

    NASA Astrophysics Data System (ADS)

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

    1999-06-01

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

  16. Development of bioprosthetic heart valve calcification in vitro and in animal models: morphology and composition

    NASA Astrophysics Data System (ADS)

    Mavrilas, D.; Apostolaki, A.; Kapolos, J.; Koutsoukos, P. G.; Melachrinou, M.; Zolota, V.; Dougenis, D.

    1999-09-01

    While calcification of bioprosthetic valves presents a clinical problem, the mechanism of formation of calcific deposits in the leaflets remains unclear. A new method for in vitro calcification is employed, in parallel with an in vivo (subcutaneous animal) model. The nature of crystal phases grown by both methods on porcine bioprosthetic heart valves was investigated. Light microscopy, scanning electron microscopy (SEM), X-ray energy dispersive spectroscopy (SEM-EDS) and stoichiometric chemical analysis were used as tools for the qualitative and quantitative assessment of the calcification process. Photomicrographs from leaflets calcified early in vitro (24-48 h) and in vivo (5-10 days) confirmed that calcification initiated in the central region of the tissue, mainly in fibrosa, and extended with time (after 28 and 56 days) in vivo towards the outer surface of the tissue. SEM micrographs from tissue sections of early in vivo and in vitro calcified leaflets showed coexistence of different sizes (1-30 ?m) of crystal phases in contact with tissue fibers. EDS analysis confirmed that the deposits were calcium phosphate salts. Chemical analysis of samples calcified in vivo for longer time periods, showed that the content of the salts was mainly calcium and phosphate with a Ca/P molar ratio 1.78 and 1.94 after 28 and 56 days, respectively. These results suggested that the calcification process is followed by a sequential hydrolytic transformation of CaHPO 42H 2O (DCPD) to Ca 4H(PO 4) 32.5H 2O (OCP) and to Ca 5(PO 4) 3OH (HAP). Calcium phosphate crystal phases grown in vitro under controlled conditions and at constant supersaturation provide a successful simulation of the calcification process in the animal model and may be applied in screening new biomaterials with respect to their potential for calcification.

  17. Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservation

    PubMed Central

    Antunes, Manuel J

    2015-01-01

    In developing countries, rheumatic fever and carditis still constitutes a major public health problem. Patients have special characteristics that differ from those with rheumatic mitral valve disease we still see in developed countries. They are usually young, poor, uneducated, and have low compliance to prophylaxis / therapy. In addition, they usually have great difficulty in accessing medical care. In these situations, the rate of complications associated to valve replacement is significantly increased. Alternatively, mitral valve repair is now known to achieve better long-term results in this pathology, but this was not widely recognized three or four decades ago, when first reports showed worse results after repair of rheumatic regurgitation than with degenerative valves. This has been reported by several groups in developing countries in different continents, with high incidence of repairs and excellent long term results. It is, therefore, becoming increasingly clear that, although, the results may not compare to those obtained with degenerative pathology, repair of rheumatic valves, when feasible, is the procedure of choice, especially in these underprivileged populations.

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

    PubMed

    Sack, Stefan; Kahlert, Philipp; Erbel, Raimund

    2009-01-01

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

  19. Echocardiographic changes after aortic valve replacement: Does the failure rate of mitral valve change?

    PubMed Central

    Khosravi, Arezoo; Sheykhloo, Hadi; Karbasi-Afshar, Reza; Saburi, Amin

    2015-01-01

    BACKGROUND Since some degrees of functional mitral regurgitation (MR) may be seen in patients who are candidate for undergoing isolated aortic valve replacement (AVR), determining the effectiveness of AVR surgery on MR rate improvement can be effective in designing a protocol to deal with patients with functional MR. The purpose of this study was to examine the echocardiographic changes after AVR surgery with a focus on changes in MR. METHODS The research was conducted as a before-after observational study on patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, who were undergone AVR surgery between 2011 and 2012. After selecting the patients and obtaining informed consent to participate in the project, transthoracic echocardiographic data were collected by a specialist in Cardiology Echocardiography using ViVid 7 device before and till one week after AVR surgery. The MR rate was measured using methods; including Color Flow Doppler, PISA, Vena Cava Width and Effective Regurgitant Orifice. RESULTS Finally, the study was conducted on 85 patients (mean age = 56.23 6.10 years, 27 women = 31.8%). Of 21 patients with preoperative MR more than mild (moderate, mild to moderate), 20 patients (95%) showed at least one degree decrease in MR. Among 64 patients who had mild MR before the surgery, 29 patients improved (45%), that this difference was statistically significant (P < 0.001). CONCLUSION The study results showed that in patients with preoperative MR degree higher than mild, after AVR the MR rate improved 24 times more than those who had preoperative MR degree equivalent to mild and lower. However, these changes are not affected by other echocardiographic changes and patients demographic characteristics. PMID:26405444

  20. Increased systolic load causes adverse remodeling of fetal aortic and mitral valves.

    PubMed

    Tibayan, Frederick A; Louey, Samantha; Jonker, Sonnet; Espinoza, Herbert; Chattergoon, Natasha; You, Fanglei; Thornburg, Kent L; Giraud, George

    2015-12-15

    While abnormal hemodynamic forces alter fetal myocardial growth, little is known about whether such insults affect fetal cardiac valve development. We hypothesized that chronically elevated systolic load would detrimentally alter fetal valve growth. Chronically instrumented fetal sheep received either a continuous infusion of adult sheep plasma to increase fetal blood pressure, or a lactated Ringer's infusion as a volume control beginning on day 126 4 of gestation. After 8 days, mean arterial pressure was higher in the plasma infusion group (63.0 mmHg vs. 41.8 mmHg, P < 0.05). Mitral annular septal-lateral diameter (11.9 mm vs. 9.1 mm, P < 0.05), anterior leaflet length (7.7 mm vs. 6.4 mm, P < 0.05), and posterior leaflet length (P2; 4.0 mm vs. 3.0 mm, P < 0.05) were greater in the elevated load group. mRNA levels of Notch-1, TGF-?2, Wnt-2b, BMP-1, and versican were suppressed in aortic and mitral valve leaflets; elastin and ?1 type I collagen mRNA levels were suppressed in the aortic valves only. We conclude that sustained elevated arterial pressure load on the fetal heart valve leads to anatomic remodeling and, surprisingly, suppression of signaling and extracellular matrix genes that are important to valve development. These novel findings have important implications on the developmental origins of valve disease and may have long-term consequences on valve function and durability. PMID:26354842

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-07-01

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

  3. Current state of transcatheter mitral valve repair with the MitraClip

    PubMed Central

    Downs, Emily A.; Lim, D. Scott; Saji, Mike

    2015-01-01

    Background Many patients affected with mitral valve regurgitation suffer from multiple comorbidities. The MitraClip device provides a safe means of transcatheter valve repair in patients with suitable mitral valve anatomy who are at prohibitive risk for surgery. We describe our early procedural outcomes and present a summary of the current state of MitraClip technology in the United States. Methods We performed a retrospective chart review of initial high-risk or inoperable patients who underwent MitraClip placement at our institution after completion of the EVEREST II study. We examined the primary outcome of 30-day mortality, and secondary outcomes included extent of reduction of mitral regurgitation (MR), New York Heart Association (NYHA) functional class improvement, length of stay, and major complications. Results A total of 115 high-risk patients (mean Society of Thoracic Surgeons predicted risk of mortality 9.4%6.1%) underwent the MitraClip procedure at our institution between March 2009 and April 2014. Co-morbidities including coronary artery disease (67.8%), pulmonary disease (39.1%) and previous cardiac surgery (44.3%) were common. The device was placed successfully in all patients with a 30-day mortality of 2.6%. All patients demonstrated 3+ or 4+ MR on preoperative imaging, and 80.7% of patients had trace or 1+ MR at hospital discharge. NYHA class improved substantially, with 79% of patients exhibiting class III or IV symptoms pre-procedure and 81% reporting class I or II symptoms at one month follow-up. Conclusions The MitraClip procedure provides a safe alternative to surgical or medical management for high-risk patients with MR and suitable valve anatomy. A comprehensive heart team approach is essential, with surgeons providing critical assessment of patient suitability for surgery versus percutaneous therapy as well as performance of the valve procedure. PMID:26309842

  4. Update on percutaneous mitral commissurotomy.

    PubMed

    Nunes, Maria Carmo P; Nascimento, Bruno Ramos; Lodi-Junqueira, Lucas; Tan, Timothy C; Athayde, Guilherme Rafael Sant'Anna; Hung, Judy

    2016-04-01

    Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure. PMID:26743926

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

    PubMed

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

    2015-07-01

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

  6. Lipid extraction attenuates the calcific degeneration of bovine pericardium used in cardiac valve bioprostheses.

    PubMed Central

    Rossi, M. A.; Braile, D. M.; Teixeira, M. D.; Souza, D. R.; Peres, L. C.

    1990-01-01

    Bovine pericardial bioprostheses frequently fail due to dystrophic calcification. Since (a) recent studies indicate that membrane-associated complexed acidic phospholipids play an important role in the process of both physiologic and pathologic calcification, and (b) cytoplasmic organelles and plasma membrane of interstitial cells seem to serve as initial sites of calcific degeneration of bioprosthetic bovine pericardial tissue, this investigation was undertaken to evaluate whether, and if so, to what extent, the mineralization of valve tissue could be attenuated by previous lipid extraction. Pretreatment of glutaraldehyde-preserved bovine pericardium with acidified sulphuric ether (pH 3.0-4.0) attenuated calcification significantly: 28 days after subcutaneous implantation in young rats the degree of mineral deposition was approximately equal to typical 7 days implants in this model. The mechanism of this beneficial effect is suggested to be due to partial extraction of tissue phospholipids, as demonstrated by electron microscopy, thus reducing the number of available sites for deposition of hydroxyapatite crystals. In addition, and importantly, the present results indicate that any attempt to reduce cardiac valve bioprosthesis mineralization will have to take into account the role of lipids and, particularly, the membranous phospholipids in the calcification mechanism. Images Fig. 1 Fig. 2 Fig. 4 PMID:2331406

  7. FSI simulation of intra-ventricular flow in patient-specific ventricular model with both mitral and aortic valves.

    PubMed

    Zhong, Liang; Su, Boyang; Zhang, Jun-Mei; Leo, Hwa Liang; Tan, Ru San

    2013-01-01

    Investigating the intra-ventricular flow is the most important to understand the left ventricular function. In this study, we proposed a fluid-structure interaction (FSI) approach to simulate the blood flow in patient-specific model by combining both mitral and aortic valves. To accommodate the large mesh deformation, moving arbitrary Lagrangian-Eulerian (ALE) meshes were used for moving ventricular wall and rotating leaflets of valves. The left ventricular wall was predescribed according to the points acquired from magnetic resonance image (MRI). Mitral and aortic valves were integrated into the model by assuming each leaflet as a rigid body. Fluid-structure interaction (FSI) approach was adopted to capture the rapid motion of leaflets. The simulation results were qualitatively similar to the measurements reported in literatures. To the best of our knowledge, this is the first to simulate the patient-specific ventricular flow with the presence of both mitral and aortic valves. PMID:24109784

  8. Concomitant Repair of Mitral Valve Papillary Muscle Rupture and Tricuspid Valve Avulsion in a Pediatric Patient after a Motor Vehicle Collision

    PubMed Central

    Hodge, Ashley; Forbus, Geoff; Hsia, Tain Yen

    2009-01-01

    Abstract: We report the case of an 8-year-old patient with severe acute mitral regurgitation and tricuspid regurgitation after a motor vehicle collision caused by traumatic injuries of the supporting structures of both valves. An echocardiogram showed avulsion of the posteromedial papillary muscle of the mitral valve and a severely prolapsed anterior tricuspid valve leaflet. In addition, there was a near-complete defect in the left ventricular side of the interventricular septum, with diffuse hematoma of the akinetic septal muscle. After emergency mitral and tricuspid valve repairs, consisting of re-implantation of the posteromedial papillary muscle and anterior tricuspid leaflet chordal support, the patient completely recovered with no residual valvular pathology. PMID:19806802

  9. Cardiobacterium hominis bioprosthetic mitral valve endocarditis presenting as septic arthritis.

    PubMed

    Apisarnthanarak, Anucha; Johnson, Raymond M; Braverman, Alan C; Dunne, William Michael; Little, J Russell

    2002-01-01

    We report an unusual case of Cardiobacterium hominis bioprosthetic valve endocarditis presenting as septic arthritis. This remarkable presentation had clinical features consistent with endocarditis generally associated with highly virulent pathogens. A literature search has failed to disclose a report of septic arthiritis as a manifestation of C. hominis endocarditis. PMID:11821177

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

    PubMed Central

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

    2014-01-01

    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 β-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/β-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/β-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/β-catenin protein levels in the AVs. In vitro analysis confirmed the Lrp5/β-catenin expression in myofibroblast cell proliferation. Conclusion Hypercholesterolemic AV calcification is attenuated by atorvastatin and is mediated in part by the Lrp5/β-catenin pathway. This developmental pathway may be important in the signaling pathway of this disease. PMID:16159822

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

    PubMed Central

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

    2015-01-01

    Previous research in our lab suggested that heart valve tissues cultured without mechanical stimulation do not retain their in vivo microstructure, i.e., cell density decreased within the deep tissue layers and increased at the periphery. In this study, a splashing rotating bioreactor was designed to apply mechanical stimulation to a mitral valve leaflet segment. Porcine valve segments (n=9–10 per group) were cultured in the bioreactor for two weeks (dynamic culture); negative controls were cultured without mechanical stimulation (static culture), and baseline controls were fresh uncultured samples. Overall changes in cellularity and ECM structure were assessed by H&E and Movat pentachrome stains. Tissues were also immunostained for multiple extracellular matrix (ECM) components and turnover mediators. After two weeks of culture, proliferating cells were distributed throughout the tissue in segments cultured in the bioreactor, in contrast to segments cultured without mechanical stimulation. Most ECM components, especially collagen types I and III, better maintained normal expression patterns and magnitudes (as found in baseline controls) over two weeks of dynamic organ culture compared to static culture. Lack of mechanical stimulation changed several aspects of the tissue microstructure, including the cell distribution and ECM locations. In conclusion, mechanical stimulation by the bioreactor maintained tissue integrity, which will enable future in vitro investigation of mitral valve remodeling. PMID:20661646

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

    PubMed Central

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

    2012-01-01

    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

  13. A Novel Left Heart Simulator for the Multi-modality Characterization of Native Mitral Valve Geometry and Fluid Mechanics

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  15. Increased mitral valve regurgitation and myocardial hypertrophy in two dogs with long-term pimobendan therapy.

    PubMed

    Tissier, R; Chetboul, V; Moraillon, R; Nicolle, A; Carlos, C; Enriquez, B; Pouchelon, J-L

    2005-01-01

    The aim of this article is to describe original adverse effects in two dogs chronically treated with the inodilator pimobendan. We report a German shepherd (i.e., dog 1) and a poodle (i.e., dog 2) that were referred to our cardiology unit after receiving pimobendan for 10 and 5 mo, respectively. In both dogs, conventional echo-Doppler examination demonstrated mitral valve regurgitation and myocardial hypertrophy. Tissue Doppler imaging (TDI) was performed in the first case and revealed an abnormal relaxation phase. After the first examination, pimobendan administration was stopped in both cases and dogs were re-examined 3 and 1 mo later, respectively. Mitral valve regurgitation assessed by echocardiography decreased in both dogs, and the systolic heart murmur disappeared in dog 1. Importantly, most echocardiographic and TDI parameters tended to normalize in dog 1, suggesting, at least partial reversal of both myocardial hypertrophy and relaxation abnormality produced during inodilator therapy. This is the first report to describe an increase in mitral regurgitation under clinical conditions in dogs treated with pimobendan. We also suggest that pimobendan may induce ventricular hypertrophy. However, prospective studies are needed to confirm this observation. PMID:15738584

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

    PubMed

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

    2007-07-01

    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

  17. Percutaneous balloon mitral commissurotomy during pregnancy.

    PubMed Central

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

    1997-01-01

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

  18. Canine model for long-term evaluation of prosthetic mitral valves.

    PubMed

    Bianco, R W; St Cyr, J A; Schneider, J R; Rasmussen, T M; Clack, R M; Shim, H S; Sandstad, J; Rysavy, J; Foker, J E

    1986-08-01

    The evaluation of mechanical prosthetic heart valves would be aided by a more satisfactory animal model. For acute assessment, a variety of animals have been used, but for chronic studies, only larger animals (pigs, calves, baboons) have been employed, creating an expensive model with laboratory management difficulties. Previously, the use of dogs for chronic evaluation has been unsatisfactory because of the frequent occurrence of early sepsis and valve-related thrombotic deaths. We have modified our existing acute dog protocol to produce a successful chronic model. Our model employs perioperative systemic antibiotics, short cardiopulmonary bypass period (range 35-60 min), a minimum of perioperative intravenous lines, postoperative anticoagulation therapy, and strict postoperative antiseptic technique for blood sampling. To evaluate this model, 11 consecutive mongrel dogs underwent mitral valve replacement with either a standard Dacron sewing skirt or a newly devised carbon-coated Teflon sewing skirt No. 23 mm Bjork-Shiley Convexo Concave (CC) prosthetic valve. Nine animals (82%) survived and were evaluated after a predetermined observation interval of either 3 or 6 months for valve function, pannus formation, and possible carbon particle migration. At sacrifice, all animals had good hemodynamics and valve function, minimal pannus formation and no carbon washout. Consequently, this model provides a relatively inexpensive, reproducible method of chronic in vivo evaluation of prosthetic valve modifications. PMID:3762124

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

    PubMed

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

    2009-01-01

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

  20. Intravascular hemolysis after mitral and aortic valve replacement with different types of mechanical prostheses.

    PubMed

    Ismeno, G; Renzulli, A; Carozza, A; De Feo, M; Iannuzzi, M; Sante, P; Cotrufo, M

    1999-05-15

    Heart valve replacement with mechanical prosthesis is associated with mild intravascular hemolysis. In this study we evaluated the incidence of hemolysis in patients with different combinations of two mechanical valves. Between 1974 and 1996, 680 patients underwent mitral and aortic valve replacement with mechanical prostheses; we selected 90 patients, divided into six groups according to the prosthetic model (Group A, ball and tilting disc; Group B, ball and bileaflet; Group C, tilting disc and tilting disc; Group D, tilting disc and bileaflet; Group E, bileaflet and tilting disc; Group F, bileaflet and bileaflet; respectively, in mitral and aortic position). Blood tests were performed to check blood hemoglobin, serum lactic dehydrogenase, percent-correlated reticulocyte fraction, serum haptoglobin, and schistocytes. Chi square test was performed for categorical data. ANOVA and Bonferroni tests were performed in order to evaluate significant statistical differences between media and variance of the hematological data. A mild degree of intravascular hemolysis was observed in 30% of patients with double mechanical prostheses. LDH values were above the normal values in all groups, although a significant difference was found only between Group B versus Groups C and D. Reticulocytes and schistocytes and serum haptoglobin values were within the normal range and no differences were found between the groups. Low levels of blood hemoglobin were found in Groups D and F. The difference was statistically significant when compared with Groups A and E. In conclusion, hemolysis is frequent but never severe in patients with mitral and aortic mechanical prostheses. A higher incidence of subclinical hemolysis was found in patients with bileaflet valves regardless of the position of the implant. PMID:10549841

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

    PubMed

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

    2011-11-15

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

  2. Left ventricular pacing can be a complementary solution for systolic anterior motion after mitral valve plasty.

    PubMed

    Ushijima, Tomoki; Nishida, Takahiro; Kan-O, Meikun; Tominaga, Ryuji

    2016-03-01

    A 54-year old man underwent redo mitral valve (MV) plasty because of recurrent mitral regurgitation (MR). Intraoperative transoesophageal echocardiography revealed severe MR and turbulent flow at the left ventricular (LV) outflow tract associated with systolic anterior motion of the MV. Various medical treatments, additional surgical correction, and atrial and right ventricular pacing had failed to resolve the MR associated with systolic anterior motion. LV pacing, however, markedly attenuated MR. Temporary LV pacing was discontinued on postoperative day 2, and subsequently MR associated with systolic anterior motion has not recurred. LV dyssynchrony resulting from conduction disturbances might cause systolic anterior motion immediately after MV plasty. We speculate that LV pacing eliminated LV dyssynchrony and improved the MR associated with systolic anterior motion. Temporary LV pacing can be performed easily and safely at the time of MV plasty. LV pacing can be a complementary treatment for systolic anterior motion and resultant MR. PMID:25904766

  3. Calcification Characteristics of Low-Flow Low-Gradient Severe Aortic Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Sthli, Barbara E.; Nguyen-Kim, Thi Dan Linh; Gebhard, Cathrine; Frauenfelder, Thomas; Tanner, Felix C.; Nietlispach, Fabian; Maisano, Francesco; Falk, Volkmar; Lscher, Thomas F.; Maier, Willibald; Binder, Ronald K.

    2015-01-01

    Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (p < 0.001), mass (p < 0.001), and density (p = 0.004) were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR. PMID:26435875

  4. Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement.

    PubMed

    Cho, In Jeong; Moon, Jeonggeun; Shim, Chi Young; Jang, Yangsoo; Chung, Namsik; Chang, Byung-Chul; Ha, Jong-Won

    2011-01-15

    Although aortic valve replacement (AVR) and mitral valve replacement (MVR) are the most commonly performed prosthetic valve replacement operations, it is unclear whether clinical outcomes of paravalvular leakage (PVL) after MVR or AVR are different. It was hypothesized that clinical outcomes of PVL after AVR would be more favorable than after MVR because the pressure gradient is much larger in PVL occurring at the mitral position, which happens at the systolic phase, than at the aortic valve. Over a 12-year period, 82 patients with PVL were identified. After excluding patients who required immediate surgical repair for severe symptoms, patients with Behet disease or infective endocarditis, and those with PVL involving both valves, 54 remaining patients (21 women, mean age 56 14 years, 23 AVRs) with mild to moderate leakage constituted the study population. The end points were cardiac death, all-cause mortality, repeat surgery, and urgent admission for heart failure. During a median follow-up period of 35 months, there were 27 events, including 23 repeated surgeries, 2 cardiac deaths, 1 noncardiac death, and 1 admission for heart failure. Cox regression analysis revealed that the valve location of PVL was the only independent clinical predictor of event-free survival. The estimated 8-year event-free survival rate was significantly higher in patients with PVL after AVR than those after MVR (70 12% vs 16 8%, p <0.0001). In conclusion, PVL after AVR demonstrated more favorable long-term clinical outcomes compared to that after MVR. In patients who develop PVL after AVR, repeat surgery may be deferred. However, in patients with PVL after MVR, more aggressive therapeutic approaches should be considered. PMID:21211606

  5. Effects of Bileaflet Mechanical Mitral Valve Rotational Orientation on Left Ventricular Flow Conditions

    PubMed Central

    Westerdale, John C; Adrian, Ronald; Squires, Kyle; Chaliki, Hari; Belohlavek, Marek

    2015-01-01

    We studied left ventricular flow patterns for a range of rotational orientations of a bileaflet mechanical heart valve (MHV) implanted in the mitral position of an elastic model of a beating left ventricle (LV). The valve was rotated through 3 angular positions (0, 45, and 90 degrees) about the LV long axis. Ultrasound scans of the elastic LV were obtained in four apical 2-dimensional (2D) imaging projections, each with 45 degrees of separation. Particle imaging velocimetry was performed during the diastolic period to quantify the in-plane velocity field obtained by computer tracking of diluted microbubbles in the acquired ultrasound projections. The resulting velocity field, vorticity, and shear stresses were statistically significantly altered by angular positioning of the mechanical valve, although the results did not show any specific trend with the valve angular position and were highly dependent on the orientation of the imaging plane with respect to the valve. We conclude that bileaflet MHV orientation influences hemodynamics of LV filling. However, determination of optimal valve orientation cannot be made without measurement techniques that account for the highly 3-dimensional (3D) intraventricular flow. PMID:26312080

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

    NASA Astrophysics Data System (ADS)

    Nigam, Vishal

    2011-11-01

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

  7. Late pericardial tamponade after aortic and mitral valve replacement.

    PubMed

    Huwer, H; Volkmer, I; Dyckmans, J

    1988-02-01

    A report is presented on a patient who developed a pericardial tamponade on the 11th postoperative day after double valve replacement. Instead of classical signs of tamponade, however, the signs of posterior wall infarction were most prominent. The administration of nitrate resulted in deterioration of the circulatory situation, but the ST elevation in supraventricular tachycardia occurring from time to time regressed. As before the operation, coronary angiography showed normal conditions, and valve function was normal. The contrast-medium imaging of the right ventricle suggested a compression from ventral, and the right ventricular and right atrial pressures corresponded to a tamponade situation: in rethoracotomy, a blood coagulum roughly the size of a fist was found ventral to the right ventricle. After clearing the hematoma, there was an immediate improvement of the circulatory situation, and the ECG alterations regressed. Enzyme alterations in terms of myocardial infarction did not occur. We explained the symptoms as follows: The coagulum compressed the outflow tract of the right ventricle and thus caused on the one hand the hemodynamic situation of tamponade and on the other hand an extreme vagotonia with consecutive bradycardia and ST elevation. PMID:3376091

  8. Proteomic analysis of mitral valve in Lewis rat with acute rheumatic heart disease

    PubMed Central

    Li, Wenting; Zeng, Zhiyu; Gui, Chun; Zheng, Huilei; Huang, Weiqiang; Wei, Heng; Gong, Danping

    2015-01-01

    Rheumatic heart disease (RHD) makes a heavy burden in human lives and economy. The proteomic analysis of acute rheumatic heart disease (ARHD) can provide precious data to study RHD at the early stages, but no one has looked into. So based on our early research we applied the method of continuous GAS stimulation on Lewis rats to duplicate the animal model of ARHD. And the mitral valves of rats in control group (n=10) and ARHD group (n=10) were selected for proteomic analysis of ARHD with the iTRAQ labeling based 2D LC-ESI-MS/MS quantitative technology. We identified 3931 proteins in valve tissue out of which we obtained 395 differentially expressed proteins containing 176 up-regulated proteins and 119 down-regulated proteins. Changes in levels of GAPDH (6.793 times higher than the control group) and CD9 (2.63 times higher than the control group) were confirmed by Western blot or immunohistochemistry. The differentially expressed proteins such as GAPDH, CD9, myosin, collagen and RAC1 may be potential biomarkers for ARHD. Moreover, the mitral valve protein profile shed light on further understanding and investigating ARHD. PMID:26823728

  9. In vitro assessment of mitral valve function in cyclically pressurized porcine hearts.

    PubMed

    Vismara, Riccardo; Leopaldi, Alberto M; Piola, Marco; Asselta, Chiara; Lemma, Massimo; Antona, Carlo; Redaelli, Alberto; van de Vosse, Frans; Rutten, Marcel; Fiore, Gianfranco B

    2016-04-01

    Recent approaches to the in vitro experimental study of cardiac fluid mechanics involve the use of whole biological structures to investigate in the lab novel therapeutic approaches for the treatment of heart pathologies. To enhance reliability and repeatability, the influence of the actuation strategy of the experimental apparatuses on the biomechanics of biological structures needs to be assessed. Using echography and intracardiac high-speed imaging, we compared the mitral valve (MV) anatomo-functional features (coaptation areas/lengths, papillary muscles-valvular plane distances) in two passive-beating-heart mock loops with internal (IPML) or external (EPML) pressurization of the ventricular chamber. Both apparatuses showed fluid dynamic conditions that closely resembled the physiology. The MVs analyzed in the EPML presented coaptation areas and lengths that were systematically higher, and exhibited greater variability from early-to peak-systole, as compared to those in the IPML. Moreover, in the EPML, the MV leaflets exhibited a convexity with high curvature toward the atrium. With the IPML, MV coaptation lengths ranged similar to available clinical data and the papillary muscles-valve plane distances were more stable throughout systole. In conclusion, both the apparatuses allow for reproducing in vitro the left heart hemodynamics, in terms of flow rates and pressures, with proper mitral valve continence. Results suggest that the IPML is more suitable for replicating the physiological MV functioning, while the EPML may have more potential as a model for the study of MV pathologies. PMID:26908180

  10. Is valve surgery indicated in patients with severe mitral regurgitation even if they are asymptomatic?

    PubMed

    Levine, H J

    1990-01-01

    There is a natural reluctance among clinicians to recommend surgery in asymptomatic patients with cardiac disease and in patients with stenotic disease of the mitral and aortic valves; this instinct will mislead us very rarely. However, among patients with chronic volume overload of the LV, this rule-of-thumb does not always apply. For truly asymptomatic patients with severe MR who clearly have normal LV function, continued medical therapy with serial monitoring of LV dynamics is a prudent alternative to the small risk of corrective surgery. However, the major challenge in addressing this problem is the definition and detection of LV dysfunction in chronic MR. Thus, for MR patients with questionable impairment of myocardial function (generally those with an SEF between 0.55 and 0.70), an examination of chamber dimensions and particularly stress-shortening relations may be necessary to detect early LV dysfunction. Should LV dysfunction be identified or should serial studies indicate an adverse trend in LV performance, a strong case can be made for proceeding with surgery. Patients with an SEF of less than 0.55 must be assumed to have LV dysfunction and analogous data from patients with chronic AR suggest that a satisfactory surgical result may be achieved if the duration of LV dysfunction is brief. Those patients with chronic MR whose disease is likely to be amenable to mitral valve repair rather than valve replacement deserve a lower threshold for corrective surgery. PMID:2199046

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

    PubMed Central

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

    2013-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  13. Multidetector row computed tomography assessment of the native aortic and mitral valve: a call for routine assessment of left-sided heart valves during coronary computed tomography.

    PubMed

    de Heer, Linda M; Habets, Jesse; Chamuleau, Steven A J; Mali, Willem P Th M; van Herwerden, Lex A; Kluin, Jolanda; Budde, Ricardo P J

    2012-01-01

    Aortic valve stenosis and mitral valve regurgitation are the most common valvular heart diseases (VHD) in Western countries. In daily clinical practice, the diagnosis and evaluation of the severity of VHD is based on clinical findings and imaging. Transthoracic echocardiography is the preferred imaging technique for the initial evaluation of VHD. In patients with inconclusive transthoracic echocardiography, transoesophageal echocardiography can have additional diagnostic value. Cardiac multidetector row computed tomography (MDCT) has proven to have diagnostic value in the evaluation of coronary artery disease in symptomatic patients with a low-to-intermediate pretest probability. The images acquired for coronary assessment also contain diagnostic information on heart valves. The purpose of this review was to discuss the diagnostic value of MDCT for the evaluation of left-sided VHD. We provide an overview of the literature comparing echocardiography and MDCT for VHD assessment focusing on aortic valve and mitral valve disease, and we present clinical recommendations. PMID:23045729

  14. Computer-assisted design of butterfly bileaflet valves for the mitral position.

    PubMed

    McQueen, D M; Peskin, C S

    1985-01-01

    This paper describes the application of computer testing to a design study of butterfly bileaflet mitral prostheses having flat or curved leaflets. The curvature is in the plane normal to the pivot axes and is such that the convex sides of the leaflets face each other when the valve is open. The design parameters considered are the curvature of the leaflets and the location of the pivot points. In this study, stagnation is assessed by computing the smallest value (over the three openings of the valve) of the peak velocity, and hemodynamic performance is judged by a benefit/cost ratio: the net stroke volume divided by the mean transvalvular pressure difference. Unlike the case of a pivoting single-disc valve, the inclusion of a constraint on the maximum angle of opening of the leaflets is found to be essential for adequate, competent performance. Results are presented with both 85 degrees and 90 degrees constraints, since best performance is achieved with the opening-angle constraint in this range. Asymmetry of leaflet motion which is observed with flat leaflets in the mitral position is reduced with modest leaflet curvature. Leaflet curvature also ameliorates central orifice stagnation, which is observed with flat leaflets. Curvature of the valve produces the following improvements in comparison with the best flat valve when the opening-angle constraint is 85 degrees: a 38% increase in the minimum peak velocity and a 16% increase in the hemodynamic benefit/cost ratio. With a 90 degrees constraint the corresponding improvements are 34% and 20%, respectively. PMID:4048884

  15. Mitral annulus segmentation from four-dimensional ultrasound using a valve state predictor and constrained optical flow.

    PubMed

    Schneider, Robert J; Perrin, Douglas P; Vasilyev, Nikolay V; Marx, Gerald R; del Nido, Pedro J; Howe, Robert D

    2012-02-01

    Measurement of the shape and motion of the mitral valve annulus has proven useful in a number of applications, including pathology diagnosis and mitral valve modeling. Current methods to delineate the annulus from four-dimensional (4D) ultrasound, however, either require extensive overhead or user-interaction, become inaccurate as they accumulate tracking error, or they do not account for annular shape or motion. This paper presents a new 4D annulus segmentation method to account for these deficiencies. The method builds on a previously published three-dimensional (3D) annulus segmentation algorithm that accurately and robustly segments the mitral annulus in a frame with a closed valve. In the 4D method, a valve state predictor determines when the valve is closed. Subsequently, the 3D annulus segmentation algorithm finds the annulus in those frames. For frames with an open valve, a constrained optical flow algorithm is used to the track the annulus. The only inputs to the algorithm are the selection of one frame with a closed valve and one user-specified point near the valve, neither of which needs to be precise. The accuracy of the tracking method is shown by comparing the tracking results to manual segmentations made by a group of experts, where an average RMS difference of 1.670.63mm was found across 30 tracked frames. PMID:22200622

  16. Recurrent infarctions due to a dome-shaped pannus above the mitral valve prosthesis

    PubMed Central

    Inoue, Yoshito; Suzuki, Satoru

    2016-01-01

    This report describes a unique case of a 56-year-old female who suffered from recurrent stroke after double mechanical valve replacement. During the four years after the surgery, she remained in normal sinus rhythm, received adequate anticoagulation therapy, and no apparent left atrial thrombus was detected. She underwent redo surgery to prevent further stroke after fourth instance of cerebral infarction. Intraoperative findings revealed a dome-shaped pannus formation covering the sewing ring of the mitral prosthesis circumferentially, probably leading to clot formation and repeated infarctions. She has been stroke free for three years after pannus resection.

  17. Valvoplasty for abnormalities of posterior (mural) cusp of the mitral valve

    PubMed Central

    Brown, A. H.; Braimbridge, M. V.; Clement, A. J.; Sabar, E.; Mendel, D.

    1968-01-01

    Five patients with abnormalities of the chordae tendineae of the posterior (mural) cusp of the mitral valve have been treated by plication of the cusp, annulus, and atrium in continuity (modified McGoon valvoplasty). They had acute symptoms with physical signs characterized by sinus rhythm and an apical pansystolic murmur radiating to the base of the heart. Investigation showed high left atrial systolic pressures in small atria. Apart from one patient who died of cerebral air embolism with a good haemodynamic result, all were immediately improved and had smooth post-operative courses. Improvement was maintained at follow-up without embolic complications despite stopping anticoagulants. Images PMID:5711769

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

    PubMed

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

    2015-06-01

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

  19. Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study

    PubMed Central

    Rezahosseini, Omid; Rezaei, Mohamadreza; Ahmadi Tafti, Seyed Hossein; Jalali, Arash; Bina, Payvand; Ghiasi, Atefeh; Karimi, Abbasali; Abbasi, Kiomars; Shirzad, Mahmood; Davoodi, Saeed; Salehi Omran, Abbas

    2015-01-01

    Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). Results: The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

  20. [Left ventricular rupture of mitral valve prosthesis implantation treated using an intra-aortic balloon pump counterpulsation].

    PubMed

    Garca-Villarreal, Ovidio Alberto; Ramrez-Gonzlez, Bertn; Saldaa-Becerra, Martn A

    2015-01-01

    Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. In spite of the fact that several methods of repair have previously been described, the mortality rate remains nearly 85%. The use of the intra-aortic balloon pump counterpulsation may increase the possibilities of success in the repair of this dreaded complication. We present here three cases of left ventricular rupture associated to mitral valve prosthesis implantation successfully treated with the aid of intra-aortic balloon pump counterpulsation. PMID:26581539

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

    PubMed Central

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

    2015-01-01

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

  2. Balloon dilatation of the mitral valve by a single bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter.

    PubMed Central

    Patel, J; Vythilingum, S; Mitha, A S

    1990-01-01

    The efficacy of balloon dilatation of the mitral valve by a bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter (single catheter technique) was assessed in 53 patients (mean age 28) with mitral stenosis, most of whom were women. The procedure was unsuccessful in three patients. After balloon dilatation the left atrial pressure decreased from 22 mm Hg to 13 mm Hg and the mitral valve gradient from 12 mm Hg to 4 mm Hg. The mitral valve area increased from 0.7 cm2 to 2.1 cm2. Exercise time on the standard Bruce protocol increased from 3.9 minutes to 7.2 minutes. In 22 (44%) patients mitral regurgitation developed or the grade of regurgitation increased. Left to right shunts with pulmonary to systemic flow ratios greater than 1:5 were detected in four patients. Transient cerebrovascular episodes developed in two patients. One patient died after emergency valve replacement for severe mitral regurgitation. Balloon dilatation of the mitral valve by the single catheter technique with the bifoil or trefoil catheters is an effective treatment for patients with mitral stenosis. Mild mitral regurgitation is a frequent complication of the procedure. Images Figure 3 PMID:2245119

  3. Successful thrombolysis of mechanical mitral valve prosthesis in a patient with cardiogenic shock

    PubMed Central

    Zuern, Christine S; Hoevelborn, Tobias; Wisbar, Anette; Hust, Martin H; Haase, Karl K; Herdeg, Christian; Gawaz, Meinrad; May, Andreas E

    2009-01-01

    A 48-year-old woman with cardiogenic shock was admitted to a nearby hospital. Her medical history included mechanical replacement of her mitral valve 4 years previously in Russia because of rheumatic stenosis. On admission, her international normalised ratio (INR) was significantly reduced below the therapeutic limit. A severe stenosis of the valve prosthesis was identified by transthoracic and transoesophageal echocardiography and the patient was transferred to our university hospital for discussion of an immediate therapeutic procedure and to ensure cardiac surgical backup. Here, the patients poor clinical status led to the decision for a non-routine treatment: a successful series of intravenous thrombolysis with alteplase. Clinical symptoms and echocardiographic parameters improved significantly. PMID:21686399

  4. How has robotic repair changed the landscape of mitral valve surgery?

    PubMed Central

    Taggarse, Amit K.; Daly, Richard C.

    2015-01-01

    The introduction of robotic technology has revolutionized the performance of certain cardiac surgical procedures such as mitral valve (MV) repair. The foundation of modern MV repair was laid by Dr. Dwight C. McGoon in 1958. The operation was first performed with robotic assistance by Carpentier in 1998 using rudimentary motion-assisted equipment. Today, four generations later, telemanipulation technology enables surgeons to carry out all known methods of MV repair traditionally performed by conventional sternotomy; utilizing tiny port access incisions to safely and reliably eliminate mitral regurgitation. Extubation in the operating room following robotic MV repair is now routine and its benefits are well-documented, including transfer to the step-down from the intensive care unit several hours after surgery. This, in turn, translates into diminished usage of blood products, decreased need for pain medication, earlier dismissal from hospital, more rapid return to work and improved patient satisfaction. In addition, smaller, more cosmetically appealing scars and comparable short and mid-term outcomes of robotic and open MV repair have made the robotic approach a preferred option for many patients who meet appropriate safety criteria. As these procedures become more commonplace in large structural heart practices, it is important to reflect upon how the robotic approach has changed the landscape of MV surgery. We discuss the evolution and current status of robotic MV repair founded upon the principles of safe and effective open mitral valvuloplasty techniques. We will explore the potential of the robotic platform to improve both early referral and patient acceptance of interventions to eliminate severe degenerative mitral regurgitation. PMID:26309846

  5. Excellent durability of Starr-Edwards ball valves implanted in the aortic and mitral positions for 27 years: report of a rare surgical case.

    PubMed

    Tochii, Masato; Takagi, Yasushi; Kaneko, Kan; Ishida, Michiko; Akita, Kiyotoshi; Higuchi, Yoshiro; Ando, Motomi

    2013-01-01

    A 59-year-old male who had undergone aortic and mitral valve replacement with Starr-Edwards ball valves 27 years ago was admitted to our hospital for hemolytic anemia and heart failure. Echocardiography revealed prosthetic valve failure with a high-pressure gradient and small effective orifice area. The Starr-Edwards ball valves were successfully replaced with bileaflet mechanical valves. The explanted valves revealed no structural abnormalities. PMID:22785448

  6. Aspergillus Flavus Endocarditis of the Native Mitral Valve in a Bone Marrow Transplant Patient

    PubMed Central

    Demir, Tolga; Ergenoglu, Mehmet Umit; Ekinci, Abdurrahman; Tanrikulu, Nursen; Sahin, Mazlum; Demirsoy, Ergun

    2015-01-01

    Patient: Male, 36 Final Diagnosis: Aspergillus flavus endocarditis Symptoms: Malaise • fatigue and dyspnea Medication: — Clinical Procedure: Mitral vale replacemnet Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection. Case Report: We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome. Conclusions: Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment. PMID:25603977

  7. Vagal Nerve Stimulation Reduces Anterior Mitral Valve Leaflet Stiffness in the Beating Ovine Heart

    PubMed Central

    Swanson, Julia C.; Krishnamurthy, Gaurav; Itoh, Akinobu; Kvitting, John-Peder Escobar; Bothe, Wolfgang; Miller, D. Craig; Ingels, Neil B.

    2012-01-01

    AIM The functional significance of the autonomic nerves in the anterior mitral valve leaflet (AML) is unknown. We tested the hypothesis that remote stimulation of the vagus nerve (VNS) reduces AML stiffness in the beating heart. METHODS Forty-eight radiopaque-markers were implanted into eleven ovine hearts to delineate left ventricular and mitral anatomy, including an AML array. The anesthetized animals were then taken to the catheterization laboratory and 4-D marker coordinates obtained from biplane videofluoroscopy before and after VNS. Circumferential (Ecirc) and radial (Erad) stiffness values for three separate AML regions, Annulus, Belly and Edge, were obtained from inverse finite element analysis of AML displacements in response to trans-leaflet pressure changes during isovolumic contraction (IVC) and isovolumic relaxation (IVR). RESULTS VNS reduced heart rate: 94±9 vs. 82±10 min−1, (mean±SD, p<0.001). Circumferential AML stiffness was significantly reduced in all three regions during IVC and IVR (all p<0.05). Radial AML stiffness was reduced from control in the annular and belly regions at both IVC and IVR (P<0.05), while the reduction did not reach significance at the AML edge. CONCLUSION These observations suggest that one potential functional role for the parasympathetic nerves in the AML is to alter leaflet stiffness. Neural control of the contractile tissue in the AML could be part of a central control system capable of altering valve stiffness to adapt to changing hemodynamic demands. PMID:22703898

  8. Classification of Prolapsed Mitral Valve versus Healthy Heart from Phonocardiograms by Multifractal Analysis

    PubMed Central

    Zajić, Goran; Reljin, Irini; Reljin, Branimir

    2013-01-01

    Phonocardiography has shown a great potential for developing low-cost computer-aided diagnosis systems for cardiovascular monitoring. So far, most of the work reported regarding cardiosignal analysis using multifractals is oriented towards heartbeat dynamics. This paper represents a step towards automatic detection of one of the most common pathological syndromes, so-called mitral valve prolapse (MVP), using phonocardiograms and multifractal analysis. Subtle features characteristic for MVP in phonocardiograms may be difficult to detect. The approach for revealing such features should be locally based rather than globally based. Nevertheless, if their appearances are specific and frequent, they can affect a multifractal spectrum. This has been the case in our experiment with the click syndrome. Totally, 117 pediatric phonocardiographic recordings (PCGs), 8 seconds long each, obtained from 117 patients were used for PMV automatic detection. We propose a two-step algorithm to distinguish PCGs that belong to children with healthy hearts and children with prolapsed mitral valves (PMVs). Obtained results show high accuracy of the method. We achieved 96.91% accuracy on the dataset (97 recordings). Additionally, 90% accuracy is achieved for the evaluation dataset (20 recordings). Content of the datasets is confirmed by the echocardiographic screening. PMID:23762185

  9. Compounded pimobendan for canine chronic degenerative mitral valve disease and pulmonary hypertension.

    PubMed

    Helms, Scott R; Fox, Samantha; Mixon, William; Vail, Jane

    2012-01-01

    Pimobendan (Vetmedin) is an effective treatment for canine chronic degenerative mitral valve disease and dilated cardiomyopathy. In an off-label use, it may also be of benefit for the treatment of pulmonary hypertension in dogs. In this report, we describe the effects of a palatable customized oral form of pimobendan used with both compounded and commercially manufactured conventional drug therapy to treat degenerative mitral valve disease and pulmonary hypertension in two small dogs. For those patients, who resisted many types of oral medication, the standard manufactured dose of pimobendan was inappropriate. Formulations of the preparations used to treat the patients described in this report are provided for easy reference. It should be noted that at the time of this writing, Boehringer Ingelheim GmbH (Ingelheim am Rhein, Germany), the manufacturer of pimobendan, has expressed concern about the stability of that agent in aqueous compounded form. To our knowledge, no current data confirming the stability or bioequivalence of compounded pimobendan exist. PMID:23050309

  10. Left atrial rupture secondary to myxomatous mitral valve disease in 11 dogs.

    PubMed

    Nakamura, Reid K; Tompkins, Emily; Russell, Nicholas J; Zimmerman, Sarah A; Yuhas, Danielle L; Morrison, Thomas J; Lesser, Michael B

    2014-01-01

    The purpose of this retrospective study was to evaluate the long-term outcome in dogs with left atrial rupture secondary to myxomatous mitral valve disease. Eleven client-owned dogs met the inclusion criteria for the study. Median age was 11.6 yr (range, 8.3-17.8 yr), and median weight was 5.8 kg (range, 3.8-15.2 kg). Of the 11 dogs, 10 survived the initial 24 hr after diagnosis and 5 of the dogs were still alive at the conclusion of data collection. The median survival of all dogs was 203 days. Dogs with no previous history of congestive heart failure (CHF) at the time of diagnosis had a significantly longer median survival time (345 days) compared with dogs with a previous history of CHF (160 days, P = 0.0038). Outcome of dogs with myxomatous mitral valve disease presenting with left atria rupture was more favorable than previously reported, and dogs without previous CHF survived the longest. PMID:25251426

  11. [Anesthetic management of a patient with moyamoya disease undergoing mitral valve repair].

    PubMed

    Ishikawa, Saki; Yamada, Tatsuya; Sakaguchi, Ryota; Hatori, Eiki; Morisaki, Hiroshi

    2014-03-01

    Moyamoya disease is the result of progressive steno-occlusive changes in the internal carotid arteries followed by formation of bilateral abnormal vascular networks. The disease may present with cerebral ischemia causing cerebral hemorrhage in the perioperative period. There are few reports of cardiac surgeries in patients with moyamoya disease, and the management during cardiopulmonary bypass for moyamoya disease has not been established. We gave general anesthesia for mitral valve plasty in patient with the moyamoya disease. A 52-year-old woman underwent mitral valve plasty. She had been diagnosed with moyamoya disease and during the cardiopulmonary bypass, we used alpha-stat blood gas management with mild hypothermia, and maintained PaCO2 around 40 mmHg. We maintained the perfusion flow of CPB above 3.0 l x min(-1) x m(-2) and the mean perfusion pressure above 70 mmHg. In addition, we used the pulsatile perfusion assist with intraaortic balloon pumping to maintain cerebral circulation. Postoperative course was uneventful without apparent neurologic deficit, and she was discharged from hospital on 10th postoperative day. PMID:24724448

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

    PubMed Central

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

    2014-01-01

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

  13. Morphological and mechanical properties of the posterior leaflet chordae tendineae in the mitral valve.

    PubMed

    Lodder, Joost; Verkerke, Gijsbertus J; Delemarre, Ben Jm; Dodou, Dimitra

    2016-02-01

    A number of studies have investigated the morphological and mechanical properties of the chordae tendineae of the mitral valve, providing comparisons between basal, marginal, and strut chordae and between chordae at the anterior and posterior leaflets. This study contributes to the literature by comparing the failure load of the chordae tendineae attached to the three posterior leaflet scallops, the anterolateral scallop (P1), middle scallop (P2), and posteromedial scallop (P3) of the mitral valve. In all, 140 chordae isolated from 23 porcine hearts were tested. First, the cross-sectional diameters of all branches in each chorda were measured using a microscope. Next, after positioning the chorda in a tensile testing machine, a preload of 0.2?N was applied, and the chordal length was measured. Cyclic loading between 0 and 0.3?N, 10 times with a speed of 1.5?mm/s, was conducted, after which the machine travelled at 1.5?mm/s until the chorda broke. We found that P2 chordae were thicker than P1 and P3 chordae and longer than P1 chordae. P2 chordae failed at significantly higher loads than P1 and P3 chordae. For all three types of chordae, almost half of the failures occurred at the chordal branch that was closest to the leaflet. PMID:26645804

  14. A histological study of the atrioventricular junction in hearts with normal and prolapsed leaflets of the mitral valve.

    PubMed

    Angelini, A; Ho, S Y; Anderson, R H; Davies, M J; Becker, A E

    1988-06-01

    The mitral annulus is the point at which the atrial and ventricular walls meet the base of the mitral valve cusps. The suggestion that a variant of this arrangement termed "disjunction" was associated with prolapse of the leaflets prompted examination of the mitral atrioventricular junctions in seven normal hearts and six with prolapse owing to floppy mitral valves. A complete cord-like ring of connective tissue that encircled the atrioventricular junction and into which the three components were inserted at the same point was found in only one heart. The remaining hearts all showed a mixture of segments in which either the three components were inserted into a cord or simply met. Disjunction, defined as a separation of the atrial wall-mitral valve junction from the other component, the left ventricular wall, can occur both with and without a cord-like annulus. There was no significant difference in the number of segments around the left atrioventricular junction which showed disjunction in hearts with normal or prolapsing leaflets. The feature termed disjunction is an anatomical variation of the normal morphological characteristics of the left atrioventricular junction. PMID:3395530

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

    PubMed Central

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-01-01

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

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

    PubMed

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-06-01

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

  17. Short-Term and Long-Term Survival After Revascularization with or without Mitral Valve Surgery of Patients with Ischemic Mitral Valve Regurgitation: A Meta-Analysis

    PubMed Central

    Zhang, Hua; Liu, Yili; Qiu, Shaodong; Liang, Weixiang; Jiang, Lan

    2015-01-01

    Background There is no consensus on whether mitral valve repair or replacement (MVRR) must be performed to treat ischemic mitral regurgitation (MVR) after myocardial infarction. Our objective in this study was to investigate the efficacy of coronary artery bypass grafting (CABG) combined with or without MVRR for the ischemic MVR. Material/Methods An article search was performed in OvidSP, PubMed, Cochrane Library, and Embase. In these articles, researchers compared the efficacy of CABG with or without MVRR in treating patients with ischemic MVR after acute coronary syndrome (ACS). We performed a meta-analysis to compare the differences in the short-term and long-term survival rates of patients treated with CABG only and those treated with both CABG and MVRR. Secondary outcomes were compared with the preoperative and postoperative degree of MVR, left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. Results Out of the 1183 studies, we selected only 5 articles. A total of 3120 patients were enrolled; the CABG and MVRR group included 575 patients, while the CABG only group included 2545 patients. Long-term survival was higher in the CABG only group (hazard ratio [HR], 1.34; 95% confidence interval [CI] 1.15–1.58, P=0.003). Hospital mortality was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65–9.95; P=0.18). No differences were found in the degree of residual MVR, the mean of LVESV, LVEF, or NYHA class. Conclusions In patients with ischemic MVR, the short-term survival rate was similar in both groups. Moreover, there was no significant improvement in the long-term survival rates of patients treated with both CAG and MVRR. PMID:26635041

  18. Short-Term and Long-Term Survival After Revascularization with or without Mitral Valve Surgery of Patients with Ischemic Mitral Valve Regurgitation: A Meta-Analysis.

    PubMed

    Zhang, Hua; Liu, Yili; Qiu, Shaodong; Liang, Weixiang; Jiang, Lan

    2015-01-01

    BACKGROUND There is no consensus on whether mitral valve repair or replacement (MVRR) must be performed to treat ischemic mitral regurgitation (MVR) after myocardial infarction. Our objective in this study was to investigate the efficacy of coronary artery bypass grafting (CABG) combined with or without MVRR for the ischemic MVR. MATERIAL AND METHODS An article search was performed in OvidSP, PubMed, Cochrane Library, and Embase. In these articles, researchers compared the efficacy of CABG with or without MVRR in treating patients with ischemic MVR after acute coronary syndrome (ACS). We performed a meta-analysis to compare the differences in the short-term and long-term survival rates of patients treated with CABG only and those treated with both CABG and MVRR. Secondary outcomes were compared with the preoperative and postoperative degree of MVR, left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. RESULTS Out of the 1183 studies, we selected only 5 articles. A total of 3120 patients were enrolled; the CABG and MVRR group included 575 patients, while the CABG only group included 2545 patients. Long-term survival was higher in the CABG only group (hazard ratio [HR], 1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95; P=0.18). No differences were found in the degree of residual MVR, the mean of LVESV, LVEF, or NYHA class. CONCLUSIONS In patients with ischemic MVR, the short-term survival rate was similar in both groups. Moreover, there was no significant improvement in the long-term survival rates of patients treated with both CAG and MVRR. PMID:26635041

  19. Mitral valve dynamics in structural and fluid-structure interaction models.

    PubMed

    Lau, K D; Diaz, V; Scambler, P; Burriesci, G

    2010-11-01

    Modelling and simulation of heart valves is a challenging biomechanical problem due to anatomical variability, pulsatile physiological pressure loads and 3D anisotropic material behaviour. Current valvular models based on the finite element method can be divided into: those that do model the interaction between the blood and the valve (fluid-structure interaction or 'wet' models) and those that do not (structural models or 'dry' models). Here an anatomically sized model of the mitral valve has been used to compare the difference between structural and fluid-structure interaction techniques in two separately simulated scenarios: valve closure and a cardiac cycle. Using fluid-structure interaction, the valve has been modelled separately in a straight tubular volume and in a U-shaped ventricular volume, in order to analyse the difference in the coupled fluid and structural dynamics between the two geometries. The results of the structural and fluid-structure interaction models have shown that the stress distribution in the closure simulation is similar in all the models, but the magnitude and closed configuration differ. In the cardiac cycle simulation significant differences in the valvular dynamics were found between the structural and fluid-structure interaction models due to difference in applied pressure loads. Comparison of the fluid domains of the fluid-structure interaction models have shown that the ventricular geometry generates slower fluid velocity with increased vorticity compared to the tubular geometry. In conclusion, structural heart valve models are suitable for simulation of static configurations (opened or closed valves), but in order to simulate full dynamic behaviour fluid-structure interaction models are required. PMID:20702128

  20. Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction.

    PubMed

    Paradis, Jean-Michel; Del Trigo, Maria; Puri, Rishi; Rods-Cabau, Josep

    2015-11-01

    Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established. We review the historical perspective of transcatheter valve-in-valve therapy, as well as the main procedural challenges and clinical outcomes associated with this new less invasive treatment option. PMID:26516006

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

    PubMed

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

    2004-10-01

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

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

    PubMed Central

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

    2014-01-01

    Background Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation (TAVI). Methods MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. Results The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 (85.3%) to 43 (63.2%) (p<0.001). Vena contracta width was decreased from 0.470.28 to 0.250.21, (p=0.043). About 59.4% (19/32) of those who had moderate to severe MR and 85.7% (12/14) of those with severe MR experienced a significant improvement in MR after the procedure (p<0.001). Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p=0.424; valve sizes were 25.81.9 in those who improved vs. 25.01.9mm in those who did not improve, p=0.105; femoral approach was 51.2% and apical approach was 41.7%, p=0.457; MR etiology was 48.1% in organic and 48.6% in functional, p=0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p=0.356. Conclusions TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study. PMID:25544817

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

    SciTech Connect

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

    2009-01-01

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

  4. Paraprosthetic leak closure 28 years after mitral caged-ball Starr-Edwards implantation.

    PubMed

    Anto?czyk, Karolina; Paluszkiewicz, Lech; Koertke, Heinrich; Gummert, Jan

    2013-08-01

    In this case report, we present a patient 28 years after mitral valve replacement with the Starr-Edwards prosthesis complicated by periprosthetic leak with severe aortic stenosis and moderate tricuspid regurgitation. We successfully repaired the periprosthetic regurgitation in a patient with extensive mitral annular calcification, without replacement of the valve. No apparent structural deterioration on the caged-ball valve was found. Moreover, aortic valve replacement and tricuspid annuloplasty were performed. One month after reoperation, the patient remained stable with improved clinical status and without any evidence for further paravalvular leak. PMID:23599186

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

    PubMed Central

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

    1995-01-01

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

  6. An in-vitro assessment of the hydraulic characteristics of the mark II Abrams-Lucas mitral valve prosthesis.

    PubMed Central

    Wright, J T

    1977-01-01

    As a result of the durability problems associated with the first Abrams-Lucas mitral valve, a redesigned model has recently been introduced into limited clinical trials. The new valve was subjected to in-vitro pulsatile flow studies, and measurements were made of mean diastolic pressure gradient and volume of reflux on closure. Similar measurements were made on other mitral valve prostheses of comparable size. High-speed cinematography was used to analyse the motion of the occluder during the simulated cardiac cycle, and the flow patterns produced by the valve in the model ventricular cavity were observed and photographed. The pressure gradient of the Abrams-Lucas valve was significantly lower than that of the 29 mm Bjrk-Shiley valve and all other prostheses tested, but its reflux level was higher at 12 ml per stroke. The valve opened and closed smoothly and the flow visualisation study revealed that the valve produced a large vortex or swirl in the model ventricular cavity. Images PMID:882943

  7. Minimally invasive mitral valve repair through right minithoracotomy in the setting of degenerative mitral regurgitation: early outcomes and long-term follow-up

    PubMed Central

    Murzi, Michele; Canarutto, Daniele; Gilmanov, Danyiar; Ferrarini, Matteo; Farneti, Pier A.; Solinas, Marco; Glauber, Mattia

    2015-01-01

    Background Mitral valve (MV) repair is the gold standard for the treatment of degenerative MV regurgitation. Recently, minimally invasive mitral valve surgery (MIMVS) has shown excellent postoperative outcomes compared with conventional surgery. The aim of our study is to report early and long-term outcomes of patients undergoing MIMVS through right mini-thoracotomy (RT) over an eight year period. Methods From September 2003 to December 2011, a total of 1,604 consecutive patients underwent MIMVS through RT. Results The mean age was 6213 years, 295 (42%) patients were female and 16 (2.3%) had previous cardiac operations. MV repair was successfully performed in 670 patients, with a rate of success of 95.3%. Repair techniques included annuloplasty (89%), leaflet resection (n=54.2%), neochordae implantation (12.1%), and sliding plasty (10.5%). Overall in-hospital mortality was 0.1%. Incidence of stroke was 1.3%. At eight-year follow-up, overall survival was 90.1%, freedom from reoperation 93%, and freedom from recurrent mitral regurgitation was 90%. Conclusions MIMV repair through right minithoracotomy is a safe and reproducible procedure associated with high rate of MV repair, and excellent early postoperative and long-term results. PMID:26539346

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

    PubMed

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

    2014-02-01

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

  9. An augmented reality environment for image-guidance of off-pump mitral valve implantation

    NASA Astrophysics Data System (ADS)

    Linte, Christian; Wiles, Andrew D.; Hill, Nick; Moore, John; Wedlake, Chris; Guiraudon, Gerard; Jones, Doug; Bainbridge, Daniel; Peters, Terry M.

    2007-03-01

    Clinical research has been rapidly evolving towards the development of less invasive surgical procedures. We recently embarked on a project to improve intracardiac beating heart interventions. Our novel approach employs new surgical technologies and support from image-guidance via pre-operative and intra-operative imaging (i.e. two-dimensional echocardiography) to substitute for direct vision. Our goal was to develop a versatile system that allowed for safe cardiac port access, and provide sufficient image-guidance with the aid of a virtual reality environment to substitute for the absence of direct vision, while delivering quality therapy to the target. Specific targets included the repair and replacement of heart valves and the repair of septal defects. The ultimate objective was to duplicate the success rate of conventional open-heart surgery, but to do so via a small incision, and to evaluate the efficacy of the procedure as it is performed. This paper describes the software and hardware components, along with the methodology for performing mitral valve replacement as one example of this approach, using ultrasound and virtual tool models to position and fasten the valve in place.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2012-04-01

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

  12. A novel low-fidelity simulator for both mitral valve and tricuspid valve surgery: the surgical skills trainer for classic open and minimally invasive techniques

    PubMed Central

    Verberkmoes, Niels J.; Verberkmoes-Broeders, Elizabeth M.P.C.

    2013-01-01

    OBJECTIVES Simulators have been proven to equip trainee surgeons with better skills than the traditional, standard approach to skill development. The purpose of this study was to develop a low-fidelity, low-cost, reusable and portable simulation device, which could provide training in nearly the full range of mitral valve surgery techniques, in both the classic, open approach as well as the minimally invasive approach. METHODS This novel simulator is made up of commonly available components. The basic elements are a classic baby bottle, with the associated feeding teat and screw ring, in combination with a sheet of dental dam. The detailed process for making this simulator is outlined in this article. Maximum suture tensile strength on the different components was tested with a digital force gauge. Reusability and the rate of wear as a result of suturing were documented. Total cost was calculated in euros (). RESULTS This study resulted in a simulation model very similar in size to the actual anatomical dimensions of the mitral valve. Various pathological conditions, according to Carpentier's Functional Classification, could be simulated. This led to the possibility of providing training in several mitral valve surgical techniques. As the model developed, it became clear that it could also be used to practice tricuspid valve surgery techniques. Maximum mean suture tensions on the silicone teat and dental dam were 42.11 and 11.15 N/m2, respectively. The feeding teat started wearing after approximately 45 suture placements. Total cost of the study model was 5.14. CONCLUSIONS This relatively simple, low-cost, low-fidelity model can provide simulation training in nearly the full range of mitral valve and tricuspid valve surgical techniques, in both the classic open approach and the minimally invasive approachand do so almost anywhere. Especially when used by young cardiothoracic surgeons in training, this model may contribute to the development of technical skills and procedural knowledge required for adequate performance in the operating room. PMID:23125307

  13. Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction.

    PubMed

    Kronen, P W; Levionnois, O L; Eckstein, F S; Moens, Y P S

    2005-10-01

    A sheep was anaesthetized for implantation of a novel device (MitroFast) to replace the posterior leaflet of the mitral valve. Anaesthetic management included a balanced anaesthetic protocol and consisted of propofol or isoflurane combined with fentanyl infusion (0.15-0.4 microg/kg/min). Deliberate hypothermia during cardiopulmonary bypass was set at 34.5-35.5 degrees C. Surgery proceeded uneventfully. Total time of aortic cross-clamping was 35 min and total time on extracorporeal circulation was 60 min. Visual inspection, intracardiac pressure testing and transesophageal echocardiography indicated proper functioning of the device. The anaesthetic period was uneventful, but recovery was prolonged with central nervous and respiratory depression and marked hypoxaemia. Administration of naloxone (1.5 microg/kg, repeated twice at 15-20 min intervals) reversed the central nervous and attenuated the respiratory depressions. An initially low rate of urine production normalized after rewarming and a single intravenous administration of furosemide. PMID:16197710

  14. Left ventricular function in patients with mitral valve prolapse. A radionuclide evaluation.

    PubMed

    Ahmad, M; Haibach, H

    1982-12-01

    Thirty patients with cineangiographically confirmed mitral valve prolapse (MVP) were studied by radionuclide angiography at rest and during exercise. Twelve patients had isolated MVP and 18 patients had associated coronary artery disease. All patients had normal resting left ventricular ejection fraction and wall motion. Of 18 patients with MVP and coronary artery disease, the left ventricular ejection fraction remained unchanged during exercise in 15 patients, decreased in two patients, and increased in one patient. Of 12 patients with MVP without associated coronary artery disease, ejection fraction increased during exercise in 6 patients, remained unchanged in 4 patients, and decreased in 2 patients. We conclude that an abnormal left ventricular function response during exercise does not always indicate the presence of coronary artery disease and may occur in patients with isolated MVP. Furthermore,the left ventricular dysfunction of patients with isolated MVP may be obvious only during exercise. PMID:7172539

  15. Evaluation of growth differentiation factor 11 (GDF11) levels in dogs with chronic mitral valve insufficiency.

    PubMed

    Ahn, Sung-Taek; Suh, Sang-Il; Moon, Hyeongsun; Hyun, Changbaig

    2016-01-01

    Growth differentiation factor 11 (GDF11) regulates cell growth and differentiation in both embryonic and adult tissues. Circulating GDF11 levels have recently been reported to be significantly lower in aging mice and restoration of GDF11 reversed age-related cardiac hypertrophy in old mice. Here, we evaluated the potential of serum levels of GDF11 as a circulating biomarker in dogs at different stages of heart failure, due to chronic mitral valve insufficiency (CMVI). We found no significant differences in serum GDF11 levels between dogs at different stages of CMVI-associated heart failure. Furthermore, the circulating levels of GDF11 did not correlate with age, body weight, echocardiographic variables, and the severity of CMVI-induced heart failure in dogs. PMID:26733738

  16. Intermediate-fidelity simulator for self-training in mitral valve surgery.

    PubMed

    Hossien, Abdullrazak

    2016-01-01

    Current training in mitral valve (MV) surgery is affected by many factors, among which are the complexity of surgical procedures and complex three-dimensional anatomy of the MV. An MV repair simulator is proposed in this study as a low-cost, reusable and portable tool to guide trainees at all levels to effectively construct it with the aim of improving their surgical skills in major techniques of MV surgery in an intermediate-fidelity concept. The simulator is a self-made portable box that is supplied with a self-made silicone MV substitute to simulate the flexible property of MV components. The building process is detailed in this study. Surgical procedures were simulated to test the surgical handling. PMID:26811508

  17. Barlows mitral valve disease: results of conventional and minimally invasive repair approaches

    PubMed Central

    Melnitchouk, Serguei I.; Seeburger, Joerg; Kaeding, Anna F.; Misfeld, Martin; Mohr, Friedrich W.

    2013-01-01

    Barlows valve is a clinically important form of degenerative mitral valve (MV) disease that is characterized by unique clinical, echocardiographic and pathological features. Successful and durable repair of Barlows MV represents a clinical challenge for most cardiac surgeons. An armamentarium of different MV repair techniques may be required, resectional, neochordal or plicational techniques. Although conventional sternotomy remains the mainstay approach for MV surgery in the majority of cardiac surgery centers, minimally invasive surgery (MIS) is becoming increasingly accepted amongst patients, referring physicians and practicing cardiac surgeons. As surgical approaches, instrumentation and operative experience develop, select centers are now performing MIS MV surgery for nearly all MV patients. Although successful Barlows MV repair is more complex than that for most degenerative pathologies, several centers have published relatively large series of MIS MV repair for Barlows disease. In this review article, we highlight and compare the early and long-term results of conventional and minimally invasive approaches to Barlows and bileaflet mitral prolapse disease. Recent studies from various large volume centers around the world have demonstrated equivalent safety and efficacy outcomes of the MIS approach compared to conventional sternotomy surgery. In addition, MIS MV surgery may allow patients to benefit from a cosmetically appealing incision, a faster recovery and a quicker return to normal activities. However, a definite learning curve has been demonstrated for MIS MV surgery. If a patient with Barlows disease or other complex MV pathology desires to undergo MIS MV surgery, referral to a center and/or surgeon with extensive experience in MIS MV surgery is recommended. PMID:24349980

  18. Evaluation of in vivo morphological results of balloon mitral valvotomy.

    PubMed

    Benedetti, M; Biagini, A; Anastasio, G; Maffei, S; Levantino, M; Salvatore, L

    1990-01-01

    Percutaneous valvotomy is now more often considered for the treatment of mitral stenosis in poor risk patients. The aim of this study was the evaluation of the morphological changes produced by a similar procedure on the mitral valves of nine nonconsecutive patients undergoing a mitral valve replacement because of calcific isolated or prevalent mitral stenosis. The mitral valve was dilated through the left atriotomy before the valve excision with the same balloon catheter used in the percutaneous procedure. The pathological condition of the valve had been studied before dilatation by means of doppler echocardiography, cardiac catheterization and a visual examination performed by the surgeon before insertion of the balloon. At that time, the orifice area was measured with a Hegar dilator. A new measurement was performed after one or two dilatations performed at a balloon pressure of 2.7 atm. After excision, the valve was examined, photographed and X-rays were taken for evaluation of valve calcification. The pre-dilatation mean mitral valve orifice area was 1.3 +/- 0.4 cm2 and after the procedure was 2.8 +/- 0.3 cm2. In only one patient did the orifice area, originally 2.4 cm2, not increase. There was only one fused and calcified commissure, the other was normal. Before dilatation, the two commissures were fused in 17/18 cases and in 9/18, calcified. After dilatation, 5/17 commissures were completely open (not all were calcified), 10/17 incompletely opened and 2/17 remained fused (one in the above-mentioned patient).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2361023

  19. The significance of aortic valve calcification in patients with bicuspid aortic valve disease.

    PubMed

    Ren, Xinshuang; Zhang, Minghui; Liu, Kun; Hou, Zhihui; Gao, Yang; Yin, Weihua; Wang, Zhiqiang; Li, Zhennan; Lu, Bin

    2016-03-01

    Bicuspid aortic valve (BAV) is a common congenital heart disease. Our study was to analyze clinical features of BAV and evaluate whether aortic valve calcium score (AVCS) was a reliable marker for aortic stenosis (AS) in patients with BAV. 101 patients with BAV who both underwent echocardiology and cardiac computed tomography (CT) scan in our institution were included. Basic clinical data, haemodynamic feature, aortic valve and coronary calcium score were collected and compared among patients with different valve function and different degree of AS. Risk factors related to severe AS were evaluated by logistic regression, and a receiver operative characteristic curve was used to determine the cutoff calcium score greater than which the diagnosis of severe AS was optimized. Patients with aortic regurgitation (AR) were younger and demonstrated larger aortic annulus and sinus compared with patients with other valve dysfunction. Aortic valve calcium score was higher in patients with AS than with AR. For patients with different degree of AS, there were statistical significances in the value of age, aortic valve calcium score and coronary calcium score. AVCS was positively related to severe AS with an odd ratio of 1.286 (95 % CI 1.099-1.504) by every 300 points increase. AVCS was also a strong predictor for severe AS with area under the curve 0.855 with a cutoff value of 897 (sensitivity 86.7 %, specificity 72.2 %). Conclusively, aortic calcium score calculated by quantitative CT is a reliable marker in evaluating severity of AS. PMID:26440659

  20. Two dimensional echocardiography in mitral, aortic and tricuspid valve prolapse - The clinical problem, cardiac nuclear imaging considerations and a proposed standard for diagnosis

    SciTech Connect

    Morganroth, J.; Jones, R.H.; Chen, C.C.; Naito, M.

    1980-12-18

    The mitral valve prolapse syndrome may present with a variety of clinical manifestations and has proved to be a common cause of nonspecific cardiac symptoms in clinical practice. Primary and secondary forms must be distinguished. Myxomatous degeneration appears to be the common denominator of the primary form. The diagnostic standard of this form has not previously been defined because the detection of mitral leaflet tissue in the left atrium (prolapse) on physical examination or angiography is nonspecific. M mode echocardiography has greatly enhanced the recognition of this syndrome but has not proved to be the best diagnostic standard because of its limited view of mitral valve motion. The advent of two-dimensional echocardiography has provided the potential means for specific identification of the mitral leaflet motion in systole and can be considered the diagnostic standard for this syndrome. Primary myxomatous degeneration with leaflet prolapse is not localized to the mitral valve. Two-dimensional echocardiography has detected in preliminary studies tricuspid valve prolapse in up to 50% and aortic valve prolapse in about 20% of patients with idiopathic mitral valve prolapse.

  1. Noticeable decreased expression of tenascin-X in calcific aortic valves.

    PubMed

    Matsumoto, Ken-Ichi; Satoh, Kazumi; Maniwa, Tomoko; Araki, Asuka; Maruyama, Riruke; Oda, Teiji

    2012-01-01

    Calcification of aortic valves results in valvular aortic stenosis and is becoming a common valvular condition in elderly populations. An understanding of the molecular mechanisms of this valve lesion is important for revealing potential biomarkers associated with the development and progression of this disease. In order to identify proteins that are differentially expressed in calcific aortic valves (CAVs) compared with those in adjacent normal valvular tissues, comprehensive analysis of differentially expressed proteins in the tissues was done by a quantitative proteomic approach with isobaric tag for absolute and relative quantitation labeling followed by nanoliquid chromatography matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry. The proteomic analysis revealed 105 proteins differentially expressed in CAVs in contrast to adjacent normal valvular tissues with high confidence. Significantly increased expression (≥1.3-fold) was found in 34 proteins, whereas decreased expression (<0.77-fold) was found in 39 proteins in CAVs. Among them, α-2-HS-glycoprotein showed the greatest increase in expression (6.54-fold) and tenascin-X showed the greatest decrease in expression (0.37-fold). Numerous extracellular matrix proteins such as collagens were identified as proteins with significantly decreased expression. Panther pathway analysis showed that some of the identified proteins were linked to blood coagulation and integrin signaling pathways. Cluster analysis of the 105 proteins differentially expressed in CAVs based on the expression pattern revealed that tenascin-X was clustered with proteins controlling collagen structure and function, especially collagen fibrillogenesis, such as decorin and fibromodulin. We confirmed decreased levels of these proteins in CAVs by Western blot analyses. These results indicated that massive destruction of the extracellular matrix occurs in CAVs. PMID:22827484

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  3. Use of Bovine Pericardium and Sutureless Biological Glue in Left Ventricular Rupture After Mitral Valve Replacement, Five Years of Follow-up

    PubMed Central

    da Costa, Mrio Augusto Cray; Laforga, Fernando Cesar; Maftum, Josu Abro; Favaro, Mateus Gustavo

    2015-01-01

    Rupture of the left ventricular wall after mitral valve replacement is an infrequent but lethal complication. Reporting correction technique of ventricular rupture with bovine pericardium patch secured with glue and without suturing: a 51 years-old female patient, with double rheumatic mitral lesion, severe stenosis and discrete insufficiency, who had a mitral valve replacement. During surgery, the patient presented a ventricular rupture of the posterior wall (atrioventricular disruption), which was successfully repaired using bovine pericardium with sutureless biological glue over the epicardium of the damaged area. Sixty months after surgery the patient has no symptoms.

  4. Influence of Tricuspid Bioprosthetic Mitral Valve Orientation Regarding the Flow Field Inside the Left Ventricle: In Vitro Hydrodynamic Characterization Based on 2D PIV Measurements.

    PubMed

    Bazan, Ovandir; Ortiz, Jayme P; Fukumasu, Newton K; Pacifico, Antonio L; Yanagihara, Jurandir I

    2016-02-01

    The flow patterns of a prosthetic heart valve in the aortic or mitral position can change according to its type and orientation. This work describes the use of 2D particle image velocimetry (PIV) applied to the in vitro flow fields characterization inside the upper part of a left ventricular model at various heart rates and as a function of two orientations of stented tricuspid mitral bioprostheses. In the ventricular model, each mitral bioprosthesis (27 and 31?mm diameter) was installed in two orientations, rotated by 180, while the aortic bileaflet mechanical valve (27?mm diameter) remained in a fixed orientation. The results (N?=?50) showed changes in the intraventricular flow fields according to the mitral bioprostheses positioning. Also, changes in the aortic upstream velocity profiles were noticed as a function of mitral orientations. PMID:26153483

  5. Comparison of the accuracy of cardiac computed tomography angiography and transthoracic echocardiography in the diagnosis of mitral valve prolapse

    PubMed Central

    Moradi, Maryam; Nazari, Masoud; Khajouei, Amir Sajjadieh; Esfahani, Morteza Abdar

    2015-01-01

    Background: Cardiac multidetector computed tomography (MDCT) has been mainly applied in the diagnosis of valvular heart morphology and function along with the assessment of coronary artery disease. This study aimed to evaluate the diagnostic performance of coronary MDCT angiography for the diagnosis of mitral valve prolapse (MVP), as compared to transthoracic echocardiography (TTE). Materials and Methods: A total of 40 patients who had undergone both TTE and MDCT within a three-month period were included in the study. Two parameters of mitral valve leaflet thickness and leaflet billowing were measured using both techniques. The MDCT results were compared with those of TTE, which was the reference standard. Results: Implementing the Receiver Operating Characteristic (ROC) test on the data for MDCT-measured leaflet billowing received from MDCT angiography suggests that the area under the ROC curve is 96% for a declared variable, which is absolutely significant (P < 0.001), and MDCT-measured leaflet billowing is an appropriate index for the diagnosis of mitral valve prolapse. On the basis of the achieved cut-off point from the ROC analysis (which equals 2.5 mm leaftlet billowing) the MDCT-measured leaflet billowing takes a sensitivity and specificity of 68.4 and 95.2%. The false positive and false negative results are 4.8 and 31.6%. The positive and negative predictive values (PPV and NPV) of the revealed test indicate 92.9 and 76.9%, respectively. Finally, the consistency of the MDCT measured leaflet billowing for diagnosing the mitral valve prolapse is 82.5%. Based on the mentioned test, the consistency of the MDCT-measured leaflet thickness test is 47.5%. Conclusion: Along with the assessment of coronary arteries, the presence or absence of MVP can be reliably evaluated by MDCT angiography. PMID:26623397

  6. Biology of mitral valve prolapse: the harvest is big, but the workers are few.

    PubMed

    Loardi, Claudia; Alamanni, Francesco; Trezzi, Matteo; Kassem, Samer; Cavallotti, Laura; Tremoli, Elena; Pacini, Davide; Parolari, Alessandro

    2011-09-01

    Mitral valve prolapse (MVP) represents a common degenerative disease, often requiring surgery. If untreated, MVP with considerable valve incompetence can lead to cardiovascular and systemic complications causing substantial morbidity and mortality. In contrast with the wide knowledge concerning clinical and physiological features, currently available data regarding its molecular bases are very limited. We review current knowledge concerning MVP biological mechanisms, focusing on specific aspects of haemostasis, platelet function, oxidative stress, extracellular matrix remodeling and genomics. In particular, available evidence supports the role played by tissue remodeling processes in determining MVP onset and progression. Moreover, even if a consistent although controversial perturbation of haemostatic system and alterations of the oxidative stress equilibrium have been proposed to influence disease development, it is unknown whether these changes precede or follow MVP occurrence. Consequently, the complete knowledge of all the biochemical pathways involved are far from complete. In addition, changes in the regulation pattern of adrenergic and renin-angiotensin-aldosterone systems have been described in MVP syndrome, a condition characterized by the association of MVP with other peculiar neurological and general symptoms, but it is unknown whether these abnormalities are shared by "traditional" MVP. In conclusion, MVP is probably a multi-factorial process, and many aspects still need to be clarified. As surgery can only correct the damaged valve but not the underlying mechanisms, a more complete knowledge of the involved molecular pathways is necessary, as it may allow the discovery of targeted therapeutic strategies aimed at modifying or slackening MVP natural course in the early phases. PMID:21168228

  7. Left ventricular outflow track obstruction and mitral valve regurgitation in a patient with takotsubo cardiomyopathy

    PubMed Central

    Wu, Yin; Fan, WuQiang; Chachula, Laura; Costacurta, Gary; Rohatgi, Rajeev; Elmi, Farhad

    2015-01-01

    Introduction Takotsubo cardiomyopathy (TCM) can be complicated by left ventricular outflow tract (LVOT) obstruction and severe acute mitral regurgitation (MR), leading to hemodynamic instability in an otherwise benign disorder. Despite the severity of these complications, there is a paucity of literature on the matter. Because up to 20–25% of TCM patients develop LVOT obstruction and/or MR, it is important to recognize the clinical manifestations of these complications and to adhere to specific management in order to reduce patient morbidity and mortality. We report the clinical history, imaging, treatment strategy, and clinical outcome of a patient with TCM that was complicated with severe MR and LVOT obstruction. We then discuss the pathophysiology, characteristic imaging, key clinical features, and current treatment strategy for this unique patient population. Case report A postmenopausal woman with no clear risk factor for coronary artery disease (CAD) presented to the emergency department with chest pain after an episode of mental/physical stress. Physical examination revealed MR, mild hypotension, and pulmonary vascular congestion. Her troponins were mildly elevated. Cardiac catheterization excluded obstructive CAD, but revealed severe apical hypokinesia and ballooning. Notably, multiple diagnostic tests revealed the presence of severe acute MR and LVOT obstruction. The patient was diagnosed with TCM complicated by underlying MR and LVOT obstruction, and mild hemodynamic instability. The mechanism of her LVOT and MR was attributed to systolic anterior motion of the mitral valve (SAM), which the transesophageal echocardiogram clearly showed during workup. She was treated with beta-blocker, aspirin, and ACE-I with good outcome. Nitroglycerin and inotropes were discontinued and further avoided. Conclusions Our case illustrated LVOT obstruction and MR associated with underlying SAM in a patient with TCM. LVOT obstruction and MR are severe complications of TCM and may result in heart failure and/or pulmonary edema. Timely and accurate identification of these complications is critical to achieve optimal clinical outcomes in patients with TCM. PMID:26653691

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

    PubMed Central

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

    2014-01-01

    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

  9. Percutaneous ventricular assist device to rescue a patient with profound shock from a thrombosed prosthetic mitral valve.

    PubMed

    Solomon, Hemant; Lim, D Scott; Ragosta, Michael

    2008-11-01

    The TandemHeart is a percutaneous ventricular assist device that has been approved to provide hemodynamic support in high-risk patients undergoing cardiac procedures, including percutaneous coronary interventions and aortic balloon valvuloplasty. Limited data exists for its role in stabilizing cardiogenic shock secondary to prosthetic valve dysfunction. In conclusion, we report the first case, to our knowledge, of profound cardiogenic shock secondary to an acutely thrombosed mechanical mitral valve in which the use of the TandemHeart was instrumental in rescuing a critically ill young female who made a full recovery. PMID:18987410

  10. [Diagnosis and differential therapy of mitral stenosis].

    PubMed

    Fassbender, D; Schmidt, H K; Seggewiss, H; Mannebach, H; Bogunovic, N

    1998-11-01

    Clinical symptoms and diagnostic findings in patients with mitral stenosis are usually determined by the extent of the stenosis. Compared to a normal mitral valve area (MVA) of > 4 cm2, MVA in patients with severe mitral stenosis is usually reduced to < 1.5 cm2. In older patients symptoms are frequently influenced by concomitant diseases (e.g. atrial fibrillation, arterial hypertension or lung disease). An important diagnostic element besides anamnesis, auscultation, ECG and chest X-ray is echocardiography, which is required in order to measure non-invasively and reliably the mitral valve gradient (MVG), the MVA and morphologic changes to the valves, as well as concomitant valvular disease, ventricular functions and, where appropriate, left-atrial thrombi. In addition to the surgical treatment of patients with severe mitral stenosis, which has been an established procedure for 50 years, percutaneous balloon mitral valvuloplasty (MVP) has recently established itself as an alternative option. At the current time, the Inoue technique seems to display the most advantages. Following transseptal puncture, the Inoue balloon is guided transvenously into the left atrium and then into the left ventricle using a special support wire. The balloon is short and soft. Its special unfolding character enables it to be placed securely in the mitral valve without any risk of ventricular perforation (Figure 1). As with surgical commissurotomy, balloon valvuloplasty leads to a separation of fused commissures. This results in a significant reduction of MVG, accompanied by an increase in the MVA (Figure 2). The results and success of MVP are influenced by the morphology of the valves and the changes to the subvalvular apparatus. In randomized studies, the results of surgical commissurotomy were comparable with those of balloon mitral valvulotomy. In our hospital, an increase in MVA from 1.0 to 1.8 cm2 could be achieved in 899 patients (mean age 56 +/- 3 years). In younger patients with less significantly changed valves, the results were correspondingly more favorable than in older patients (Figure 3). Provided valve morphology is suitable, a relapse following previous surgical commissurotomy is not a contraindication for MVP. The MVP complication rate is very low in skilled hands: mortality is below 1%; mitral insufficiency occurs in 3 to 10% of interventions; we observed a severe mitral insufficiency in 5% of our patient group. Thromboembolic complications may be prevented after exclusion of atrial thrombi by transesophageal echocardiography. The occurrence of a hemodynamically significant atrial septum defect is a very rare event. The mid-term results (5 to 10 years) and the low restenosis rate following MVP in patients with suitable valves are comparable with those of surgical commissurotomy. In older patients with considerably changed, calcified and fibrotic valves, restenosis may be expected within 1 to 5 years. In these patients MVP represents no more than a palliative intervention in order to prolong the point of surgery, for example in patients where a concomitant aortic valve disease in itself is not yet an indication for surgery. Special indications are to be found in young patients with severe mitral stenosis yet few symptoms, in pregnant females and in emergency situations, as well as in patients with Grade II mitral stenosis with intermittent atrial fibrillation. Catheter therapy is much less invasive than surgery. In case of failure the patient still has the option of surgical therapy. Patients with morphologically significantly altered valves usually receive a valve replacement since an unsuccessful reconstruction would lead to a second operation within a very short time interval. Contraindications for MVP are thrombi in the left atrium, a previously existing > Grade II mitral regurgitation and marked, degenerative destruction of the subvalvular apparatus or extensive calcification of the valves. MVP thus represents a significant addi PMID:9859036

  11. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles: A consensus document from the mitral valve academic research consortium.

    PubMed

    Stone, Gregg W; Vahanian, Alec S; Adams, David H; Abraham, William T; Borer, Jeffrey S; Bax, Jeroen J; Schofer, Joachim; Cutlip, Donald E; Krucoff, Mitchell W; Blackstone, Eugene H; Gnreux, Philippe; Mack, Michael J; Siegel, Robert J; Grayburn, Paul A; Enriquez-Sarano, Maurice; Lancellotti, Patrizio; Filippatos, Gerasimos; Kappetein, Arie Pieter

    2015-08-01

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26170467

  12. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part1: Clinical Trial Design Principles: A Consensus Document From the Mitral Valve Academic Research Consortium.

    PubMed

    Stone, Gregg W; Vahanian, Alec S; Adams, David H; Abraham, William T; Borer, Jeffrey S; Bax, Jeroen J; Schofer, Joachim; Cutlip, Donald E; Krucoff, Mitchell W; Blackstone, Eugene H; Gnreux, Philippe; Mack, Michael J; Siegel, Robert J; Grayburn, Paul A; Enriquez-Sarano, Maurice; Lancellotti, Patrizio; Filippatos, Gerasimos; Kappetein, Arie Pieter

    2015-07-21

    Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. Theadoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MVdevices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. PMID:26184622

  13. Prenatal ultrasonographic diagnosis of generalized arterial calcification of infancy.

    PubMed

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

    2015-01-01

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

  14. Horseshoe thrombus in a patient with mechanical prosthetic mitral valve: A case report and review of literature

    PubMed Central

    Mehra, Sanjay; Movahed, Assad; Espinoza, Carlos; Marcu, Constantin B

    2015-01-01

    Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications. PMID:26380832

  15. [Knack and pitfall in valve replacement].

    PubMed

    Takano, T; Amano, J

    2010-07-01

    We choose prosthetic or bioprosthetic valves according to AHA/ACC guidelines in valve replacement. It is important to remove only the calcification and avoid over-resection to preserve the valve annulus during aortic valve replacement. We leave posterior leaflet as well as basal chordae in mitral valve replacement in case of large mitral annulus. Sutures should be tied-down after those on both adjacent sides are pulled up and the sawing cuff and annulus are firmly attached. Intra-operative transesophageal echocardiography is useful for detecting a stack valve, perivalvular leakage and remnant air in the cardiac chambers. We performed 53 cases of valve replacement in 2009. One patient (1.9%) died because of ventricular arrhythmia during hospital stay. Re-operation was required in 2 cases (3.8%) of infective endocarditis due to prosthetic valve endocarditis. No other major complication was observed. PMID:20715438

  16. Relationship between Urinary Level of Phytate and Valvular Calcification in an Elderly Population: A Cross-Sectional Study

    PubMed Central

    Fernández-Palomeque, Carlos; Grau, Andres; Perelló, Joan; Sanchis, Pilar; Isern, Bernat; Prieto, Rafel M.; Costa-Bauzá, Antonia; Caldés, Onofre J.; Bonnin, Oriol; Garcia-Raja, Ana; Bethencourt, Armando; Grases, Felix

    2015-01-01

    Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (<0.610 μM), intermediate (0.61–1.21 μM), and high (>1.21 μM). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution. PMID:26322979

  17. Correlation between conjunctival and corneal calcification and cardiovascular calcification in patients undergoing maintenance hemodialysis.

    PubMed

    Sun, Wenxue; Sun, Mei; Zhang, Minghui; Liu, Yi; Lin, Xiaomin; Zhao, Sisi; Ma, Lulu

    2015-04-01

    The purpose of this study was to investigate the correlation of conjunctival and corneal calcification (CCC) with cardiovascular calcification in patients undergoing maintenance hemodialysis (MHD). A total of 122 patients undergoing MHD in our hospital were included in this study. Conjunctival and corneal calcification was examined by slit lamp and graded. Abdominal aortic calcification (AAC), aortic valve calcification (AVC), and mitral valve calcification (MVC) were determined by X-ray or ultrasound. The correlation of CCC with AAC, AVC, and MVC was analyzed. Biochemical, hematological, and cardiovascular data were compared between patients with different severity of CCC or AAC. Mitral valve calcification was significantly associated with AAC in our patients. Conjunctival and corneal calcification positively correlated with AAC. We also found that patients with severe CCC exhibited significantly higher levels of serum calcium, phosphate, product of calcium and phosphate, serum copper, cystatin, intact parathyroid hormone, and vitamin D than patients with mild CCC. In addition to significantly increased levels of serum calcium, product of calcium and phosphate, serum copper, and cystatin, patients with severe AAC also had higher high-sensitivity C-reactive protein level and greater left ventricular posterior wall thickness and left ventricular end-diastolic interventricular septum thickness than patients with mild AAC. Our results suggest that patients undergoing MHD with severe CCC or AAC have high degree of mineral metabolism disorder, inflammation, and cardiovascular function disorder. The strong correlation between CCC and AAC indicates that CCC score might be used as an indirect indicator to predict cardiovascular risks in patients undergoing MHD. PMID:25377787

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

    PubMed Central

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

    2010-01-01

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

  19. Triglycidylamine Crosslinking of Porcine Aortic Valve Cusps or Bovine Pericardium Results in Improved Biocompatibility, Biomechanics, and Calcification Resistance

    PubMed Central

    Connolly, Jeanne M.; Alferiev, Ivan; Clark-Gruel, Jocelyn N.; Eidelman, Naomi; Sacks, Michael; Palmatory, Elizabeth; Kronsteiner, Allyson; DeFelice, Suzanne; Xu, Jie; Ohri, Rachit; Narula, Navneet; Vyavahare, Narendra; Levy, Robert J.

    2005-01-01

    We investigated a novel polyepoxide crosslinker that was hypothesized to confer both material stabilization and calcification resistance when used to prepare bioprosthetic heart valves. Triglycidylamine (TGA) was synthesized via reacting epichlorhydrin and NH3. TGA was used to crosslink porcine aortic cusps, bovine pericardium, and type I collagen. Control materials were crosslinked with glutaraldehyde (Glut). TGA-pretreated materials had shrink temperatures comparable to Glut fixation. However, TGA crosslinking conferred significantly greater collagenase resistance than Glut pretreatment, and significantly improved biomechanical compliance. Sheep aortic valve interstitial cells grown on TGA-pretreated collagen did not calcify, whereas sheep aortic valve interstitial cells grown on control substrates calcified extensively. Rat subdermal implants (porcine aortic cusps/bovine pericardium) pretreated with TGA demonstrated significantly less calcification than Glut pretreated implants. Investigations of extracellular matrix proteins associated with calcification, matrix metalloproteinases (MMPs) 2 and 9, tenascin-C, and osteopontin, revealed that MMP-9 and tenascin-C demonstrated reduced expression both in vitro and in vivo with TGA crosslinking compared to controls, whereas osteopontin and MMP-2 expression were not affected. TGA pretreatment of heterograft biomaterials results in improved stability compared to Glut, confers biomechanical properties superior to Glut crosslinking, and demonstrates significant calcification resistance. PMID:15631995

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

    PubMed

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

    2015-04-01

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

  1. Developmental pathways and endothelial to mesenchymal transition in canine myxomatous mitral valve disease.

    PubMed

    Lu, Chi-Chien; Liu, Meng-Meng; Clinton, Michael; Culshaw, Geoff; Argyle, David J; Corcoran, Brendan M

    2015-12-01

    Epithelial to mesenchymal transition (EMT) and the cardiovascular equivalent, endothelial to mesenchymal transition (EndoMT), contribute to a range of chronic degenerative diseases and cancer metastasis. Chronic valvulopathies exhibit some features of EndoMT and activation of developmental signalling pathways, such as osteogenesis and chondrogenesis, expression of cell differentiation markers, basement membrane damage and endothelial transformation. The aim of the present study was to investigate the potential role of developmental mechanisms in canine myxomatous mitral valve disease (MMVD) using a combination of transcriptomic array technology, RT-PCR and immunohistochemistry. There was significant differential expression for genes typically associated with valvulogenesis and EndoMT, including markers of inflammation (IL6, IL18 and TLR4), basement membrane disarray (NID1, LAMA2 and CTSS), mesenchymal and endothelial cell differentiation (MYH11 and TAGLN) and EndoMT (ACTA2, SNAI1, CTNNB1, HAS2, CDH5, and NOTCH1), with fold changes from +15.35 (ACTA2) to -5.52 (LAMA2). These changes in gene expression were confirmed using RT-PCR, except for HAS2. In silico analysis identified important gene networks and canonical pathways in MMVD that have associations with development and organogenesis, including inflammation, valve morphogenesis and EMT, as well as components of the basement membrane and extra-cellular matrix. Immunohistochemistry identified changes in the expression of hyaluronic acid synthase (Has2), Snai1, ?-smooth muscle actin (?-SMA) and VE-cadherin (CDH5), and co-expression of Has2 with ?-SMA. These research findings strongly suggest involvement of developmental signalling pathways and mechanisms, including EndoMT, in the pathogenesis of canine MMVD. PMID:26586213

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

    SciTech Connect

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

    1985-06-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. Plain radiographic diagnosis of thrombosis of left atrial appendage in mitral valve disease

    SciTech Connect

    Matsuyama, S.; Watabe, T.; Kuribayashi, S.; Ootaki, M.; Suzuki, Y.; Sugihara, M.; Kawada, S.; Koide, S.; Shohtsu, A.; Tomoda, H.

    1983-01-01

    Conventional posteroanterior chest radiographs of 42 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the presence or absence of the convexity of the left lower midcardiac border (left artrial segment). The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in six (60%) of 10 patients who had left atrial thrombosis, and in three (9%) of 32 patients who did not have thrombosis (false positive diagnosis). Four of the 10 patients who had left atrial thrombosis did not show this finding on the radiographs (false negative diagnosis). One of these four had a thrombus only against the posterior wall of the body of the left atrium. Therefore, the accuracy in the diagnosis of thrombosis of the left atrial appendage was 66.7% (six of nine) for patients who had thrombosis of the appendage. Standard chest radiographs are important in the evaluation of the patient with thrombosis of the left atrial appendage.

  5. [Intraoperative transesophageal echocardiography and systolic anterior motion of the mitral valve: findings during noncardiac surgery].

    PubMed

    Cabrera Schulmeyer, M C; Labb, M; Schmied, S; De la Maza, J

    2007-01-01

    Systolic anterior motion is an under-recognized cause of acute systemic hypotension during noncardiac surgery. This dynamic event has come to light with the introduction of intraoperative transesophageal echocardiography, which provides anatomic and functional images in real time. The cause of this abnormal motion is still uncertain, although it is thought that changes in the shape and function of the left ventricle allow displacement of the mitral valve annulus so that 1 or more leaflets can be pulled toward the outflow tract and obstruct it during the systole. It is important to recognize and diagnose this phenomenon as a cause of hypotension during noncardiac surgery because it can be treated with volume replacement and beta-blockers. The results of such measures can be monitored on intraoperative echocardiographic images. Volume replacement should increase the size of the ventricle and the beta-blockers should decrease the hyperdynamic state. We report a case of abnormal systolic motion during noncardiac surgery that was managed with the help of echocardiography. PMID:17953339

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

    PubMed Central

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

    2014-01-01

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

  7. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective

    PubMed Central

    Griffin, William F.; Gudimella, Preeti; ONeal, Wesley T.; Davies, Stephen W.; Crane, Patricia B.; Anderson, Ethan J.; Kindell, Linda C.; Landrine, Hope; ONeal, Jason B.; Alwair, Hazaim; Kypson, Alan P.; Nifong, Wiley L.; Chitwood, W. Randolph

    2015-01-01

    Background Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). Methods Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. Results Non-smoking men (?65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. Conclusions In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures. PMID:26539348

  8. Mitral valve prolapse associated with celiac artery stenosis: a new ultrasonographic syndrome?

    PubMed Central

    Arcari, Luciano

    2004-01-01

    Background Celiac artery stenosis (CAS) may be caused by atherosclerotic degeneration or compression exerted by the arched ligament of the diaphragm. Mitral valve prolapse (MVP) is the most common valvular disorder. There are no reports on an association between CAS and MVP. Methods 1560 (41%) out of 3780 consecutive patients undergoing echocardiographic assessment of MVP, had Doppler sonography of the celiac tract to detect CAS. Results CAS was found in 57 (3.7%) subjects (23 males and 34 females) none of whom complained of symptoms related to visceral ischemia. MVP was observed in 47 (82.4%) subjects with and 118 (7.9%) without CAS (p < 0.001). The agreement between MVP and CAS was 39% (95% CI 3249%). PSV (Peak Systolic Velocity) was the only predictor of CAS in MPV patients (OR 0.24, 95% CI 0.080.69) as selected in a multivariate logistic model. Conclusion CAS and MVP seem to be significantly associated in patients undergoing consecutive ultrasonographic screening. PMID:15588321

  9. Mass-spring systems for simulating mitral valve repair using 3D ultrasound images.

    PubMed

    Skornitzke, Stephan; Schummers, Georg; Schreckenberg, Marcus; Ender, Jrg; Eibel, Sarah; Bungartz, Hans-Joachim; Kauczor, Hans-Ulrich; Stiller, Wolfram

    2015-10-01

    Mitral valve (MV) diseases are among the most common types of heart diseases, while heart diseases are the most common cause of death worldwide. MV repair surgery is connected to higher survival rates and fewer complications than the total replacement of the MV, but MV repair requires extensive patient-specific therapy planning. The simulation of MV repair with a patient-specific model could help to optimize surgery results and make MV repair available to more patients. However, current patient-specific simulations are difficult to transfer to clinical application because of time-constraints or prohibitive requirements on the resolution of the image data. As one possible solution to the problem of patient-specific MV modeling, we present a mass-spring MV model based on 3D transesophageal echocardiographic (TEE) images already routinely acquired for MV repair therapy planning. Our novel approach to the rest-length estimation of springs allows us to model the global support of the MV leaflets through the chordae tendinae without the need for high-resolution image data. The model is used to simulate MV annuloplasty for five patients undergoing MV repair, and the simulated results are compared to post-surgical TEE images. The comparison shows that our model is able to provide a qualitative estimate of annuloplasty surgery. In addition, the data suggests that the model might also be applied to simulating the implantation of artificial chordae. PMID:26241162

  10. Predominance of Abdominal Visceral Adipose Tissue Reflects the Presence of Aortic Valve Calcification

    PubMed Central

    Oikawa, Masayoshi; Owada, Takashi; Yamauchi, Hiroyuki; Misaka, Tomofumi; Machii, Hirofumi; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2016-01-01

    Background. Aortic valve calcification (AVC) is a common feature of aging and is related to coronary artery disease. Although abdominal visceral adipose tissue (VAT) plays fundamental roles in coronary artery disease, the relationship between abdominal VAT and AVC is not fully understood. Methods. We investigated 259 patients who underwent cardiac and abdominal computed tomography (CT). AVC was defined as calcified lesion on the aortic valve by CT. %abdominal VAT was calculated as abdominal VAT area/total adipose tissue area. Results. AVC was detected in 75 patients, and these patients showed higher %abdominal VAT (44% versus 38%, p < 0.05) compared to those without AVC. When the cutoff value of %abdominal VAT was set at 40.9%, the area under the curve to diagnose AVC was 0.626. Multivariable logistic regression analysis showed that age (OR 1.120, 95% CI 1.0781.168, p < 0.01), diabetes (OR 2.587, 95% CI 1.3235.130, p < 0.01), and %abdominal VAT (OR 1.032, 95% CI 1.0031.065, p < 0.05) were independent risk factors for AVC. The net reclassification improvement value for detecting AVC was increased when %abdominal VAT was added to the model: 0.5093 (95% CI 0.24890.7697, p < 0.01). Conclusion. We determined that predominance of VAT is associated with AVC. PMID:26904670

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

    PubMed Central

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

    2009-01-01

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

  12. The role of glutaraldehyde-induced cross-links in calcification of bovine pericardium used in cardiac valve bioprostheses.

    PubMed Central

    Golomb, G.; Schoen, F. J.; Smith, M. S.; Linden, J.; Dixon, M.; Levy, R. J.

    1987-01-01

    Calcification is the principal cause of failure of tissue-derived cardiac valve replacements pretreated with glutaraldehyde (GLUT). The objective of this study was to determine the role of GLUT-induced cross-links in bovine pericardial tissue calcification. Various levels of 3H-GLUT incorporation were obtained by varying incubation pH, and protein modification was determined by amino acid analysis and resistance to collagenase digestion. Calcification of cross-linked tissue was studied using subdermal implants in rats. Low GLUT uptake (less than 150 nm/mg) resulted in minimal calcification (Ca2+, 12.8 micrograms/mg) and stability (4% residual weight following digestion) due to a limited crosslinking (lysine + hydroxylysine = 26.1 residues/1000 amino acids [AA]). In contrast, higher GLUT uptake induced more cross-links (Lys + Hyl = 8.2 residues/1000 AA) and consequent higher stability (95% residual wt); such tissues calcified severely (Ca2+, 93.5 micrograms/mg). Incorporation of GLUT two to three times beyond a critical level did not further enhance calcification. It is concluded that the amount of GLUT incorporated controls the extent of cross-links, which in turn directly determines tissue stability and calcification. Images Figure 4 PMID:3105321

  13. Assessment of transmitral flow after mitral valve edge-to-edge repair using High-speed particle image velocimetry

    NASA Astrophysics Data System (ADS)

    Jeyhani, Morteza; Shahriari, Shahrokh; Labrosse, Michel; Kadem, Lyes

    2013-11-01

    Approximately 500,000 people in North America suffer from mitral valve regurgitation (MR). MR is a disorder of the heart in which the mitral valve (MV) leaflets do not close securely during systole. Edge-to-edge repair (EtER) technique can be used to surgically treat MR. This technique produces a double-orifice configuration for the MV. Under these un-physiological conditions, flow downstream of the MV forms a double jet structure that may disturb the intraventricular hemodynamics. Abnormal flow patterns following EtER are mainly characterized by high-shear stress and stagnation zones in the left ventricle (LV), which increase the potential of blood component damage. In this study, a custom-made prosthetic bicuspid MV was used to analyze the LV flow patterns after EtER by means of digital particle image velocimetry (PIV). Although the repair of a MV using EtER technique is an effective approach, this study confirms that EtER leads to changes in the LV flow field, including the generation of a double mitral jet flow and high shear stress regions.

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

    PubMed Central

    2014-01-01

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

  15. Radiation induced cardiac valve disease in a man from Chernobyl.

    PubMed

    Bose, Anita Subash Chandra; Shetty, Vijay; Sadiq, Adnan; Shani, Jacob; Jacobowitz, Israel

    2009-08-01

    A young man presented with a new heart murmur. History revealed that the patient was from Ukraine, which was affected by the Chernobyl nuclear plant explosion in 1986. Physical examination revealed murmurs of mitral regurgitation and aortic stenosis. Transesophageal echocardiography revealed severely calcified mitral and calcified tricuspid aortic valves with mitral and aortic regurgitation and aortic stenosis. Following valve replacement surgery, pathologic examination of the valves showed severe dystrophic calcifications and changes suggestive of a chronic inflammatory process such as radiation-induced valve disease. In the absence of another etiology explaining such severe valve disease in a young man, it can only be surmised that heavy radiation exposure from the nuclear plant caused this significant valve damage. PMID:19647162

  16. Biologic determinants of dystrophic calcification and osteocalcin deposition in glutaraldehyde-preserved porcine aortic valve leaflets implanted subcutaneously in rats.

    PubMed Central

    Levy, R. J.; Schoen, F. J.; Levy, J. T.; Nelson, A. C.; Howard, S. L.; Oshry, L. J.

    1983-01-01

    Bioprosthetic cardiac valve calcification is a frequent complication after long-term valve replacement. In this study the authors sought to examine the biologic determinants of this type of dystrophic calcification using subcutaneous implants of glutaraldehyde-preserved porcine aortic valve leaflets (GPVs) in rats. GPVs and clinical valvular bioprostheses were prepared identically. Retrieved implants were examined for calcification and the deposition of osteocalcin (OC), a vitamin K-dependent, bone-derived protein, that is found in other dystrophic and ectopic calcifications. GPVs implanted in 3-week-old rats calcified progressively (GPV Ca2+, 122.9 +/- 6.0 micrograms/mg) after 21 days, with mineral deposition occurring in a morphologic pattern comparable to that noted in clinical retrievals. Calcified GPVs accumulated osteocalcin (OC, 183.4 +/- 19.4 ng/mg); Nonpreserved porcine aortic leaflet implants did not calcify (Ca2+ + 5.6 +/- 1.0 micrograms/mg). Millipore diffusion chamber (0.45-mu pore size enclosed GPV implants accumulated calcium and adsorbed osteocalcin despite the absence of attached host cells. GPVs implanted for 21 days in 8-month-old rats calcified less (GPV Ca2+, 22.4 +/- 5.0 micrograms/mg) than did GPVs implanted in 3-week-old rats (see above). High-dose warfarin therapy (80 mg/kg) did not alter GPV calcification (GPV Ca2+, 39.6 +/- 2.9 micrograms/mg) in 72-hour subcutaneous implants in 3-week-old male rats, compared with control rats (GPV Ca2+, 40.8 +/- 4.8 micrograms/mg). Images Figure 3 Figure 1 Figure 2 Figure 4 Figure 6 Figure 7 PMID:6605687

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

    PubMed Central

    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

    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 PMID:25696195

  18. Carnitine Deficiency as the Possible Etiology of Idiopathic Mitral Valve Prolapse

    PubMed Central

    Trivellato, Mario; De Palo, Elio; Gatti, Rosalba; Parenti, Anna; Piazza, Mario

    1984-01-01

    Idiopathic mitral valve prolapse (IMVP) is a very common cardiac abnormality that may be linked to carnitine deficit (inadequate nutritional intake or absorption). One patient with IMVP and related symptoms that were resistant to drug therapy was fully studied. Free plasma carnitine and 24-hour free urine carnitine were measured twice, 10 days apart, after an overnight fast. Findings: Free plasma carnitine 23 and 28 ?M/L (our laboratory N=382 ?M/L); free urine C 25 and 44 ?M/24 hr (N=25566 ?M/24 hr); FFA 0.88 mEq/L, Duncombe method (N=0.09-0.60); LDL 42% (N = 44-65); cholesterol 161 mg/dl (N = 180-280); triglycerides 84 mg/dl (N = 50-172); SGOT 79 MU/ml (N = up to 40); SGPT 147 MU/ml (N = up to 40); OCT 11.2 MU/ml (N = up to 10.0); aldolase 11.5 MU/ml (N = up to 3.1, Bruns method). Deltoid biopsy: light microscopy showed the presence of optically empty vacuoles; electron microscopy showed lipid droplets near the subsarcolemma area and intermyofibrillar spaces. The mitochondria contained electron dense granules. The electromyogram was also abnormal. In a random sample of four patients with IMVP and related classic symptoms, we have found low levels of plasma and/or urinary carnitine in each case. This study may be the first step towards L-carnitine therapy for what has previously appeared to be idiopathic cardiomyopathy. Images PMID:15226877

  19. Targeted Mybpc3 Knock-Out Mice with Cardiac Hypertrophy Exhibit Structural Mitral Valve Abnormalities

    PubMed Central

    Judge, Daniel P.; Neamatalla, Hany; Norris, Russell A.; Levine, Robert A.; Butcher, Jonathan T.; Vignier, Nicolas; Kang, Kevin H.; Nguyen, Quangtung; Bruneval, Patrick; Perier, Marie-Ccile; Messas, Emmanuel; Jeunemaitre, Xavier; de Vlaming, Annemarieke; Markwald, Roger; Carrier, Lucie; Hagge, Albert A.

    2015-01-01

    MYBPC3 mutations cause hypertrophic cardiomyopathy, which is frequently associated with mitral valve (MV) pathology. We reasoned that increased MV size is caused by localized growth factors with paracrine effects. We used high-resolution echocardiography to compare Mybpc3-null, heterozygous, and wild-type mice (n = 84, aged 36 months) and micro-CT for MV volume (n = 6, age 6 months). Mybpc3-null mice showed left ventricular hypertrophy, dilation, and systolic dysfunction compared to heterozygous and wild-type mice, but no systolic anterior motion of the MV or left ventricular outflow obstruction. Compared to wild-type mice, echocardiographic anterior leaflet length (adjusted for left ventricular size) was greatest in Mybpc3-null mice (1.92 0.08 vs. 1.72 0.08 mm, p < 0.001), as was combined leaflet thickness (0.23 0.04 vs. 0.15 0.02 mm, p < 0.001). Micro-CT analyses of Mybpc3-null mice demonstrated increased MV volume (0.47 0.06 vs. 0.15 0.06 mm3, p = 0.018) and thickness (0.35 0.04 vs. 0.12 0.04 mm, p = 0.002), coincident with increased markers of TGF? activity compared to heterozygous and wild-type littermates. Similarly, excised MV from a patient with MYBPC3 mutation showed increased TGF? activity. We conclude that MYBPC3 deficiency causes hypertrophic cardiomyopathy with increased MV leaflet length and thickness despite the absence of left ventricular outflow-tract obstruction, in parallel with increased TGF? activity. MV changes in hypertrophic cardiomyopathy may be due to paracrine effects, which represent targets for therapeutic studies.

  20. Severity of Mitral Valve Degeneration Is Associated with Chromosome 15 Loci in Whippet Dogs.

    PubMed

    Stern, Joshua A; Hsue, Weihow; Song, Kun-Ho; Ontiveros, Eric S; Luis Fuentes, Virginia; Stepien, Rebecca L

    2015-01-01

    Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs. This phenomenon makes a traditional case versus control genetic study prone to phenotyping error. This study sought to avoid these common pitfalls by identifying genetic loci associated with severity of MVD in Whippets through a genome-wide association study (GWAS). 138 Whippet dogs were characterized for MVD by echocardiographic examination and a novel disease severity score was developed and adjusted for age in each subject. Single nucleotide polymorphism (SNP) genotype data (170k Illumina CanineHD SnpChip) was obtained for DNA isolated from blood of each study subject. Continuous variable genome wide association was performed after correction for population stratification by efficient mixed model association expedited (EMMAX) in 130 dogs. A genome wide significant association was identified on chromosome 15 (peak locus 57,770,326; Padj = 0.049) and secondary loci of suggestive association were identified on chromosome 2 (peak locus 37,628,875; Padj = 0.079). Positional candidate genes were identified within the primary and secondary loci including follistatin-related protein 5 precursor (FSTL5) and Rho GTPase-activating protein 26 (ARHGAP26). These results support the hypothesis that severity of MVD in whippets has a genetic basis and warrants further study by either candidate gene sequencing or next-generation techniques. PMID:26509595

  1. Severity of Mitral Valve Degeneration Is Associated with Chromosome 15 Loci in Whippet Dogs

    PubMed Central

    Stern, Joshua A.; Hsue, Weihow; Song, Kun-Ho; Ontiveros, Eric S.

    2015-01-01

    Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs. This phenomenon makes a traditional case versus control genetic study prone to phenotyping error. This study sought to avoid these common pitfalls by identifying genetic loci associated with severity of MVD in Whippets through a genome-wide association study (GWAS). 138 Whippet dogs were characterized for MVD by echocardiographic examination and a novel disease severity score was developed and adjusted for age in each subject. Single nucleotide polymorphism (SNP) genotype data (170k Illumina CanineHD SnpChip) was obtained for DNA isolated from blood of each study subject. Continuous variable genome wide association was performed after correction for population stratification by efficient mixed model association expedited (EMMAX) in 130 dogs. A genome wide significant association was identified on chromosome 15 (peak locus 57,770,326; Padj = 0.049) and secondary loci of suggestive association were identified on chromosome 2 (peak locus 37,628,875; Padj = 0.079). Positional candidate genes were identified within the primary and secondary loci including follistatin-related protein 5 precursor (FSTL5) and Rho GTPase-activating protein 26 (ARHGAP26). These results support the hypothesis that severity of MVD in whippets has a genetic basis and warrants further study by either candidate gene sequencing or next-generation techniques. PMID:26509595

  2. A meso-scale layer-specific structural constitutive model of the mitral heart valve leaflets.

    PubMed

    Zhang, Will; Ayoub, Salma; Liao, Jun; Sacks, Michael S

    2016-03-01

    Fundamental to developing a deeper understanding of pathophysiological remodeling in mitral valve (MV) disease is the development of an accurate tissue-level constitutive model. In the present work, we developed a novel meso-scale (i.e. at the level of the fiber, 10-100?m in length scale) structural constitutive model (MSSCM) for MV leaflet tissues. Due to its four-layer structure, we focused on the contributions from the distinct collagen and elastin fiber networks within each tissue layer. Requisite collagen and elastin fibrous structural information for each layer were quantified using second harmonic generation microscopy and conventional histology. A comprehensive mechanical dataset was also used to guide model formulation and parameter estimation. Furthermore, novel to tissue-level structural constitutive modeling approaches, we allowed the collagen fiber recruitment function to vary with orientation. Results indicated that the MSSCM predicted a surprisingly consistent mean effective collagen fiber modulus of 162.72MPa, and demonstrated excellent predictive capability for extra-physiological loading regimes. There were also anterior-posterior leaflet-specific differences, such as tighter collagen and elastin fiber orientation distributions (ODF) in the anterior leaflet, and a thicker and stiffer atrialis in the posterior leaflet. While a degree of angular variance was observed, the tight valvular tissue ODF also left little room for any physically meaningful angular variance in fiber mechanical responses. Finally, a novel fibril-level (0.1-1?m) validation approach was used to compare the predicted collagen fiber/fibril mechanical behavior with extant MV small angle X-ray scattering data. Results demonstrated excellent agreement, indicating that the MSSCM fully captures the tissue-level function. Future utilization of the MSSCM in computational models of the MV will aid in producing highly accurate simulations in non-physiological loading states that can occur in repair situations, as well as guide the form of simplified models for real-time simulation tools. PMID:26712602

  3. Diminished global fibrinolytic capacity in patients with mitral valve prolapse is associated with transient ischemic attacks.

    PubMed

    Atalar, Enver; Açil, Tayfun; Aytemir, Kudret; Haznedaroğlu, Ibrahim; Ozer, Necla; Kiliç, Harun; Kuru, Gülcan; Aksöyek, Serdar; Ovünç, Kenan; Kes, Sirri; Kirazli, Serafettin; Ozmen, Ferhan

    2002-01-01

    Although mitral valve prolapse (MVP) has shown to be associated with thromboembolic complications, the cause of thromboembolic events in those patients is still unknown. The purpose of this study was to evaluate the fibrinolytic activity in MVP patients. The study included 35 consecutive patients (25 women, mean age 25+/-11 years) with echocardiographically documented MVP and 25 age- and sex-matched subjects as a control group. Four of MVP patients have a history of transient ischemic attack (TIA). Global fibrinolytic capacity (GFC), a new technique that examines the effectiveness of the entire fibrinolytic system, was measured. Global fibrinolytic capacity was found to be nonsignificantly increased in MVP patients (3.14+/-1.42 microg/mL) compared to those in control subjects (2.36+/-1.33 microg/mL) (p>0.05). However, in four of these MVP patients who had a history of transient ischemic attack, the GFC level was significantly lower than in patients who have no history of transient ischemic attack (1.67+/-0.6 microg/mL vs 3.27+/-1.46 (microg/mL, p=0.003). Furthermore, the GFC levels of these four patients were less than those of controls (p=0.04). These results showed that global fibrinolytic activity was similar in MVP patients without a history of TIA and control subjects. However, MVP patients with a history of TIA had significantly decreased global fibrinolytic activity compared to controls and as well as MVP patients without a history of TIA. PMID:11991238

  4. Plummer-Vinson syndrome with pectus carinatum mitral valve prolapsus and exotropia in an 18-year-old boy

    PubMed Central

    Sahin, Cem; Ozseker, Burak; Rencuzogullari, Ibrahim; Zeybek, Arife

    2014-01-01

    The Plummer-Vinson syndrome is a clinical syndrome characterised by dysphagia, web or webs in upper oesophagus and iron-deficiency anaemia. The syndrome is often seen in women of age 4070?years and rarely in adolescents. Plummer-Vinson syndrome might be associated with malignancy, myeloproliferative disorder and autoimmune diseases including coeliac disease, rheumatoid arthritis and Sjgren syndrome. However, according to our literature search, there are no reports of such case associated with thorax deformity, cardiac pathology and ocular findings. We present a case of an 18-year-old boy with a rare presentation of this syndrome including pectus carinatum, exotropia and mitral valve prolapsus. PMID:24451233

  5. Catheter ablation of an accessory pathway within the marshall vein in a patient with mechanical mitral valve.

    PubMed

    Aslani, Amir; Moradi, Mehdi; Kheirkhah, Jalal; Haghjoo, Majid

    2013-05-01

    A 37-year-old man, known case of mitral valve replacement, was referred for ablation. Meticulous mapping showed the earliest signal in the distal coronary sinus (CS). Endocardial ablation via transseptal approach failed to permanently ablate the accessory pathway. Similarly, ablation within the CS was unsuccessful. Finally, the mapping catheter was introduced into the vein of Marshall (VoM) and a very early signal was obtained. In the first 3 seconds of the radiofrequency energy application within the VoM, delta wave disappeared. During 1-year follow-up, the patient had no recurrence of the palpitations and electrocardiogram showed no delta wave. PMID:21453338

  6. Elucidating the Molecular-Level Events in Valvular Interstitial Cell Calcification to Improve the Design of Tissue-Engineered Heart Valves

    NASA Astrophysics Data System (ADS)

    Gu, Xiaoxiao

    Calcification is the leading cause of native and bioprosthetic heart valve failure, yet its etiology and progression remain poorly understood. Total valve replacement, which is both invasive and accompanied by numerous shortcomings, is commonly performed to replace stenotic valves, but there are currently no medical agents that are FDA-approved for the prevention of aortic valve disease progression. Tissue engineering offers an attractive alternative to current valve replacement options. Thus, there is a pressing need to: (1) better understand the progression of valve calcification, (2) develop more options for prevention and treatment of valve calcification, and (3) define the properties of appropriate scaffold environments that will support the growth of engineered valve tissue. In this thesis, we describe our plan to bring together these goals in cardiovascular medicine: we aim to identify differences between calcifying and non-calcifying valve cultures and then use this information to discover potential calcification inhibitors and define biomaterial environments that can be used to support either healthy or diseased valvular interstitial cell function.

  7. Mineral metabolism disturbances are associated with the presence and severity of calcific aortic valve disease*

    PubMed Central

    Yang, Zhen-kun; Ying, Chen; Zhao, Hong-yan; Fang, Yue-hua; Chen, Ying; Shen, Wei-feng

    2015-01-01

    Objective: We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease (CAVD) in patients with normal or mildly impaired renal function. Methods: We measured serum levels of calcium, phosphate, alkaline phosphatase (AKP), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OHD), and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis (AVSc) (n=164) or stenosis (AVS) (n=96) and in 164 age- and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results: Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels (all P<0.001). Similarly, osteocalcin, procollagen I N-terminal peptide, and ?-isomerized type I collagen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS (all P<0.001). In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding variables, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were independently associated with the presence and severity of CAVD. Conclusions: This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism. PMID:25990053

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

    PubMed

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

    2007-02-01

    Heart valve replacements fabricated from glutaraldehyde (Glut)-crosslinked heterograft materials, porcine aortic valves or bovine pericardium, have been widely used in cardiac surgery to treat heart valve disease. However, these bioprosthetic heart valves often fail in long-term clinical implants due to pathologic calcification of the bioprosthetic leaflets, and for stentless porcine aortic valve bioprostheses, bioprosthetic aortic wall calcification also typically occurs. Previous use of the epoxide-based crosslinker, triglycidyl amine (TGA), on cardiac bioprosthetic valve materials demonstrated superior biocompatibility, mechanics, and calcification resistance for porcine aortic valve cusps (but not porcine aortic wall) and bovine pericardium, vs. Glut-prepared controls. However, TGA preparation did not completely prevent long-term calcification of cusps or pericardium. Herein we report further mechanistic investigations of an added therapeutic component to this system, 2-mercaptoethylidene-1,1-bisphosphonic acid (MABP), a custom synthesized thiol bisphosphonate, which has previously been shown in a preliminary report to prevent bioprosthetic heterograft biomaterial calcification when used in combination with initial TGA crosslinking for 7 days. In the present studies, we have further investigated the effectiveness of MABP in experiments that examined: (1) The use of MABP after optimal TGA crosslinking, in order to avoid any competitive interference of MABP-reactions with TGA during crosslinking; (2) Furthermore, recognizing the importance of alkaline phosphatase (ALP) in the formation of dystrophic calcific nodules, we have investigated the hypothesis that the mechanism by which MABP primarily functions is through the reduction of ALP activity. Results from cell-free model systems, cell culture studies, and rat subcutaneous implants, show that materials functionalized with MABP after TGA crosslinking have reduced ALP activity, and in vivo have no significant calcification in long-term implant studies. It is concluded that bioprosthetic heart valves prepared in this fashion are compelling alternatives for Glut-prepared bioprostheses. PMID:17027944

  9. MECHANISMS OF THE IN VIVO INHIBITION OF CALCIFICATION OF BIOPROSTHETIC PORCINE AORTIC VALVE CUSPS AND AORTIC WALL WITH TRIGLYCIDYLAMINE/MERCAPTO BISPHOSPHONATE

    PubMed Central

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

    2007-01-01

    Heart valve replacements fabricated from glutaraldehyde (Glut)-crosslinked heterograft materials, porcine aortic valves or bovine pericardium, have been widely used in cardiac surgery to treat heart valve disease. However, these bioprosthetic heart valves often fail in long-term clinical implants due to pathologic calcification of the bioprosthetic leaflets, and for stentless porcine aortic valve bioprostheses, bioprosthetic aortic wall calcification also typically occurs. Previous use of the epoxide-based crosslinker, Triglycidyl amine (TGA), on cardiac bioprosthetic valve materials demonstrated superior biocompatibility, mechanics, and calcification resistance for porcine aortic valve cusps (but not porcine aortic wall) and bovine pericardium, versus Glut-prepared controls. However, TGA preparation did not completely prevent long-term calcification of cusps or pericardium. Herein we report further mechanistic investigations of an added therapeutic component to this system, 2-Mercaptoethylidene-1,1-bisphosphonic acid (MABP), a custom synthesized thiol bisphosphonate, which has previously been shown in a preliminary report to prevent bioprosthetic heterograft biomaterial calcification when used in combination with initial TGA crosslinking for 7 days. In the present studies we have further investigated the effectiveness of MABP in experiments that examined: 1) The use of MABP after optimal TGA crosslinking, in order to avoid any competitive interference of MABP-reactions with TGA during crosslinking; 2) Furthermore, recognizing the importance of alkaline phosphatase in the formation of dystrophic calcific nodules, we have investigated the hypothesis that the mechanism by which MABP primarily functions is through the reduction of alkaline phosphatase activity. Results from cell-free model systems, cell culture studies, and rat subcutaneous implants, show that materials functionalized with MABP after TGA crosslinking have reduced alkaline phosphatase activity, and in vivo have no significant calcification in long term implant studies. It is concluded that bioprosthetic heart valves prepared in this fashion are compelling alternatives for Glut-prepared bioprostheses. PMID:17027944

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

    PubMed

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

    2014-06-27

    Estimation of regional tissue stresses in the functioning heart valve remains an important goal in our understanding of normal valve function and in developing novel engineered tissue strategies for valvular repair and replacement. Methods to accurately estimate regional tissue stresses are thus needed for this purpose, and in particular to develop accurate, statistically informed means to validate computational models of valve function. Moreover, there exists no currently accepted method to evaluate engineered heart valve tissues and replacement heart valve biomaterials undergoing valvular stresses in blood contact. While we have utilized mitral valve anterior leaflet valvuloplasty as an experimental approach to address this limitation, robust computational techniques to estimate implant stresses are required. In the present study, we developed a novel numerical analysis approach for estimation of the in-vivo stresses of the central region of the mitral valve anterior leaflet (MVAL) delimited by a sonocrystal transducer array. The in-vivo material properties of the MVAL were simulated using an inverse FE modeling approach based on three pseudo-hyperelastic constitutive models: the neo-Hookean, exponential-type isotropic, and full collagen-fiber mapped transversely isotropic models. A series of numerical replications with varying structural configurations were developed by incorporating measured statistical variations in MVAL local preferred fiber directions and fiber splay. These model replications were then used to investigate how known variations in the valve tissue microstructure influence the estimated ROI stresses and its variation at each time point during a cardiac cycle. Simulations were also able to include estimates of the variation in tissue stresses for an individual specimen dataset over the cardiac cycle. Of the three material models, the transversely anisotropic model produced the most accurate results, with ROI averaged stresses at the fully-loaded state of 432.646.5 kPa and 241.440.5 kPa in the radial and circumferential directions, respectively. We conclude that the present approach can provide robust instantaneous mean and variation estimates of tissue stresses of the central regions of the MVAL. PMID:24275434

  11. Patterns of systolic stress distribution on mitral valve anterior leaflet chordal apparatus. A structural mechanical theoretical analysis.

    PubMed

    Nazari, S; Carli, F; Salvi, S; Banfi, C; Aluffi, A; Mourad, Z; Buniva, P; Rescigno, G

    2000-04-01

    Increasing diffusion and complexity of mitral valve repair procedures may prompt an interest in the evaluation of the patterns of stress distribution on the chords, which are, from the structural mechanical point of view, the weakest element of valve apparatus. This theoretical analysis concentrates in particular on the mitral valve anterior leaflet. As is known, the vast majority of the chordae are attached to the anterior leaflet within the coaptation area; during systole they are then necessarily parallel, aligned along the same plane as that of the leaflets' coaptation surface, to which they are attached; moreover the thickness of the chordae increases significantly from the marginal chordae to the more central ones. In normal conditions during systole the progressively wider coaptation surface causes the increasing stress to be supported by an increasing number of progressively thicker chords, which are substantially parallel and aligned on the coaptation surface plane in such a way that they can share the stress between them, according to their thickness; in other words chords form a multifilament functional unit which enrolls elements of increasing thickness in response to the mounting stress. The geometrical modifications of the valve apparatus architecture (annulus dilatation, leaflet retraction, chordal elongation or retraction) often associated with valve insufficiency due to chordal rupture, have the common result of causing, during systole, a radial disarrangement of the direction of most of the secondary chordae which are no longer parallel, aligned on the coaptation surface plane. Due to the negligible elastic module of the valve leaflet, in this new arrangement the various chordae cannot share the stress between themselves as they do in a normal physiological situation; on the contrary the thinner chordae nearer to the free margin are also loaded with the peak systolic stress, thus generating conditions favoring their rupture. It can, therefore, be hypothesized that the anatomopathological picture of valve insufficiency due to chordal rupture may be the final event of a series of geometrical modifications of valve apparatus architecture, the common consequence of which is to load thinner marginal chords with peak systolic stress from which they are normally spared, thus favoring their rupture. PMID:10901521

  12. AN INVERSE MODELING APPROACH FOR STRESS ESTIMATION IN MITRAL VALVE ANTERIOR LEAFLET VALVULOPLASTY FOR IN-VIVO VALVULAR BIOMATERIAL ASSESSMENT

    PubMed Central

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

    2013-01-01

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

  13. Prosthesis-Patient Mismatch after Mitral Valve Replacement: Comparison of Different Methods of Effective Orifice Area Calculation

    PubMed Central

    Cho, In-Jeong; Lee, Seung Hyun; Lee, Sak; Chang, Byung-Chul; Shim, Chi Young; Chang, Hyuk-Jae; Ha, Jong-Won; Chung, Namsik

    2016-01-01

    Purpose The incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) has been reported to vary. The purpose of the current study was to investigate incidence of PPM according to the different methods of calculating effective orifice area (EOA), including the continuity equation (CE), pressure half time (PHT) method and use of reference EOA, and to compare these with various echocardiographic variables. Materials and Methods We retrospectively reviewed 166 individuals who received isolated MVR due to rheumatic mitral stenosis and had postoperative echocardiography performed between 12 and 60 months after MVR. EOA was determined by CE (EOACE) and PHT using Doppler echocardiography. Reference EOA was determined from the literature or values offered by the manufacturer. Indexed EOA was used to define PPM as present if ≤1.2 cm2/m2. Results Prevalence of PPM was different depending on the methods used to calculate EOA, ranging from 7% in PHT method to 49% in referred EOA method to 62% in CE methods. The intraclass correlation coefficient was low between the methods. PPM was associated with raised trans-prosthetic pressure, only when calculated by CE (p=0.021). Indexed EOACE was the only predictor of postoperative systolic pulmonary artery (PA) pressure, even after adjusting for age, preoperative systolic PA pressure and postoperative left atrial volume index (p<0.001). Conclusion Prevalence of mitral PPM varied according to the methods used to calculate EOA in patients with mitral stenosis after MVR. Among the various methods used to define PPM, EOACE was the only predictor of postoperative hemodynamic parameters. PMID:26847283

  14. Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty.

    PubMed

    Arakawa, Mamoru; Yamaguchi, Atsushi; Nishimura, Takashi; Itoh, Satoshi; Yuri, Koichi; Kyo, Shunei; Adachi, Hideo

    2015-12-01

    Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case. PMID:25971993

  15. Degenerative mitral valve disease: Survival of dogs attending primary-care practice in England.

    PubMed

    Mattin, M J; Boswood, A; Church, D B; McGreevy, P D; O'Neill, D G; Thomson, P C; Brodbelt, D C

    2015-12-01

    This study aimed to evaluate survival of dogs with degenerative mitral valve disease (DMVD). A retrospective cohort study of dogs with DMVD attending primary-care practices in England was undertaken. Cases of DMVD were identified within the electronic patient records (EPRs) of practices sharing data with VetCompass. Kaplan-Meier curves were used to explore survival and Cox regression models identified factors associated with hazard of death. The EPRs from 111,967 dogs, attending 93 veterinary practices between January 2010 and December 2011 identified 405 cases diagnosed with DMVD giving a prevalence of diagnosed DMVD of 0.36% (95% CI: 0.29-0.45%). A further 3557 dogs were classified as possible cases (heart murmurs consistent with DMVD). Overall, a total of 3962 dogs were classified as heart murmur cases (possible and diagnosed DMVD), giving a prevalence of 3.54% (95% CI: 3.26-3.84%). One hundred and sixteen (28.6%) of the diagnosed DMVD cases were incident, newly diagnosed with DMVD. The mean age at diagnosis was 9.52 years (95% CI: 8.98-10.14 years). Fifty-eight (50.0%) of the incident cases died during the study period. The median survival time (MST) for all-cause mortality was 25.4 months (95% CI: 20.4-34.4 months) after disease detection for DMVD cases. For possible cases, 121 (29.7%) from a random sample of 407 possible DMVD cases were incident cases (newly detected heart murmur consistent with DMVD during the study period). The mean age at which a heart murmur was first recorded in possible cases was 9.73 years (95% CI: 9.02-10.44 years). Forty-nine (40.5%) possible cases died during the study period. The MST for all-cause mortality was 33.8 months (95% CI: 23.7-43.1 months) after a heart murmur was initially detected. In the multivariable survival analysis for possible and diagnosed cases, Cavalier King Charles Spaniels (CKCSs) and other purebreds had higher hazards of death than crossbreds. Dogs weighing ?20.0kg and older dogs had an increased hazard of death compared with those <20.0kg and younger dogs, respectively. The study highlights poorer survival for all-cause mortality in CKCSs and larger dogs. The reported survival characteristics could aid veterinary surgeons' advice on the prognosis for dogs with DMVD and help the assessment of the impact of the condition at a population level. PMID:26058819

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

    PubMed Central

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

    2015-01-01

    Background Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid?late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). Methods and Results We included 609 consecutive patients with ?III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid?late systole on continuous?wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (6014 versus 5314 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (3311 versus 279 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.53 versus 10.53), compared to the MLS MR group (all P<0.05). There were 54 events during 7.13 years of follow?up. On step?wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age? and gender?predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05). Conclusion In patients with ?III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors. PMID:25672368

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

    PubMed Central

    de Campos, Nelson Leonardo Kerdahi Leite

    2014-01-01

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

  18. Risk Factors for New-Onset Cardiac Valve Calcification in Patients on Maintenance Peritoneal Dialysis

    PubMed Central

    Tian, Yunhuan; Feng, Sheng; Zhan, Zhoubing; Lu, Ying; Wang, Yancai; Jiang, Shan; Song, Kai; Shen, Huaying

    2016-01-01

    Objective Patients with end-stage renal disease are susceptible to cardiac valve calcification (CVC) due to mineral metabolism disorders and other factors. The purpose of this study was to investigate the risk factors for new-onset CVC in patients on maintenance peritoneal dialysis (PD). Methods This study included patients who underwent PD catheter insertion from January 2006 to June 2013 in our Peritoneal Dialysis Center. Clinical data were collected on CVC status during echocardiography evaluations (twice) at an interval of >6 months. The data collected included intact parathyroid hormone, C-reactive protein (CRP), serum phosphorus (P), serum calcium (Ca), albumin (Alb), prealbumin and the use of five types of antihypertensive drugs, statins, active vitamin D3 and Ca tablets. Results In total, 194 patients — 105 (54.1%) men, average age 60.5 ± 13.0 years — were included. CVC was present in 50 (25.8%) patients during PD catheter placement. After an average PD duration of 20.9 ± 10.4 months, CVC was detected in 97 patients (50.0%). New-onset CVC was found in 62 patients (32.0%). Multivariate logistic regression analysis revealed that only serum P levels (p = 0.01, OR = 2.569), Alb levels (p = 0.04, OR = 0.935), dialysis duration (p = 0.03, OR = 1.039) and CRP levels (p = 0.02, OR = 1.031) were associated with CVC. Conclusion Serum P, Alb and CRP levels as well as dialysis duration are independent risk factors for CVC. PMID:26989400

  19. MicroRNA-125b and chemokine CCL4 expression are associated with calcific aortic valve disease.

    PubMed

    Ohukainen, Pauli; Syvranta, Suvi; Npnkangas, Juha; Rajamki, Kristiina; Taskinen, Panu; Peltonen, Tuomas; Helske-Suihko, Satu; Kovanen, Petri T; Ruskoaho, Heikki; Rys, Jaana

    2015-01-01

    Calcific aortic valve disease (CAVD) is a progressive pathological condition with no effective pharmacological therapy. To identify novel molecular pathways as potential targets for pharmacotherapy, we studied microRNA (miRNA) profiles of heavily stenotic aortic valves (AS). One of the most upregulated miRNAs in AS valves compared to control valves was miR-125b (1.4-fold; P < 0.05). To identify CAVD-related changes in gene expression, DNA microarray analysis was performed, including an intermediate fibro(sclero)tic stage of the disease. This revealed changes especially in genes related to inflammation and immune response, including chemokine (C-C motif) ligand 3 (CCL3) and 4 (CCL4). CCL3 mRNA level was increased 3.9-fold (P < 0.05) when AS valves were compared to control valves, and a 2.5-fold increase (P < 0.05) in CCL4 gene expression was observed when fibro(sclero)tic valves were compared to control valves. Both CCL3 and CCL4 localized to macrophages by immunofluorescence. To identify chemokine-miRNA target pairs, data from miRNA target prediction databases were combined with valvular miRNA and mRNA expression profiles. MiR-125b was computationally predicted to target CCL4, as confirmed experimentally in cultured human THP-1 macrophages. Collectively, miR-125b and CCL4 appear to be involved in the progression of CAVD and may offer novel therapeutic and diagnostic strategies related to this disease. PMID:26203686

  20. Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease

    PubMed Central

    Baran, Cagdas; Durdu, Serkan; Eryilmaz, Sadik; Sirlak, Mustafa; Akar, A. Ruchan

    2015-01-01

    We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation. PMID:26649221

  1. Role of serum high density lipoprotein levels and functions in calcific aortic valve stenosis progression

    PubMed Central

    Olgun Kk, Hilal; Kk, U?ur; Demirta?, Canan; zdemir, Murat

    2015-01-01

    Background: Clinical and epidemiological data well defines the role of atherosclerotic risk factors in pathogenesis of aortic stenosis. Especially dyslipidemia with elevated total and LDL cholesterol levels exerts certain histopathological changes on calcified valve tissue. Exact role of HDL in this process is not known. Objective: To evaluate the lipid profiles of patients with mild aortic valve stenosis with special focus on HDL; HDL subspecies, serum apoA1 levels, HDL related PON1 and PAF-AH enzyme activities and to correlate this with disease progression rates. Method: 42 patients (26 female; 16 male), with calcific aortic valve stenosis were enrolled in the study. Serum fasting lipid parameters, HDL subspecies (HDL2, HDL3), serum apoA1 levels and HDL related PON1 and PAF-AH enzyme activities were determined. All participants underwent detailed follow-up transthoracic echocardiography examination. Results: Among 42 study participants mean serum total cholesterol level was 195 27.3 mg/dl, LDL-c level was 123 19.1 mg/dl, HDL-c level was 44 10.3 mg/dl and total cholesterol/HDL-c ratio was 4.64 1.13. Basal peak aortic jet velocity (Vmax2) was 2.67 0.39 m/sec, mean pressure gradient (Pmean2) was 15.6 5.5 mmhg. Annual progression rate in peak aortic jet velocity (Vmax) was 0.23 0.17 m/sec, in mean pressure gradient (Pmean) was 3 2.1 mmhg. Annual progression rate in Pmean was most strongly correlated with serum HDL-c level and total/HDL-c ratio (r=-0.528 and 0.505; <0.001 and 0.001 respectively). Progression in Vmax values was positively correlated with serum LDL-c level and total/HDL-c ratio while negatively correlated with serum HDL-c levels (r=0.328, 0.499 and -0.464; P=0.034, 0.001 and 0.002 respectively). Among HDL subspecies HDL2 was the predominant type. HDL2 levels were found to be positively correlated with progression rates. There was no significant correlation between apolipoprotein A1 level and annual progression rate. Serum PON1 activity level was determined to be negatively correlated to doppler echocardiographic progression parameters while HDL related PAF-AH activity was independent of disease progression. Conclusion: Present study demonstrated a positive correlation between disease progression and serum total cholesterol/HDL-c ratio. Serum HDL-c level was inversely correlated with hemodynamic progression. The majority of HDL was HDL2 subtype. Among HDL related enzymes PON1 enzyme activity exhibited an inverse correlation with disease progression. PMID:26885240

  2. In vitro computerized evaluation of biological cardiac prosthesis calcification.

    PubMed

    Gatti, A M; Noera, G; Massini, C

    1985-01-01

    The late valvular bioprostheses failure is mainly related to leaflet calcification. This study reports a new approach to testing the biological prostheses calcification applying a computerized technique to x-ray pic