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Sample records for mitral em pacientes

  1. Mitral valve regurgitation

    MedlinePlus

    Mitral valve regurgitation; Mitral valve insufficiency; Heart mitral regurgitation; Valvular mitral regurgitation ... regurgitation is the most common type of heart valve disorder. Blood that flows between different chambers of ...

  2. Mitral Valve Disease

    MedlinePlus

    ... disease occurs when the mitral valve doesn’t work properly. Types of Mitral Valve Disease Types of ... until you are able to go back to work, depending on your job. Everyday activities such as ...

  3. 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.

  4. '2' much mitral tissue.

    PubMed

    Barriales-Villa, Roberto; Pérez-Martínez, Fernando; Alvarez-Juárez, Ana I; Vázquez-Rey, Eugenia; Castro-Beiras, Alfonso

    2010-03-01

    A 73-year-old female patient was referred for evaluation after suffering an atypical chest pain. Physical examination and ECG were normal. The echocardiogram showed a normal ventricular function. Attached to the anterior leaflet an accessory mitral valve tissue was identified. In systole, this mitral tissue creates an image that looks like the 'number 2'.

  5. Floppy mitral valve/mitral valve prolapse/mitral valvular regurgitation: effects on the circulation.

    PubMed

    Boudoulas, H; Wooley, C F

    2001-01-01

    The floppy mitral valve prolapses into the left atrium in such a dynamic manner that the prolapsing floppy mitral valve becomes a space-occupying lesion within the left atrium. A significant result of the floppy mitral valve prolapsing into the left atrium during left ventricular systole is the development of a "third chamber" located between the mitral annulus and the prolapsing mitral valve leaflets. Since the blood in the third chamber does not contribute to forward stroke volume, the third chamber may have significant effects on stroke volume and cardiac output. The floppy mitral valve/mitral valve prolapse dynamics also affect left ventricular papillary muscle tension and traction, altering the patterns of left ventricular contraction and relaxation, activating papillary muscle and left ventricular stretch receptors, and contributing to the production of cardiac arrhythmias. Floppy mitral valve innervation patterns with distinct nerve terminals provide a neural basis for brain-heart interactions, augmented by mechanical stimuli from the prolapsing floppy mitral valve. With the onset of mitral valvular regurgitation, and gradual progression of the mitral valve regurgitation from mild, to moderate, to severe, alterations in left atrial and left ventricular chamber size and performance occur, resulting in left atrial and left ventricular myopathy. As a connective tissue disorder, floppy mitral valve/mitral valve prolapse may be associated with abnormal structural and elastic properties of the aorta, with resultant changes in aortic function. Progression of mitral valve regurgitation and the aging process also affect aortic function indices in an adverse manner. The phenomena associated with floppy mitral valve dysfunction, with prolapse of the mitral valve into the left atrium and the unique, resultant forms of mitral valve regurgitation, are dynamic in nature. As the long-term natural history of these interrelated phenomena is being clarified, it is apparent

  6. Mitral valve prolapse

    MedlinePlus

    ... to keep blood from moving backwards when the heart beats (contracts). Mitral valve prolapse is the term used ... Dizziness Fatigue Panic attacks Sensation of feeling the heart beat ( palpitations ) Shortness of breath with activity or when ...

  7. 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)

  8. Mitral valve surgery - open

    MedlinePlus

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

  9. 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

  10. Effectiveness of Percutaneous Balloon Mitral Valvuloplasty for Rheumatic Mitral Stenosis with Mild to Severe Mitral Regurgitation

    PubMed Central

    Lu, LinXiang; Hong, Lang; Fang, Jun; Chen, LiangLong

    2016-01-01

    This study is designed to test whether percutaneous balloon mitral valvuloplasty (PBMV) is effective for rheumatic mitral stenosis in Chinese patients with moderate to severe mitral regurgitation. Fifty-six patients with rheumatic mitral valve stenosis were divided into the mild, moderate, and severe regurgitation groups. Cardiac ultrasonography was measured before and 1 to 2 days after PBMV. Following PBMV, the mitral orifice was enlarged, and the left atrial diameter was reduced in the 3 patient groups. The enlargement of the mitral orifice in the mild regurgitation group was greater than that observed in the moderate and severe regurgitation groups. The size of the regurgitation area increased in the mild regurgitation group and decreased in the moderate and severe regurgitation groups, with the decrease in the severe regurgitation group being greater than that in the moderate regurgitation group. Therefore, PBMV is effective for treating rheumatic mitral stenosis in Chinese patients with mild to severe mitral regurgitation. PMID:27034933

  11. Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

    PubMed Central

    Lee, Seong; Chee, Hyun Keun; Kim, Jun Seok; Song, Myong Gun; Park, Jae Bum; Shin, Je Kyoun

    2015-01-01

    Background There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods In this study, we assessed 15 patients (mean age, 47.7±9.7 years; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5±7 years. The mean preoperative Wilkins score was 9.4±2.6. Results The mean mitral valve area obtained using planimetry increased from 1.16±0.16 cm2 to 1.62±0.34 cm2 (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from 202.4±58.6 ms to 152±50.2 ms (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4±4.0 mmHg to 5.8±1.5 mmHg (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39±16 months). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467–64.866). Conclusion On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair. PMID:26509126

  12. Mitral Valve Prolapse in Pregnancy

    PubMed Central

    Yuan, Shi-Min; Yan, Song-Li

    2016-01-01

    Mitral valve prolapse is a benign condition. Mitral regurgitation is only complicated in patients with severe mitral valve prolapse. Women with mitral valve prolapse in the absence of other cardiovascular disorders tolerate pregnancy well and do not develop remarkable cardiac complications. Nevertheless, serious complications of mitral valve prolapse, including arrhythmia, infective endocarditis and cerebral ischemic events, can be present in pregnancy. Debates remain with regard to the use of prophylactic antibiotics and β-blockers in the pregnant women with mitral valve prolapse. The prognosis of the pregnant patients might be closely related to the pathological and (or) functional changes of the mitral valve. Non-myxomatous mitral valve prolapse poses no or little obstetric risks in terms of pregnancy, labor and neonatal complications; whereas myxomatous mitral valve prolapse is a major etiology of valvular heart disease in women of childbearing age. In the pregnant patients with mitral valve prolapse progressing into major complications, surgical interventions are considered. Medicinal treatment of such patients with β-blockers should be a concern for the fetal safety. PMID:27556316

  13. Transvalvular mitral regurgitation following mitral valve replacement a diagnostic dilemma

    PubMed Central

    Kumar, U. S. Dinesh; Nareppa, Umesh; Shetty, Shyam Prasad; Wali, Murugesh

    2015-01-01

    After mitral valve replacement with a prosthetic valve, the valve should be competent and there should not be any residual prosthetic valve regurgitation. Transvalvular residual prosthetic valve regurgitation are difficult to diagnose and quantify. we are reporting interesting TEE images as a diagnostic dilemma in a case of transvalvular mitral regurgitation following mitral valve replacement secondary to entrapment of sub-valvular apparatus in a Chitra mechanical heart valve. PMID:26440249

  14. Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse

    PubMed Central

    Basso, Cristina; De Lazzari, Manuel; Rizzo, Stefania; Cipriani, Alberto; Giorgi, Benedetta; Lacognata, Carmelo; Rigato, Ilaria; Migliore, Federico; Pilichou, Kalliopi; Cacciavillani, Luisa; Bertaglia, Emanuele; Frigo, Anna Chiara; Bauce, Barbara; Corrado, Domenico; Thiene, Gaetano; Iliceto, Sabino

    2016-01-01

    Background— Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch. Methods and Results— Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001). Conclusions— Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification. PMID

  15. Echocardiographic assessment of ischemic mitral regurgitation.

    PubMed

    Dudzinski, David M; Hung, Judy

    2014-01-01

    Ischemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Echocardiographic diagnosis and assessment of ischemic mitral regurgitation are critical to gauge its adverse effects on prognosis and to attempt to tailor rational treatment strategy. There is no single approach to the echocardiographic assessment of ischemic mitral regurgitation: standard echocardiographic measures of mitral regurgitation severity and of LV dysfunction are complemented by assessments of displacement of the papillary muscles and quantitative indices of mitral valve deformation. Development of novel approaches to understand mitral valve geometry by echocardiography may improve understanding of the mechanism, clinical trajectory, and reparability of ischemic mitral regurgitation.

  16. Mitral Valve Annuloplasty

    PubMed Central

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

    2012-01-01

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

  17. Basic Mechanisms of Mitral Regurgitation

    PubMed Central

    Dal-Bianco, Jacob P.; Beaudoin, Jonathan

    2014-01-01

    Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral regurgitation (MR). The mechanism responsible for MV malcoaptation and MR can be dysfunction or structural change of the left ventricle, the papillary muscles, the chordae tendineae, the mitral annulus and the MV leaflets. The rationale for MV treatment depends on the MR mechanism and therefore it is essential to identify and understand normal and abnormal MV and MV apparatus function. PMID:25151282

  18. 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

  19. [Mitral valve replacement for congenital parachute mitral valve].

    PubMed

    Sasahashi, N; Ando, F; Okamoto, F; Yamanaka, K; Hanada, T; Makino, S

    1995-07-01

    A one-year-old boy was admitted with refractory congestive biventricular heart failure for medical treatment. On echocardiogram and cardiac catheterization revealed severe mitral stenosis from parachute deformity with pulmonary hypertension. During the operation, a single round orifice of 7 mm in diameter was detected in the mitral valve and adhered chordae were attached to a large single papillary muscle which was located at the posteromedial portion of the left ventricle. An isolated muscle band which was not attached to the mitral valve was observed at the anterolateral wall of the left ventricle. The mitral valve was replaced with 16 mm Carbo-Medicus prosthesis. Postoperative catheterization revealed residual pulmonary hypertension which was responsive to Imidarine infusion. He was discharged from the hospital without any sequelae, and has been on regimen including anticoaglant and vasodilator. PMID:7561327

  20. Mitral valve surgery - minimally invasive

    MedlinePlus

    ... valve repair - partial upper or lower sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty ... of your life. Biological, made of human or animal tissue. These valves last 10 to 15 years ...

  1. 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

  2. Robotic mitral valve surgery.

    PubMed

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

    2003-12-01

    A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for

  3. 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

  4. Emergency mitral valve replacement for traumatic mitral insufficiency following balloon mitral valvotomy: an early haemodynamic study.

    PubMed

    Tempe, D K; Mehta, N; Mohan, J C; Tandon, M S; Nigam, M

    1998-07-01

    Acute severe mitral insufficiency may occur during percutaneous transvenous balloon mitarl valvotomy. Urgent surgical intervention in the form of mitral valve repair or replacement may be necessary in these patients. The haemodynamic measurements at various stages in these patients were obtained and compared with those of patients undergoing elective mitral valve replacement for chronic mitral regurgitation. Between September 1995 and December 1947, urgent mitral valve replacement was performed in 14 patients out of a total of 1688 patients who underwent balloon mitral valvotomy. Haemodynamic measurements could be obtained in 7 of these patients and they constituted group I. Eight other patients undergoing elective mitral valve replacement during the same period for chronic mitral regurgitation constituted group II. Standard haemodynamic measurements were obtained at the following stages: (1) Baseline- 20-30 min after endotracheal intubation; (2) stage 1- 20-30 min after termination of the cardiopulmonary bypass: (3) stage 2- four hours after the patient was transferred to ICU and (4) stage 3-30 min after extubation. All the patients were suffering from severe pulmonary hypertension. However, the indices of pulmonary artery hypertension such as mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance as well as right ventricular systolic and end-diastolic pressures did not decrease after surgery in group I. In contrast, in group II, there was significant decrease in mean pulmonary artery pressure (p<0.05), pulmonary capillary wedge pressure (p<0.05), right ventricular systolic (p<0.001) and end-diastolic pressures (p<0.05) at stage 1. These changes persisted throughout the study period. Pulmonary vascular resistance showed a decreasing trend, but attained statistical significance at stage 1 only. Two patients died; one of intractable cardiac failure and another from septicaemia and multiple organ failure in group I, but

  5. 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

  6. Mitral insufficiency caused by left atrial chordae.

    PubMed

    Aksu, Hale Unal; Uslu, Nevzat; Aslan, Muzaffer; Gul, Mehmet; Aksu, Huseyin

    2012-04-01

    We report an unusual case of moderate mitral regurgitation caused by abnormal insertion of chordae tendinea to the interatrial septum and tethering the middle scallop of the anterior mitral leaflet. This is an extremely rare congenital abnormality causing mitral regurgitation. PMID:22176469

  7. Minimally Invasive Mitral Valve Surgery II

    PubMed Central

    Wolfe, J. Alan; Malaisrie, S. Chris; Farivar, R. Saeid; Khan, Junaid H.; Hargrove, W. Clark; Moront, Michael G.; Ryan, William H.; Ailawadi, Gorav; Agnihotri, Arvind K.; Hummel, Brian W.; Fayers, Trevor M.; Grossi, Eugene A.; Guy, T. Sloane; Lehr, Eric J.; Mehall, John R.; Murphy, Douglas A.; Rodriguez, Evelio; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Lewis, Clifton T. P.; Barnhart, Glenn R.; Goldman, Scott M.

    2016-01-01

    Abstract Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery. PMID:27654406

  8. Mitral valve repair

    PubMed Central

    Pozzoli, Alberto; De Bonis, Michele; Alfieri, Ottavio

    2016-01-01

    Mitral regurgitation (MR) is the most common valvular heart disease in the Western world. The MR can be either organic (mainly degenerative in Western countries) or functional (secondary to left ventricular remodeling in the context of ischemic or idiopathic dilated cardiomyopathy). Degenerative and functional MR are completely different disease entities that pose specific decision-making problems and require different management. The natural history of severe degenerative MR is clearly unfavorable. However, timely and effective correction of degenerative MR is associated with a normalization of life expectancy. By contrast, the prognostic impact of the correction of functional MR is still debated and controversial. In this review, we discuss the optimal treatment of both degenerative and functional MR, taking into account current surgical and percutaneous options. In addition, since a clear understanding of the etiology and mechanisms of valvular dysfunction is important to guide the timing and choice of treatment, the role of the heart team and of echo imaging in the management of MR is addressed as well. PMID:27347389

  9. Rare Case of Unileaflet Mitral Valve

    PubMed Central

    Jain, Tarun; Shah, Sunay; Mawri, Sagger; Ananthasubramaniam, Karthikeyan

    2016-01-01

    Unileaflet mitral valve is the rarest of the congenital mitral valve anomalies and is usually life threatening in infancy due to severe mitral regurgitation (MR). In most asymptomatic individuals, it is mostly due to hypoplastic posterior mitral leaflet. We present a 22-year-old male with palpitations, who was found to have an echocardiogram revealing an elongated anterior mitral valve leaflet with severely hypoplastic posterior mitral valve leaflet appearing as a unileaflet mitral valve without MR. Our case is one of the 11 reported cases in the literature so far. We hereby review those cases and conclude that these patients are likely to be at risk of developing worsening MR later in their lives. PMID:27358711

  10. Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis

    PubMed Central

    Malla, Rabi; Rajbhandari, Rajib; Shakya, Urmila; Sharma, Poonam; Shrestha, Nagma; KC, Bishal; Limbu, Deepak; KC, Man Bahadur

    2016-01-01

    Background Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. Methods It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. Results During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm2 to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm2 in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. Conclusions PTMC in JMS is safe and effective. PMID:26885488

  11. A new valve retractor for mitral valve procedures.

    PubMed

    Lucchese, F A; Kalil, R; Prates, P R; Nesralla, I A; Jatene, A D

    1980-02-01

    Optimal exposure greatly facilitates reconstructive mitral valve procedures. We describe an effective method for exposing this valve using a specially designed mitral valve retractor. This technique proved useful in 321 patients who underwent operation on the mitral valve.

  12. Supravalvar Mitral Ring: a Case Report

    PubMed Central

    Baharestani, Bahador; Sadat Afjehi, Reza; Givtaj, Nader; Sharifi, Mehrzad

    2012-01-01

    Supravalvar mitral ring is a rare congenital heart defect of surgical importance. The condition is characterized by an abnormal ridge of the connective tissue on the atrial side of the mitral valve. It often substantially obstructs the mitral valve inflow. We herein introduce a case of a supravalvar mitral ring in a 17-year-old male, who was admitted to our hospital with cardiac syncope. He had undergone a cardiac operation for ventricular septal defect (VSD) closure and mitral valve repair 15 years before. Transthoracic echocardiography, transesophageal echocardiography, and finally cardiac catheterization revealed a neglected supravalvular mitral ring. The ring was resected in a second operation, and the patient was discharged from the hospital symptom free. PMID:23074643

  13. Mitral Stenosis Presenting as Asthma.

    PubMed

    Li, Shenjing; Jbeli, Aiham; Stys, Maria; Stys, Adam

    2016-02-01

    Although wheezing is one of the most common symptoms and physical findings in asthma, other causes of wheezing should be kept in mind: vocal cord dysfunction, postnasal drip syndrome, chronic obstructive pulmonary disease, bronchiectasis, and non-pulmonary diseases, like heart failure and pulmonary edema. Here, we present a case of severe mitral stenosis with pulmonary edema treated for resistant asthma. If asthma is difficult to control, other etiologies of wheezing, including cardiac disease, should be taken into consideration during diagnosis. PMID:26999914

  14. Mitral valve repair in acquired dextrocardia.

    PubMed

    Elmistekawy, Elsayed; Chan, Vincent; Hynes, Mark; Mesana, Thierry

    2015-10-01

    Surgical correction of valvular heart disease in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve repair in a patient with acquired dextrocardia. Successful mitral valve repair was performed through a right lateral thoracotomy. We describe our surgical strategy and summarize the literature.

  15. Parachute deformity of the mitral valve

    PubMed Central

    Bett, J. H. N.; Stovin, P. G. I.

    1969-01-01

    A case of parachute deformity of the mitral valve, a rare congenital form of mitral stenosis characterized by insertion of the chordae tendineae into a single posterior papillary muscle, is described in an 11-year-old girl. The eleven other cases in the English literature are reviewed. Images PMID:5348334

  16. Mitral valve disease--morphology and mechanisms.

    PubMed

    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

    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

  17. Minimally Invasive Mitral Valve Surgery I

    PubMed Central

    Ailawadi, Gorav; Agnihotri, Arvind K.; Mehall, John R.; Wolfe, J. Alan; Hummel, Brian W.; Fayers, Trevor M.; Farivar, R. Saeid; Grossi, Eugene A.; Guy, T. Sloane; Hargrove, W. Clark; Khan, Junaid H.; Lehr, Eric J.; Malaisrie, S. Chris; Murphy, Douglas A.; Rodriguez, Evelio; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Goldman, Scott M.; Lewis, Clifton T. P.; Barnhart, Glenn R.

    2016-01-01

    Abstract Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. PMID:27654407

  18. Degenerative mitral valve regurgitation: best practice revolution

    PubMed Central

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

    2010-01-01

    Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation. PMID:20624767

  19. 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

  20. Mitral valve disease--morphology and mechanisms.

    PubMed

    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

    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.

  1. Mitral Valve Replacement with Half-and-Half Technique for Recurrent Mitral Paravalvular Leakage.

    PubMed

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

    2015-05-01

    Reoperation for paravalvular leakage can cause recurrent paravalvular leakage through severe damage to the mitral annulus. Previously, mitral valve replacement using a half-and-half technique for extensive mitral annular calcification was reported; here, application of the technique to treat recurrent paravalvular leakage is described. A 78-year-old male with three prior mitral valve replacements developed recurrent paravalvular leakage, for which he had undergone his third mitral valve replacement at the age of 69 years. On this occasion, a mechanical valve with circumferential equine pericardial patch reinforcement of the annulus had been used. Five years later, the patient developed hemolytic anemia and congestive heart failure due to recurrent paravalvular leakage. Intraoperatively, broad dehiscence was seen between the prosthetic valve and mitral annulus at two sites, the anterior and posterior commissures, without infection. A fourth mitral valve replacement was performed with a St. Jude Medical valve, using a half-and-half technique. This entailed the use of non-everting mattress sutures on the anterior half of the annulus, and everting mattress sutures on the left atrial wall around the posterior half of the annulus. Extensive annular defects required reinforcement of the posterior mitral annulus with a bovine pericardial patch. Postoperative echocardiography showed no paravalvular leakage. The half-and-half technique may be useful in treating recurrent paravalvular leakage of the mitral valve. PMID:26901904

  2. 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

  3. [Prolapse of the mitral valve in children].

    PubMed

    Capka, K; Janovský, P

    1990-05-01

    The purpose of the paper is a review of contemporary findings on the problem of prolapse of the mitral valve in child age, as it is detected on ultrasonic examination in particular in adolescents. Warth's submitted diagnostic criteria of prolapse of the mitral valve differentiate it from normal closure. When these criteria are not respected, this may lead to unnecessary restriction of physical activity or altered work capacity. PMID:2249296

  4. Visual complications of mitral leaflet prolapse.

    PubMed

    Wilson, L A; Keeling, P W; Malcolm, A D; Russel, R W; Webb-Peploe, M M

    1977-07-01

    Four young women and six older men with mitral leaflet prolapse presented with visual disturbances consistent with embolism in the ophthalmic or posterior cerebral circulation. Cardiac arrhythmias were common, but these are rarely associated with focal ischaemia. The evidence that mitral leaflet prolapse caused the embolism in these patients is suggestive but not conclusive. Further studies are needed. All patients with acute cerebral or ocular ischaemia should undergo through cardiovascular assessment, which should include routine echocardiography.

  5. Parabolic resection for mitral valve repair.

    PubMed

    Drake, Daniel H; Drake, Charles G; Recchia, Dino

    2010-02-01

    Parabolic resection, named for the shape of the cut edges of the excised tissue, expands on a common 'trick' used by experienced mitral surgeons to preserve tissue and increase the probability of successful repair. Our objective was to describe and clinically analyze this simple modification of conventional resection. Thirty-six patients with mitral regurgitation underwent valve repair using parabolic resection in combination with other techniques. Institution specific mitral data, Society of Thoracic Surgeons data and preoperative, post-cardiopulmonary bypass (PCPB) and postoperative echocardiography data were collected and analyzed. Preoperative echocardiography demonstrated mitral regurgitation ranging from moderate to severe. PCPB transesophageal echocardiography demonstrated no regurgitation or mild regurgitation in all patients. Thirty-day surgical mortality was 2.8%. Serial echocardiograms demonstrated excellent repair stability. One patient (2.9%) with rheumatic disease progressed to moderate regurgitation 33 months following surgery. Echocardiography on all others demonstrated no or mild regurgitation at a mean follow-up of 22.8+/-12.8 months. No patient required mitral reintervention. Longitudinal analysis demonstrated 80% freedom from cardiac death, reintervention and greater than moderate regurgitation at four years following repair. Parabolic resection is a simple technique that can be very useful during complex mitral reconstruction. Early and intermediate echocardiographic studies demonstrate excellent results.

  6. [Pathologic aspects of mitral valve prolapse syndrome].

    PubMed

    Kawai, S; Okada, R

    1986-01-01

    To comprehend clinical pictures of mitral valve prolapse syndrome (MVP), specific pathoanatomical knowledge is required. There is no definite structure of the anterior mitral valve ring. The mitral valve ring is not flat; the anterior segment of the ring tilts up superiorly. The number of scallops of the posterior leaflet depends on the definition of the incisura. The term "rough zone chorda" (Lam et al., 1970) is a misnomer. From the pathological point of view, more than two subgroups of MVP are present. In isolated MVP, pathological lesions are restricted to the local ballooned segment. However, in MVP with connective tissue disorders (for example, Marfan syndrome, etc.), the lesions are principally diffuse. Mitral valve changes in hypertrophic cardiomyopathy with obstruction are caused by torsion and the relatively elongated anterior leaflet due to narrowing of the mitral orifice, septal hypertrophy and displacement of the papillary muscles. MVP in atrial septal defect is caused by the turbulence of a large shunt flow or by the torsion of the mitral ring due to right ventricular volume overload. Further investigation of surgical and necropsied cases will be required to clearly the subgroups of MVP. PMID:3681006

  7. 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 38±17 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 3.2±1.5 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

  8. Anterior Mitral Leaflet Augmentation for Ischemic Mitral Regurgitation Performed Via a Right Thoracotomy Approach.

    PubMed

    Mihos, Christos G; Pineda, Andres M; Horvath, Sofia A; Santana, Orlando

    2016-01-01

    Ischemic mitral regurgitation (MR) after myocardial infarction is associated with poor long-term survival, and the optimal treatment strategy remains debated. The most common repair technique used is a restrictive annuloplasty. However, up to 15% to 30% of patients experience recurrent MR owing to progressive left ventricular remodeling and geometric distortion of the mitral valve apparatus. Anterior mitral leaflet augmentation using a pericardial patch, in combination with a true-sized mitral annuloplasty, has been proposed as an adjunctive technique to increase the durability of valve repair for ischemic MR. Herein, we describe 2 cases of anterior mitral leaflet augmentation with annuloplasty repair for severe ischemic MR via a minimally invasive right thoracotomy, and review the literature regarding patient selection and clinical outcomes of this technique.

  9. What Are the Signs and Symptoms of Mitral Valve Prolapse?

    MedlinePlus

    ... from the NHLBI on Twitter. What Are the Signs and Symptoms of Mitral Valve Prolapse? Most people ... major mitral valve backflow. When MVP does cause signs and symptoms, they may include: Palpitations (feelings that ...

  10. Coronary air embolism during mitral valvuloplasty.

    PubMed

    Rifaie, Osama; Nammas, Wail

    2011-10-01

    A 30-year-old male with a history of rheumatic mitral valve disease presented with progressive exertional dyspnoea. Echocardiography revealed a mitral valve area of 1 cm2, a mitral valve score of 6/16, and absence of mitral regurgitation. Percutaneous mitral valvuloplasty was performed using the multitrack technique. Unexpectedly, one balloon suddenly ruptured during a second inflation. The patient experienced severe chest pain and shock. The electrocardiogram showed ST-segment elevation in leads II, III, and aFV. Prompt resuscitation was performed and right coronary angiography showed a bubble of air trapped at the crux of the right coronary artery, with loss of myocardial blush.The operator injected 100 mcg of nitroglycerin inside the right coronary, followed by intracoronary infusion of normal saline. Ultimately, right coronary angiography revealed that the air was successfully cleared off the artery, with TIMI grade 3 flow and, return of myocardial blush. Eventually, chest pain disappeared, with a favourable haemodynamic condition. PMID:22032066

  11. [Mitral surgery by superior biatrial septotomy].

    PubMed

    Saade, A; Delepine, G; Lemaitre, C; Baehrel, B

    1995-01-01

    The superior biatrial septotomy approach consists of two semicircular right atrial and septal incisions joined at the superior end of the interatrial septum and extended across the dome of the left atrium, allowing exposure of the mitral valve by reflecting the ventricular side using stay sutures. From 1991 to 1993, 81 patients underwent mitral valve surgery by this technic. Mitral valve operation was combined with other cardiac procedures in 30 patients (37%) and was performed as a second operation in 21 patients (25.9%). Duration of cardiopulmonary bypass and aortic occlusion was not significantly different from that of patients operated via a conventional left atrial approach. The five hospital deaths (6.2%) were not related to this operative approach. Only 2 patients (3.3%) with preoperative in sinus rythm were discharged in atrial fibrillation after operation. In one patient (1.6%), atrioventricular block appeared at late follow-up. There were no cases of bleeding, atrioventricular nodal dysfunction or intra-atrial shunting related to the approach. This approach provides excellent exposure of the mitral valve even in unfavorable situations such as a small left atrium, dense adhesions from previous procedures or a previously implanted aortic prosthesis, without damage to various cardiac structures due to excessive traction. No retractor or vena cava repair are required. These data support a wide application of the superior biatrial septotomy approach in mitral valve surgery.

  12. 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…

  13. Systolic anterior motion of the mitral valve after mitral valve repair: a method of prevention.

    PubMed

    Sternik, Leonid; Zehr, Kenton J

    2005-01-01

    Factors predisposing patients to systolic anterior motion of the mitral valve (SAM) with left ventricular outflow tract (LVOT) obstruction after mitral valve repair are the presence of a myxomatous mitral valve with redundant leaflets, a nondilated hyperdynamic left ventricle, and a short distance between the mitral valve coaptation point and the ventricular septum after repair. From December 1999 through March 2000, we used our surgical method in 6 patients with severely myxomatous regurgitant mitral valves who were at risk of developing SAM. Leaflets were markedly redundant in all 6. Left ventricular function was hyperdynamic in 4 patients and normal in 2. Triangular or quadrangular resection of the midportion of the posterior leaflet and posterior band annuloplasty were performed. To prevent SAM and LVOT obstruction, extra, posteriorly directed, mid-posterior-leaflet secondary chordae tendineae, which would otherwise have been resected, were transferred to the underside of the middle of the mid-anterior leaflet with a small piece of associated valve as an anchoring pledget. This kept the redundant anterior leaflet edge, which extended below the coaptation point, away from the LVOT No post-repair SAM or LVOT obstruction was observed on intraoperative or discharge echocardiography. All patients had no or trivial residual mitral regurgitation. We conclude that extra chordae tendineae, when available, can be used in mitral valve repair to tether the redundant anterior leaflet and thus prevent it from flipping into the LVOT. This will theoretically prevent SAM and LVOT obstruction in patients with risk factors for SAM.

  14. Piezogenic Pedal Papules with Mitral Valve Prolapse

    PubMed Central

    Altin, Cihan; Askin, Ulku; Gezmis, Esin; Muderrisoglu, Haldun

    2016-01-01

    Piezogenic pedal papules (PPP) are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP) is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases. PMID:27057041

  15. Novel Annular and Subvalvular Enlargement in Congenital Mitral Valve Replacement.

    PubMed

    Carroll, Nels D; Beers, Kevin M; Maldonado, Elaine M; Calhoon, John H; Husain, S Adil

    2016-09-01

    Reparative procedures are not always feasible in congenitally abnormal mitral valves. Mechanical prosthesis has been accepted as the choice for valve replacement in the pediatric population. This report describes a case of congenital mitral valve disease requiring mitral valve replacement. The infant's mitral valve annulus was not amenable to placement of the smallest available mechanical prosthesis. The approach used here for annular and subvalvular enlargement facilitated implantation of a larger prosthesis for congenital mitral valve replacement. Five-year outcomes in a single patient may indicate broader applicability and avoidance of patient-prosthesis mismatch.

  16. 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

  17. Parachute mitral valve with severe mitral regurgitation in an adult patient.

    PubMed

    Espinola-Zavaleta, Nilda; Chugh, Reema; Ramírez, Gabriela Meléndez

    2012-05-01

    Parachute mitral valve (PMV) is rarely seen in the adult population, in isolation or in association with other congenital heart defects, since most patients may have had milder lesions previously that were asymptomatic early in life, or were not detected due to lack of a comprehensive examination. We report a case of an 18-year-old woman with a history of exertional dyspnea, atypical chest pain, and cough for about 1 year. The echocardiographic examination identified a PMV with severe mitral regurgitation associated with bicuspid aortic valve and coarctation of the aorta. Most patients present with mitral stenosis of varying degree of severity, and rarely present with severe mitral regurgitation as seen in our patient.

  18. CONHECIMENTO DA LEI GERAL DE SAÚDE – RESPEITO ÀS TRANSFUSÕES SANGUÍNEAS EM MÉDICOS E PACIENTES TESTEMUNHAS DE JEOVÁ DO HOSPITAL DR. DARÍO CONTRERAS DA REPÚBLICA DOMINICANA

    PubMed Central

    SANTANA, ELSA DÍAZ

    2010-01-01

    Este estudo avalia quanto o corpo médico do Hospital Dr. Darío Contreras de República Dominicana conhece, respeita, informa e aplica a Lei Geral de Saúde em relação aos direitos do paciente Testemunha de Jeová de negar-se a ser transfundido (respeito a sua autonomia); também se os Testemunhas de Jeová conhecem a Lei Geral de Saúde e até que ponto têm se beneficiado diante dessa proposição. O estudo revelou que nem médicos, nem Testemunhas de Jeová conhecem de fato essa lei. PMID:20689657

  19. Mitral Valve Stenosis after Open Repair Surgery for Non-rheumatic Mitral Valve Regurgitation: A Review

    PubMed Central

    Shabsigh, Muhammad; Lawrence, Cassidy; Rosero-Britton, Byron R.; Kumar, Nicolas; Kimura, Satoshi; Durda, Michael Andrew; Essandoh, Michael

    2016-01-01

    Mitral stenosis (MS) after mitral valve (MV) repair is a slowly progressive condition, usually detected many years after the index MV surgery. It is defined as a mean transmitral pressure gradient (TMPG) >5 mmHg or a mitral valve area (MVA) <1.5 cm2. Pannus formation around the mitral annulus or extending to the mitral leaflets is suggested as the main mechanism for developing delayed MS after MV repair. On the other hand, early stenosis is thought to be a direct result of an undersized annuloplasty ring. Furthermore, in MS following ischemic mitral regurgitation (MR) repair, subvalvular tethering is the hypothesized pathophysiology. MS after MV repair has an incidence of 9–54%. Several factors have been associated with a higher risk for developing MS after MV repair, including the use of flexible Duran annuloplasty rings versus rigid Carpentier–Edwards rings, complete annuloplasty rings versus partial bands, small versus large anterior leaflet opening angle, and anterior leaflet tip opening length. Intraoperative echocardiography can measure the anterior leaflet opening angle, the anterior leaflet tip opening dimension, the MVA and the mean TMPG, and may help identify patients at risk for developing MS after MV repair. PMID:27148540

  20. Successful surgical repair of the parachute mitral valve with mitral valve regurgitation.

    PubMed

    Shiraishi, Manabu; Yamaguchi, Atsushi; Adachi, Hideo

    2012-01-01

    A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.

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

    PubMed Central

    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

  2. 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…

  3. Echocardiographic Assessment of Mantle Radiation Mitral Stenosis.

    PubMed

    Bastiaenen, Rachel; Sneddon, James; Sharma, Rajan

    2016-02-01

    The long-term sequelae of mantle radiotherapy include lung disease and cardiac disorders. Dyspnea on exertion is a common complaint and can be due to one or more pathologies. We describe a case of mantle radiotherapy-induced mitral stenosis, characterized by aorto-mitral continuity calcification and absent commissural fusion which precludes balloon valvotomy. The latency period is long, and this patient presented 42 years after radiotherapy. Importantly, as previously described with radiation-induced valve disease, significant mitral stenosis developed 10 years after surgery for significant aortic stenosis. Two-dimensional and three-dimensional transthoracic and transesophageal echocardiography should be considered during assessment of symptomatic survivors of Hodgkin's disease where the index of suspicion for valvular stenosis increases over time. Given the natural history of mantle radiation valvular disease, a lower threshold for surgical intervention in radiation-induced mitral stenosis may need to be considered if cardiac surgery is planned for other reasons in order to avoid repeated sternotomy in patients with prior irradiation. PMID:26493026

  4. Minimally Invasive Mitral Valve Surgery III

    PubMed Central

    Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

    2016-01-01

    Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

  5. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons.

    PubMed

    Silverman, Norman H

    2014-12-01

    I surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

  6. Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation.

    PubMed

    Hulman, Michal; Bena, Martin; Artemiou, Panagiotis; Gasparovic, Ivo; Hudec, Vladan; Rajani, Ronak; Bapat, Vinayak

    2016-10-01

    Transcatheter mitral valve replacement using balloon-expandable valves is an emerging technique for the treatment of patients with significant mitral regurgitation who have been judged to be inoperable owing to significant mitral valve annulus calcification. Although initial reports have been promising, there remains a lack of consensus as to how to plan for transcatheter mitral valve replacement deployment in terms of appropriateness, sizing, and positioning to mitigate the risks of valve displacement and paravalvular regurgitation. We describe two cases of transcatheter mitral valve replacement in patients with significant mitral valve annulus calcification. The first was complicated by valve displacement into the left atrium, which was successfully managed by surgical redeployment and fixation. The second case was thereafter performed successfully using iterative learning and the application of specific preprocedural planning techniques acquired from a root cause analysis of the first case. We describe our experience with both cases and the specific planning principles required to prevent transcatheter mitral valve replacement displacement in patients with mitral valve annulus calcification. PMID:27645964

  7. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.

    PubMed

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

    2013-01-01

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

  8. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation.

    PubMed

    Li, Chi-Hion; Arzamendi, Dabit; Carreras, Francesc

    2016-04-01

    Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures.

  9. 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

  10. 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.

  11. 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

  12. Cardiogenic shock: A look at acute functional mitral incompetence.

    PubMed

    Steyn, F A; Vosloo, J; Naude, H; Steyn, A J

    2016-08-01

    A 44-year-old man presented with cardiogenic shock secondary to acute functional mitral incompetence as well as septic shock related to pneumonia. The patient deteriorated haemodynamically despite adequate medical therapy. An echocardiogram revealed a massive mitral incompetence and an ejection fraction of 32%. An intra-aortic balloon pump was placed and the patient improved dramatically. On day 6 after admission the echocardiogram was repeated, revealing a mild mitral incompetence and an ejection fraction of 58%. PMID:27499404

  13. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    PubMed

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  14. Transjugular approach for transcatheter closure of mitral paraprosthetic leak.

    PubMed

    Joseph, George; Thomson, Viji Samuel

    2009-11-15

    Transcatheter closure of mitral paraprosthetic leak (PPL) using femoral antegrade transseptal or retrograde approach is often unsuccessful when the involved part of the mitral annulus is difficult to access or when the left atrium is large. We report the successful use of jugular venous approach to perform transseptal antegrade PPL closure in a 49-year-old male with mitral PPL located in the anteromedial part of the annulus. This technique could serve as a useful alternative in patients in whom transcatheter closure of mitral PPL is technically difficult. PMID:19626688

  15. [THE MECHANISMS OF ISCHEMIC MITRAL VALVE INSUFFICIENCY FORMATION].

    PubMed

    Rudenko, S A

    2015-07-01

    In clinic in the period from 2012 to 2014 in 142 patients were performed interventions on the mitral valve for coronary heart disease and ischemic mitral valve insufficiency (MVI). The majority of patients were able to work, its witness for social-economic significance of problem. The main reason of the ischemic MVI arised were the dilatation of mitral valve fibrousing and substitution of papillar muscles for left ventricle remodelling. Symmetrical deformation of mitral valve arised in most cases after anterior-septal myocardium infarction, left ventricle global remodelling and apical substitution of papillar muscles; asymmetrical ones--after posterior myocardial infarction for local left ventricle papillar muscles. PMID:26591216

  16. Peri-procedural imaging for transcatheter mitral valve replacement.

    PubMed

    Natarajan, Navin; Patel, Parag; Bartel, Thomas; Kapadia, Samir; Navia, Jose; Stewart, William; Tuzcu, E Murat; Schoenhagen, Paul

    2016-04-01

    Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR. PMID:27054104

  17. 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.

  18. Peri-procedural imaging for transcatheter mitral valve replacement

    PubMed Central

    Natarajan, Navin; Patel, Parag; Bartel, Thomas; Kapadia, Samir; Navia, Jose; Stewart, William; Tuzcu, E. Murat

    2016-01-01

    Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR. PMID:27054104

  19. Flail mitral and tricuspid valves due to myxomatous disease.

    PubMed

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

    2008-03-01

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

  20. Robotically assisted minimally invasive mitral valve surgery

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  2. Adjustable mitral annuloplasty for the surgical treatment of ischaemic mitral insufficiency.

    PubMed

    Czesla, Markus; Götte, Julia; Doll, Nicolas

    2013-01-01

    Presentation of the MiCardia enCorSQ annuloplasty device implantation technique for ischaemic mitral regurgitation including late-stage activation: exposure of mitral valve using video-assisted right lateral mini-thoracotomy, annuloplasty, tunnelling of permanently attached lead through the left atrial wall and subcutaneous implantation; and late activation: minor cut-down procedure for lead exposure, connection to proprietary energy source (MC-100 RF generator), echocardiography and fluoroscopy guidance, anterior-posterior diameter reduction of memory-shape alloy core annuloplasty device by raising the temperature a few degrees above body temperature. PMID:24413004

  3. Gargantuan left atrium: a sequela of mitral regurgitation and mitral stenosis.

    PubMed

    Omslaer, Brian T; Biederman, Robert W W

    2015-06-01

    Cardiac magnetic resonance imaging and echocardiography revealed a gargantuan left atrium measuring 18.9 cm × 15.7 cm × 11.3 cm in a 56-year-old patient diagnosed with severe rheumatic mitral stenosis, severe pulmonary hypertension, and permanent atrial fibrillation. A chest x-ray also revealed a cardiothoracic ratio approaching 1.0 and a transthoracic echocardiogram measured diameters as large as 19.2 cm. The patient then underwent mitral valve replacement and left atrial reduction surgery and has had no further admissions or complications. PMID:25556297

  4. Mitral valve prolapse and body habitus in children.

    PubMed

    Arfken, C L; Schulman, P; McLaren, M J; Lachman, A S

    1993-01-01

    Mitral valve prolapse has generally been associated in adults with a thin body habitus. However, prior studies used biased samples or limited anthropometric measures. In addition, no information has been available on the subjective assessment of body habitus and diagnosis of mitral valve prolapse, especially in children. We conducted a cross-sectional study on 813 children with uniform assessment of anthropometric measures and mitral valve prolapse. Consistent with research conducted on adults, those subjects with mitral valve prolapse were lighter, thinner, and had, on average, lower values for several, quantifiable anthropometric parameters with the exception of height. However, the subjective assessment showed that while the assessment did not differ by diagnosis, those subjects with mitral valve prolapse were never described as fat. These data support an association between mitral valve prolapse and slender body habitus and extends it to children, thus underscoring the clinical importance that a thin body habitus may be a marker for mitral valve prolapse throughout the age span. This association may partly explain the observed genetic distribution of mitral valve prolapse.

  5. Multiplane transesophageal echocardiographic evaluation of mitral valve disease.

    PubMed

    Stewart, W J; Griffin, B; Thomas, J D

    1995-04-01

    With the additional ability to rotate the image around the axis of the centerline of the sector, multiplane transesophageal echocardiography (TEE) improves over single or biplane TEE in ease of use and diagnostic accuracy. This article reviews the anatomic, physiological, and topographic considerations that affect the use of multiplane TEE in evaluation of patients with mitral valve disease. The optimum mitral valve examination includes a true "short-axis" view, obtained by a transverse (zero-degree angle) transgastric image orientation with the probe tip flexed anteriorly, and several "long-axis" views, obtained from various rotations of the basilar multiplane TEE image planes. This provides a useful and accurate means to determine the mechanism of mitral regurgitation, which is useful in planning and timing, determining the likelihood, and predicting the surgical techniques that will be required for mitral valve repair. The postcardiopulmonary bypass (postpump) TEE examination in a patient with mitral regurgitation is a second important component of the process of repair, to determine the presence and severity of residual mitral regurgitation, and identify any complications of surgery. Of 1,550 mitral repair operations studied with postpump echocardiography at our hospital since 1987, a total of 105 (7%) have had second pump runs. Multiplane TEE is also useful to pinpoint the exact site of periprosthetic regurgitation around a mitral prosthesis, enabling direct surgical closure in some cases. Understanding special technical features of multiplane TEE is an important component for optimum utilization of this powerful diagnostic modality.

  6. Double-orifice mitral valve associated with atrioventricular canal defects

    PubMed Central

    Rhissassi, Jaafar; El Malki, Hicham; Benmessaoud, Fatima Azzahra; El Kandoussi, Tahar; Laaroussi, Mohamed

    2016-01-01

    A 4 year-old male presented with effort dyspnea, and was diagnosed as atrioventricular canal defects. This finding was confirmed by open heart surgery, and a congenital double orifice mitral valve was discovered. The septal defect was closed but the double orifice mitral valve was respected because of the absence of hemodynamic disturbance. We report this case with review of literature. PMID:27347288

  7. Mitral valve prolapse: associations with symptoms and anxiety.

    PubMed

    Arfken, C L; Lachman, A S; McLaren, M J; Schulman, P; Leach, C N; Farrish, G C

    1990-03-01

    Mitral valve prolapse has been studied extensively in the adult population, but less is known about it in children. Therefore, 813 children between 9 and 14 years of age were examined by a team of cardiologists and technicians. The children also responded to a questionnaire concerning the presence of symptoms and the What I Think and Feel anxiety instrument. The prevalence of mitral valve prolapse using auscultatory criteria was 4.2% (6.2% for girls, 2.3% for boys). Of those with mitral valve prolapse, 85% had a solitary click, 9% had a click and systolic murmur, and 6% had multiple clicks. Children with auscultatory mitral valve prolapse were less likely to have symptoms than those free of cardiac abnormalities. No difference in average anxiety scores was detected between the two groups. It is concluded that auscultatory mitral valve prolapse is common in children and not accompanied by an increased likelihood of symptoms or anxiety.

  8. Modification of a stented bovine jugular vein conduit (melody valve) for surgical mitral valve replacement.

    PubMed

    Abdullah, Ibrahim; Ramirez, Francisco Boye; McElhinney, Doff B; Lock, James E; del Nido, Pedro J; Emani, Sitaram

    2012-10-01

    We report the use of a Melody valve as a surgical implant in the mitral position in 2 infants, one with severe mitral regurgitation and another with mitral stenosis, where other prostheses are not small enough to be implanted in the mitral position nor expandable as the child grows. PMID:23006723

  9. A meta-analysis of mitral valve repair versus replacement for ischemic mitral regurgitation

    PubMed Central

    Virk, Sohaib A.; Sriravindrarajah, Arunan; Dunn, Douglas; Liou, Kevin; Wolfenden, Hugh; Tan, Genevieve

    2015-01-01

    Background The development of ischemic mitral regurgitation (IMR) portends a poor prognosis and is associated with adverse long-term outcomes. Although both mitral valve repair (MVr) and mitral valve replacement (MVR) have been performed in the surgical management of IMR, there remains uncertainty regarding the optimal approach. The aim of the present study was to meta-analyze these two procedures, with mortality as the primary endpoint. Methods Seven databases were systematically searched for studies reporting peri-operative or late mortality following MVr and MVR for IMR. Data were independently extracted by two reviewers and meta-analyzed according to pre-defined study selection criteria and clinical endpoints. Results Overall, 22 observational studies (n=3,815 patients) and one randomized controlled trial (n=251) were included. Meta-analysis demonstrated significantly reduced peri-operative mortality [relative risk (RR) 0.61; 95% confidence intervals (CI), 0.47-0.77; I2=0%; P<0.001] and late mortality (RR, 0.78; 95% CI, 0.67-0.92; I2=0%; P=0.002) following MVr. This finding was more pronounced in studies with longer follow-up beyond 3 years. At latest follow-up, recurrence of at least moderate mitral regurgitation (MR) was higher following MVr (RR, 5.21; 95% CI, 2.66-10.22; I2=46%; P<0.001) but the incidence of mitral valve re-operations were similar. Conclusions In the present meta-analysis, MVr was associated with reduced peri-operative and late mortality compared to MVR, despite an increased recurrence of at least moderate MR at follow-up. However, these findings must be considered within the context of the differing patient characteristics that may affect allocation to MVr or MVR. Larger prospective studies are warranted to further compare long-term survival and freedom from re-intervention. PMID:26539343

  10. Premeasured Chordal Loops for Mitral Valve Repair.

    PubMed

    Gillinov, Marc; Quinn, Reed; Kerendi, Faraz; Gaudiani, Vince; Shemin, Richard; Barnhart, Glenn; Raines, Edward; Gerdisch, Marc W; Banbury, Michael

    2016-09-01

    Premeasured expanded polytetrafluoroethylene chordal loops with integrated sutures for attachment to the papillary muscle and leaflet edges facilitate correction of mitral valve prolapse. Configured as a group of 3 loops (length range 12 to 24 mm), the loops are attached to a pledget that is passed through the papillary muscle and tied. Each of the loops has 2 sutures with attached needles; these needles are passed through the free edge of the leaflet and then the sutures are tied to each other, securing the chordal loop to the leaflet. PMID:27549563

  11. Left Atrial Myxoma Mimicking Mitral Stenosis

    PubMed Central

    Ojji, Dike B; Mamven, Manmak H; Omonua, Odiase; Habib, Zaiyad; Osaze, Hamamatu; Sliwa, Karen

    2012-01-01

    Cardiac myxoma is a benign (non-malignant) neoplasm that represents the most common primary tumour of the heart. We present the case of a 36 year old woman with background hypertension who presented with features of left ventricular failure and seizures, and was found during transthoracic echocardiography to have left atrial myxoma protruding through the mitral valve orifice. She subsequently had excision of the atrial myxoma. The usefulness of early transthoracic echocardiography in any patient presenting with features of heart failure even when the aetiology seems obvious cannot be over-emphasised. PMID:22844201

  12. Pseudopapillary fibroelastoma of the mitral valve.

    PubMed Central

    Madu, E.; Myles, J.; Fraker, T. D.

    1995-01-01

    Papillary fibroelastomas are well-recognized benign cardiac neoplasms. They are primarily asymptomatic, but occasionally are associated with neurologic and cardiac symptoms. Pseudopapillary fibroelastomas presenting with usual clinical and echocardiographic manifestations of papillary fibroelastoma but lacking characteristic histologic features have not been described previously. This article describes a 42-year-old, previously healthy female admitted with sudden hemiparesis and dysarthria. Symptoms completely resolved within 4 days. Extensive investigations revealed no etiology except for a pedunculated mitral valve mass with echocardiographic appearance suggestive of papillary fibroelastoma. Histologic staining, however, failed to reveal characteristic features of papillary fibroelastoma. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:7869409

  13. Pseudopapillary fibroelastoma of the mitral valve.

    PubMed

    Madu, E; Myles, J; Fraker, T D

    1995-01-01

    Papillary fibroelastomas are well-recognized benign cardiac neoplasms. They are primarily asymptomatic, but occasionally are associated with neurologic and cardiac symptoms. Pseudopapillary fibroelastomas presenting with usual clinical and echocardiographic manifestations of papillary fibroelastoma but lacking characteristic histologic features have not been described previously. This article describes a 42-year-old, previously healthy female admitted with sudden hemiparesis and dysarthria. Symptoms completely resolved within 4 days. Extensive investigations revealed no etiology except for a pedunculated mitral valve mass with echocardiographic appearance suggestive of papillary fibroelastoma. Histologic staining, however, failed to reveal characteristic features of papillary fibroelastoma.

  14. Progression to calcific mitral stenosis in end-stage renal disease.

    PubMed

    D'Cruz, I A; Madu, E C

    1995-12-01

    A 59-year-old man with end-stage renal disease and on hemodialysis had neither mitral stenosis nor mitral calcification on echo-Doppler examination in 1989, but had extensive mitral calcification and definite mitral stenosis on conventional and transesophageal echocardiography in 1994. The left ventricle had marked concentric hypertrophy. To our knowledge this is the first documentation of the development of calcific mitral stenosis in end-stage renal disease revealed by serial echo-Doppler studies.

  15. Mitral Valve Surgery: Current Minimally Invasive and Transcatheter Options

    PubMed Central

    Ramlawi, Basel; Gammie, James S.

    2016-01-01

    The mitral valve is a highly complex structure, the competency and function of which relies on the harmonious action of its component parts. Minimally invasive cardiac surgery (MICS) for mitral valve repair or replacement (MVR/r) has been performed successfully with incremental improvements in techniques over the past decade. These minimally invasive procedures, while attractive to patients and referring physicians, should meet the same high bar for optimal clinical outcomes and long-term durability of valve repair as traditional sternotomy procedures. The majority of MICS MVR/r procedures are performed via a right minithoracotomy approach with direct or camera-assisted visualization, with a minority of centers performing robotic MVR/r. Outcomes with MICS MVR/r have been shown to have similar morbidity and mortality rates as traditional sternotomy MV procedures but with the advantage of reduced transfusions, postoperative atrial fibrillation, and time to recovery. More recently, transcatheter mitral valve repair and replacement (TMVR/r) has become a reality. Percutaneous MV repair technology is currently FDA approved for patients with nonsurgical high-risk degenerative mitral regurgitation. Other TMVR/r technology is at various levels of preclinical and clinical investigation, although these devices are proving to be more challenging compared to transcatheter aortic valve replacement (TAVR) due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment. In this article, we review current techniques for MICS MVR/r and upcoming catheter-based therapies for the mitral valve. PMID:27127558

  16. Mechanics of the Mitral Annulus in Chronic Ischemic Cardiomyopathy

    PubMed Central

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

    2013-01-01

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

  17. En face view of the mitral valve: definition and acquisition.

    PubMed

    Mahmood, Feroze; Warraich, Haider Javed; Shahul, Sajid; Qazi, Aisha; Swaminathan, Madhav; Mackensen, G Burkhard; Panzica, Peter; Maslow, Andrew

    2012-10-01

    A 3-dimensional echocardiographic view of the mitral valve, called the "en face" or "surgical view," presents a view of the mitral valve similar to that seen by the surgeon from a left atrial perspective. Although the anatomical landmarks of this view are well defined, no comprehensive echocardiographic definition has been presented. After reviewing the literature, we provide a definition of the left atrial and left ventricular en face views of the mitral valve. Techniques used to acquire this view are also discussed. PMID:22859687

  18. Mitral valve repair in a patient with acromegaly.

    PubMed

    Omoto, Tadashi; Tedoriya, Takeo; Oi, Masaya; Nagano, Naoko; Miyauchi, Tadamasa; Ishikawa, Noboru

    2012-01-01

    We report on a successful mitral valve (MV) repair and modified Cox maze procedure in a 35-year-old male patient with acromegaly, associated with severe mitral regurgitation and atrial fibrillation. He underwent a transsphenoidal adenomectomy, 7 months after the cardiac operation, and IGF-I level was normalized postoperatively. Valvular disease in patients with acromegaly is associated with hormonal activity, and control of growth hormone and insulin-like growth factor I excesses is important in the long-term durability of mitral valve repair.

  19. Safeguards and pitfalls in minimally invasive mitral valve surgery.

    PubMed

    Czesla, Markus; Götte, Julia; Weimar, Timo; Ruttkay, Tamas; Doll, Nicolas

    2013-11-01

    Minimally invasive mitral valve surgery has been established in many institutions worldwide. Appropriate indications and patient selection for this procedure must be based on a thorough understanding of its limitations and specific pitfalls. Particular risks can be minimized with careful attention to detail when planning and performing the surgery. The following chapter offers a stepwise description of the procedure; we point out particular advantages, discuss our rationale for certain steps, as well as focus on potential dangers of minimally invasive mitral valve surgery. Several graphics have also been provided to illustrate our approach and demonstrate important structural and anatomical concepts of the mitral valve apparatus.

  20. Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis

    PubMed Central

    Joshi, Hasit Sureshbhai; Deshmukh, Jagjeet Kishanrao; Prajapati, Jayesh Somabhai; Sahoo, Sibasis Shahsikant; Vyas, Pooja Maheshbhai

    2015-01-01

    Introduction In pregnant women mitral stenosis is the commonest cardiac valvular lesion. When it is present in majorly severe condition it leads to maternal and fetal morbidity and mortality. In mitral stenosis pregnancy can lead to development of heart failure. Aim To evaluate the safety and efficacy of balloon mitral valvulotomy (BMV) in pregnant females with severe mitral stenosis. Materials and Methods A total of 30 pregnant patients who underwent BMV were included in the study from July 2011 to November 2013. Clinical follow-up during pregnancy was done every 3 months until delivery and after delivery. The mean follow up time after BMV was 6.72±0.56 months. Results From the 30 pregnant females 14 (46.67%) and 16 (53.3%) patients underwent BMV during the third and second trimester of pregnancy respectively. The mean mitral valve area was 0.85+0.16 cm2 before BMV that increased to 1.60+0.27 cm2 (p<0.0001) immediately after BMV. Peak and mean diastolic gradients had decreased significantly within 48 hours after the procedure (p<0.001) but remained very much unchanged at 6.72 month period of follow-up. Two patients had an increase in mitral regurgitation by 2 grades. Conclusion During pregnancy BMV technique is safe and effective in patients with severe mitral stenosis. This results in marked symptomatic relief along with long term maternal and fetal outcomes. PMID:26816932

  1. Conservative surgical management of mitral insufficiency: an alternative approach.

    PubMed

    Gregori Junior, Francisco

    2012-01-01

    Mitral valve insufficiency is frequently the result of elongated or ruptured chordae tendineae. Several techniques have been described for its correction. However, when there is a severe elongation or rupture of the chordae, the most widely accepted treatment option has been valve replacement. The best long-term outcomes observed in conservative surgeries led us to choose this procedure rather than the correction of mitral valve insufficiency. We described three techniques for correction of mitral prolapse due to elongated and/or ruptured chordae tendineae. In addition, we developed mold pre built bovine pericardial chords (Braile-Gregori prosthesis) for chordae replacement. Finally, since 1987, the rigid prosthetic semicircular ring (Gregori-Braile ring) has been consistently used in our centre for correction of the posterior dilation of mitral annulus preferably in its portion close to the posteromedial commissure. PMID:22996984

  2. [Mitral valve replacement in dextrocardia and situs inversus].

    PubMed

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

    2012-09-01

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

  3. Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks

    MedlinePlus

    Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks - David X. Zhao, MD Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  4. Degenerative Mitral Stenosis: Unmet Need for Percutaneous Interventions.

    PubMed

    Sud, Karan; Agarwal, Shikhar; Parashar, Akhil; Raza, Mohammad Q; Patel, Kunal; Min, David; Rodriguez, Leonardo L; Krishnaswamy, Amar; Mick, Stephanie L; Gillinov, A Marc; Tuzcu, E Murat; Kapadia, Samir R

    2016-04-19

    Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients. PMID:27142604

  5. Bacterial endocarditis of the mitral valve associated with annual calcification.

    PubMed

    Mambo, N C; Silver, M D; Brunsdon, D F

    1978-08-26

    Bacterial endocarditis, caused mainly by Staphylococcus aureus, was found at autopsy in five patients who had a calcified posterior mitral valve annulus. Clincopathologic correlation indicates that the infection should be suspected in elderly patients with a calcified mitral annulus, the murmur of mitral insufficiency, fever, anemia, polymorphonuclear leukocytosis and a positive blood culture, regardless of evidence of peripheral embolism or of another disease that could cause the last four features. Pertinent pathologic findings are a calcified mitral valve annulus, vegetations of bacterial endocarditis towards the base of the posterior leaflet associated with leaflet perforation and an annulus abscess, and no other valvular disease. The infection may develop on the atrial aspect of a leaflet ulcerated by the calcium mass or may begin on its ventricular aspect, subsequently perforating the leaflet and infecting its atrial surface.

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

    PubMed Central

    Lukács, 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

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

    PubMed

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

    2013-01-01

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

  8. A self-retaining retractor for mitral valve operations.

    PubMed

    Cosgrove, D M

    1986-08-01

    A new self-retaining retractor for mitral valve operations is described. It is universally adjustable, may be affixed to any sternal retractor, and is completely removable when not required for the intracardiac portion of the procedure.

  9. Self-retaining pledgeted suture as retractor for mitral procedure.

    PubMed

    Ng, Choi-Keung; Benedikt, Peter; Schwarz, Christian; Hartl, Peter

    2009-04-01

    A simple reliable maneuver to optimize exposure of the left atrium for mitral valve operations is described. It offers more space to mobilize the valvular structure, facilitating complicated reconstruction in the posteromedial commisural area.

  10. Transcatheter mitral valve implantation (TMVI) using the Edwards FORTIS device.

    PubMed

    Bapat, Vinayak; Buellesfeld, Lutz; Peterson, Mark D; Hancock, Jane; Reineke, David; Buller, Chris; Carrel, Thierry; Praz, Fabien; Rajani, Ronal; Fam, Neil; Kim, Han; Redwood, Simon; Young, Christopher; Munns, Christopher; Windecker, Stephan; Thomas, Martyn

    2014-09-01

    Transcatheter aortic valve implantation (TAVI) has demonstrated the feasibility of treating valvular heart disease with transcatheter therapy. On the back of this success, various transcatheter concepts are being evaluated to treat other valvular disease, especially mitral regurgitation (MR). The concepts currently approved to treat MR replicate surgical mitral valve repair. However, most of them cannot eliminate MR completely. Similar to TAVI, a transcatheter mitral valve implantation may provide a valuable alternative. The FORTIS transcatheter mitral valve (Edwards Lifesciences, Irvine, CA, USA) is a self-expanding device implanted via a transapical approach. We describe our experience and early results in the first five patients treated on compassionate grounds. We also describe the details of the device, selection criteria and technical details of implantation. PMID:25256325

  11. Single coronary artery anomaly causing ischemic mitral insufficiency.

    PubMed

    Ay, Yasin; Aydın, Cemalettin; Ay, Nuray Kahraman; Inan, Bekir; Başel, Halil; Zeybek, Rahmi

    2014-05-01

    Single coronary artery anomaly is rarely seen, and although it can present with sudden death, chest pain, arrhythmia, myocardial infarction, or congestive heart failure, it can also be asymptomatic. We describe the case of a 58-year-old man with single coronary artery anomaly in whom the coronary artery stemmed from the left coronary sinus and caused ischemic mitral insufficiency due to left anterior descending artery stenosis. He underwent successful mitral valve repair and coronary bypass. PMID:24771737

  12. Mitral valve involvement as a predominant feature of cardiac amyloidosis

    PubMed Central

    Viswanathan, Girish; Williams, James; Slinn, Simon; Campbell, Philip

    2010-01-01

    Cardiac involvement in systemic amyloidosis carries poor prognosis with a median survival of 5 months.1 The authors report an unusual presentation of cardiac amyloidosis in the form of predominant mitral regurgitation. The patient responded very well to medical therapy with subsequent improvement of mitral valve dysfunction. The authors would like to highlight this multisystem involvement and the presence of a complex overlap of systemic features. PMID:22767536

  13. Acute dysfunction of Starr-Edwards mitral prostheses

    PubMed Central

    Gunstensen, John

    1971-01-01

    Four cases of acute dysfunction of Starr-Edwards mitral prostheses are recorded. The patients presented with sudden dysponea 4 to 18 months after apparently successful mitral valve replacement. The prosthetic valve dysfunction was caused by thrombus on the bare metal cage of the prosthesis. No warning thromboembolic phenomena had been recorded. Urgent replacement of the valve resulted in the survival of one patient. Images PMID:5576532

  14. Minimally invasive mitral valve surgery: “The Leipzig experience”

    PubMed Central

    Seeburger, Joerg; Pfannmueller, Bettina; Garbade, Jens; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich W.

    2013-01-01

    Background Minimally invasive mitral valve surgery has become a routine procedure at our institution. The present study analyzed the early and long-term outcomes of patients undergoing minimally invasive mitral valve surgery over the last decade, with special focus on mitral valve repairs (MVRp). Methods The preoperative variables, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were prospectively collected in our database from May 1999 to December 2010. The survival and freedom from reoperation were evaluated with life tables and Kaplan-Meier analyses. Results A total of 3,438 patients underwent minimally invasive mitral valve surgery, of which 2,829 were MVRps and 609 were mitral valve replacements (MVR). Forty-five patients (1.6%) required MVR due to failure of repair. The mean age was 60.3±13 years. More than a third of patients underwent concomitant procedures like tricuspid valve surgery, atrial septal defect (ASD) closure and cryoablation. The rate of conversion to sternotomy was less than 1.4%. The 30-day mortality was 0.8%. The 5- and 10-year survival of all patients (MVR and MVRp) undergoing minimally invasive mitral valve surgery was 85.7±0.6% and 71.5±1.2%, respectively. For MVRp, the survival was 87.0±0.7% and 74.2±1.4% at 5 and 10 years, respectively. Freedom from reoperation was 96.6±0.4% and 92.9±0.9% at 5 and 10 years, respectively. Conclusions Minimally invasive MVRp can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable. PMID:24349976

  15. Noncompaction of the ventricular myocardium associated with mitral regurgitation and preserved ventricular systolic function.

    PubMed

    Ali, Sulafa Khalid M; Omran, Ahmed S; Najm, Hani; Godman, Michael J

    2004-01-01

    Noncompaction of the ventricular myocardium is an embryonic cardiomyopathy that is increasingly being recognized. Mitral regurgitation, when present, is usually a result of the associated left ventricular systolic dysfunction. We report 4 patients with noncompaction of the ventricular myocardium in whom ventricular systolic function was preserved. Mitral regurgitation was associated with changes in the mitral valve leaflets and an abnormal coaptation pattern. This association of noncompaction of the ventricular myocardium with mitral regurgitation has not, to our knowledge, been reported.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2012-10-01

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

  18. Three-Dimensional Ultrasound-Derived Physical Mitral Valve Modeling

    PubMed Central

    Witschey, Walter RT; Pouch, Alison M; McGarvey, Jeremy R; Ikeuchi, Kaori; Contijoch, Francisco; Levack, Melissa M; Yushkevick, Paul A; Sehgal, Chandra M; Jackson, Benjamin; Gorman, Robert C; Gorman, Joseph H

    2015-01-01

    Purpose Advances in mitral valve repair and adoption have been partly attributed to improvements in echocardiographic imaging technology. To further educate and guide repair surgery, we have developed a methodology to quickly produce physical models of the valve using novel 3D echocardiographic imaging software in combination with stereolithographic printing. Description Quantitative virtual mitral valve shape models were developed from 3D transesophageal echocardiographic images using software based on semi-automated image segmentation and continuous medial representation (cm-rep) algorithms. These quantitative virtual shape models were then used as input to a commercially available stereolithographic printer to generate a physical model of the each valve at end systole and end diastole. Evaluation Physical models of normal and diseased valves (ischemic mitral regurgitation and myxomatous degeneration) were constructed. There was good correspondence between the virtual shape models and physical models. Conclusions It was feasible to create a physical model of mitral valve geometry under normal, ischemic and myxomatous valve conditions using 3D printing of 3D echocardiographic data. Printed valves have the potential to guide surgical therapy for mitral valve disease. PMID:25087790

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

    PubMed Central

    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; Su Hao, LO; Dolmatova, Elena; Simonet, Floriane; Lecointe, Simon; Kyndt, Florence; Redon, Richard; Le Marec, Hervé; Froguel, Philippe; Ellinor, Patrick T.; Vasan, Ramachandran S.; Bruneval, Patrick; Norris, Russell A.; Milan, David J.; Slaugenhaupt, Susan A.; Levine, Robert A.; Schott, Jean-Jacques; Hagege, Albert A.; Jeunemaitre, Xavier

    2016-01-01

    Non-syndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown aetiology that predisposes to mitral regurgitation, heart failure and sudden death1. Previous family and pathophysiological studies suggest a complex pattern of inheritance2–5. We performed a meta-analysis of two genome-wide association studies in 1,442 cases and 2,439 controls. We identified and replicated in 1,422 cases and 6,779 controls six loci and provide functional evidence for candidate genes. We highlight LMCD1 encoding a transcription factor6, for which morpholino knockdown in zebrafish results in atrioventricular (AV) valve regurgitation. A similar zebrafish phenotype was obtained for tensin1 (TNS1), a focal adhesion protein involved in cytoskeleton organization. We also show the expression of tensin1 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 repair7. PMID:26301497

  20. Mitral valve repair: an echocardiographic review: Part 2.

    PubMed

    Maslow, Andrew

    2015-04-01

    Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair. PMID:25440616

  1. Mitral valve repair in a patient with mesocardia.

    PubMed

    Morisaki, Akimasa; Hattori, Koji; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2014-01-01

    A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.

  2. 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

  3. Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management.

    PubMed

    Wolfe, J Alan; Malaisrie, S Chris; Farivar, R Saeid; Khan, Junaid H; Hargrove, W Clark; Moront, Michael G; Ryan, William H; Ailawadi, Gorav; Agnihotri, Arvind K; Hummel, Brian W; Fayers, Trevor M; Grossi, Eugene A; Guy, T Sloane; Lehr, Eric J; Mehall, John R; Murphy, Douglas A; Rodriguez, Evelio; Salemi, Arash; Segurola, Romualdo J; Shemin, Richard J; Smith, J Michael; Smith, Robert L; Weldner, Paul W; Lewis, Clifton T P; Barnhart, Glenn R; Goldman, Scott M

    2016-01-01

    Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery. PMID:27654406

  4. New concepts for mitral valve imaging.

    PubMed

    Noack, Thilo; Kiefer, Philipp; Ionasec, Razvan; Voigt, Ingmar; Mansi, Tammaso; Vollroth, Marcel; Hoebartner, Michael; Misfeld, Martin; Mohr, Friedrich-Wilhelm; Seeburger, Joerg

    2013-11-01

    The high complexity of the mitral valve (MV) anatomy and function is not yet fully understood. Studying especially the dynamic movement and interaction of MV components to describe MV physiology during the cardiac cycle remains a challenge. Imaging is the key to assessing details of MV disease and to studying the lesion and dysfunction of MV according to Carpentier. With the advances of computational geometrical and biomechanical MV models, improved quantification and characterization of the MV has been realized. Geometrical models can be divided into rigid and dynamic models. Both models are based on reconstruction techniques of echocardiographic or computed tomographic data sets. They allow detailed analysis of MV morphology and dynamics throughout the cardiac cycle. Biomechanical models aim to simulate the biomechanics of MV to allow for examination and analysis of the MV structure with blood flow. Two categories of biomechanical MV models can be distinguished: structural models and fluid-structure interaction (FSI) models. The complex structure and dynamics of MV apparatus throughout the cardiac cycle can be analyzed with different types of computational models. These represent substantial progress in the diagnosis of structural heart disease since MV morphology and dynamics can be studied in unprecedented detail. It is conceivable that MV modeling will contribute significantly to the understanding of the MV.

  5. New concepts for mitral valve imaging.

    PubMed

    Noack, Thilo; Kiefer, Philipp; Ionasec, Razvan; Voigt, Ingmar; Mansi, Tammaso; Vollroth, Marcel; Hoebartner, Michael; Misfeld, Martin; Mohr, Friedrich-Wilhelm; Seeburger, Joerg

    2013-11-01

    The high complexity of the mitral valve (MV) anatomy and function is not yet fully understood. Studying especially the dynamic movement and interaction of MV components to describe MV physiology during the cardiac cycle remains a challenge. Imaging is the key to assessing details of MV disease and to studying the lesion and dysfunction of MV according to Carpentier. With the advances of computational geometrical and biomechanical MV models, improved quantification and characterization of the MV has been realized. Geometrical models can be divided into rigid and dynamic models. Both models are based on reconstruction techniques of echocardiographic or computed tomographic data sets. They allow detailed analysis of MV morphology and dynamics throughout the cardiac cycle. Biomechanical models aim to simulate the biomechanics of MV to allow for examination and analysis of the MV structure with blood flow. Two categories of biomechanical MV models can be distinguished: structural models and fluid-structure interaction (FSI) models. The complex structure and dynamics of MV apparatus throughout the cardiac cycle can be analyzed with different types of computational models. These represent substantial progress in the diagnosis of structural heart disease since MV morphology and dynamics can be studied in unprecedented detail. It is conceivable that MV modeling will contribute significantly to the understanding of the MV. PMID:24349983

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

    PubMed Central

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

    1977-01-01

    Ten patients without valvular disease were studied by ventriculography, and the rate and pattern of phasic blood flow into the left ventricle were determined by ventricular volume determinations at intervals of 33 ms during a single diastolic filling period. The derived left ventricular inflow patterns were then compared with the echocardiographic mitral EF slope obtained no more than 25 minutes before left ventriculography. The steepness of the EF slope was found to be inversely correlated with the time required to reach peak inflow velocity (r = 0.80, P less than 0.01) and directly correlated with the peak left ventricular inflow velocity divided by the time required to reach peak velocity (r = 0.72, P less than 0.05). No correlation was found between mean flow velocity into the left ventricle and the EF slope (r = 0.40, P = NS). A significant inverse correlation was found between the EF slope and the fraction of the diastolic filling period elapsed when 50 per cent of the filling volume had entered the left ventricle (r = 0.85, P less than 0.01). These findings suggest that the time required to reach left ventricular peak inflow velocity is one of the determinants of the mitral EF slope. PMID:603729

  7. Percutaneous Mitral Valvotomy in a Case of Situs Inversus Totalis and Juvenile Rheumatic Critical Mitral Stenosis: Case Report

    PubMed Central

    Sinha, Santosh Kumar; Thakur, Ramesh; Jha, Mukesh Jitendra; Sayal, Karandeep Singh; Sachan, Mohit; Krishna, Vinay; Kumar, Ashutosh; Mishra, Vikas; Varma, Chandra Mohan

    2016-01-01

    Situs inversus totalis is a rare congenital disorder where the heart being a mirror image is situated on the right side of the body. Distorted cardiac anatomy makes fluoroscopy-guided percutaneous mitral valvotomy (PMV) technically challenging and there are only few reports of PMV in situs inversus totalis. Here we report a case where PMV was successfully done for situs inversus totalis with rare coincidence of juvenile rheumatic severe mitral stenosis in a 12-year-old boy with a few modifications of standard Inoue technique. He had exertional dyspnea of NYHA class III with initial mitral valve area (MVA) of 0.6 cm2 and severe pulmonary arterial hypertension with features suitable for PMV. Femoral vein was accessed from the left side to align the septal puncture needle and balloon to facilitate left ventricular entry. Septal descent and puncture by Brockenbrough needle was performed in the right anterior oblique view with the needle facing 5 o’clock position. Accura balloon was negotiated across mitral valve in left anterior oblique and procedure was successfully executed. Echocardiography showed a well-divided anterior commissure with an MVA of 2.0 cm2 and mild mitral regurgitation. In summary, PMV is safe and feasible in the rare patient with situs inversus totalis with few modifications of the Inoue technique. PMID:26985259

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

    PubMed

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

    2014-03-01

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

  9. The Ross II procedure: pulmonary autograft in the mitral position.

    PubMed

    Athanasiou, Thanos; Cherian, Ashok; Ross, Donald

    2004-10-01

    The surgical management of mitral valve disease in women of childbearing age, young patients, and children with congenital mitral valve defects is made difficult by the prospect of lifelong anticoagulation. We suggest the use of a pulmonary autograft in the mitral position (Ross II procedure) as an alternative surgical technique. We present a review of the literature, historical perspectives, indications, selection criteria, and surgical technique for the Ross II procedure. Our literature search identified 14 studies that reported results from the Ross II operation. Performed in 103 patients, the overall in-hospital mortality was 7 (6.7%), with a late mortality of 10 (9%). Although further research is needed, current evidence suggests the Ross II operation is a valuable alternative in low-risk young patients where valve durability and the complication rate from other procedures is unsatisfactory and anticoagulation not ideal.

  10. Percutaneous coronary intervention for acute myocardial infarction with mitral regurgitation

    PubMed Central

    Tu, Yan; Zeng, Qing-Chun; Huang, Ying; Li, Jian-Yong

    2016-01-01

    Ischemic mitral regurgitation (IMR) is a common complication of acute myocardial infarction (AMI). Current evidences suggest that revascularization of the culprit vessels with percutaneous coronary artery intervention (PCI) or coronary artery bypass grafting can be beneficial for relieving IMR. A 2.5-year follow-up data of a 61-year-old male patient with ST-segment elevation AMI complicated with IMR showed that mitral regurgitation area increased five days after PCI, and decreased to lower steady level three months after PCI. This finding suggest that three months after PCI might be a suitable time point for evaluating the possibility of IMR recovery and the necessity of surgical intervention of the mitral valve for AMI patient. PMID:27582769

  11. 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

  12. Curious case of calciphylaxis leading to acute mitral regurgitation

    PubMed Central

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

    2014-01-01

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

  13. Percutaneous coronary intervention for acute myocardial infarction with mitral regurgitation.

    PubMed

    Tu, Yan; Zeng, Qing-Chun; Huang, Ying; Li, Jian-Yong

    2016-09-01

    Ischemic mitral regurgitation (IMR) is a common complication of acute myocardial infarction (AMI). Current evidences suggest that revascularization of the culprit vessels with percutaneous coronary artery intervention (PCI) or coronary artery bypass grafting can be beneficial for relieving IMR. A 2.5-year follow-up data of a 61-year-old male patient with ST-segment elevation AMI complicated with IMR showed that mitral regurgitation area increased five days after PCI, and decreased to lower steady level three months after PCI. This finding suggest that three months after PCI might be a suitable time point for evaluating the possibility of IMR recovery and the necessity of surgical intervention of the mitral valve for AMI patient. PMID:27582769

  14. Surgical phantom for off-pump mitral valve replacement

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  15. [Conventional and color Doppler echocardiography in mitral balloon valvotomy].

    PubMed

    Rodrigo, J L; Aubele, A; Alfonso, F; Macaya, C; Fernández Ortiz, A; Zarco, P

    1992-01-01

    With the aim of assessing the value of conventional echocardiography and Doppler and colour Doppler during and in the follow-up of percutaneous mitral valvotomy we have studied prospectively 100 consecutive patients with 1 (90%), 6 (69%) and 12 (53%) months follow-up. Age was 50 years and 80% were women. The single balloon technique was used in 68%, mitral valve area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2 and decrease in pulmonary artery pressure was 10 +/- 0.05 mmHg. We found that: 1) percutaneous mitral valvotomy produced and acute and transient decrease in left ventricular ejection fraction (pre 69 +/- 9%, post 61 +/- 10% p less than 0.001; 1 month 70 +/- 10; 2) a severe mitral regurgitation appeared in 4% of patients and 17% of patients had a moderate degree of regurgitation after valvotomy; 3) after valvular dilation an increase in the width of the aliasing greater than 29% predicted a successful procedure (final area greater than 1.5 cm2) with a sensibility 80% and specificity 94%, and 4) colour Doppler detected an atrial septal defect immediately after valvular dilation in 77% of patients, and permitted non invasive follow-up of the left to right shunt. At one year a left to right shunt at the atrial level persisted roughly in 1/3 of patients. We conclude that colour Doppler Echocardiography during percutaneous mitral valvotomy is useful for a rapid assessment of the increase in valve area, the detection and quantification of mitral regurgitation induced by valvular dilation and the follow-up in these patients.

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

    PubMed

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

    2013-11-01

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

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

    PubMed

    Rybicka, Justyna; Dobrowolski, Piotr; Kuśmierczyk, Mariusz; Rózański, Jacek; Kowalski, Mirosław; 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.

  18. Three-dimensional echocardiography of the mitral valve: lessons learned.

    PubMed

    Maffessanti, Francesco; Mirea, Oana; Tamborini, Gloria; Pepi, Mauro

    2013-07-01

    Three-dimensional echocardiography has markedly improved our understanding of normal and pathologic mitral valve (MV) mechanics. Qualitative and quantitative analysis of three-dimensional (3D) data on the mitral valve could have a clinical impact on diagnosis, patient referral, surgical strategies, annuloplasty ring design and evaluation of the immediate and long-term surgical outcome. This review covers the contribution of 3D echocardiography in the diagnosis of MV disease, its role in selecting and monitoring surgical procedures, and in the assessment of surgical outcomes. Moreover, advantages of this technique versus the standard 2D modality, as well as future applications of advanced analysis techniques, will be reviewed. PMID:23686753

  19. Multi-modality imaging of an adult parachute mitral valve.

    PubMed

    Purvis, John A; Smyth, Stephen; Barr, Stephen H

    2011-03-01

    A parachute abnormality of the mitral valve is an extremely rare finding in adults. It is usually seen as part of Shone's complex. The authors present multimodality imaging from a case of adult parachute abnormality of the mitral valve to illustrate and explain features such as the characteristic "pear" shape of the valve and "doming" of the subvalvular apparatus. The solitary papillary muscle that defines the condition may be difficult to identify on transthoracic echocardiography, but redundancy of the chordae is a key echocardiographic feature in the adult form of the condition.

  20. New method of posterior scallop augmentation for ischemic mitral regurgitation.

    PubMed

    Aoki, Masakazu; Ito, Toshiaki

    2015-03-01

    We report a new method of posterior middle scallop (P2) augmentation for ischemic mitral regurgitation to achieve deep coaptation. First, P2 was divided straight at the center and partially detached from the annulus in a reverse T shape. A narrow pentagon-shaped section of pericardium was sutured to the divided P2 and annular defect. The tip of the pentagon was attached directly to the papillary muscle, thus creating a very large P2 scallop. A standard-sized ring was placed. We adopted this technique in 2 patients with advanced ischemic cardiomyopathy, and no mitral regurgitation was observed during a 1-year follow-up. PMID:25742844

  1. 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

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

    PubMed

    Little, Sherard G

    2014-12-01

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

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

    PubMed Central

    2011-01-01

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

  4. Effect of Transcatheter Mitral Annuloplasty With the Cardioband Device on 3-Dimensional Geometry of the Mitral Annulus.

    PubMed

    Arsalan, Mani; Agricola, Eustachio; Alfieri, Ottavio; Baldus, Stephan; Colombo, Antonio; Filardo, Giovanni; Hammerstingl, Christophe; Huntgeburth, Michael; Kreidel, Felix; Kuck, Karl-Heinz; LaCanna, Giovanni; Messika-Zeitoun, David; Maisano, Francesco; Nickenig, Georg; Pollock, Benjamin D; Roberts, Bradley J; Vahanian, Alec; Grayburn, Paul A

    2016-09-01

    This study was performed to assess the acute intraprocedural effects of transcatheter direct mitral annuloplasty using the Cardioband device on 3-dimensional (3D) anatomy of the mitral annulus. Of 45 patients with functional mitral regurgitation (MR) enrolled in a single arm, multicenter, prospective trial, 22 had complete pre- and post-implant 3D transesophageal echocardiography (TEE) images stored in native data format that allowed off-line 3D reconstruction. Images with the highest volume rate and best image quality were selected for analysis. Multiple measurements of annular geometry were compared from baseline to post-implant using paired t tests with Bonferroni correction to account for multiple comparisons. The device was successfully implanted in all patients, and MR was reduced to moderate in 2 patients, mild in 17 patients, and trace in 3 patients after final device cinching. Compared with preprocedural TEE, postprocedural TEE showed statistically significantly reductions in annular circumference (137 ± 15 vs 128 ± 17 mm; p = 0.042), intercommissural distance (42.4 ± 4.3 vs 38.6 ± 4.4 mm; p = 0.029), anteroposterior distance (40.0 ± 5.4 vs 37.0 ± 5.7 mm; p = 0.025), and aortic-mitral angle (117 ± 8° vs 112 ± 8°; p = 0.032). This study demonstrates that transcatheter direct mitral annuloplasty with the Cardioband device results in acute remodeling of the mitral annulus with successful reduction of functional MR.

  5. [Structure and function of the mitral valve. Eligibility criteria for surgical and interventional approaches].

    PubMed

    Balzer, J; Kelm, M

    2015-06-01

    Mitral valve disease, especially severe mitral valve insufficiency, is an increasing issue in our population. Older patients with multiple comorbidities in particular are often denied surgery due to an increased perioperative risk. Because conservative medical treatment of mitral valve disease is often unsatisfactory, interventional techniques to treat mitral valve disease have emerged in recent years as serious alternatives to surgical treatment. Innovative developments in cardiovascular imaging have opened up new ways of looking at the mitral valve for improved diagnostic and therapeutic management of patients with mitral valve disease. These advantages of imaging are important for correct patient selection with either surgical or interventional strategies. This review describes the diagnostic capabilities of echocardiographic techniques for a precise diagnosis of the mitral valve structure and function for planning and performing interventional or surgical procedures. PMID:25963035

  6. Transfemoral Treatment of a Paraprosthetic Mitral Leak and Mitral Bioprosthesis Failure Complicated by Embolization of In-Situ Vascular Plug.

    PubMed

    Ruparelia, Neil; Latib, Azeem; Agricola, Eustachio; Monaco, Fabrizio; Spagnolo, Pietro; Alfieri, Ottavio; Montorfano, Matteo; Colombo, Antonio

    2015-09-01

    Today, increasing numbers of patients are presenting to clinical teams with signs and symptoms of mitral bioprosthesis failure. Whilst redo surgery is currently the treatment option of choice, many patients have multiple co-morbidities and are deemed to be of prohibitively high surgical and anaesthetic risk. Percutaneous transcatheter treatment can offer a potential solution for these patients. Herein is reported a case where simultaneous transcatheter interventions for paraprosthetic leak and mitral bioprosthesis implantation were performed via the transfemoral route, and an unforeseen complication was successfully managed.

  7. Clinical Effect of Left Ventricular Dysfunction in Patients with Mitral Stenosis after Mitral Valve Replacement

    PubMed Central

    Park, Kwon Jae; Woo, Jong Soo; Park, Jong Yoon; Jung, Jae Hwa

    2016-01-01

    Background Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction. Methods Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 (EF≤45%) included 13 patients and group 2 (EF>45%) included 97 patients. Results Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304). Conclusion This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and as more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation. PMID:27733994

  8. Custodiol® HTK Cardioplegia Use in Robotic Mitral Valve

    PubMed Central

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

    2013-01-01

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

  9. The Evolving Role of Percutaneous Mitral Valve Repair

    PubMed Central

    Stewart, Merrill H.; Jenkins, J. Stephen

    2016-01-01

    Background: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery. However, many questions are left unanswered about when to perform this procedure and whom to perform it on. Methods: We reviewed major published literature on the MitraClip from 2003-2016 to help guide clinical decision-making. A PubMed search was conducted using the phrase “mitraclip” or “percutaneous mitral valve repair” to identify relevant articles pertaining to the clip as well as surgical valve repair. Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the MitraClip but did not prove its superiority to surgical repair in the population studied. Numerous subsequent registries have suggested that the success of the MitraClip varies with the patient population studied. The currently enrolling Cardiovascular Outcomes for Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional MR (COAPT) trial hopes to answer some of these questions. Conclusion: The MitraClip is a new and exciting technology for percutaneously treating disease processes traditionally managed with surgery. The future of the clip and its patient population is dependent on further studies.

  10. The Evolving Role of Percutaneous Mitral Valve Repair

    PubMed Central

    Stewart, Merrill H.; Jenkins, J. Stephen

    2016-01-01

    Background: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery. However, many questions are left unanswered about when to perform this procedure and whom to perform it on. Methods: We reviewed major published literature on the MitraClip from 2003-2016 to help guide clinical decision-making. A PubMed search was conducted using the phrase “mitraclip” or “percutaneous mitral valve repair” to identify relevant articles pertaining to the clip as well as surgical valve repair. Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the MitraClip but did not prove its superiority to surgical repair in the population studied. Numerous subsequent registries have suggested that the success of the MitraClip varies with the patient population studied. The currently enrolling Cardiovascular Outcomes for Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional MR (COAPT) trial hopes to answer some of these questions. Conclusion: The MitraClip is a new and exciting technology for percutaneously treating disease processes traditionally managed with surgery. The future of the clip and its patient population is dependent on further studies. PMID:27660576

  11. 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.

  12. Localisation and direction of mitral regurgitant flow in mitral orifice studied with combined use of ultrasonic pulsed Doppler technique and two dimensional echocardiography.

    PubMed Central

    Miyatake, K; Nimura, Y; Sakakibara, H; Kinoshita, N; Okamoto, M; Nagata, S; Kawazoe, K; Fujita, T

    1982-01-01

    Regurgitant flow was analysed in 40 cases of mitral regurgitation, using combined ultrasonic pulsed Doppler technique and two dimensional echocardiography. Abnormal Doppler signals indicative of mitral regurgitant flow were detected in reference to the two dimensional image of the long axis view of the heart and the short axis view at the level of the mitral orifice. The overall direction of regurgitant flow into the left atrium was clearly seen in 28 of 40 cases, and the localisation of regurgitant flow in the mitral orifice in 38 cases. In cases with mitral valve prolapse of the anterior leaflet or posterior leaflet the regurgitant flow was directed posteriorly or anteriorly, respectively. The prolapse occurred at the anterolateral commissure or posteromedial commissure and resulted in regurgitant flow located near the anterolateral commissure or posteromedial commissure of the mitral orifice, respectively. In cases with rheumatic mitral regurgitation the regurgitant flow is usually towards the central portion of the left atrium and is sited in the mid-part of the orifice. The Doppler findings were consistent with left ventriculography and surgical findings. The ultrasonic pulsed Doppler technique combined with two dimensional echocardiography is useful for non-invasive analysis and preoperative assessment of mitral regurgitation. Images PMID:7138708

  13. A Pig Model of Ischemic Mitral Regurgitation Induced by Mitral Chordae Tendinae Rupture and Implantation of an Ameroid Constrictor

    PubMed Central

    Tian, Yi; Yuan, Wei-Min; Peng, Peng; Yang, Jian-Zhong; Zhang, Bao-Jie; Zhang, Hui-Dong; Wu, Ai-Li; Tang, Yue

    2014-01-01

    A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10–20% at one week, 30–40% at two weeks and 90–100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients. PMID:25479001

  14. Mitral valve repair for ischemic moderate mitral regurgitation in patients undergoing coronary artery bypass grafting

    PubMed Central

    Toktas, Faruk; Yavuz, Senol; Ozsin, Kadir K.; Sanri, Umut S.

    2016-01-01

    Objectives: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes. Methods: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48.9%) underwent combined CABG+MVR. The remaining 46 (51.1%) underwent CABG alone. Ventricular functions and effort capacities of patients in both groups were evaluated echocardiographically and clinically in the preoperative period, and in the first postoperative year. Results: Postoperative regurgitant volume changes according to preoperative values were -24.76±19 ml/beat in the combined CABG+MVR group, and -8.70±7.2 ml/beat in the CABG alone group (p=0.001). The change of vena contracta width was -3.40±0.2 mm in the combined CABG+MVR group whereas in the CABG alone -1.45±0.7 mm (p=0.019). The changes of left ventricular end-systolic volume index were -30.77±25.9 ml/m2 in the combined CABG+MVR group and -15.6±9.4 ml/m2 in the CABG alone group (p=0.096). Ejection fraction changes in the combined CABG+MVR group was +1.51±5.3% and in the CABG alone group was +1.15±4.3%. No statistically significant difference was found between both groups (p=0.604). Preoperative New York Heart Association class values in the combined CABG+MVR group was 2.18±0.45, and in the CABG alone group was 2.13±0.54. Conclusions: Moderate MR in patients undergoing CABG affects the outcome adversely and it does not reliably improve after CABG alone. Therefore, patients with ischemic moderate MR should undergo simultaneous MVR at the time of CABG. PMID:27464861

  15. Echocardiographic Follow-up of Robotic Mitral Valve Repair for Mitral Regurgitation due to Degenerative Disease

    PubMed Central

    Wang, Yao; Gao, Chang-Qing; Shen, Yan-Song; Wang, Gang

    2016-01-01

    Background: Mitral valve (MV) repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation (MR). However, there has been limited information regarding the echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods: A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients (79.8%), artificial chordae in 20 (23.8%), and ring annuloplasty in 79 (94.1%). Eighty-one (96.4%) of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results: At a median echocardiographic follow-up of 36.0 months (interquartile range 14.3–59.4 months), four patients (4.9%) developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 (Z = −8.456, P < 0.001), LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm (t = 15.131, P < 0.001), LVEDD from 51.0 ± 5.0 to 43.3 ± 2.2 mm (t = 14.481, P < 0.001), and LVEF from 67.3 ± 7.0% to 63.9 ± 5.1% (t = 4.585, P < 0.001). Conclusion: Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up. PMID:27625092

  16. Quinapril therapy in patients with chronic mitral regurgitation.

    PubMed

    Schön, H R; Schröter, G; Barthel, P; Schömig, A

    1994-05-01

    Pre- and afterload reduction is known to have beneficial effects in patients with chronic mitral regurgitation. To date, no controlled study has been reported analyzing the long term influence of angiotensin-converting enzyme inhibitor treatment on patients with chronic mitral regurgitation. Therefore the aim of this study was to assess the effects of one year angiotensin-converting enzyme inhibition with quinapril on myocardial performance in patients with chronic mitral regurgitation. Twelve patients with moderate to severe isolated chronic mitral regurgitation and no coronary disease on coronary angiography were studied under control conditions and followed up until one year of quinapril therapy (10-20mg/day) using echocardiography and simultaneous right heart catheterization, and radionuclide ventriculography at rest and exercise. As the result of a significant pre- and afterload reduction after one year quinapril treatment regurgitant fraction fell from 0.43 +/- 0.10 at control before therapy to 0.25 +/- 0.08 (p = 0.0001), left ventricular end-diastolic volume was reduced from 146 +/- 26 to 109 +/- 24 ml/m2 (p = 0.0001) and end-systolic volume decreased from 63 +/- 43 to 47 +/- 29 ml/m2 (p = 0.02). Left ventricular ejection fraction at control averaged 0.59 +/- 0.20 at rest, increased to 0.65 +/- 0.21 with maximum exercise and was unchanged after one year quinapril therapy. After one year treatment left ventricular mass was reduced by 15% (p = 0.0004) and septal wall thickness decreased from 11.8 +/- 0.7 to 10.8 +/- 0.8 mm (p = 0.0006). Moreover, there was significant functional improvement of nearly one NYHA class after one year quinapril therapy. In conclusion, in patients with chronic mitral regurgitation long term angiotensin-converting enzyme inhibition with quinapril reduces regurgitation and decreases left ventricular size and mass thereby demonstrating functional improvement. In addition, these data suggest that angiotensin-converting enzyme inhibition

  17. [Simultaneous operation of WPW syndrome combined with mitral regurgitation caused by infective endocarditis].

    PubMed

    Sueda, T; Nakashima, Y; Hamanaka, Y; Ishihara, H; Matsuura, Y; Isobe, F

    1990-03-01

    A case of WPW syndrome combined with mitral regurgitation caused by infective endocarditis underwent surgical division of accessory pathway and mitral valve replacement preserving posterior leaflet simultaneously. A 56-years old woman suffered atrial fibrillation with pseudo VT and cardiac failure caused by mitral regurgitation. Electro-physiological study (EPS) revealed accessory pathway in postero-lateral wall in left atrium and atrio-fascicular pathway like James bundle in AV node. ECHO cardiography showed mitral valve prolapse and severe regurgitation. Accessory pathway was divided surgically and deep freeze coagulation was followed. Perforation of anterior leaflet and chordal rupture of posterior leaflet caused by infective endocarditis were repaired by annuloplasty (Kay and McGoon method) at first, but regurgitation retained moderately. After re-clamping of aorta, mitral valve was replaced with prosthesis (SJM 29 mm) preserving posterior leaflet. Postoperative examination revealed division of accessory pathway and no regurgitation of mitral prosthesis. PMID:2348136

  18. The evolution of mitral valve prolapse: insights from the Framingham Heart Study.

    PubMed

    Niu, Zhaozhuo; Chan, Vincent; Mesana, Thierry; Ruel, Marc

    2016-08-01

    The Framingham Heart Study group has described the non-diagnostic variants may evolve into mitral valve prolapse over time. These non-diagnostic variants include minimal systolic displacement, and abnormal anterior coaptation which is measured on surface echocardiography. Computed tomography and cardiac magnetic resonance imaging are evolving and can assess the degree of mitral regurgitation (MR); imaging techniques aside, genetic and proteomic detection of mitral prolapse is also evolving. However, the genetic basis for mitral prolapse is complex and likely involves multiple genetic loci. The same is also true for work determining possible biomarkers associated with mitral prolapse. The present study may be useful in counseling patients with a family history of mitral prolapse. Registry data is therefore of paramount importance in providing unbiased insight into this common disease. PMID:27620164

  19. The evolution of mitral valve prolapse: insights from the Framingham Heart Study

    PubMed Central

    Niu, Zhaozhuo; Chan, Vincent; Mesana, Thierry

    2016-01-01

    The Framingham Heart Study group has described the non-diagnostic variants may evolve into mitral valve prolapse over time. These non-diagnostic variants include minimal systolic displacement, and abnormal anterior coaptation which is measured on surface echocardiography. Computed tomography and cardiac magnetic resonance imaging are evolving and can assess the degree of mitral regurgitation (MR); imaging techniques aside, genetic and proteomic detection of mitral prolapse is also evolving. However, the genetic basis for mitral prolapse is complex and likely involves multiple genetic loci. The same is also true for work determining possible biomarkers associated with mitral prolapse. The present study may be useful in counseling patients with a family history of mitral prolapse. Registry data is therefore of paramount importance in providing unbiased insight into this common disease. PMID:27620164

  20. Safety and feasibility of a novel adjustable mitral annuloplasty ring: a multicentre European experience†

    PubMed Central

    Andreas, Martin; Doll, Nicolas; Livesey, Steve; Castella, Manuel; Kocher, Alfred; Casselman, Filip; Voth, Vladimir; Bannister, Christina; Encalada Palacios, Juan F.; Pereda, Daniel; Laufer, Guenther; Czesla, Markus

    2016-01-01

    OBJECTIVES Recurrent mitral regurgitation is a significant problem after mitral valve repair in patients with functional valve disease. We report the safety and feasibility of a novel adjustable mitral annuloplasty device that permits downsizing of the anterior–posterior diameter late after initial surgery. METHODS In this multicentre, non-randomized, observational register, patients with moderate or severe mitral regurgitation undergoing surgical mitral valve repair with the MiCardia EnCorSQ™ Mitral Valve Repair system were evaluated. Patient characteristics, operative specifications and results as well as postoperative follow-up were collected for all five centres. RESULTS Ninety-four patients with a median age of 71 (64–75) years (EuroSCORE II 6.7 ± 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and 15% degenerative disease) were included. Operative mortality was 1% and the 1-year survival was 93%. Ring adjustment was attempted in 12 patients at a mean interval of 9 ± 6 months after surgery. In three of these attempts, a technical failure occurred. In 1 patient, mitral regurgitation was reduced two grades, in 2 patients mitral regurgitation was reduced one grade and in 6 patients, mitral regurgitation did not change significantly. The mean grade of mitral regurgitation changed from 2.9 ± 0.9 to 2.1 ± 0.7 (P = 0.02). Five patients were reoperated after 11 ± 9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION We conclude that this device may provide an additional treatment option in patients with functional mitral regurgitation, who are at risk for reoperation due to recurrent mitral regurgitation. Clinical results in this complex disease were ambiguous and patient selection seems to be a crucial step for this device. Further trials are required to estimate the clinical value of this therapeutic concept. PMID:25694471

  1. Exposure of the mitral valve using flexible self-retaining retractors and an atrial hook.

    PubMed

    Shibata, Toshihiko; Yasuoka, Takashi; Inoue, Kazushige; Ikuta, Takeshi; Bito, Yasuyuki

    2007-10-01

    We hereby present our technique for using the self-retaining flexible arm retractor and its attachments for mitral valve exposure. The Aortic Valve Assistant, which was developed for aortic valve exposure, is also very useful for exposure of the inferior wall of the left atrium. Our modified atrial hook provides excellent exposure of the anterior mitral annulus. Extensive dissection and the combined use of the flexible arm and attachments allows us comfortable access for mitral valve operations.

  2. Mitral valve replacement in systemic lupus erythematosus associated Libman-Sacks endocarditis.

    PubMed

    Akhlaq, Anam; Ali, Taimur A; Fatimi, Saulat H

    2016-04-01

    Libman-Sacks endocarditis, first discovered in 1924, is a cardiac manifestation of systemic lupus erythematosus (SLE). Valvular involvement has been associated with SLE and antiphospholipid syndrome (APS). Mitral valve, especially its posterior leaflet, is most commonly involved. We report a case of a 34 year old woman with antiphospholipid antibody syndrome and SLE, who presented with mitral valve regurgitation. The patient underwent a prosthetic mitral valve replacement, with no followup complications. We suggest mechanical valve replacement employment in the management of mitral regurgitation in Libman-Sacks endocarditis, in view of the recent medical literature and our own case report.

  3. 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

  4. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

    PubMed Central

    Li, Wilson W.L.; van Paridon, Marieke; Bindraban, Navin R.; de Mol, Bas A.J.M.

    2016-01-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature. PMID:27547149

  5. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm.

    PubMed

    Tomsic, Anton; Li, Wilson W L; van Paridon, Marieke; Bindraban, Navin R; de Mol, Bas A J M

    2016-08-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature. PMID:27547149

  6. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    PubMed

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial "Surgical Treatment of Moderate Ischemic Mitral Regurgitation". They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled.

  7. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    PubMed Central

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial “Surgical Treatment of Moderate Ischemic Mitral Regurgitation”. They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled. PMID:26779511

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

    PubMed Central

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

    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 Björk-Shiley mitral valves. The remaining patient did not survive, and at autopsy, the lens was found at the aortic bifurcation level. Because of this potentially lethal complication, careful follow-up of patients with Beall mitral valve prostheses (Models 103 and 104) is recommended. Images PMID:15216211

  9. Robotic Tissue Tracking for Beating Heart Mitral Valve Surgery

    PubMed Central

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

    2010-01-01

    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

  10. 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.

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

    PubMed

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

    2000-06-01

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

  12. Minimally Invasive Mitral Valve Procedures: The Current State

    PubMed Central

    Ritwick, Bhuyan; Chaudhuri, Krishanu; Crouch, Gareth; Edwards, James R. M.; Worthington, Michael; Stuklis, Robert G.

    2013-01-01

    Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS). PMID:24382998

  13. Hemolysis and infective endocarditis in a mitral prosthetic valve.

    PubMed

    Koç, Fatih; Bekar, Lütfi; Kadı, Hasan; Ceyhan, Köksal

    2010-09-01

    Traumatic intravascular hemolysis after heart valve replacement can be a serious problem. It is commonly associated with either structural deterioration or paravalvular leaks. A 63-year-old woman with a six-year history of surgery for mitral stenosis presented with complaints of weakness and dyspnea. She received treatment at other centers three times in the past six months for dyspnea and anemia requiring transfusion of red blood cells. Transthoracic echocardiography showed a normally functioning mitral mechanic prosthesis. Laboratory findings were abnormal for hemoglobin, hematocrit, white blood cell count, C-reactive protein, serum haptoglobin, and lactate dehydrogenase. Peripheral blood smear showed marked schistocytes, indicative of mechanical erythrocyte destruction. Transesophageal echocardiography demonstrated severe paravalvular leak and a large (9x13 mm) vegetation adhering to the prosthetic valve, protruding into the left atrium. Enterococcus faecalis was isolated from blood cultures. Surgery was planned because of large vegetation, repeated hemolysis, and severe paravalvular regurgitation, but the patient refused surgical treatment. PMID:21200125

  14. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan

    PubMed Central

    Nieto Estrada, Victor H.; Molano Franco, Daniel L.; Valencia Moreno, Albert Alexander; Rojas Gambasica, Jose A.; Jaller Bornacelli, Yamil E.; Martinez Del Valle, Anacaona

    2015-01-01

    Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient’s signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context. PMID:26566415

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

    PubMed

    Vörös, Károly; Szilvási, Viktória; Manczur, Ferenc; Máthé, Ákos; Reiczigel, Jenő; Nolte, Ingo; Hungerbühler, 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

  16. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan.

    PubMed

    Nieto Estrada, Victor H; Molano Franco, Daniel L; Valencia Moreno, Albert Alexander; Rojas Gambasica, Jose A; Jaller Bornacelli, Yamil E; Martinez Del Valle, Anacaona

    2015-12-01

    Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient's signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context. PMID:26566415

  17. Percutaneous Balloon Mitral Valvulotomy and Coexisting Left Atrial Hemangioma

    PubMed Central

    van Buuren, Frank; Langer, Christoph; Faber, Lothar; Butz, Thomas; Schmidt, Henning Karl; Esdorn, Hermann; Bogunovic, Nikola; Mellwig, Klaus Peter; Scholtz, Werner; Horstkotte, Dieter

    2010-01-01

    Hemangiomas of the heart are extremely rare. The prognosis is quite variable, because this benign tumor may grow, involute, or stop growing; therefore, resection is usually the treatment of choice. In patients with tumors of the left atrium, percutaneous balloon mitral valvulotomy is generally contraindicated. Yet for patients with moderate-to-severe mitral valve stenosis, balloon valvulotomy is an established therapy. Herein, we present the case of a 73-year-old woman who was referred to our department in 1995 with severe mitral valve stenosis. Echocardiography showed a valve orifice area of 0.9 cm2, according to Gorlin's formula, and a mean pressure gradient of 11 mmHg. Surgical therapy was declined by the patient. There were no signs of coronary artery disease. The injection of contrast medium into the left coronary artery showed a hemangioma at the posterior wall of the left atrium. Magnetic resonance imaging and transesophageal echocardiography confirmed the diagnosis. Despite the increased risk posed by the hemangioma, we performed successful percutaneous balloon mitral valvulotomy with an Inoue balloon. We saw the patient in 2001, and again in 2008 when she was 86 years of age. She was in excellent condition, with no signs of relevant dyspnea. Magnetic resonance imaging showed the size of the hemangioma to be stable. By use of echocardiography, we were able to confirm a good long-term result of the balloon valvulotomy. In this patient, a nonsurgical approach was adequate because of the lack of growth of the hemangioma in the left atrium. PMID:20200640

  18. Multiplane transesophageal echocardiography: a roadmap for mitral valve repair.

    PubMed

    Shah, P M; Raney, A A; Duran, C M; Oury, J H

    1999-11-01

    Multiplane transesophageal echocardiography (TEE) is useful in providing a detailed anatomic map for successful mitral valve repair. This report describes an approach, developed over the past two to three years, which helps to delineate valve anatomy in specific detail. Mid-esophageal views are selected to view different segments of the valve leaflets. When correlated with surgical anatomy, this approach is found to be both practical and useful.

  19. Right ventricular function before and after percutaneous balloon mitral valvuloplasty.

    PubMed

    Burger, W; Brinkies, C; Illert, S; Teupe, C; Kneissl, G D; Schräder, R

    1997-01-01

    Aim of this study was to evaluate right ventricular performance in patients with mitral stenosis and its modification by balloon valvuloplasty. Right ventricular volumes of 24 patients with postrheumatic mitral stenosis were determined by thermodilution 1 or 2 days before and 1 or 2 days after valvuloplasty. Right ventricular ejection fraction at rest was 43 (36-47)% (median and interquartile range). Right ventricular end-diastolic volume was 100 (86-119) ml/m2. Supine bicycle exercise (50 Watt) reduced right ventricular ejection fraction to 30 (29-37)% (P < 0.0001) and increased right ventricular end-diastolic volume to 124 (112-141) ml/m2 (P < 0.0001). At rest, right ventricular ejection fraction correlated inversely with pulmonary vascular resistance (r = -0.64, P < 0.0001), while no significant correlation with mitral valve area was found. Valvuloplasty increased right ventricular ejection fraction at rest to 48 (44-50)% (P < 0.005), and during exercise to 42 (38-45)% (P < 0.0001). This improvement of right ventricular ejection fraction correlated inversely with the value of this parameter before valvuloplasty (r = -0.88, P < 0.0001) and with the gain in stroke volume (r = 0.57, P < 0.01). The right ventricular function curve, disturbed before commissurotomy, was reestablished by the procedure. In conclusion, at the here investigated stage of mitral stenosis right ventricular function is reversibly impaired. This is predominantly caused by the hemodynamic consequences of the valvular defect and not by an impairment of right ventricular myocardial function.

  20. 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.

  1. 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

  2. Non-invasive diagnosis of mitral regurgitation by Doppler echocardiography.

    PubMed Central

    Blanchard, D; Diebold, B; Peronneau, P; Foult, J M; Nee, M; Guermonprez, J L; Maurice, P

    1981-01-01

    The value of Doppler echocardiography for the non-invasive diagnosis of mitral regurgitation was studied blindly in 161 consecutive invasively investigated adult patients. Regurgitation was graded from 0 to 3 at selective left ventricular angiography. The Doppler echocardiographic examination was considered to be positive when a disturbed systolic flow was found within the left atrium behind the aorta or the anterior leaflet of the mitral valve. The test was considered to be negative in the absence of a regurgitant jet. The level of the signal to noise ratio was checked by the recording of the ventricular filling flow. The study was performed in 131 cases from the left side of the sternum and in 101 cases from the apex. There were no false positives and thus the specificity was 100 per cent. The 20 false negatives were all in patients with grade 1 regurgitation. Thus only some (33%) instances of mild regurgitation were misdiagnosed, and the sensitivity for moderate to severe mitral regurgitation was 100 per cent. PMID:7236465

  3. Percutaneous mitral heart valve repair--MitraClip.

    PubMed

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

    2014-01-01

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

  4. Managing mitral regurgitation: focus on the MitraClip device

    PubMed Central

    Magruder, J Trent; Crawford, Todd C; Grimm, Joshua C; Fredi, Joseph L; Shah, Ashish S

    2016-01-01

    Based on the principle of surgical edge-to-edge mitral valve repair (MVR), the MitraClip percutaneous MVR technique has emerged as a minimally invasive option for MVR. This catheter-based system has been widely demonstrated to be safe, although inferior to surgical MVR. Studies examining patients with ≥3+ mitral regurgitation (MR) show that, for all patients treated, freedom from death, surgery, or MR ≥3+ is in the 75%–80% range 1 year following MitraClip implantation. Despite its inferiority to surgical therapy, in high-risk surgical patients, data suggest that the MitraClip system can be employed safely and that it can result in symptomatic improvement in the majority of patients, while not precluding future surgical options. MitraClip therapy also appears to reduce heart failure readmissions in the high-risk cohort, which may lead to an economic benefit. Ongoing study is needed to clarify the impact of percutaneous mitral valve clipping on long-term survival in high-risk populations, as well as its role in other patient populations, such as those with functional MR. PMID:27110142

  5. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair.

    PubMed

    Ghulam Ali, Sarah; Fusini, Laura; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Mapelli, Massimo; Zanobini, Marco; Alamanni, Francesco; Pepi, Mauro

    2016-07-01

    A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing. PMID:27184171

  6. The flail mitral valve: echocardiographic findings by precordial and transesophageal imaging and Doppler color flow mapping.

    PubMed

    Himelman, R B; Kusumoto, F; Oken, K; Lee, E; Cahalan, M K; Shah, P M; Schiller, N B

    1991-01-01

    To determine the echocardiographic and Doppler characteristics of mitral regurgitation associated with a flail mitral valve, precordial and transesophageal echocardiography with pulsed wave and Doppler color flow mapping was performed in 17 patients with a flail mitral valve leaflet due to ruptured chordae tendineae (Group I) and 22 patients with moderate or severe mitral regurgitation due to other causes (Group II). Echocardiograms were performed before or during cardiac surgery; cardiac catheterization was also performed in 28 patients (72%). Mitral valve disease was confirmed at cardiac surgery in all patients. By echocardiography, the presence of a flail mitral valve leaflet was defined by the presence of abnormal mitral leaflet coaptation or ruptured chordae. Using these criteria, transesophageal imaging showed a trend toward greater sensitivity and specificity than precordial imaging in the diagnosis of flail mitral valve leaflet. By Doppler color flow mapping, a flail mitral valve leaflet was also characterized by an eccentric, peripheral, circular mitral regurgitant jet that closely adhered to the walls of the left atrium. The direction of flow of the eccentric jet in the left atrium distinguished a flail anterior from a flail posterior leaflet. By transesophageal echocardiography with Doppler color flow mapping, the ratio of mitral regurgitant jet arc length to radius of curvature was significantly higher in Group I than Group II patients (5.0 +/- 2.3 versus 0.7 +/- 0.6, p less than 0.001); all of the Group I patients and none of the Group II patients had a ratio greater than 2.5.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. A Genomics-Based Model for Prediction of Severe Bioprosthetic Mitral Valve Calcification.

    PubMed

    Ponasenko, Anastasia V; Khutornaya, Maria V; Kutikhin, Anton G; Rutkovskaya, Natalia V; Tsepokina, Anna V; Kondyukova, Natalia V; Yuzhalin, Arseniy E; Barbarash, Leonid S

    2016-01-01

    Severe bioprosthetic mitral valve calcification is a significant problem in cardiovascular surgery. Unfortunately, clinical markers did not demonstrate efficacy in prediction of severe bioprosthetic mitral valve calcification. Here, we examined whether a genomics-based approach is efficient in predicting the risk of severe bioprosthetic mitral valve calcification. A total of 124 consecutive Russian patients who underwent mitral valve replacement surgery were recruited. We investigated the associations of the inherited variation in innate immunity, lipid metabolism and calcium metabolism genes with severe bioprosthetic mitral valve calcification. Genotyping was conducted utilizing the TaqMan assay. Eight gene polymorphisms were significantly associated with severe bioprosthetic mitral valve calcification and were therefore included into stepwise logistic regression which identified male gender, the T/T genotype of the rs3775073 polymorphism within the TLR6 gene, the C/T genotype of the rs2229238 polymorphism within the IL6R gene, and the A/A genotype of the rs10455872 polymorphism within the LPA gene as independent predictors of severe bioprosthetic mitral valve calcification. The developed genomics-based model had fair predictive value with area under the receiver operating characteristic (ROC) curve of 0.73. In conclusion, our genomics-based approach is efficient for the prediction of severe bioprosthetic mitral valve calcification. PMID:27589735

  8. A Genomics-Based Model for Prediction of Severe Bioprosthetic Mitral Valve Calcification

    PubMed Central

    Ponasenko, Anastasia V.; Khutornaya, Maria V.; Kutikhin, Anton G.; Rutkovskaya, Natalia V.; Tsepokina, Anna V.; Kondyukova, Natalia V.; Yuzhalin, Arseniy E.; Barbarash, Leonid S.

    2016-01-01

    Severe bioprosthetic mitral valve calcification is a significant problem in cardiovascular surgery. Unfortunately, clinical markers did not demonstrate efficacy in prediction of severe bioprosthetic mitral valve calcification. Here, we examined whether a genomics-based approach is efficient in predicting the risk of severe bioprosthetic mitral valve calcification. A total of 124 consecutive Russian patients who underwent mitral valve replacement surgery were recruited. We investigated the associations of the inherited variation in innate immunity, lipid metabolism and calcium metabolism genes with severe bioprosthetic mitral valve calcification. Genotyping was conducted utilizing the TaqMan assay. Eight gene polymorphisms were significantly associated with severe bioprosthetic mitral valve calcification and were therefore included into stepwise logistic regression which identified male gender, the T/T genotype of the rs3775073 polymorphism within the TLR6 gene, the C/T genotype of the rs2229238 polymorphism within the IL6R gene, and the A/A genotype of the rs10455872 polymorphism within the LPA gene as independent predictors of severe bioprosthetic mitral valve calcification. The developed genomics-based model had fair predictive value with area under the receiver operating characteristic (ROC) curve of 0.73. In conclusion, our genomics-based approach is efficient for the prediction of severe bioprosthetic mitral valve calcification. PMID:27589735

  9. Minimally Invasive Repair of Mitral Valve Prolapse and Concomitant Atrial Fibrillation Ablation in a Heart Transplant.

    PubMed

    Martens, Thomas; Caes, Frank; De Pauw, Michel; Hens, Lineke; Bove, Thierry

    2016-10-01

    Significant mitral valve disease with atrial fibrillation after heart transplantation is unusual. We report the diagnosis and minimally invasive surgical treatment 17 years after transplantation, in which mitral valve repair together with left atrial ablation was performed, resulting in a satisfying clinical and echocardiographic improvement. PMID:27645968

  10. Minimally Invasive Mitral Valve Repair in a Marfan Patient with Severe Scoliokyphosis

    PubMed Central

    Noack, Thilo; Lehmkuhl, Lukas; Seeburger, Joerg; Mohr, Friedrich Wilhelm

    2014-01-01

    A 26-year-old female Marfan patient with extensive scoliokyphosis presented with severe mitral valve regurgitation. The patient was treated with minimally invasive mitral valve repair via a right lateral minithoracotomy. In this report, we discuss the operative procedure followed in this special case and the current literature. PMID:25798347

  11. Poor outcome following percutaneous balloon mitral valvotomy in patients with atrial fibrillation

    PubMed Central

    Aslanabadi, Naser; Ghaffari, Samad; Khezerlouy Aghdam, Naser; Ahmadzade, Masoumeh; Kazemi, Babak; Nasiri, Babak; Separham, Ahmad; Sohrabi, Bahram; Taban, Mohamadreza; Aslanabadi, Arash

    2016-01-01

    Introduction: Atrial fibrillation (AF) is the most common arrhythmia in patients with mitral stenosis (MS) and it may increase complications and decreases success rates of percutaneous balloon mitral valvotomy (PBMV). This study aimed to investigate the short and long term results of PBMV in patients with AF compared to sinus rhythm (SR). Methods: In this cross sectional study, 1000 patients with MS who had undergone PBMV between 1999 and 2013 were enrolled including 585 and 415 patients with AF and SR respectively. Patients were followed for a mean of 7.27 ± 3.16 years. Clinical, echocardiographic and hemodynamic data were collected. Procedure success, in-hospital and long-term outcome were evaluated. Results: Patients with AF were older and had greater symptoms, mitral regurgitation, mitral echocardiographic score, and mitral pressure gradient before PBMV. PBMV success rate were significantly lower in AF group (P < 0.001). In-hospital complications, including severe mitral regurgitation, emergency mitral valve surgery, peripheral embolism and long-term complications, including mortality, re-valvotomy, mitral replacement surgery and peripheral embolism/stroke were significantly higher in patients with AF. Conclusion: AF leads to worse in-hospital and long-term outcome and lower PBMV success rate. Repeated assessment and early decision to PBMV in patients with MS to reduce AF and AF related complication seems necessary. PMID:27777698

  12. Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning.

    PubMed

    Ailawadi, Gorav; Agnihotri, Arvind K; Mehall, John R; Wolfe, J Alan; Hummel, Brian W; Fayers, Trevor M; Farivar, R Saeid; Grossi, Eugene A; Guy, T Sloane; Hargrove, W Clark; Khan, Junaid H; Lehr, Eric J; Malaisrie, S Chris; Murphy, Douglas A; Rodriguez, Evelio; Ryan, William H; Salemi, Arash; Segurola, Romualdo J; Shemin, Richard J; Smith, J Michael; Smith, Robert L; Weldner, Paul W; Goldman, Scott M; Lewis, Clifton T P; Barnhart, Glenn R

    2016-01-01

    Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. PMID:27654407

  13. 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.

  14. 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

  15. Durability, reliability, viability: 48 year-survival of a Starr-Edwards mitral valve.

    PubMed

    Ayub, Bilal; Guthier, Justin; Wu, James K; Martinez, Matthew W

    2014-01-01

    We report a case of 67 year-old female with a 48-year survival of a Starr-Edwards valve at mitral position. The patient underwent Starr-Edwards mitral valve replacement at age of 19 years for mitral stenosis secondary to severe rheumatic valve disease. The patient had experienced a progressive decline in her functional status with increasing dyspnoea on exertion over a two-week period to eventual development of severe shortness of breath at rest prior to hospitalisation. Transoesophageal echocardiogram revealed severe para-prosthetic and intravalvular mitral valve regurgitation. The patient underwent explantation of Starr-Edwards valve and replacement with a mechanical prosthesis. Our case details the longest reported survival of a Starr-Edwards prosthetic valve at mitral area.

  16. Cognitive tools pipeline for assistance of mitral valve surgery

    NASA Astrophysics Data System (ADS)

    Schoch, Nicolai; Philipp, Patrick; Weller, Tobias; Engelhardt, Sandy; Volovyk, Mykola; Fetzer, Andreas; Nolden, Marco; De Simone, Raffaele; Wolf, Ivo; Maleshkova, Maria; Rettinger, Achim; Studer, Rudi; Heuveline, Vincent

    2016-03-01

    For cardiac surgeons, mitral valve reconstruction (MVR) surgery is a highly demanding procedure, where an artificial annuloplasty ring is implanted onto the mitral valve annulus to re-enable the valve's proper closing functionality. For a successful operation the surgeon has to keep track of a variety of relevant impact factors, such as patient-individual medical history records, valve geometries, or tissue properties of the surgical target, and thereon-based deduce type and size of the best-suitable ring prosthesis according to practical surgery experience. With this work, we aim at supporting the surgeon in selecting this ring prosthesis by means of a comprehensive information processing pipeline. It gathers all available patient-individual information, and mines this data according to 'surgical rules', that represent published MVR expert knowledge and recommended best practices, in order to suggest a set of potentially suitable annuloplasty rings. Subsequently, these rings are employed in biomechanical MVR simulation scenarios, which simulate the behavior of the patient-specific mitral valve subjected to the respective virtual ring implantation. We present the implementation of our deductive system for MVR ring selection and how it is integrated into a cognitive data processing pipeline architecture, which is built under consideration of Linked Data principles in order to facilitate holistic information processing of heterogeneous medical data. By the example of MVR surgery, we demonstrate the ease of use and the applicability of our development. We expect to essentially support patient-specific decision making in MVR surgery by means of this holistic information processing approach.

  17. Complete Transversal Disc Fracture in a Björk-Shiley Delrin Mitral Valve Prosthesis 43 Years After Implantation.

    PubMed

    González-Santos, Jose María; Arnáiz-García, María Elena; Dalmau-Sorlí, María José; Sastre-Rincón, Jose Alfonso; Hernández-Hernández, Jesús; Pérez-Losada, María Elena; Sagredo-Meneses, Víctor; López-Rodríguez, Javier

    2016-10-01

    A patient who underwent previous implantation of a mitral valve replacement with a Björk-Shiley Delrin (BSD) mitral valve prosthesis during infancy was admitted to our institution 43 years later after an episode of syncope and cardiac arrest. Under extreme hemodynamic instability, a mitral valve prosthetic dysfunction causing massive mitral regurgitation was identified. The patient underwent an emergent cardiac operation, and a complete disc fracture with partial disc migration was found. Exceptional cases of mechanical prosthetic heart valve fracture exist. We report the first case of complete transversal disc rupture of a BSD mitral valve prosthesis after the longest period of implantation ever reported in that position. PMID:27645963

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

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-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

  19. 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

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

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-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.

  1. 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.

  2. Hemodynamics and annuloplasty in isolated mitral regurgitation in children.

    PubMed

    Sulayman, R; Mathew, R; Thilenius, O G; Replogle, R; Arcilla, R A

    1975-12-01

    Isolated mitral insufficiency in children is quantitated angiographically by comparing the stroke volumes of the right ventricle and left ventricle. The disease results in greater enlargement of the left atrium than of the left ventricle and is accompanied by a significant increase in left atrial "distensibility." Right and left heart pressures may be normal or may be increased; they tend to be elevated in the group with regurgitant fractions of over 50%. Annuloplasty results in marked clinical and hemodynamic improvement and may even be corrective.

  3. 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.; O’Gara, 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

  4. Mitral valve replacement in a dialysis-dependent patient.

    PubMed

    Mo, Ansheng; Tao, Zhihu; Feng, Zhiqiang; Yang, Xiaoping; Wu, Jun

    2016-08-01

    Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement. PMID:27668230

  5. RVOT mural and mitral valve endocarditis: A case report.

    PubMed

    Jawad, Maadh; Cardozo, Shaun

    2015-01-01

    Mural endocarditis is a very rare condition. This entity involves bacterial growth on cardiac walls. In addition, concomitant valvular endocarditis, along with mural endocarditis, is an extremely rare combination. The diagnosis of mural endocarditis is difficult and requires more advanced cardiac imaging, such as a transesophageal echocardiogram. The differential diagnoses of mural masses include vegetations, thrombi, metastasis, and benign and malignant tumors. We present a rare and unusual case of Methicillin-Resistant Staphylococcus aureus bacteremia with findings of both right ventricular outflow tract mural endocarditis and valvular endocarditis involving the mitral valve.

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

    PubMed Central

    2014-01-01

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

  7. Clinical comparison of St. Jude and porcine mitral valve prostheses.

    PubMed

    Douglas, P S; Hirshfeld, J W; Edie, R N; Stephenson, L W; Gleason, K; Edmunds, L H

    1988-01-01

    One hundred and six consecutive patients who had mitral valve replacement with either a St. Jude or porcine heterograft prosthesis were prospectively studied. The 2 groups are similar with respect to 67 clinical and operative factors and allow comparison of valve performance as an independent variable. Total follow-up is 3,312 patient-months (mean 36 months, range 2-57 months, 94% complete). There are no statistical differences in symptomatic improvement or mortality by life table analysis. Valve-related complications expressed as percent per patient-year are: reoperation: 1.8 St. Jude and 3.8 porcine; endocarditis: 1.2 and 1.9; regurgitant murmur: 2.3 and 1.9; hemolysis: 1.8 and 0.0; late thromboembolism: 1.8 and 1.0; hemorrhage: 2.9 and 2.9; and valve failure: 0.0 and 1.0. There were no significant differences found. Actuarial survival at 3 years was 78% in St. Jude and 81% in porcine patients. Forty-six percent of patients with St. Jude valves and 55% of patients with porcine valves were alive and free of all complications at latest follow-up. The clinical performance of St. Jude and porcine mitral valves are similar over this period of intermediate follow-up. PMID:3360831

  8. 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.

  9. Biaxial Creep Resistance and Structural Remodeling of the Aortic and Mitral Valves in Pregnancy.

    PubMed

    Pierlot, Caitlin M; Moeller, Andrew D; Lee, J Michael; Wells, Sarah M

    2015-08-01

    Pregnancy produces rapid, dramatic volume-overload changes to the maternal circulation. This paper examines pregnancy-induced structural-mechanical changes in bovine aortic and mitral heart valve leaflets. Valve leaflets were harvested from non-pregnant heifers and pregnant cows. Dimensions, biaxial extensibility and creep resistance were assessed and related to changes in the collagen network: histological leaflet and anatomic layer thicknesses plus collagen crimp, and biochemical collagen content. Collagen stability and crosslinking were assessed thermomechanically. Pregnancy altered both aortic and mitral valve leaflets. Both valves demonstrated biphasic changes in leaflet stretch, decreasing in early pregnancy and recovering by late pregnancy. Creep in leaflets from both valves was minimal and decreased even further with pregnancy in the mitral valve. There were valve-specific changes in preconditioning areal extension with pregnancy: increasing in the aortic valve and decreasing in the mitral valve. Leaflet area increased dramatically (84% aortic, 56% mitral), with thickening mainly in the fibrosa, accompanied by increases in collagen content (8% aortic, 16% mitral): together suggesting synthesis of new collagen. Collagen crimp was almost completely lost in pregnancy, with the denaturation temperature decreased by approximately 2 °C. Mature and total crosslinking increased, curiously without a significant increase in immature crosslinking. Mature aortic and mitral heart valve leaflets in the maternal cardiovascular system remodel substantially and similarly-despite their different embryological origins.

  10. Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse

    PubMed Central

    Chua, Yeow Leng; Yap, Yen Ping; Salam, Zakir Hussain Abdul; Chen, Yang Tian

    2015-01-01

    Objective: To review our experience of mitral valve repair for degenerative posterior mitral leaflet prolapse, comparing the outcomes of chordal reconstruction and leaflet resection. Methods: From 2000 to 2014, 205 patients underwent successful repair for degenerative posterior mitral leaflet prolapse. One hundred and four (51.5%) underwent leaflet resection (group R) and 98 (48.5%) underwent chordal reconstruction (group C). Follow-up was 96.5% complete with a mean follow-up of 6.1 ± 4.0 years. Results: Mean age was 57.0 ± 11.0 years. Males accounted for 73.8%. Ring annuloplasty was performed in 195 (96.5%). There were no operative mortalities within 30 days. Overall survival was 97.8% ± 1.3% at 7 years. Outcomes at 6 years: freedom from severe mitral regurgitation (group R 97.1% ± 2.0%, group C 100%, P = 0.288), freedom from moderate or severe mitral regurgitation (group R 97.1% ± 2.0%, group C 94.4% ± 5.4%, P = 0.541). Group C patients received larger annuloplasty rings and had significantly lower postoperative transmitral gradients. Conclusions: Leaflet resection and chordal reconstruction are effective techniques for repair of degenerative posterior mitral leaflet prolapse. Both techniques result in a low incidence of recurrent mitral regurgitation. Chordal reconstruction accommodates larger annuloplasty rings and is associated with lower transmitral gradients. PMID:26727025

  11. 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.

  12. Towards patient-specific finite-element simulation of MitralClip procedure.

    PubMed

    Mansi, T; Voigt, I; Assoumou Mengue, E; Ionasec, R; Georgescu, B; Noack, T; Seeburger, J; Comaniciu, D

    2011-01-01

    MitralClip is a novel minimally invasive procedure to treat mitral valve (MV) regurgitation. It consists in clipping the mitral leaflets together to close the regurgitant hole. A careful preoperative planning is necessary to select respondent patients and to determine the clipping sites. Although preliminary indications criteria are established, they lack prediction power with respect to complications and effectiveness of the therapy in specific patients. We propose an integrated framework for personalized simulation of MV function and apply it to simulate MitralClip procedure. A patient-specific dynamic model of the MV apparatus is computed automatically from 4D TEE images. A biomechanical model of the MV, constrained by the observed motion of the mitral annulus and papillary muscles, is employed to simulate valve closure and MitralClip intervention. The proposed integrated framework enables, for the first time, to quantitatively evaluate an MV finite-element model in-vivo, on eleven patients, and to predict the outcome of MitralClip intervention in one of these patients. The simulations are compared to ground truth and to postoperative images, resulting in promising accuracy (average point-to-mesh distance: 1.47 +/- 0.24 mm). Our framework may constitute a tool for MV therapy planning and patient management.

  13. [Some aspects regarding degenerative mitral valvular lesions encountered in medical practice].

    PubMed

    Ionescu, Simona Daniela; Sandru, V; Artenie, R; Manea, Paloma; Rezuş, C; Burdujan, Alina; Hrustovici, A; Cosovanu, A

    2003-01-01

    In the last years, the degenerative valvular heart diseases have the tendency to equalize in frequency the rheumatismal valvular diseases. The maximum attention has been paid on the degenerative aortic stenosis as being a lesion with maximum frequency and a severe evolution. This study, given on the 18391 admissions in the period 1997-2001, is a retrospective analyse and it is concerned with the degenerative mitral valvular lesions. Of the 223 patients with degenerative valvular heart lesions, 139 patients (62.3%) had degenerative aortic stenosis and 96 patients (38.5%) were diagnosed with degenerative mitral valvular lesions from which 30 patients have had no association with aortic valvular lesions while 66 patients have had such an association. The pointed out types of mitral lesions were: the mitral insufficiency in 59 patients, the mitral annular calcification without hemodynamic disease in 19 patients, the mitral stenosis in 9 patients and the mitral disease in 9 patients, too. The women was affected nearly 1.7 times more frequent than the men, with a maximum average age greater with four years for women but with a low minimal average age at 60 years for women and 52 years for men. The detailed analyse of this 96 cases had shown the presence of a cholesterol value over 200 mg/dl in 50 patients (52%), the diabetic mellitus of type II in 12 patients (12.5%), an association with HTA in 42 patients (43.7%), the cardiac insufficiency in 68 patients (70.8%), a permanent atrial fibrillation in 24 patients (25%), the chronical myocardiac infarct in 19 patients (19.7%) and disorders in the transmission of stimuli in 8 patients (8.3%). The degenerative mitral valvular lesions had occurred more and more frequently realizing more complex features under the mitral insufficiency predominance. Its frequent association with the degenerative valvular lesions determines the evolutive and therapeutic particularities that are dominated by the high gravity prognostic.

  14. [Some aspects of degenerative mitral valve lesions encountered in medical practice].

    PubMed

    Ionescu, Simona Daniela; Artenie, R; Rezuş, C; Manea, Paloma; Sandru, V; Burdujan, Alina; Cosovanu, A

    2004-01-01

    In recent years, degenerative valvular heart diseases have the tendency to be equal in frequency with rheumatic valvular diseases. The maximum attention has been paid on the degenerative aortic stenosis as being a lesion with maximum frequency and a severe evolution. This study, given on the 18,391 admissions in the period 1997-2001, is a retrospective analysis and it is concerned with the degenerative mitral valvular lesions. Of the 223 patients with degenerative valvular heart lesions, 139 patients (62.3%) had degenerative aortic stenosis and 96 patients (38.5%) were diagnosed with degenerative mitral valvular lesions from which 30 patients have had no association with aortic valvular lesions while 66 patients have had such an association. The pointed out types of mitral lesions were: the mitral insufficiency in 59 patients, the mitral annular calcification without hemodynamic disease in 19 patients, the mitral stenosis in 9 patients and the mitral disease in 9 patients, too. The women were affected nearly 1.7 times more frequent than the men, with a maximum average age greater with four years for women but with a low minimal average age at 60 years for women and 52 years for men. The detailed analysis of this 96 cases had shown the presence of a cholesterol value over 200 mg/dl in 50 patients (52%), the diabetes mellitus of type II in 12 patients (12.5%), an association with HTA in 42 patients (43.7%), the cardiac insufficiency in 68 patients (70.8%), a permanent atrial fibrillation in 24 patients (25%), chronic myocardial infarct in 19 patients (19.7%) and disorders in the transmission of stimuli in 8 patients (8.3%). The degenerative mitral valvular lesions had occurred more and more frequently realizing more complex features under the mitral insufficiency predominance. Its frequent association with the degenerative valvular lesions determines the evolutive and therapeutic particulars that are dominated by the high gravity prognostic.

  15. Minimally invasive mitral surgery through right mini-thoracotomy under direct vision

    PubMed Central

    Ward, Alison F.; Grossi, Eugene A.

    2013-01-01

    In the 1990s, the success of ‘minimally invasive’ laparoscopic operations in other surgical subspecialties sparked an interest in minimally-invasive approaches for cardiac surgery, specifically for mitral valve repair. In 1996 at New York University (NYU) we began our experience with minimally invasive mitral valve repair performed through a small right anterior mini-thoracotomy incision using the Port-Access system in a phase I clinical trial. This was the beginning of our extensive right mini-thoracotomy experience for mitral valve repair at NYU. Currently at our institution the preferred approach for the right mini-thoracotomy mitral valve surgery is through the 3rd or 4th interspace mini-thoracotomy incision. Perfusion is accomplished with direct aortic or femoral cannulation, long femoral venous cannula drainage, and a retrograde cardioplegia catheter placed trans-atrialy in the coronary sinus under TEE guidance. An antegrade cardioplegia and venting needle is placed in the ascending aorta and direct external aortic clamping is achieved with one of several specialized crossclamps. With over four decades of experience, more than 4,000 patients have undergone mitral valve repair at NYU including 1,922 performed through a right mini-thoracotomy. We have reported an overall operative mortality of 1.3%, 8-year freedom from reoperation of 95%, freedom from reoperation or severe recurrent mitral regurgitation of 93%, and freedom from all valve-related complications of 90% for our initial series of 1,071 right mini-thoracotomy mitral valve repair. Based on our extensive experience we believe that mitral valve repair through a right mini-thoracotomy provides a durable and safe alternative to a traditional sternotomy with the benefits of improved cosmesis, reduced post-operative pain, less blood loss with fewer blood transfusions, fewer infections, shorter length of stay, and faster return to activity. It is our standard of care approach for mitral valve surgery

  16. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations.

    PubMed

    Roberts, Brad J; Grayburn, Paul A

    2003-09-01

    Qualitative grading of mitral regurgitation severity has significant pitfalls secondary to hemodynamic variables, sonographic technique, blood pool entrainment, and the Coanda effect. Volumetric and proximal isovelocity surface area methods can be used to quantitate regurgitant orifice area, regurgitant volume, and regurgitant fraction, but have several limitations and can pose technical challenges. The vena contracta width method provides a rapid and accurate quantitative assessment of mitral regurgitation severity, but is clinically underused. This article is intended to generate an understanding of the flow mechanics of the vena contracta and the sonographic technique required to provide consistent and accurate measurements of vena contracta width in patients with mitral regurgitation. PMID:12931115

  17. The Alfieri stitch: the advantages for mitral valve repair in difficult circumstances.

    PubMed

    Sherlock, Katrina E; Muthuswamy, Ganapathy; Basu, Rahul; Mitchell, Ian M

    2011-09-01

    In certain complex cases, where there is severe calcification of the mitral annulus but significant mitral regurgitation or systolic anterior motion (SAM), or in high-risk cases where prolonged bypass is to be avoided, the Alfieri-stitch repair of the mitral valve may be the most appropriate option available, particularly as it can be performed quickly through the aortic valve. We describe three cases undergoing aortic valve replacement, in which this technique was successfully applied in patients in whom more conventional repair techniques or valve replacement would have been hazardous, due to annular calcification and patient frailty. 

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

    PubMed

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

    2014-06-01

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

  19. 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.

  20. The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical Outcome after Mitral Valve Repair for Degenerative Mitral Regurgitation

    PubMed Central

    Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

    2014-01-01

    Purpose: The aim of this study is to elucidate the impact of preoperative and postoperative pulmonary hypertension (PH) on long-term clinical outcomes after mitral valve repair for degenerative mitral regurgitation. Methods: A total of 654 patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2010 were retrospectively reviewed. Patients were divided into PH(+) group (137 patients) and PH(–) group (517 patients). Follow-up was complete in 99.0%. The median follow-up duration was 7.5 years. Results: Patients in PH(+) group were older, more symptomatic and had higher tricuspid regurgitation grade. Thirty-day mortality was not different between 2 groups (p = 0.975). Long-term survival rate was lower in PH(+) group; 10-year survival rate after the operation was 85.2% ± 4.0% in PH(+) group and 89.7% ± 1.8% in PH(–) group (Log-rank, p = 0.019). The incidence of late cardiac events were not different between groups, however, the recurrence of PH was more frequent in PH(+) group. The recurrence of PH had an adverse impact on survival rate, late cardiac events and symptoms. Univariate analysis showed age and preoperative tricuspid regurgitation grade were the predictors of PH recurrence. Conclusion: Early surgical indication should be advocated for degenerative mitral regurgitation before the progression of pulmonary hypertension and tricuspid regurgitation. PMID:24747547

  1. Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.

    PubMed

    Said, S A; Veerbeek, A; van der Wieken, L R

    1991-07-01

    A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

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

    PubMed

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

    2015-12-01

    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 5(th) post-operative day.

  3. 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

  4. Enlargement of mitral valve ring in a young woman with severe prosthesis-patient mismatch.

    PubMed

    Attisani, Matteo; Pellegrini, Augusto; Sorrentino, Paolo; Rinaldi, Mauro

    2014-04-01

    Mechanical prosthesis is the first choice for valve replacement at the mitral position in children. Replacement of the original prosthesis because of prosthesis-patient mismatch (PPM) is almost inevitable when prostheses are implanted in small children. The impact of PPM on long-term mortality becomes significant when the effective orifice area (EOA) is severely reduced. In these cases prosthesis replacement can be technically difficult, and it often requires extended enlargement of the mitral valve annulus ring. We report a case of a woman who underwent a mitral valve replacement with a 19-mm St. Jude mechanical prosthetic valve at the age of 3 years. At the age of 33 years, the patient underwent a successful minimally invasive mitral annulus ring enlargement and implantation of a 23-mm St. Jude mechanical prosthetic valve via a right minithoracotomy. PMID:24808442

  5. Late calcific mitral stenosis after MitraClip procedure in a dialysis-dependent patient.

    PubMed

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

    2013-05-01

    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.

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

    PubMed

    Okamoto, Kazuma; Yozu, Ryohei

    2015-07-01

    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 surgeon's 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.

  7. Japan's first robot-assisted totally endoscopic mitral valve repair with a novel atrial retractor.

    PubMed

    Ishikawa, Norihiko; Watanabe, Go; Tomita, Shigeyuki; Nagamine, Hiroshi; Yamaguchi, Shojiro

    2009-10-01

    This case report presents the first robot-assisted totally endoscopic mitral valve plasty in Japan. A 54-year-old woman was found by echocardiography to have grade III mitral valve regurgitation because of prolapse of the posterior leaflet. Surgical repair was performed using the da Vinci Surgical System. For the totally endoscopic mitral valve repair, a right-sided approach was used through four ports. A transthoracic aortic cross-clamp and novel flexible port access retractor were inserted through a 5-mm skin incision. Quadrangular resection of the posterior leaflet was performed, and an annuloplasty band was placed into the atrium. Resection of the valve segment took 13 min, and band implementation, 45 min. The total pump time was 197 min and the aortic cross-clamp time, 117 min. Postoperative echocardiography confirmed the absence of mitral insufficiency.

  8. Right Coronary Artery Septic Embolization Secondary to Aerococcus urinae Native Mitral Valve Endocarditis.

    PubMed

    Kotkar, Kunal D; Said, Sameh M; Michelena, Hector; Wanta, Brendan; Fritock, Maria D; Baddour, Larry M

    2016-10-01

    Septic embolization to the coronary arteries from infective endocarditis is a rare occurrence. Appropriate treatment is not yet fully determined. We report a case of mitral valve endocarditis due to Aerococcus urinae presenting as acute inferior myocardial infarction. PMID:27645966

  9. A rare native mitral valve endocarditis successfully treated after surgical correction

    PubMed Central

    Garcia, Daniel C; Nascimento, Rhanderson; Soto, Victor; Mendoza, Cesar E

    2014-01-01

    Mycobacterium abscessus and Kocuria species are rare causes of infections in humans. Endocarditis by these agents has been reported in only 11 cases. M. abscessus is a particularly resistant organism and treatment requires the association of antibiotics for a prolonged period of time. We report a case of native mitral valve bacterial endocarditis due to M. abscessus and Kocuria species in a 48-year-old man with a history of intravenous drug use. The case was complicated by a perforation of the posterior mitral valve leaflet, leading to surgical mitral valve replacement. Cultures from the blood and mitral valve disclosed M. abscessus and Kocuria species. The patient was treated for 6 months with clarithromycin, imipenem and amikacin, with resolution of symptoms. Repeated blood cultures were negative. Acid-fast staining should be done in subacute endocarditis in order to identify rapidly growing mycobacteria. PMID:25270154

  10. Live 3D TEE demonstrates and guides the management of prosthetic mitral valve obstruction.

    PubMed

    Chahal, Mangeet; Pandya, Utpal; Adlakha, Satjit; Khouri, Samer J

    2011-08-01

    A 43-year-old woman, with a remote history of rheumatic mitral stenosis and a St. Jude prosthetic mitral valve replacement, presented with shortness of breath and palpitations, shortly after a long flight. On admission, atrial fibrillation with a rapid ventricular response was noted in the setting of a long history of noncompliance with her anticoagulation. Transesophageal echocardiography (TEE) demonstrated multiple laminated thrombi in the left atrial appendage. Live three-dimensional (3D) TEE confirmed this diagnosis and demonstrated an immobile posterior leaflet of the mitral prosthesis, which had direct implications in her management. She successfully underwent surgery for mitral valve replacement, left atrial appendage ligation, and a Maze procedure on the following day. The multiple thrombi within the atrial appendage were confirmed intraoperatively and pannus formation was determined to be the etiology of the leaflet immobility.

  11. Asymptomatic large left-atrial ball thrombus. Secondary to mitral stenosis.

    PubMed Central

    Vitale, M; Agnino, A; Serena, D; Schena, S; Piscitelli, D; Fiore, T; de Luca Tupputi Schinosa, L

    1997-01-01

    We describe the very unusual case of a patient with a large, free-floating left-atrial thrombus secondary to severe mitral stenosis, in whom the peculiar symptoms and complications of a ball thrombus were absent. The patient's only symptom before the episode reported here was mild dyspnea, which was attributed to mitral stenosis. She experienced neither embolism nor syncope. While even her clinical signs did not indicate a left-atrial ball thrombus, both echocardiography and angiography showed a free-floating thrombus. Because of the risk of stroke and acute obstruction of the mitral valve, emergency surgery was performed upon diagnosis of the ball thrombus. The surgery, which consisted of removing the thrombus and replacing the mitral valve with a mechanical prosthesis, was uneventful. A computed tomographic brain scan prior to discharge did not detect any cerebral infarction. Images PMID:9456496

  12. Isolated parachute mitral valve in a 29 years old female; a case report.

    PubMed

    Toufan, Mehrnoush; Mahmoudi, Seyed Sajjad

    2016-01-01

    A 29-year old female patient was referred to our hospital for evaluation of dyspnea NYHA class I which begun from several months ago. The only abnormal sign found on physical examination was a grade 2/6 systolic murmur at the apex position without radiation. Echocardiography revealed normal left and right ventricular sizes and systolic function, and only one papillary muscle in left ventricular (LV) cavity which all chordae tendineae inserted into that muscle. The mitral valve orifice was eccentrically located at the lateral side with mild to moderate mitral regurgitation but without significant mitral stenosis. No other congenital heart anomalies were identified. Thus, the final diagnosis was isolated parachute mitral valve (IPMV). She was one of the very rare IPMV cases have ever been reported in adults. PMID:27069567

  13. Isolated parachute mitral valve in a 29 years old female; a case report

    PubMed Central

    Toufan, Mehrnoush; Mahmoudi, Seyed Sajjad

    2016-01-01

    A 29-year old female patient was referred to our hospital for evaluation of dyspnea NYHA class I which begun from several months ago. The only abnormal sign found on physical examination was a grade 2/6 systolic murmur at the apex position without radiation. Echocardiography revealed normal left and right ventricular sizes and systolic function, and only one papillary muscle in left ventricular (LV) cavity which all chordae tendineae inserted into that muscle. The mitral valve orifice was eccentrically located at the lateral side with mild to moderate mitral regurgitation but without significant mitral stenosis. No other congenital heart anomalies were identified. Thus, the final diagnosis was isolated parachute mitral valve (IPMV). She was one of the very rare IPMV cases have ever been reported in adults PMID:27069567

  14. Isolated parachute mitral valve in a 29 years old female; a case report.

    PubMed

    Toufan, Mehrnoush; Mahmoudi, Seyed Sajjad

    2016-01-01

    A 29-year old female patient was referred to our hospital for evaluation of dyspnea NYHA class I which begun from several months ago. The only abnormal sign found on physical examination was a grade 2/6 systolic murmur at the apex position without radiation. Echocardiography revealed normal left and right ventricular sizes and systolic function, and only one papillary muscle in left ventricular (LV) cavity which all chordae tendineae inserted into that muscle. The mitral valve orifice was eccentrically located at the lateral side with mild to moderate mitral regurgitation but without significant mitral stenosis. No other congenital heart anomalies were identified. Thus, the final diagnosis was isolated parachute mitral valve (IPMV). She was one of the very rare IPMV cases have ever been reported in adults.

  15. 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.

  16. Totally endoscopic set-up for mitral valve repair.

    PubMed

    Walcot, Nicholas; Hohenberger, Wolfgang; Lakew, Fitsum; Batz, Gerhard; Diegeler, Anno; Perier, Patrick

    2015-01-01

    Minimally invasive mitral surgery is increasingly recognized as routine. We describe here the financially economical set-up for totally endoscopic surgery, which also represents currently the smallest surgical access, limited only by prosthesis and retractor size. This allows the full range of repairs to be performed. Cannulation for cardiopulmonary bypass is performed via the groin. A cosmetic, periareolar (in males) or inframammary fold (in females) incision is made and the chest entered on bypass. An aortic cross-clamp and crystalloid cardioplegia are used via the aortic root prior to atriotomy and surgical repair. This method gives the highest level of cosmesis available and minimal discomfort, without compromising on the extremely good published results.

  17. [Minimally Invasive Mitral Valve Plasty;My Technique].

    PubMed

    Ito, Toshiaki

    2016-07-01

    We perform minimally invasive mitral valve plasty under totally endoscopic view. Skin incisions are composed of a 3 to 5 cm of main wound along the right 4th intercostal space, 1 trocar port in the 3rd intercostal space, and a camera port in the 5th intercostal space. Matal rib spreader is not used. A 3-dimensional endoscope was recently introduced. Forceps controlled by the left hand are inserted through the independent trocar port in the 3rd intercostal space. Left atrial retractor, aortic clamp, and all the cannulae are inserted through the main incision. Cardio-pulmonary bypass is established through the right femoral artery and vein cannulation. No additional venous cannula through the right jugular vein is used. Posterior leaflet lesions are repaired by resection and suture technique. Anterior leaflet prolapse is repaired mainly using the loop technique. Bleeding from the chest wall is meticulously checked before closing the chest.

  18. Congenital isolated cleft mitral valve leaflet and apical muscular ventricular septal defect in a Holstein calf.

    PubMed

    Depenbrock, Sarah M; Visser, Lance C; Kohnken, Rebecca A; Russell, Duncan S; Simpson, Katharine M; Bonagura, John D

    2015-09-01

    A 5-week-old Holstein heifer calf presented for emergency treatment of signs referable to gastrointestinal disease and hypovolemic shock. Fluid resuscitation uncovered clinical signs of primary cardiac disease and echocardiography revealed multiple congenital cardiac defects. Malformations included a cleft anterior mitral valve leaflet resembling an isolated cleft mitral valve and an apically-located muscular ventricular septal defect. The echocardiographic and postmortem findings associated with these defects are presented and discussed in this report.

  19. TAVI in the case of preexisting mitral prosthesis: tips & tricks and literature review.

    PubMed

    Vavuranakis, Manolis; Vrachatis, Dimitrios A; Kariori, Maria G; Moldovan, Carmen; Kalogeras, Konstantinos; Lavda, Maria; Aznaouridis, Konstantinos; Stefanadis, Christodoulos

    2014-11-01

    Very limited data exist on transcatheter aortic valve implantation (TAVI) in the setting of a preexisting mitral prosthesis regarding the technique, potential complications, and outcomes. Here, we report two cases of transfemoral TAVI with a self-expanding bioprosthesis (CoreValve; Medtronic, Inc) in patients who had previously undergone mitral valve replacement (one with an Omniscience and one with a St. Jude prosthesis). A brief literature review is also presented. PMID:25364003

  20. The phonocardiogram in a partially detached mitral (Starr-Edwards) prosthesis

    PubMed Central

    Raj, M. V. Jeeva; Clarke, C. R. A.; Fleming, H. A.

    1975-01-01

    Phonocardiographic evidence of extreme variability of the time interval between the aortic sound (A2) and the opening click (OC) with intermittent absence of the OC of a partially detached mitral prosthesis of the Starr-Edwards type has not hitherto been reported. This case illustrates the diagnostic use of phonocardiography in a malfunctioning mitral Starr-Edwards prosthesis. ImagesFig. 1Fig. 2 PMID:1197179

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

    PubMed

    Leddet, P; Couppié, 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.

  2. Three-dimensional echocardiographic pictures of isolated double-orifice mitral valve.

    PubMed

    Toyota, Naoki; Hayashi, Tomohiro; Ogino, Kayo; Hara, Shigeto; Waki, Kenji; Arakaki, Yoshio; Maruo, Takeshi; Baba, Kiyoshi

    2011-12-01

    We present a case of a 12-year-old boy with a rare form of cardiac anomaly, isolated double-orifice mitral valve. He was referred to our hospital at 1.5 years old because of heart murmur. Two-dimensional echocardiography showed double-orifice mitral valve without any associated cardiac anomalies. He has been followed carefully without any medication for 11 years. He has had no symptoms and an excellent natural course thus far.

  3. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  4. Pathogenesis of mitral valve disease in mucopolysaccharidosis VII dogs.

    PubMed

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

    2013-11-01

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

  5. Mitral valve repair for active culture positive infective endocarditis

    PubMed Central

    Doukas, G; Oc, M; Alexiou, C; Sosnowski, A W; Samani, N J; Spyt, T J

    2006-01-01

    Objective To describe the clinical and echocardiographic outcome after mitral valve (MV) repair for active culture positive infective MV endocarditis. Patients and methods Between 1996 and 2004, 36 patients (mean (SD) age 53 (18) years) with positive blood culture up to three weeks before surgery (or positive culture of material removed at operation) and intraoperative evidence of endocarditis underwent MV repair. Staphylococci and streptococci were the most common pathogens. All patients had moderate or severe mitral regurgitation (MR). Mean New York Heart Association (NYHA) class was 2.3 (1.0). Follow up was complete (mean 38 (19) months). Results Operative mortality was 2.8% (one patient). At follow up, endocarditis has not recurred. One patient developed severe recurrent MR and underwent valve replacement and one patient had moderate MR. There were two late deaths, both non‐cardiac. Kaplan‐Meier five year freedom from recurrent moderate to severe MR, freedom from repeat operation, and survival were 94 (4)%, 97 (3)%, and 93 (5)%, respectively. At the most recent review the mean NYHA class was 1.17 (0.3) (p < 0.0001). At the latest echocardiographic evaluation, left atrial diameters, left ventricular end diastolic diameter, and MV diameter were significantly reduced (p < 0.05) compared with preoperative values. Conclusions MV repair for active culture positive endocarditis is associated with low operative mortality and provides satisfactory freedom from recurrent infection, freedom from repeat operation, and survival. Hence, every effort should be made to repair infected MVs and valves should be replaced only when repair is not possible. PMID:15951395

  6. 3D reconstruction and quantitative assessment method of mitral eccentric regurgitation from color Doppler echocardiography

    NASA Astrophysics Data System (ADS)

    Liu, Qi; Ge, Yi Nan; Wang, Tian Fu; Zheng, Chang Qiong; Zheng, Yi

    2005-10-01

    Based on the two-dimensional color Doppler image in this article, multilane transesophageal rotational scanning method is used to acquire original Doppler echocardiography while echocardiogram is recorded synchronously. After filtering and interpolation, the surface rendering and volume rendering methods are performed. Through analyzing the color-bar information and the color Doppler flow image's superposition principle, the grayscale mitral anatomical structure and color-coded regurgitation velocity parameter were separated from color Doppler flow images, three-dimensional reconstruction of mitral structure and regurgitation velocity distribution was implemented separately, fusion visualization of the reconstructed regurgitation velocity distribution parameter with its corresponding 3D mitral anatomical structures was realized, which can be used in observing the position, phase, direction and measuring the jet length, area, volume, space distribution and severity level of the mitral regurgitation. In addition, in patients with eccentric mitral regurgitation, this new modality overcomes the inherent limitations of two-dimensional color Doppler flow image by depicting the full extent of the jet trajectory, the area of eccentric regurgitation on three-dimensional image was much larger than that on two-dimensional image, the area variation tendency and volume variation tendency of regurgitation have been shown in figure at different angle and different systolic phase. The study shows that three-dimensional color Doppler provides quantitative measurements of eccentric mitral regurgitation that are more accurate and reproducible than conventional color Doppler.

  7. Replacement of the Aortic and Mitral Valves Using the Starr-Edwards Ball-Valve Prosthesis

    PubMed Central

    Callaghan, John C.

    1964-01-01

    The aortic and mitral valves were replaced in 50 patients at the University of Alberta Hospital using the Starr-Edwards ball-valve prosthesis. The basis of the selection of 20 patients for isolated aortic valve replacement and 27 for mitral valve replacement using this type of prosthesis is presented, and the techniques of insertion of the aortic and mitral valve are described in detail. Of the 27 patients in whom the mitral valve was replaced by the Starr-Edwards prosthesis six died within 30 days of surgery and two after discharge from hospital at two and a half and four months, respectively. Left atrial thrombosis was the cause of death in four of these patients. In 20 patients in whom the aortic valve was replaced, four died in hospital and two died more than 30 days after returning home. Three of these six patients died from bleeding—the result of the use of anticoagulants. The difficulty in assessing whether or not anticoagulants are needed following replacement by a Starr-Edwards prosthesis is considered. It is felt, in our present state of knowledge, that anticoagulants should be used following mitral valve replacement but are probably not essential following replacement of the aortic valve. Two patients survived replacement of both aortic and mitral valves and have been followed up 18 months and seven months, respectively. ImagesFig. 1Fig. 2Fig. 4Fig. 5Fig. 7Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13 PMID:14179062

  8. 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

  9. Quantification of mitral regurgitation: comparison between transthoracic and transesophageal color Doppler flow mapping.

    PubMed

    Mimo, R; Sparacino, L; Nicolosi, G; D'Angelo, G; Dall'Aglio, V; Lestuzzi, C; Pavan, D; Cervesato, E; Zanuttini, D

    1991-11-01

    We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16-83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 +/- 6.35 cm 2 at TTE and 3.04 +/- 3.79 cm 2 at TEE (P = NS). Correlation was r = 0.69 (TEE = 0.41 TTE + 1.55; P less than 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE.

  10. 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.

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

    PubMed Central

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  13. Ring-Noose-String Technique Allows Adjustable Papillary Muscle Repositioning During Minimally Invasive Mitral Valve Repair in Patients with Functional/Ischemic Mitral Regurgitation.

    PubMed

    Bothe, Wolfgang; Doenst, Torsten

    2016-08-01

    In patients with functional/ischemic mitral regurgitation (FMR/IMR), mitral annuloplasty alone frequently results in recurrent regurgitation because of ongoing left ventricular dilatation and recurrent leaflet tethering. Adjunctive subvalvular approaches exist, but the technical shortcomings limit their clinical acceptance. A novel adjunctive technique was applied in three patients: A polytetrafluoroethylene string and noose were anchored to the posteromedial and anterolateral papillary muscle, respectively. The string ends were guided through the noose, exteriorized through the midposterior annulus into the left atrium, and length-adjusted during the saline test. The procedure allowed safe and straightforward papillary muscle repositioning and may stabilize repair results in FMR/IMR patients.

  14. Management of the congenital aneurysm of the left ventricle associated with mitral insufficiency in a child: a case report.

    PubMed

    Mitsomoy, Michel Francklyn; Ajaja, Mohomed Reda; Fkiri, Btisam; Haddour, L; Cheikhaoui, Younes

    2013-01-01

    The combination of congenital left ventricular aneurysm associated with mitral insufficiency is rare. We describe the case of a girl aged 11 years, bearing these two entities simultaneously. Aneurysmal resection of the left ventricle was performed with Dor technic to allow remodelation of the anatomy of the left ventricle. Mitral annuloplasty was performed through a transseptal approach. Three months after surgery, the child presents a good myocardial contractility without mitral regurgitation and normal ejection fraction. PMID:24251007

  15. Management of the Congenital Aneurysm of the Left Ventricle Associated with Mitral Insufficiency in a Child: A Case Report

    PubMed Central

    Mitsomoy, Michel Francklyn; Ajaja, Mohomed Reda; Fkiri, Btisam; Haddour, L; Cheikhaoui, Younes

    2013-01-01

    The combination of congenital left ventricular aneurysm associated with mitral insufficiency is rare. We describe the case of a girl aged 11 years, bearing these two entities simultaneously. Aneurysmal resection of the left ventricle was performed with Dor technic to allow remodelation of the anatomy of the left ventricle. Mitral annuloplasty was performed through a transseptal approach. Three months after surgery, the child presents a good myocardial contractility without mitral regurgitation and normal ejection fraction. PMID:24251007

  16. Three-Directional Evaluation of Mitral Flow in the Rat Heart by Phase-Contrast Cardiovascular Magnetic Resonance

    PubMed Central

    Skårdal, Kristine; Espe, Emil KS; Zhang, Lili; Aronsen, Jan Magnus; Sjaastad, Ivar

    2016-01-01

    Purpose Determination of mitral flow is an important aspect in assessment of cardiac function. Traditionally, mitral flow is measured by Doppler echocardiography which suffers from several challenges, particularly related to the direction and the spatial inhomogeneity of flow. These challenges are especially prominent in rodents. The purpose of this study was to establish a cardiovascular magnetic resonance (CMR) protocol for evaluation of three-directional mitral flow in a rodent model of cardiac disease. Materials and Methods Three-directional mitral flow were evaluated by phase contrast CMR (PC-CMR) in rats with aortic banding (AB) (N = 7) and sham-operated controls (N = 7). Peak mitral flow and deceleration rate from PC-CMR was compared to conventional Doppler echocardiography. The accuracy of PC-CMR was investigated by comparison of spatiotemporally integrated mitral flow with left ventricular stroke volume assessed by cine CMR. Results PC-CMR portrayed the spatial distribution of mitral flow and flow direction in the atrioventricular plane throughout diastole. Both PC-CMR and echocardiography demonstrated increased peak mitral flow velocity and higher deceleration rate in AB compared to sham. Comparison with cine CMR revealed that PC-CMR measured mitral flow with excellent accuracy. Echocardiography presented significantly lower values of flow compared to PC-CMR. Conclusions For the first time, we show that PC-CMR offers accurate evaluation of three-directional mitral blood flow in rodents. The method successfully detects alterations in the mitral flow pattern in response to cardiac disease and provides novel insight into the characteristics of mitral flow. PMID:26930073

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

    PubMed

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

    2015-11-01

    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.

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

    PubMed

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

    2012-05-15

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

  19. Value of repeated multiplane transesophageal echocardiography in a patient with mitral valve ring abscess and left ventricular pseudoaneurysm.

    PubMed

    Wisbar, A; Keim, M W; Momper, R; Eschenbruch, E M; Braun, B; Hust, M H

    2001-07-01

    Mitral valve ring abscess and ventricular pseudoaneurysm are rare complications of infective endocarditis. We describe the case of a 58-year-old man who was admitted to our hospital with sepsis caused by Staphylococcus aureus and in whom tricuspid and mitral valve endocarditis developed within 2 weeks. Despite widespread antibiotic therapy, the endocarditis proceeded to form a mitral valve ring abscess and a left ventricular pseudoaneurysm. The diagnosis was set by repeated multiplane transesophageal echocardiography and confirmed by heart surgery.

  20. Ecocardiografía tridimensional. Nuevas perspectivas sobre la caracterización de la válvula mitral

    PubMed Central

    Solis, Jorge; Sitges, Marta; Levine, Robert A.; Hung, Judy

    2010-01-01

    Recent developments in three-dimensional echocardiography have made it possible to obtain images in real time, without the need for off-line reconstruction. These developments have enabled the technique to become an important tool for both research and daily clinical practice. A substantial proportion of the studies carried out using three-dimensional echocardiography have focused on the mitral valve, the pathophysiology of mitral valve disease and, in particular, functional mitral regurgitation. The aims of this article were to review the contribution of three-dimensional echocardiography to understanding of the functional anatomy of the mitral valve and to summarize the resulting clinical applications and therapeutic implications. PMID:19232192

  1. [Experimental principles for preserving annulo-ventricular integrity of the mitral valve].

    PubMed

    Gams, E; Schad, H; Heimisch, W

    1996-06-01

    Despite numerous improvement in cardiac surgery the results in mitral valve replacement are still not satisfactory, since impaired left ventricular function continues to be a problem during the postoperative course. In order to investigate the effect of mitral valve replacement on left ventricular function canine experiments were performed: During extracorporeal circulation bileaflet mitral valve prostheses were implanted preserving the ventriculo-annular continuity. Flexible wires were slung around the chordae of the subvalvular mitral apparatus and brought to the outside through the left ventricular wall. Left ventricular diameters were measured by sonomicrometry, left ventricular stroke volume, left ventricular enddiastolic volume and ejection fraction by dye dilution technique as well as left ventricular and aortic pressure by catheter tip manometers. After finishing cardiopulmonary bypass control values were registered and different preload values achieved by volume loading with blood transfusions to left ventricular enddiastolic pressures of 12 mm Hg. Subsequently under normovolumic conditions the chordae tendineae of the anterior and posterior papillary muscles of the mitral valve were cut from the outside, while the heart was beating, by application of electrocautery on the steel wires. Following severance of the ventriculo-annular continuity of the mitral valve again function curves of left ventricular hemodynamics were made during volume transfusions. When the chordae had been divided the left ventricular enddiastolic diameter increased by 10% in the major axis, while in the minor axis no significant changes occurred. The systolic shortening was impaired substantially by reduction of 43% during the ejection phase when the subvalvular mitral apparatus had been severed. Left ventricular enddiastolic volume was increased by 18% at any preload level, while left ventricular ejection fraction was reduced by 16%. Consequently left ventricular stroke volume was

  2. Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography.

    PubMed Central

    Czer, L S; Maurer, G; Bolger, A F; DeRobertis, M; Chaux, A; Matloff, J M

    1996-01-01

    To determine the effectiveness of revascularization alone or combined with mitral valve repair for ischemic mitral regurgitation, we performed color Doppler echocardiography intraoperatively before and after cardiopulmonary bypass in 49 patients (mean age, 70 +/- 9 years) with concomitant mitral regurgitation and coronary artery disease (triple vessel or left main in 88%; prior infarction in 90%). After revascularization alone (n = 25), the mitral annulus diameter (2.88 +/- 0.44 cm vs 2.88 +/- 0.44 cm), leaflet-to-annulus ratio (1.44 +/- 0.30 vs 1.44 +/- 0.29), and mitral regurgitation grade (1.7 +/- 0.9 vs 1.8 +/- 0.7) remained unchanged (p = NS, postpump vs prepump); mitral regurgitation decreased by 2 grades in only 1 patient (4%). After combined revascularization and mitral valve suture annuloplasty (Kay-Zubiate; n = 24), the annulus diameter decreased (to 2.57 +/- 0.45 cm from 3.11 +/- 0.43 cm), the leaflet-to-annulus ratio increased (to 1.46 +/- 0.25 from 1.20 +/- 0.21), and the mitral regurgitation grade decreased significantly (to 0.9 +/- 0.9 from 2.8 +/- 1.0) (p < 0.01); mitral regurgitation decreased by 2 grades or more (successful repair) in 75%. The origin of the jet correlated with the site of prior infarction (p < 0.05), being inferior in cases of posterior or inferior infarction (67%), and central or broad in cases of combined anterior and inferior infarction (70%). Despite a slightly higher 30-day mortality in the repair group (p = 0.10), there was no significant difference in survival between the 2 surgical groups at 5 years or 8 years. Therefore, in this study of patients with mitral regurgitation and coronary artery disease, reduction in regurgitation grade with revascularization alone was infrequent. Concomitant suture annuloplasty significantly reduced regurgitation by reestablishing a more normal relationship between the leaflet and annulus sizes. The failure rate after suture annuloplasty was 25%; alternative repair techniques such as ring

  3. Subvalvular apparatus and adverse outcome of balloon valvotomy in rheumatic mitral stenosis☆

    PubMed Central

    Bhalgat, Parag; Karlekar, Shrivallabh; Modani, Santosh; Agrawal, Ashish; Lanjewar, Charan; Nabar, Ashish; Kerkar, Prafulla; Agrawal, Nandu; Vaideeswar, Pradeep

    2015-01-01

    Background Balloon mitral valvotomy (BMV) is a well-established therapeutic modality for rheumatic mitral stenosis (RMS). However, there are chances of procedural failure and the more ominous post-procedural severe mitral regurgitation. There are only a few prospective studies, which have evaluated the pathogenic mechanisms for these major complications of BMV, especially in relation to the subvalvular apparatus (SVA) pathology. Methods All symptomatic patients of RMS suitable for BMV by echocardiographic criteria in a span of 1 year were selected. In addition to the standard echocardiographic assessment of RMS (Wilkins score and score by Padial et al.), a separate grading and scoring system was assigned to evaluate the severity of the SVA pathology. The SVA score was ‘I’, when none of the two SVAs had severe disease, ‘II’ when one of the two SVAs has severe disease, and ‘III’ when both SVAs had severe disease. With these scoring systems, the outcomes of BMV (successful procedure, failure, and post-procedural mitral regurgitation) were analyzed. Emergency valve replacement was performed depending on clinical situation, and in cases of replacement, the pathology of the excised mitral valves were compared with echocardiographic findings. Results Of the 356 BMVs performed in a year, 43 patients had adverse outcomes in the form of failed procedure (14 patients) and mitral regurgitation (29 patients). Forty-one among these had a SVA score of III. The sensitivity and specificity of the MR score was lesser than the SVA score (sensitivity 0.34 vs. 1.00, specificity 0.92 vs. 0.99, respectively). The mitral valvular morphology in 39 patients who underwent post-procedural valve replacements correlated well with echocardiography findings. Conclusion It is important to assess the degree of SVA pathology in the conventional echocardiographic assessment for RMS, as BMV would have adverse events when both SVAs were severely diseased. PMID:26432729

  4. Mitral valve surgery in a patient with dextrocardia and 180° counter-clockwise rotated heart due to congenital agenesis of the right lung.

    PubMed

    Atsumi, Yosuke; Tokunaga, Shigehiko; Yasuda, Shota; Fushimi, Kenichi; Masuda, Munetaka

    2013-11-01

    We report a case of severe mitral regurgitation (MR) with dextrocardia and 180° counterclockwise rotated situs solitus heart. We describe the technique for mitral valve surgery in a patient with dextrocardia and agenesis of the right lung.

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

    NASA Technical Reports Server (NTRS)

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

    2003-01-01

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

  6. 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.

  7. Axillary Artery Access for Combined Endoaortic Balloon Occlusion and Perfusion During Robotic Mitral Valve Surgery.

    PubMed

    Ambur, Vishnu V; Kadakia, Sagar S; Taghavi, Sharven; Jayarajan, Senthil N; Kashem, Mohammed Abul; McCarthy, James; Shiose, Akira; Wheatley, Grayson H; Toyoda, Yoshiya; Guy, T Sloane

    2016-01-01

    We aimed to develop a method that provides an alternative cannulation site in robotic mitral valve surgery that allows simultaneous endo-occlusion and antegrade perfusion. A 71-year-old man with severe mitral regurgitation and history of coronary artery bypass grafting underwent totally endoscopic robotic mitral valve repair. A 23-mm endoreturn cannula was placed through a 10-mm graft that was sewn to the left axillary artery. An endoballoon was passed through the Dacron/cannula complex and into the ascending aorta. This complex was used for simultaneous antegrade perfusion, endoballoon occlusion, and antegrade cardioplegia. Completion transesophageal echocardiography showed no evidence of mitral regurgitation. The patient had an uneventful postoperative course and was doing well at his 2-month follow-up appointment. The left axillary artery is a viable option for simultaneous endoballoon occlusion, antegrade perfusion, and antegrade cardioplegia in robotic mitral valve surgery. This has the potential benefit of providing antegrade perfusion, which some studies have shown to be associated with a decreased risk of complications when compared with retrograde perfusion specifically in patients with severe peripheral vascular disease. PMID:27093272

  8. Suture Forces in Undersized Mitral Annuloplasty: Novel Device and Measurements

    PubMed Central

    Siefert, Andrew; Pierce, Eric; Lee, Madonna; Jensen, Morten; Aoki, Chikashi; Takebayashi, Satoshi; Gorman, Robert; Gorman, Joseph; Yoganathan, Ajit

    2014-01-01

    Purpose: Demonstrate the first use of a novel technology for quantifying suture forces on annuloplasty rings to better understand the mechanisms of ring dehiscence. Description: Force transducers were developed, attached to a size 24 Physio™ ring, and implanted in the mitral annulus of an ovine animal. Ring suture forces were measured after implantation and for cardiac cycles reaching peak left ventricular pressures (LVP) of 100, 125, and 150 mmHg. Evaluation: After implanting the undersized ring to the flaccid annulus, the mean suture force was 2.0±0.6 N. During cyclic contraction, anterior ring suture forces were greater than posterior ring suture forces at peak LVPs of 100 mmHg (4.9±2.0 N vs. 2.1±1.1 N), 125 mmHg (5.4±2.3 N vs. 2.3±1.2 N), and 150 mmHg (5.7±2.4 N vs. 2.4±1.1 N). The largest force was 7.4 N at 150 mmHg. Conclusions: Preliminary results demonstrate trends in annuloplasty suture forces and their variation with location and LVP. Future studies will significantly contribute to clinical knowledge by elucidating the mechanisms of ring dehiscence while improving annuloplasty ring design and surgical repair techniques. PMID:24996707

  9. A Case of Microangiopathic Hemolytic Anemia after Myxoma Excision and Mitral Valve Repair Presenting as Hemolytic Uremic Syndrome

    PubMed Central

    Park, Young Joo; Kim, Sang Pil; Shin, Ho-Jin

    2016-01-01

    Microangiopathic hemolytic anemia occurs in a diverse group of disorders, including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and prosthetic cardiac valves. Hemolytic anemia also occurs as a rare complication after mitral valve repair. In this report, we describe a case of microangiopathic hemolytic anemia following myxoma excision and mitral valve repair, which was presented as hemolytic uremic syndrome. PMID:27081450

  10. A Case of Microangiopathic Hemolytic Anemia after Myxoma Excision and Mitral Valve Repair Presenting as Hemolytic Uremic Syndrome.

    PubMed

    Park, Young Joo; Kim, Sang Pil; Shin, Ho-Jin; Choi, Jung Hyun

    2016-03-01

    Microangiopathic hemolytic anemia occurs in a diverse group of disorders, including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and prosthetic cardiac valves. Hemolytic anemia also occurs as a rare complication after mitral valve repair. In this report, we describe a case of microangiopathic hemolytic anemia following myxoma excision and mitral valve repair, which was presented as hemolytic uremic syndrome. PMID:27081450

  11. Local intense mosaic pattern at site of flail mitral leaflet: report of a new color Doppler sign.

    PubMed

    Khouzam, Rami N; D'Cruz, Ivan A; Minderman, Daniel; Kaiser, Jacqueline

    2005-10-01

    Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR. In 3 other patients, the sign was absent; two of those had flail mitral leaflet with severe MR. No local mosaic pattern was seen on color Doppler in 20 other patients with MR but no flail mitral leaflet. We speculate that the focal intense mosaic color Doppler morphology may have been caused by intrusion of the flail leaflet into the MR stream, or to a Coanda-like effect of the MR jet "adhering" to the flail leaflet. PMID:16194168

  12. Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

    PubMed Central

    Chen, Zhang-Qiang; Hong, Lang; Wang, Hong; Lu, Lin-Xiang; Yin, Qiu-Lin; Lai, Heng-Li; Li, Hua-Tai; Wang, Xiang

    2015-01-01

    Background: Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation. Methods: Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years. Results: After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm2, P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15

  13. Retrograde Transcatheter Closure of Mitral Paravalvular Leak through a Mechanical Aortic Valve Prosthesis: 2 Successful Cases

    PubMed Central

    Zhou, Daxin; Pan, Wenzhi; Guan, Lihua; Qian, Juying

    2016-01-01

    The presence of a mechanical aortic valve prosthesis has been considered a contraindication to retrograde percutaneous closure of mitral paravalvular leaks, because passing a catheter through the mechanical aortic valve can affect the function of a mechanical valve and thereby lead to severe hemodynamic deterioration. We report what we believe are the first 2 cases of retrograde transcatheter closure of mitral paravalvular leaks through a mechanical aortic valve prosthesis without transseptal or transapical puncture. Our experience shows that retrograde transcatheter closure of mitral paravalvular leaks in this manner can be an optional approach for transcatheter closure of such leaks, especially when a transapical or transseptal puncture approach is not feasible. This technique might also be applied to other transcatheter procedures in which there is a need to pass a catheter through a mechanical aortic valve prosthesis. PMID:27127428

  14. Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure

    NASA Technical Reports Server (NTRS)

    Temporelli, P. L.; Scapellato, F.; Corra, U.; Eleuteri, E.; Firstenberg, M. S.; Thomas, J. D.; Giannuzzi, P.

    2001-01-01

    Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.

  15. An unusually accentuated diastolic anterior motion of the mitral valve in aortic insufficiency.

    PubMed

    Rudominer, Rebecca; Saric, Muhamed; Benenstein, Ricardo; Skolnick, Adam H

    2013-01-01

    A 55-year-old woman was diagnosed with endocarditis involving the aortic valve and resulting in moderate aortic insufficiency. Transesophageal and transthoracic echocardiography demonstrated an unusually accentuated diastolic anterior motion of the anterior mitral valve leaflet toward the interventricular septum. The anterior leaflet remained within a few millimeters of the septum throughout diastole, with a narrow jet of aortic insufficiency separating the anterior leaflet from the septum. We hypothesize that the particularly long anterior mitral leaflet was drawn toward the septum during diastole due to the Venturi effect of the aortic insufficiency jet within a narrow ventricular outflow tract. This accentuated diastolic anterior motion may be a diastolic correlate of systolic anterior motion of the mitral valve. PMID:22678922

  16. Transmitral exclusion of a giant congenital left ventricular aneurysm associated with mitral insufficiency in adult.

    PubMed

    El Malki, Hicham; El Kandoussi, Tahar; Rhissassi, Jaafar; Laaroussi, Mohamed

    2015-12-01

    Congenital left ventricular aneurysm is rare, poorly understood and potentially lethal. It usually occurs in isolation. Its combination with mitral insufficiency is an uncommon entity. Because the literature on this kind of aneurysms consists of case reports and small series described especially in children, we report here an interesting and unique case of an adult aged 35 years bearing simultaneously a congenital left ventricular aneurysm and mitral insufficiency. Without medical past history, he consults for palpitations and dyspnoea. Once diagnosis was made by chest X-ray, echocardiography and computed tomography, an open heart surgery was necessary to prevent complications. Through a transmitral approach, aneurysmal exclusion was performed by closing the aneurysmal collar with a Dacron patch and mitral replacement was accomplished. At 12 months, follow-up was favourable without residual communication between aneurysm and ventricle or paraprosthetic leak. PMID:26399261

  17. Transapical off-pump Neochord implantation on bileaflet prolapse to treat severe mitral regurgitation.

    PubMed

    Colli, Andrea; Bellu, Roberto; Pittarello, Demetrio; Gerosa, Gino

    2015-10-01

    A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance. Four Neochordae were implanted on the posterior leaflet and two on the anterior leaflet in order to correct a residual anterior prolapse that was not seen at preoperative screening. After 11 months of follow-up, the patient presented with recurrence of symptomatic moderate MR due to rupture of one of two neochordae implanted on the anterior leaflet and new onset of atrial fibrillation. The patient underwent uneventful mitral valve replacement. PMID:26180097

  18. Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

    PubMed Central

    Zhu, Jiasi; Sin, Yoong Kong; Chua, Yeow Leng

    2016-01-01

    Most mitral paravalvular leaks (PVLs) occur during the first year after mitral valve replacement (MVR). This report describes the surgical management of 6 patients who developed very late mitral PVLs. The median interval between MVR and initial diagnosis of PVL was 16.5 years. All patients presented with congestive cardiac failure and haemolytic anaemia. The median EuroSCORE II was 9.5%. Two patients (33%) had failed attempts at transcatheter closure. Five patients underwent suture repair of the PVL. One patient underwent MVR after removal of the previous prosthesis. No in-hospital mortalities occurred. At latest follow-up (median 3.3 years), 5 patients (83%) were asymptomatic with no residual PVL. Haemolytic anaemia persisted in 1 patient with a mild residual PVL. PVL occurring decades after MVR is a rare but serious complication. Reoperative surgery can be performed in these high-risk patients with satisfactory early and midterm outcomes. PMID:27747034

  19. Pigtail catheter "propping" for MitraClip percutaneous transcatheter mitral valve repair.

    PubMed

    Sandhu, Kully; Butler, Robert; Large, Adrian

    2016-08-01

    In recent years percutaneous therapy has emerged as a feasible and effective option for the treatment of mitral regurgitation, particularly in cases where the risks of conventional cardiac surgery are prohibitively high. To date the most widely used percutaneous approach is beating heart, edge-to-edge repair with the MitraClip device (Abbott Vascular-Structural Heart, Menlo Park, CA). The technique requires simultaneous grasping and approximation of both mitral valve leaflets prior to securing and releasing the clip. However, this may be technically challenging or indeed impossible in patients with failure of coaptation, particularly when there is a large coaptation gap. We present an approach for overcoming this relatively common obstacle based on "propping" the anterior mitral valve leaflet toward its posterior counterpart with a diagnostic pigtail catheter to reduce the coaptation gap and to allow grasping of both leaflets without difficulty. © 2016 Wiley Periodicals, Inc. PMID:26959728

  20. Mitral valve repair after a right pneumonectomy: a minimally invasive approach.

    PubMed

    Rose, David; Liew, Chee K; Zacharias, Joseph

    2015-10-01

    A 31-year old man was admitted to our unit with severe mitral regurgitation secondary to infective endocarditis on a background of a right pneumonectomy performed 8 years previously for a central carcinoid tumour. A previous right thoracotomy for lung resection is considered a contraindication to a minimal access approach to the mitral valve. Following the right pneumonectomy, a left-to-right displacement of the mediastinum had occurred. We report our experience on performing a mitral valve repair through a right mini-thoracotomy in a patient who had undergone a right pneumonectomy. In this case, three-dimensional computed tomography reconstructions were used to guide our surgical approach. We hope that this case presentation will help further broaden the applicability of a thru-port approach to this rare subgroup of patients.

  1. [Reverse myocardial remodeling in patients with aortic valve disease and mitral insufficiency in early postoperative period].

    PubMed

    Belov, Iu V; Katkov, A I; Seslavinskaia, T V; Vinokurov, I A; Salagaev, G I

    2015-01-01

    Surgical treatment of patients with aortic valve disease and concomitant mitral insufficiency remains debatable. We analyzed early postoperative results of surgical treatment of 80 patients depending on type of surgery. All patients were divided into three groups: the 1st - aortic valve replacement in patients without mitral valve dysfunction (control group) (n=44); the 2nd - isolated aortic valve replacement in patients with concomitant mitral regurgitation degree 2-3 (n=18), the 3rd - simultaneous aortic and mitral valve replacement (n=18). Combined valve replacement was associated with more intraoperative blood loss (852.78±442.08 ml) compared with aortic valve replacement (658.7±374.09 ml), p<0.05. In patients with mitral regurgitation greater hematocrit decrease was observed (22.13±3.6% in group 2 and 21.4±4.48 in group 3) in comparison with control group (24.17±3.72% in group 1), p<0.05. Incidence of postoperative complications did not differ in all groups. Mortality rate was 6.8% in group 1 and 11.1% in group 3, there were no deaths in group 2. Both valves correction provided faster myocardial remodeling. Left ventricular end-diastolic volume decreased on 50 ml in group 3, on 33.67 ml in group 2 and on 50.73 ml in group 1 (p<0.05). Pulmonary pressure decreased on 20 mm Hg in group 3, on 13 mm Hg - in group 2 and on 12.57 mm Hg - in group 1, p<0.05. In groups 1 and 3 pulmonary pressure became normal after operation, in group 2 signs of pulmonary hypertension were observed (pressure - 35.3 mm Hg). Analysis of the results showed that simultaneous mitral and aortic valves replacement initiates normalization of intracardiac hemodynamics in early postoperative period. PMID:26081181

  2. 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

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

    PubMed Central

    Sarı, Cenk; Baştuğ, Serdal; Kasapkara, Hacı Ahmet; Durmaz, Tahir; Keleş, Telat; Akçay, 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

  4. Effectiveness of balloon valvuloplasty for palliation of mitral stenosis after repair of atrioventricular canal defects.

    PubMed

    Robinson, Joshua D; Marx, Gerald R; Del Nido, Pedro J; Lock, James E; McElhinney, Doff B

    2009-06-15

    Closure of a mitral valve (MV) cleft, small left-sided cardiac structures, and ventricular imbalance all may contribute to mitral stenosis (MS) after repair of atrioventricular canal (AVC) defects. MV replacement is the traditional therapy but carries high risk in young children. The utility of balloon mitral valvuloplasty (BMV) in postoperative MS is not established and may offer alternative therapy or palliation. Since 1996, 10 patients with repaired AVC defects have undergone BMV at a median age of 2.5 years (range 8 months to 14 years), a median of 2 years after AVC repair. At catheterization, the median value of mean MS gradients was 16 mm Hg (range 12 to 22) and was reduced by 34% after BMV. Before BMV, there was mild mitral regurgitation in 9 of 10 patients, which increased to severe in 1 patient. All patients were alive at follow-up (median 5.4 years). Repeat BMV was performed in 4 patients, 10 weeks to 18 months after initial BMV. One patient underwent surgical valvuloplasty; 3 underwent MV replacement 2, 3, and 28 months after BMV. In the 6 patients (60%) with a native MV at most recent follow-up (median 3.2 years), the mean Doppler MS gradient was 9 mm Hg, the median weight had doubled, and weight percentile had increased significantly. In conclusion, BMV provides relief of MS in most patients with repaired AVC defects; marked increases in mitral regurgitation are uncommon. Because BMV can incompletely relieve obstruction and increase mitral regurgitation, it will not be definitive in most patients but will usually delay MV replacement to accommodate a larger prosthesis.

  5. A meta-analysis of robotic vs. conventional mitral valve surgery

    PubMed Central

    Wolfenden, Hugh; Liou, Kevin; Pathan, Faraz; Gupta, Sunil; Nienaber, Thomas A.; Chandrakumar, David; Indraratna, Praveen; Yan, Tristan D.

    2015-01-01

    Objectives The present study is the first meta-analysis to compare the surgical outcomes of robotic vs. conventional mitral valve surgery in patients with degenerative mitral valve disease. Methods A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic vs. conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalization and duration of intensive care unit (ICU) stay. Echocardiographic outcomes were assessed when possible. Results Six relevant retrospective studies with comparative data for robotic vs. conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalization and ICU stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. Conclusions Current evidence on comparative outcomes of robotic vs. conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety. PMID:26309839

  6. Systemic Artery to Pulmonary Artery Fistula Associated with Mitral Regurgitation: Successful Treatment with Endovascular Embolization

    SciTech Connect

    Iwazawa, Jin; Nakamura, Kenji; Hamuro, Masao; Nango, Mineyoshi; Sakai, Yukimasa; Nishida, Norifumi

    2008-07-15

    We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.

  7. [Role of beta-blockers in the treatment of mitral stenosis, apropos of 4 cases].

    PubMed

    Kane, A; Ba, S A; Fall, M D; Sarr, M; Diop, I B; Hane, L; Diouf, S M

    1997-01-01

    The use of beta blockers during treatment of mitral stenosis is discussed on four cases involving females patients who are symptomatic. All had sinusal tachycardia, one was pregnant, one with cardiothyreosis, two with anemia. In all cases, it's the use of beta-blockers with diuretic, veinous vasodilator and digitalic drugs that allowed the successful treatment of the pulmonary oedema. These observations, added with the literature study, showed that beta-blockers treatment is wise when the subject is carefully studied. The best result is obtained on pure mitral stenosis without left ventricular systolic dysfunction, with sinusal tachycardia and high cardiac output state.

  8. Successful retrieval of broken coiled guidewire from left atrium during balloon mitral valvotomy: a rare complication.

    PubMed

    Deora, Surender; More, Dheeraj; Shah, Sanjay; Patel, Tejas

    2014-09-01

    Abstract Balloon mitral valvotomy (BMV) is the procedure of choice for rheumatic mitral stenosis with favorable valve morphology. Fracture of 0.025 inch coiled guidewire during BMV is a very rare complication. The various factors which may cause this complication are utilization of reused hardware, improper placement of guidewire, abnormal angulation between guidewire and dilator with forceful septal dilation and rarely manufacturing defect. Here, we report successful retrieval of broken 0.025 inch coiled guidewire from left atrium during BMV using 10F Amplatzer long sheath without any complication.

  9. Mitral valve-in-valve and valve-in-ring: technical aspects and procedural outcomes.

    PubMed

    Dvir, Danny; Webb, John

    2016-09-18

    There is a growing practice of transcatheter treatment of failed mitral valves after cardiac surgery, including valve-in-valve and valve-in-ring. Although commonly successful, these procedures can be associated with device malposition (including delayed malposition) and elevated post-procedural gradients (especially when performed inside small surgical valves). Valve-in-ring procedures have elevated risks of left ventricular outflow tract obstruction and post-procedural regurgitation. Careful patient selection and meticulous evaluation of patient anatomy and surgical implant characteristics are essential to achieve optimal clinical results with mitral valve-in-valve and valve-in-ring implantation. PMID:27640048

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

    PubMed Central

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

    2014-01-01

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

  11. Paraprosthetic leak closure 28 years after mitral caged-ball Starr-Edwards implantation.

    PubMed

    Antończyk, 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.

  12. Paraprosthetic leak closure 28 years after mitral caged-ball Starr-Edwards implantation

    PubMed Central

    Antończyk, Karolina; Paluszkiewicz, Lech; Koertke, Heinrich; Gummert, Jan

    2013-01-01

    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

  13. 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

  14. 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

  15. Concomitant Tricuspid Valve Surgery Affects Outcomes Following Mitral Operations: A multi-institutional, statewide analysis

    PubMed Central

    LaPar, Damien J.; Mulloy, Daniel P.; Stone, Matthew L.; Crosby, Ivan K.; Lau, Christine L; Kron, Irving L.; Ailawadi, Gorav

    2012-01-01

    Background Mitral valve disease is often accompanied by concomitant tricuspid valve disease. The purpose of this study was to determine the influence of performing tricuspid procedures in the setting of mitral valve surgery within a multi-institutional patient population. Methods From 2001–2008, 5,495 mitral valve operations were performed at 17 different statewide centers. Patients underwent either mitral valve alone (MV alone, n=5,062, age=63.4±13.0 years) or mitral + tricuspid valve operations (MV+TV, n=433, age=64.0±14.2 years). Univariate and multivariate analyses were used to assess the influence of concomitant tricuspid procedures on operative mortality and the composite incidence of major complications. Results Patients undergoing MV+TV were more commonly female (62.7% vs. 45.5%, p<0.001), had higher rates of heart failure (73.7% vs. 50.9%, p<0.001), and more frequently underwent reoperations (17.1% vs. 7.4%, p<0.001) compared to MV alone patients. Other patient characteristics, including preoperative endocarditis (8.5% vs. 8.2%, p=0.78), were similar between groups. Mitral replacement (63.5%) was more common than repair (36.5%, p<0.001) in MV+TV operations, and MV+TV operations incurred longer median cardiopulmonary bypass (181 min. vs. 149 min, p<0.001) times. Unadjusted operative mortality (6.0% vs. 10.4%, p=0.001) and postoperative complications were higher following MV+TV compared to MV alone. Importantly, after risk adjustment, performance of concomitant tricuspid valve procedures proved an independent predictor of operative mortality (OR=1.50, p=0.03) and major complications (OR=1.39, p=0.004). Conclusions Concomitant tricuspid surgery is a proxy for more advanced valve disease. Compared to mitral operations alone, simultaneous mitral-tricuspid valve operations are associated with elevated morbidity and mortality even after risk adjustment. This elevated risk should be considered during preoperative patient risk stratification. PMID:22607786

  16. A Cranial-Sided Approach for Repeated Mitral Periprosthetic Leak After Right Pneumonectomy.

    PubMed

    Takahashi, Yosuke; Shibata, Toshihiko; Sasaki, Yasuyuki; Kato, Yasuyuki; Motoki, Manabu; Morisaki, Akimasa; Nishimura, Shinsuke; Hattori, Koji

    2016-03-01

    A 72-year-old man presented with worsening dyspnea on effort. He underwent right pneumonectomy 40 years ago, then mitral valve replacement through a right thoracotomy 8 years ago with repeat surgery to repair a periprosthetic valve leak; the mediastinum was displaced to the right, and the heart was rotated counterclockwise. Transthoracic echocardiography showed periprosthetic valve leak recurrence near the left atrial appendage. We repaired the periprosthetic valve leak through a median sternotomy. Transecting the main pulmonary artery allowed us to widely open the cranial-sided left atrium. We obtained good exposure of the mitral valve, and repaired the periprosthetic valve leak using pledgeted sutures and a pericardial patch.

  17. DISC VARIANCE OF THE HARKEN MITRAL PROSTHESIS: THE CONTRIBUTION OF ASSOCIATED AORTIC REGURGITATION

    PubMed Central

    Yarnoz, Michael D.; Hueter, David; McCormick, John R.; Black, Harrison; Berger, Robert L.

    1977-01-01

    Four cases of severe mitral regurgitation due to disc variance of the Harken disc prosthesis in the mitral position are described. The valve occluder actually escaped into the left atrium in two patients, and neither survived despite emergency valve replacement. In the other two, disc malfunction was identified by flouroscopy, the prosthesis was replaced, and both patients survived. All four patients had associated aortic regurgitation, which most likely contributed to erosion of the disc edges. It is suggested that patients with the Harken disc prosthesis undergo periodic evaluation to detect abnormal disc motion. Images PMID:15216088

  18. 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.

  19. Direct measurements of nitric oxide release in relation to expression of endothelial nitric oxide synthase in isolated porcine mitral valves.

    PubMed

    Moesgaard, S G; Olsen, L H; Aasted, B; Viuff, B M; Pedersen, L G; Pedersen, H D; Harrison, A P

    2007-04-01

    The aim of this study was to measure the direct release of nitric oxide (NO) from the porcine mitral valve using a NO microelectrode. Furthermore, the expression and localization of endothelial nitric oxide synthase (eNOS) in the mitral valve was studied using immunohistochemistry, Western blotting and RT-PCR. Results show that bradykinin increases NO release from mitral valves (DeltaBradykinin: 33.71 +/- 10.41 nm NO, P < 0.001, n = 10), whereas N-nitro-l-arginine methyl esther (l-NAME) decreases NO release when compared with basal level (Deltal-NAME: 82.69 +/- 15.66 nm NO, P < 0.005, n = 4). Both protein and mRNA expression of eNOS in mitral valves and in isolated valvular endothelial cells suggest that the NO release is mainly associated with the mitral valve endothelium. It is concluded that direct NO release from porcine mitral valves coincides with eNOS expression. This study documents useful techniques for investigations into the role of local NO release in mitral valve diseases.

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

    PubMed

    Boronyak, Steven M; Merryman, W David

    2014-03-21

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

  1. One-year results from cryopreserved mitral allograft transplantation into the tricuspid position in a sheep experimental model.

    PubMed

    Mokracek, A; Canadyova, J; Simunkova, Z; Fiala, R; Hmirak, M; Sulda, M; Burkert, J; Tintera, J; Kobylka, P; Spatenka, J

    2015-01-01

    Mitral allografts are still used only exceptionally in the mitral or tricuspid position. The main indication remains infectious endocarditis of atrioventricular valves for its flexibility and low risk of infection. The aim of our study was to evaluate 1-year results of mitral allografts transplantation into the tricuspid position in a sheep model. Mitral allografts were processed, cryopreserved, and transplanted into the tricuspid position anatomically (Group I - 11 animals) or antianatomically (Group II - 8 animals). All survivors (4 from Group I, and 3 from Group II) were checked at 3, 6, and 12 months by echocardiography with the exception of one survivor from Group II (which was examinated only visually). Examination throughout follow-up included for mitral allograft regurgitation and annuli dilatation. At postmortem, the papillary muscles were healed and firmly anchored to the right ventricular wall in all subjects. Transventricular fixation of the papillary muscles with buttressed sutures was proven to be a stable, reproducible, and safe method for anchoring mitral allograft leaflets. There were no significant differences between the two implantation methods. Annulus support of mitral allografts might be very useful in this type of operation and could prevent annular dilatation.

  2. Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus

    PubMed Central

    Wartak, Siddharth; Sadiq, Adnan; Crooke, Gregory; Moskovits, Manfred; Frankel, Robert; Hollander, Gerald; Shani, Jacob

    2016-01-01

    A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy. PMID:27610249

  3. Characterization of biomechanical properties of aged human and ovine mitral valve chordae tendineae.

    PubMed

    Zuo, Keping; Pham, Thuy; Li, Kewei; Martin, Caitlin; He, Zhaoming; Sun, Wei

    2016-09-01

    The mitral valve (MV) is a highly complex cardiac valve consisting of an annulus, anterior and posterior leaflets, chordae tendineae (chords) and two papillary muscles. The chordae tendineae mechanics play a pivotal role in proper MV function: the chords help maintain proper leaflet coaptation and rupture of the chordae tendineae due to disease or aging can lead to mitral valve insufficiency. Therefore, the aim of this study was to characterize the mechanical properties of aged human and ovine mitral chordae tendineae. The human and ovine chordal specimens were categorized by insertion location (i.e., marginal, basal and strut) and leaflet type (i.e., anterior and posterior). The results show that human and ovine chords of differing types vary largely in size but do not have significantly different elastic and failure properties. The excess fibrous tissue layers surrounding the central core of human chords added thickness to the chords but did not contribute to the overall strength of the chords. In general, the thinner marginal chords were stiffer than the thicker basal and strut chords, and the anterior chords were stiffer and weaker than the posterior chords. The human chords of all types were significantly stiffer than the corresponding ovine chords and exhibited much lower failure strains. These findings can be explained by the diminished crimp pattern of collagen fibers of the human mitral chords observed histologically. Moreover, the mechanical testing data was modeled with the nonlinear hyperelastic Ogden strain energy function to facilitate accurate computational modeling of the human MV.

  4. Characterization of biomechanical properties of aged human and ovine mitral valve chordae tendineae.

    PubMed

    Zuo, Keping; Pham, Thuy; Li, Kewei; Martin, Caitlin; He, Zhaoming; Sun, Wei

    2016-09-01

    The mitral valve (MV) is a highly complex cardiac valve consisting of an annulus, anterior and posterior leaflets, chordae tendineae (chords) and two papillary muscles. The chordae tendineae mechanics play a pivotal role in proper MV function: the chords help maintain proper leaflet coaptation and rupture of the chordae tendineae due to disease or aging can lead to mitral valve insufficiency. Therefore, the aim of this study was to characterize the mechanical properties of aged human and ovine mitral chordae tendineae. The human and ovine chordal specimens were categorized by insertion location (i.e., marginal, basal and strut) and leaflet type (i.e., anterior and posterior). The results show that human and ovine chords of differing types vary largely in size but do not have significantly different elastic and failure properties. The excess fibrous tissue layers surrounding the central core of human chords added thickness to the chords but did not contribute to the overall strength of the chords. In general, the thinner marginal chords were stiffer than the thicker basal and strut chords, and the anterior chords were stiffer and weaker than the posterior chords. The human chords of all types were significantly stiffer than the corresponding ovine chords and exhibited much lower failure strains. These findings can be explained by the diminished crimp pattern of collagen fibers of the human mitral chords observed histologically. Moreover, the mechanical testing data was modeled with the nonlinear hyperelastic Ogden strain energy function to facilitate accurate computational modeling of the human MV. PMID:27315372

  5. 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

  6. Comparison of transesophageal Doppler methods with angiography for evaluation of the severity of mitral regurgitation.

    PubMed

    Flachskampf, F A; Frieske, R; Engelhard, B; Grenner, H; Frielingsdorf, J; Beck, F; Reineke, T; Thomas, J D; Hanrath, P

    1998-09-01

    Doppler evaluation of mitral regurgitation remains difficult; thus, a head-to-head comparison of the diagnostic accuracy of Doppler methods was undertaken. Fifty patients with native mitral regurgitation underwent multiplane transesophageal echocardiography within 5 days of catheterization. Angiographic grade of mitral regurgitation and, in 20 patients with grade II-IV regurgitation, invasively determined regurgitant stroke volume were compared with color Doppler area, regurgitant jet diameter, ratio of systolic to diastolic peak pulmonary venous flow velocities, and (based on the proximal convergence zone) maximal regurgitant flow rate and regurgitant orifice area. Rank correlation coefficients of angiographic grade with Doppler parameters were 0.61 for color jet area, -0.61 for pulmonary venous flow velocity ratio, 0.69 for color jet diameter, 0.79 for maximal regurgitant flow rate, and 0.78 for regurgitant orifice area (all P < .01). Convergence zone-based parameters also correlated best (r=0.73) with invasively determined regurgitant stroke volume. Receiver operating characteristic curve analysis confirmed higher diagnostic accuracy for proximal jet width and proximal convergence zone parameters than for color jet area or pulmonary venous flow velocity ratio. Proximal convergence zone parameters and proximal color jet diameter best distinguished severe from mild forms of mitral regurgitation. PMID:9758380

  7. Transcatheter treatment of chronic mitral regurgitation with the MitraClip system: an Italian consensus statement.

    PubMed

    Maisano, Francesco; Alamanni, Francesco; Alfieri, Ottavio; Bartorelli, Antonio; Bedogni, Francesco; Bovenzi, Francesco M; Bruschi, Giuseppe; Colombo, Antonio; Cremonesi, Alberto; Denti, Paolo; Ettori, Federica; Klugmann, Silvio; La Canna, Giovanni; Martinelli, Luigi; Menicanti, Lorenzo; Metra, Marco; Oliva, Fabrizio; Padeletti, Luigi; Parolari, Alessandro; Santini, Francesco; Senni, Michele; Tamburino, Corrado; Ussia, Gian P; Romeo, Francesco

    2014-03-01

    New percutaneous technologies are rapidly emerging for the treatment of structural heart disease including mitral valve disease. Preliminary data suggest a potential clinical benefit of percutaneous treatment of mitral regurgitation by the MitraClip procedure in selected patients. Until final data are available from randomized, controlled, multicenter clinical trials, there is an urgent need for a consensus among all the operators involved in the treatment of patients with mitral regurgitation, including clinical cardiologists, heart failure specialists, surgeons, interventional cardiologists, and imaging experts. In the absence of evidence-based guidelines, the heart-team approach is the most reliable method of making proper decisions. This study is the result of multidisciplinary consensus activity, and has the aim of helping physicians in the difficult task of making decisions for the treatment of patients with mitral regurgitation. It is the result of a joint effort of the major Italian Cardiology and Cardiac Surgery Societies, working together to find a proper balance between the points of view of the clinical cardiologist, the interventional cardiologist, and the cardiac surgeon. PMID:24662461

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

    PubMed

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

    2010-03-01

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

  9. Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus.

    PubMed

    Wartak, Siddharth; Akkad, Isaac; Sadiq, Adnan; Crooke, Gregory; Moskovits, Manfred; Frankel, Robert; Hollander, Gerald; Shani, Jacob

    2016-01-01

    A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy. PMID:27610249

  10. Surgical mitral valve intervention following a failed MitraClip procedure.

    PubMed

    Elhmidi, Yacine; Voss, Bernhard; Lange, Rüdiger

    2016-09-18

    The MitraClip procedure has shown promising results in patients with high surgical risk. However, data concerning outcomes of open mitral valve surgery for failed MitraClip procedures are sparse. In a retrospective clinical investigation, baseline characteristics, intraoperative and histopathological findings, surgical indications and results of patients who required surgery after a failed MitraClip procedure were collected. Between March 2010 and May 2016, 25 patients presented at our department with severe mitral valve regurgitation following a failed MitraClip procedure. Leaflet destruction or severe adhesions between leaflets and the implanted clip were the commonest intraoperative findings. Upon surgery, the mitral valve was either repaired (n=5, 20%) or replaced (n=20, 80%) with a biological prosthesis. Four patients who had presented in cardiogenic shock prior to the operation died within the first 30 days. In the majority of cases, mitral valve replacement is preferred over repair due to severe leaflet damage following the MitraClip procedure. Only those patients who present in cardiogenic shock are at extremely high risk for in-hospital mortality. PMID:27640017

  11. Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches.

    PubMed

    Lehr, Eric J; Guy, T Sloane; Smith, Robert L; Grossi, Eugene A; Shemin, Richard J; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K; Fayers, Trevor M; Hargrove, W Clark; Hummel, Brian W; Khan, Junaid H; Malaisrie, S Chris; Mehall, John R; Murphy, Douglas A; Ryan, William H; Salemi, Arash; Segurola, Romualdo J; Smith, J Michael; Wolfe, J Alan; Weldner, Paul W; Barnhart, Glenn R; Goldman, Scott M; Lewis, Clifton T P

    2016-01-01

    Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

  12. Mitral valvuloplasty: when the art of repair meets the biological science.

    PubMed

    Spadaccio, Cristiano; Gutermann, Herbert; Dion, Robert

    2014-05-01

    The majority of approaches currently described and practiced in mitral repair surgery result in the vertical immobilization of the posterior leaflet, with the anterior leaflet striving to produce an adequate coaptation. Despite the satisfactory hemodynamic outcome and disappearance of mitral regurgitation, this non-physiological situation results in a redistribution of forces within the mitral apparatus with an increased stress on the leaflets. Biological evidences are pointing at the ability of the valvular interstitial cells to actively respond to biomechanical changes, switching their phenotype and producing different patterns of extracellular matrix proteins. This biological event translates to changes in the anatomical and mechanical properties of the leaflets, leading to an increased stiffening and a susceptibility to develop calcification. These concepts find a clinical reflex in reports on the long-term thickening and calcification of the leaflets after mitral repair, and in the leaflets remodeling phenomena described in chronically dilated ventricles. The importance of respecting the physiological movement and dynamics of the leaflets when performing a valvuloplasty is underlined, and a potential pharmacological modulation of the aforementioned biological processes to ameliorate long-term results of the repair is hypothesized.

  13. Perforation of the Anterior Mitral Leaflet After Impella LP 5.0 Therapy in Cardiogenic Shock.

    PubMed

    Eftekhari, Ashkan; Eiskjær, Hans; Terkelsen, Christian Juhl; Nielsen, Sten Lyager; Christiansen, Evald Høj; Poulsen, Steen Hvitfeldt

    2016-05-01

    A 52-year old man was admitted with out-of-hospital cardiac arrest, and he was resuscitated after 100 minutes. The initial hemodynamic condition was critical due to cardiogenic shock (left ventricular ejection fraction 10 % and mean arterial pressure 60 mmHg on inotropics). Acute coronary angiography did not reveal any new lesions. Due to persistent hemodynamic instability, mechanical support with Impella LP 5.0 was decided. The surgical procedure guided by fluoroscopy and transesophageal echocardiography was uncomplicated. The hemodynamic improved subsequently and after 17 days of intensive care, and additional 30 days of hospitalization, the patient was ready for discharge. Routine echocardiography prior to discharge revealed severe mitral regurgitation due to perforation of anterior mitral leaflet, a finding not observed in the previous echocardiograms. The patient was discharged to close follow up of the severe mitral regurgitation and future surgical intervention is likely. Therefore, close monitoring of mitral valve is necessary and explanation may be required if valve dysfunction is observed, as repositioning of the Impella system is not possible.

  14. Premature valve closure in patients with a mitral Starr-Edwards prosthesis and aortic incompetence

    PubMed Central

    Agnew, T. M.; Carlisle, R.

    1970-01-01

    A mitral Starr-Edwards ball valve has, in three patients with concomitant aortic incompetence, permitted recognition of intermittent premature valve closure by auscultation and this has been documented by phonocardiograms. In two instances the observations were confirmed during cardiac catheterization. The features of premature Starr valve closure are described and the mechanism is discussed. Images PMID:5433303

  15. 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.

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

    PubMed Central

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

    1980-01-01

    Two cases are described in which severe mechanical haemolytic anaemia developed shortly after operation for repair of non-rheumatic mitral regurgitation. One patient had a "floppy" valve and the other cleft mitral leaflets, and both had chordal rupture. In both there was residual regurgitation after repair though in one this was initially only trivial. Clinically manifest haemolysis ceased after replacement of the valve by a frame-mounted xenograft. There are two previously reported cases in which haemolytic anaemia followed an unsuccessful mitral valve repair operation. Subclinical haemolysis or mild haemolytic anaemia may occur with unoperated valve lesions, but hitherto frank haemolytic anaemia has been observed only when turbulent blood flow is associated with the presence of a prosthetic valve or patch of prosthetic fabric. In these four cases, however, polyester or Teflon sutures were the only foreign material, and it is suggested that when these are used for the repair of leaflets, particularly in non-rheumatic mitral valve disease, they may increase the damaging effect of turbulence on circulating red blood cells. PMID:7426198

  17. Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus

    PubMed Central

    Wartak, Siddharth; Sadiq, Adnan; Crooke, Gregory; Moskovits, Manfred; Frankel, Robert; Hollander, Gerald; Shani, Jacob

    2016-01-01

    A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy.

  18. Native mitral valve endocarditis due to Rhizobium Radiobacter - first case report.

    PubMed

    Guerra, Nuno Carvalho; Nobre, Angelo; Cravino, João

    2013-01-01

    Rhizobium Radiobacter (RR) has rarely been associated with human infection, mainly sepsis or bacteremia, and an unique case of prosthetic aortic endocarditis has been reported. We present a case of native mitral valve endocarditis to RR, to our knowledge the first clinical report of such infection.

  19. Optimal Surgical Management of Severe Ischemic Mitral Regurgitation: To Repair or to Replace?

    PubMed Central

    Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

    2013-01-01

    Background Ischemic mitral regurgitation (MR), a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results This paper describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic (CT) Surgical Trials Network. This paper addresses challenges in selecting a feasible primary endpoint, characterizing the target population (including the degree of MR), and analytical challenges in this high mortality disease. Conclusions The paper concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life and cardiac physiology in therapeutic decision-making. PMID:22054660

  20. Differential MicroRNA Expression Profile in Myxomatous Mitral Valve Prolapse and Fibroelastic Deficiency Valves

    PubMed Central

    Chen, Yei-Tsung; Wang, Juan; Wee, Abby S. Y.; Yong, Quek-Wei; Tay, Edgar Lik-Wui; Woo, Chin Cheng; Sorokin, Vitaly; Richards, Arthur Mark; Ling, Lieng-Hsi

    2016-01-01

    Myxomatous mitral valve prolapse (MMVP) and fibroelastic deficiency (FED) are two common variants of degenerative mitral valve disease (DMVD), which is a leading cause of mitral regurgitation worldwide. While pathohistological studies have revealed differences in extracellular matrix content in MMVP and FED, the molecular mechanisms underlying these two disease entities remain to be elucidated. By using surgically removed valvular specimens from MMVP and FED patients that were categorized on the basis of echocardiographic, clinical and operative findings, a cluster of microRNAs that expressed differentially were identified. The expressions of has-miR-500, -3174, -17, -1193, -646, -1273e, -4298, -203, -505, and -939 showed significant differences between MMVP and FED after applying Bonferroni correction (p < 0.002174). The possible involvement of microRNAs in the pathogenesis of DMVD were further suggested by the presences of in silico predicted target sites on a number of genes reported to be involved in extracellular matrix homeostasis and marker genes for cellular composition of mitral valves, including decorin (DCN), aggrecan (ACAN), fibromodulin (FMOD), α actin 2 (ACTA2), extracellular matrix protein 2 (ECM2), desmin (DES), endothelial cell specific molecule 1 (ESM1), and platelet/ endothelial cell adhesion molecule 1 (PECAM1), as well as inverse correlations of selected microRNA and mRNA expression in MMVP and FED groups. Our results provide evidence that distinct molecular mechanisms underlie MMVP and FED. Moreover, the microRNAs identified may be targets for the future development of diagnostic biomarkers and therapeutics. PMID:27213335

  1. 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.

  2. Procedural guidance using advance imaging techniques for percutaneous edge-to-edge mitral valve repair.

    PubMed

    Quaife, Robert A; Salcedo, Ernesto E; Carroll, John D

    2014-02-01

    The complexity of structural heart disease interventions such as edge-to edge mitral valve repair requires integration of multiple highly technical imaging modalities. Real time imaging with 3-dimensional (3D) echocardiography is a relatively new technique that first, allows clear volumetric imaging of target structures such as the mitral valve for both pre-procedural diagnosis and planning in patients with degenerative or functional mitral valve regurgitation. Secondly it provides intra-procedural, real-time panoramic volumetric 3D view of structural heart disease targets that facilitates eye-hand coordination while manipulating devices within the heart. X-ray fluoroscopy and RT 3D TEE images are used in combination to display specific targets and movement of catheter based technologies in 3D space. This integration requires at least two different image display monitors and mentally fusing the individual datasets by the operator. Combined display technology such as this, allow rotation and orientation of both dataset perspectives necessary to define targets and guidance of structural disease device procedures. The inherently easy concept of direct visual feedback and eye-hand coordination allows safe and efficient completion of MitraClip procedures. This technology is now merged into a single structural heart disease guidance mode called EchoNavigator(TM) (Philips Medical Imaging Andover, MA). These advanced imaging techniques have revolutionized the field of structural heart disease interventions and this experience is exemplified by a cooperative imaging approach used for guidance of edge-to-edge mitral valve repair procedures.

  3. Acute renal infarction secondary to calcific embolus from mitral annular calcification.

    PubMed

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

    2011-06-01

    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.

  4. Papillary muscle traction in mitral valve prolapse: quantitation by two-dimensional echocardiography.

    PubMed

    Sanfilippo, A J; Harrigan, P; Popovic, A D; Weyman, A E; Levine, R A

    1992-03-01

    Previous angiographic observations in patients with mitral valve prolapse have suggested that superior leaflet displacement results in abnormal superior tension on the papillary muscle tips that causes their superior traction or displacement. It has further been postulated that such tension can potentially affect the mechanical and electrophysiologic function of the left ventricle. The purpose of this study was to confirm and quantitate this phenomenon noninvasively by using two-dimensional echocardiography to determine whether superior displacement of the papillary muscle tips occurs and its relation to the degree of mitral leaflet displacement. Directed echocardiographic examination of the papillary muscles and mitral anulus was carried out in a series of patients with classic mitral valve prolapse and results were compared with those in a group of normal control subjects. Distance from the anulus to the papillary muscle tip was measured both in early and at peak ventricular systole. In normal subjects, this distance did not change significantly through systole, whereas in the patient group it decreased, corresponding to a superior displacement of the papillary muscle tips toward the anulus in systole (8.5 +/- 2.6 vs. 0.8 +/- 0.7 mm; p less than 0.0001). This superior papillary muscle motion paralleled the superior displacement of the leaflets in individual patients (y = 1.0x + 0.8; r = 0.93) and followed a similar time course.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Differential MicroRNA Expression Profile in Myxomatous Mitral Valve Prolapse and Fibroelastic Deficiency Valves.

    PubMed

    Chen, Yei-Tsung; Wang, Juan; Wee, Abby S Y; Yong, Quek-Wei; Tay, Edgar Lik-Wui; Woo, Chin Cheng; Sorokin, Vitaly; Richards, Arthur Mark; Ling, Lieng-Hsi

    2016-01-01

    Myxomatous mitral valve prolapse (MMVP) and fibroelastic deficiency (FED) are two common variants of degenerative mitral valve disease (DMVD), which is a leading cause of mitral regurgitation worldwide. While pathohistological studies have revealed differences in extracellular matrix content in MMVP and FED, the molecular mechanisms underlying these two disease entities remain to be elucidated. By using surgically removed valvular specimens from MMVP and FED patients that were categorized on the basis of echocardiographic, clinical and operative findings, a cluster of microRNAs that expressed differentially were identified. The expressions of has-miR-500, -3174, -17, -1193, -646, -1273e, -4298, -203, -505, and -939 showed significant differences between MMVP and FED after applying Bonferroni correction (p < 0.002174). The possible involvement of microRNAs in the pathogenesis of DMVD were further suggested by the presences of in silico predicted target sites on a number of genes reported to be involved in extracellular matrix homeostasis and marker genes for cellular composition of mitral valves, including decorin (DCN), aggrecan (ACAN), fibromodulin (FMOD), α actin 2 (ACTA2), extracellular matrix protein 2 (ECM2), desmin (DES), endothelial cell specific molecule 1 (ESM1), and platelet/ endothelial cell adhesion molecule 1 (PECAM1), as well as inverse correlations of selected microRNA and mRNA expression in MMVP and FED groups. Our results provide evidence that distinct molecular mechanisms underlie MMVP and FED. Moreover, the microRNAs identified may be targets for the future development of diagnostic biomarkers and therapeutics. PMID:27213335

  6. Surgical management of ischemic mitral regurgitation: indications, procedures, and future prospects.

    PubMed

    Yaku, Hitoshi; Doi, Kiyoshi; Okawa, Kazunari

    2013-09-01

    Ischemic mitral regurgitation (IMR) is one of the most important risk factors affecting prognosis of patients who suffer from myocardial infarction. The mechanisms of IMR, the indications for surgical intervention, the operative procedures, and the limitations of surgical procedures are discussed in this review article.

  7. A Congenital Gerbode Defect associated with a Rare Structural Abnormality of the Mitral Valve Diagnosed in an Adult Patient

    PubMed Central

    Mateescu, Anca D.; Beladan, Carmen C.; Radulescu, Bogdan; Ginghina, Carmen; Popescu, Bogdan A.

    2016-01-01

    We report the case of a rare association of a congenital Gerbode defect with severe mitral regurgitation due to abnormal linear structure of mitral valve, diagnosed in an adult patient. The case highlights the importance of a thorough examination interpreting the echocardiographic findings on a pathophysiological basis. It also underlines the complementary role of different imaging techniques with transesophageal echocardiography, allowing the precise assessment of both structural and functional abnormalities in such a complex case. The patient underwent mitral valve replacement with a bileaflet mechanical prosthesis and repair of the Gerbode defect. The imaging findings were confirmed during the surgical procedure, leading to a good outcome. PMID:27721869

  8. 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

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

    PubMed Central

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

    1983-01-01

    Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the reliability of these measurements cross sectional echocardiographic and angiographic left atrial volumes were compared in 19 patients with mitral valve disease, giving an excellent correlation. A moderate correlation was found between the anteroposterior dimension of the left atrium obtained using M mode echocardiography and that obtained using the parasternal short axis and long axis projections. In normal subjects a good correlation was found between SI and ML dimensions, while a lower correlation was found between SI and AP, and ML and AP dimensions. The SI dimension was the major axis of the left atrium and AP dimension the minor axis. In patients with mitral valve disease a good correlation was found between SI and ML dimensions, while SI and ML dimensions had a low correlation with AP dimensions. The AP dimension was the minor axis of the left atrium, while the SI and ML dimensions were not significantly different. All left atrial dimensions were significantly greater in patients with mitral valve disease than in normal subjects. Of 30 patients with at least one dimension increased, all three dimensions were abnormal in 16, two dimensions were increased in 10, and only one dimension was increased in four. AP, SI, and ML dimensions were abnormal in 25, 20, and 27 patients, respectively. Cross sectional echocardiography may provide a reliable estimate of left atrial dimensions. In patients with mitral valve disease a thorough examination of the left atrium using multiple cross sectional views is necessary to detect asymmetric left atrial enlargement and to measure

  10. 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.

  11. 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

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

    PubMed

    Vismara, Riccardo; Fiore, Gianfranco B

    2010-12-01

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

  13. Percutaneous mitral commisurotomy during pregnancy - A report of two cases performed in a United Kingdom tertiary centre and a review of the literature.

    PubMed

    Kapoor, Dipanwita; Choudhary, Ferrah; Smith, William Ht; Wallace, Suzanne

    2015-12-01

    We report two cases of severe mitral stenosis where percutaneous mitral commisurotomy was performed within pregnancy. The first case involves an emergency procedure for a new diagnosis of severe mitral stenosis in a woman presenting with pulmonary oedema at 27 weeks' gestation. The second case is of a woman known to have mitral stenosis who underwent a semi-elective procedure for deterioration in symptoms. This procedure is not commonly performed in the United Kingdom because of low incidence of rheumatic heart disease. In addition, percutaneous mitral commisurotomy during pregnancy is rarely performed in the United Kingdom because of the improved healthcare system where majority of the women with moderate to severe mitral stenosis (even asymptomatic) will undergo planned interventions (percutaneous mitral commisurotomy or mitral valve surgery) before contemplating pregnancy. These cases highlight both the acute and chronic presentations of mitral stenosis and the impact pregnancy has on this condition. In addition, these cases show the importance of retaining skills in performing percutaneous mitral commisurotomy within our United Kingdom cardiologists.

  14. The effect of some drugs on the mitral cell odor-evoked responses in the gecko olfactory bulb.

    PubMed

    Tonosaki, K; Shibuya, T

    1985-01-01

    The activity of odor-evoked olfactory mitral cell response of the gecko was recorded extracellularly by glass microelectrodes. The activities of the mitral cell observed during the presentation of the odor (n-amyl acetate) could be described as excitation, suppression or zero. The present experiments were undertaken to study the neural activities of the mitral cell in the olfactory bulb by perfusion application of some drugs (cobalt chloride, carnosine, norepinephrine, GABA and D-L-homocysteate) on the olfactory bulb surface or iontophoretic application of some drugs (carnosine, norepinephrine, GABA and D-L-homocysteate) to the glomerulus and the external plexiform layer to change the physiological environment. The effect of the drugs suggested that the synaptic neurons on the mitral cell have different chemical characteristics.

  15. Successful treatment of severe mechanical mitral valve thrombosis with tissue plasminogen activator in a 7-month-old infant.

    PubMed

    Cheung, Eva W; Aponte-Patel, Linda; Bacha, Emile A; Singh, Rakesh K; Rosenzweig, Erika Berman; Sen, Anita I

    2013-01-01

    Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanical mitral valve thrombus in a 7 month-old patient with trisomy 21, complete atrioventricular canal defect and pulmonary hypertension status post complete atrioventricular canal repair and subsequent prosthetic mitral valve replacement. He presented with respiratory decompensation and shock secondary to severe mechanical mitral valve stenosis. Serial echocardiograms showed significant resolution of the thrombus within 18 h of infusion with no major bleeding complications during the treatment course. Although a rare complication of mechanical valve placement in pediatrics, thrombosis of mechanical valves may result in severe hemodynamic and respiratory compromise. This case demonstrates that thrombolytic therapy is a feasible option for the treatment of critical thrombosis in pediatric patients after MVR.

  16. How to do it: importance of left atrial side retraction in robotic and minimally invasive mitral valve surgery.

    PubMed

    Ishikawa, Norihiko; Sun, You Su; Nifong, L Wiley; Watanabe, Go; Chitwood, W Randolph

    2008-01-01

    A customized transthoracic atrial retractor was previously developed for robotic and minimally invasive mitral valve surgery, but it has sometimes failed to provide sufficient exposure of the mitral valve because some atrial tissues push away the operative field from the right side. This report describes 3 new atrial side retractors (the foldaway retractor, the spoon retractor, and the wired retractor) and their use in performing robotic mitral valve repair in fresh frozen human cadavers. These retractors provided exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery in human cadavers without causing traumatic injury, and these retractors should be useful in live patients because they will be used in arrested hearts.

  17. Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

    PubMed Central

    Islam, AKM Monwarul; Salam, Md. Abdus; Sayeed, Md. Zahidus; Kibria, Md. Golam

    2015-01-01

    Spontaneous echo contrast (SEC) and thrombus in enlarged left atrium (LA) are common in mitral valvular disease (MVD) and SEC is considered to be a prethrombotic condition. Reliable exclusion of LA thrombus is important before any definitive curative attempts like percutaneous transluminal mitral commissurotomy (PTMC), closed mitral commissurotomy (CMC) or innovative therapies like pulmonary vein isolation and percutaneous closure of the LA appendage. Echocardiography, particularly the transesophageal echocardiography (TEE) is considered to be the gold standard for the diagnosis and to exclude LA thrombus. However, LA thrombus may remain rarely undetected even by TEE potentially making the interventions a risky job. We present a case of mitral stenosis (MS) with giant LA where profuse, dense SEC masked the underlying thrombus in the LA cavity. PMID:26649032

  18. Lesions of the mitral valve as a cause of central retinal artery occlusion: presentation and discussion of two cases.

    PubMed

    Ayati, Maryam; Gori, Tommaso; Münzel, Thomas

    2010-01-01

    We present two cases of mitral valve lesions that manifested with unilateral blindness caused by central retinal artery occlusion (CRAO): Case 1. A 68-year-old woman was admitted to our clinic for sudden blindness. Retinal artery angiogram showed CRAO. Transthoracic and transesophageal echocardiography (TEE) documented a mass attached to the ventricular side of the posterior mitral leaflet, which at pathology was identified as a blood cyst. Case 2. A 67-year-old man was admitted for a sudden unilateral painless loss of vision. Retinal angiogram documented CRAO, and TEE showed a highly mobile, spherical, lesion on the atrial side of anterior mitral leaflet. In this case, the pathological finding was a degenerated calcified thrombosis. We report on two cases of very rare abnormalities of the mitral valve presenting with a very rare embolic complication, i.e., CRAO. Like for cryptogenic stroke, transesophageal echocardiography plays a central role in the diagnosis of cardiogenic embolic sources. PMID:20070361

  19. 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.

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

    PubMed

    Hendzel, Piotr; Suwalski, Grzegorz; Gryszko, Leszek; Szałański, Przemysław; Gołowicz, Jarosław; Gierak, Ewa

    2012-01-01

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

  1. 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

  2. A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during minimally invasive mitral valve surgery.

    PubMed

    Solinas, Marco; Bevilacqua, Stefano; Karimov, Jamshid H; Glauber, Mattia

    2010-04-01

    Minimally invasive mitral valve surgery is becoming increasingly popular worldwide. Mitral valve disease is often associated with atrial fibrillation (AF), also due to the ageing of the population. We present a technique to perform a left atrial ablation with bipolar irrigated radio-frequency (RF) through a single right thoracotomy. We have operated on eight patients: six female with a mean age 68+/-8 years. Six patients suffered from permanent AF and other two from paroxysmal AF. PMID:19942447

  3. Thrombo-embolic complications of the cloth-covered Starr-Edwards prostheses No. 2300 aortic and No. 6300 mitral

    PubMed Central

    Cleland, J.; Molloy, P. J.

    1973-01-01

    The thrombo-embolic complications of the cloth-covered Starr-Edwards prostheses No. 2300 aortic and No. 6300 mitral followed for an average of 14 months in 155 patients are reviewed. There was a high incidence of early fatal and disabling thrombo-embolus in patients having mitral valve replacement. Late emboli were more common after aortic valve replacement. Anticoagulant control was unsatisfactory and not without hazards. PMID:4685210

  4. How I do it: self-retaining atrial retractors for robotic and minimally invasive mitral valve surgery.

    PubMed

    Ishikawa, Norihiko; Sun, You Su; Nifong, L Wiley; Watanabe, Go; Chitwood, W Randolph

    2007-01-01

    Successful surgery, particularly on the heart valves, is dependent on excellent and consistent exposure of the operative field. In this report, we describe 2 types of new atrial retractors designed for robotic and minimally invasive mitral valve surgery. These simple and easy-to-handle atrial retractors provide exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery and prevent traumatic injury.

  5. 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.

  6. Design, Rationale, and Initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial: A Report from the Cardiothoracic Surgical Trials Network

    PubMed Central

    Smith, Peter K.; Michler, Robert E.; Woo, Y. Joseph; Alexander, John H.; Puskas, John D.; D’Alessandro, David A.; Hahn, Rebecca T.; Williams, Judson B.; Dent, John M.; Ferguson, T. Bruce; Moquete, Ellen; Pagé, Pierre; Jeffries, Neal O.; O’Gara, Patrick T.; Ascheim, Deborah D.

    2011-01-01

    Background Patients with moderate ischemic mitral regurgitation have demonstrably poorer outcome compared to coronary artery disease patients without mitral regurgitation. The optimal treatment of this condition has become increasingly controversial and a randomized trial evaluating current practices is warranted. Methods and Results We describe the design and initial execution of the Cardiothoracic Surgical Trials Network moderate ischemic mitral regurgitation trial. This is an ongoing prospective, multi-center, randomized, controlled clinical trial designed to test the safety and efficacy of mitral repair in addition to coronary artery bypass grafting in the treatment of moderate ischemic mitral regurgitation. Conclusion The results of the Cardiothoracic Surgical Trials Network ischemic mitral regurgitation trials will provide long-awaited information on controversial therapies for a morbid disease process. PMID:21788032

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

    PubMed

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

    2015-08-01

    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.

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

    PubMed

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

    2012-10-01

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

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

    PubMed

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

    2015-08-01

    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

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

    PubMed

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

    2012-10-01

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

  11. Multiple periannular defects after an inadequate mitral valve repair procedure and unsuccessful redo valve surgery with pericardial patches in an elderly patient

    PubMed Central

    Avci, Anil; Yanartas, Mehmed; Tabakci, Mehmet Mustafa; Acar, Emrah; Ozkan, Mehmet

    2016-01-01

    The fastest growing demographic group in Europe and America is the elderly, and significant mitral regurgitation is very prevalent in this population. At present, with mitral valve surgery in elderly individuals gaining greater acceptance worldwide, the question whether to repair or replace the valve remains controversial. Recent studies have demonstrated the safety, feasibility, and durability of repair over replacement in elderly patients. Herein, we report the case of an elderly patient who underwent surgical re-interventions on the mitral valve following an unsuccessful mitral valve repair procedure. PMID:27516787

  12. Percutaneous transcatheter closure of mitral paravalvular leak via transarterial retrograde approach

    PubMed Central

    Yu, Ho-Ping; Huang, Chi-Hung; Hou, Shaw-Min; Hsiung, Ming-Chon; Tsai, Shen-Kou; Yin, Wei-Hsian

    2015-01-01

    Repeat surgery has usually been considered the first choice to solve paravalvular leaks of prosthetic valves, but it carries a high operative risk, a high mortality rate and an increased risk for re-leaks. Percutaneous closure of such defects is possible, and different approaches and devices are used for this purpose. For mitral paravalvular leaks, constructing an arterio-venous wire loop for delivering the closure device through an antegrade approach is the most commonly used technique. Transcatheter closure can also be performed through a transapical approach or retrograde transfemoral arterial approach. We present a case of 68-year-old man with a mitral paravalvular leak that was successfully closed using an Amplatzer® Duct Occluder II, via retrograde transfemoral arterial approach under three-dimensional transesophageal echocardiographic guidance, without the use of a wire loop. The initial attempt to cross the paravalvular defect was unsuccessful, but the obstacle was finally overcome by introducing complex interventional techniques. PMID:26788047

  13. Congenital quadricuspid aortic valve associated with aortic insufficiency and mitral regurgitation

    PubMed Central

    2013-01-01

    Congenital quadricuspid aortic valve is a rare cardiac anomaly. More than half of the patients with this abnormality will develop aortic insufficiency in adulthood. It is vital that patients with quadricuspid aortic valve who present with progressive aortic regurgitation undergo valve replacement or repair at appropriate time. Here, we present two cases of quadricuspid aortic valve. We first describe a 58-year-old man who had mitral regurgitation and ascending aorta dilatation with quadricuspid aortic valve. He underwent aortic valve replacement and mitral valve plasty and recovered well. The second patient is a 20-year-old asymptomatic boy who has been closely followed up and has not received any surgical treatment. PMID:23587156

  14. Congenital quadricuspid aortic valve associated with aortic insufficiency and mitral regurgitation.

    PubMed

    Zhu, Jiaquan; Zhang, Junwen; Wu, Shubin; Zhang, Yunjiao; Ding, Fangbao; Mei, Ju

    2013-01-01

    Congenital quadricuspid aortic valve is a rare cardiac anomaly. More than half of the patients with this abnormality will develop aortic insufficiency in adulthood. It is vital that patients with quadricuspid aortic valve who present with progressive aortic regurgitation undergo valve replacement or repair at appropriate time. Here, we present two cases of quadricuspid aortic valve. We first describe a 58-year-old man who had mitral regurgitation and ascending aorta dilatation with quadricuspid aortic valve. He underwent aortic valve replacement and mitral valve plasty and recovered well. The second patient is a 20-year-old asymptomatic boy who has been closely followed up and has not received any surgical treatment. PMID:23587156

  15. Rare early prosthesis obstruction after mitral valve replacement: a case report and literature review

    PubMed Central

    2012-01-01

    As a dreadful complication after the mechanical heart valve replacement, prosthetic valve obstruction caused by pannus formation occurs increasingly with time. The authors here present a case of 42-year-old woman who was urgently admitted to hospital with acute heart failure symptoms due to the mechanical mitral valve failure only 3 months after surgery. Transthoracic and transesophageal echocardiography demonstrated that the bileaflet of the mitral prosthesis were completely immobilized with only a small transvalvular jet remained. During the reoperation, the reason of the prosthetic valve obstruction was attributed to the noncircular pannus ingrowth extending from the atrioventricular side. For a better understanding of the prosthetic valve dysfunction caused by pannus formation, the authors then compile a literature review to briefly discuss the status quo of the clinical characteristics of this uncommon complication. PMID:22747990

  16. Staphylococcus hominis native mitral valve bacterial endocarditis (SBE) in a patient with hypertrophic obstructive cardiomyopathy.

    PubMed

    Cunha, Burke A; Esrick, Michael D; Larusso, Melissa

    2007-01-01

    There are several species of coagulase-negative Staphylococci (CoNS) that are part of the normal skin flora and are relatively noninvasive/low virulence organisms. CoNS are important pathogens in patients with prosthetic devices and are the most common pathogen associated with prosthetic valve endocarditis. CoNS native valve infective endocarditis (IE) is rare. Patients with hypertrophic obstructive cardiomyopathy and an outflow pressure gradient greater than 30 mm Hg are predisposed to IE. There has been only one reported case of non-mitral valve IE due to CoNS in a patient with hypertrophic obstructive cardiomyopathy. To the best of our knowledge, we report the first case of Staphylococcal hominis mitral valve endocarditis in a patient with hypertrophic obstructive cardiomyopathy.

  17. Fibrinolytic Treatment after Transient Ischaemic Attack Caused by Prosthetic Mitral Valve Thrombosis

    PubMed Central

    Neuß, Michael; Tambor, Grit; Hölschermann, Frank; Butter, Christian

    2016-01-01

    Prosthetic valve thrombosis is one of the most severe complications after surgical valve replacement. There are many possible presentations: from asymptomatic to life-threatening complications. We report on a 61-year-old female patient with prosthetic replacement of the aortic and mitral valve in the in-house department of cardiac surgery 3 months ago. The patient was suffering from aphasia during 5 minutes in domesticity. After her presentation in the emergency room, the echocardiographic examination revealed a thrombotic formation of the prosthetic mitral valve. At presentation, the anticoagulation was outside the effective range (INR: 1.7). A successful thrombolytic therapy with the plasminogen activator urokinase was begun with complete resolution of the thrombus. PMID:27313908

  18. Intrapericardial rupture of a mitral subannular aneurysm: A case report and review of the literature.

    PubMed

    Diop, I B; Leye, M; Diallo, A D; Sarr, E H M; Manga, S J; Diene, L L; Jobe, M

    2016-04-01

    Mitral subannular aneurysm is a rare heart disease that can have many different forms of clinical presentations. It was first described in young men of African descent and was later reported in other geographical areas of the world. The etiopathogenesis as per data from the literature can be congenital, acquired or idiopathic. We report the case of a 19-year-old male in whom we made the diagnosis of mitral subannular aneurysm. The evolution was fatal following a rupture of the aneurysm into the pericardium. Through this case report, we stress the importance of echocardiography in the diagnosis of this condition. In resource-limited countries, the prognosis is unfortunately often unfavorable especially the ruptured forms. Therefore, a high degree of suspicion is needed to make a prompt diagnosis and timely surgical intervention. PMID:25702237

  19. Sexual dimorphism in accessory olfactory bulb mitral cells: a quantitative Golgi study.

    PubMed

    Caminero, A A; Segovia, S; Guillamón, A

    1991-01-01

    The purpose of the present study was to identify the existence of sexual dimorphism in the dendritic field of accessory olfactory bulb mitral cells in rats and to investigate the effects of male orchidectomy and female androgenization on the day of birth upon this dendritic field. The rapid Golgi method was used to conduct a quantitative study of various characteristics of the dendritic field of accessory olfactory bulb mitral cells. The results indicated greater values for males than females for the following characteristics: (i) somatic area; (ii) degree of branching in the dendritic field; (iii) total dendritic length; and (iv) dendritic density around the neuronal soma. Orchidectomy of males, as well as androgenization of females, on the day of birth inverted these differences.

  20. 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

  1. Critical evaluation of the MitraClip system in the management of mitral regurgitation

    PubMed Central

    Deuschl, Florian; Schofer, Niklas; Lubos, Edith; Blankenberg, Stefan; Schäfer, Ulrich

    2016-01-01

    The MitraClip (MC) system is a device for percutaneous, transseptal edge-to-edge reconstruction of the mitral valve (MV) in patients with severe mitral regurgitation (MR) not eligible for surgery. Recently, a number of studies have underlined the therapeutic benefit of the MC system for patients with extreme and high risk for MV surgery suffering from either degenerative or functional MR. The MC procedure shows negligible intraprocedural mortality, low periprocedural complication rates, and a significant reduction in MR, as well as an improvement in functional capacity and most importantly quality of life. Presently, the MC system has become an additional interventional tool in the concert of surgical methods. It hereby enlarges the spectrum of MV repair for the Heart Team. Lately, many reviews focused on the MC system. The current review describes the developments in the treatment of MR with the MC system. PMID:26811687

  2. Successful treatment of mechanical mitral valve thrombosis without thrombolytic therapy or surgery.

    PubMed

    Al Habib, Hamad F; Tarola, Christopher; Diamantorous, Pantelis; Chu, Michael W A

    2013-11-01

    Prosthetic valve thrombosis is an uncommon, life-threatening complication that often mandates urgent repeat surgery or thrombolytic therapy. We present an alternative approach in a patient with rheumatic heart disease who presented with subacute thrombosis of a recently implanted On-X mechanical mitral valve (On-X Life Technologies Inc, Austin, TX), diagnosed on echocardiography and valve fluoroscopy. The patient refused surgery, hence we elected to treat the patient with high-dose antithrombotic therapy alone. Echocardiographic monitoring demonstrated complete reabsorption of the thrombus within 6 months without any embolic complications. Endogenous fibrinolysis with appropriate antithrombotic therapy might be a suitable option for select, high-risk patients with mechanical mitral valve thrombosis.

  3. Mortality after percutaneous edge-to-edge mitral valve repair: a contemporary review

    PubMed Central

    de Beenhouwer, Thomas; Swaans, Martin J.; Post, Marco C.; van der Heyden, Jan A. S.; Eefting, Frank D.; Rensing, Benno J. W. M.

    2016-01-01

    Percutaneous edge-to-edge mitral valve (MV) repair is a relatively new treatment option for mitral regurgitation (MR). After the feasibility and safety having been proved in low-surgical-risk patients, the use of this procedure has shifted more to the treatment of high-risk patients. With the absence of randomized controlled trials (RCT) for this particular subgroup, observational studies try to add evidence to the safety aspect of this procedure. These also provide short- and mid-term mortality figures. Several mortality predictors have been identified, which may help the optimal selection of patients who will benefit most from this technique. In this article we provide an overview of the literature about mortality and its predictors in patients treated with the percutaneous edge-to-edge device. PMID:27054105

  4. 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

  5. Modified Valsalva Maneuver for Venous Cannulation in Cardiopulmonary Bypass for Minimal Incision Mitral Valve Surgery.

    PubMed

    Rajaratnam, Kawryshanker; Tak, Chaitanya; Alexander, Sweeka; Passage, Jurgen

    2016-01-01

    A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulations such as withdrawing and reinserting, twisting, and to-and-fro movements did not result in success. Eventually, we attempted a novel maneuver, the modified "Valsalva maneuver," that worked incredibly well. PMID:27532301

  6. Disc wear and entrapment in a Starr-Edwards mitral caged-disc valve.

    PubMed

    Aoyagi, Shigeaki; Fukunaga, Shuji; Arinaga, Koichi

    2011-07-01

    A case of wear and entrapment of a polyethylene disc observed in a Starr-Edwards (SE) mitral caged-disc valve at 37 years after implantation is reported. A 66-year-old woman who had undergone mitral valve replacement with a SE disc valve 37 years previously was admitted to the authors' hospital. Cinefluoroscopy showed the polyethylene disc of the SE valve to have impinged against a calcified mass on the left ventricular posterior wall, causing a tipping motion of the disc during opening. The valve was successfully replaced at surgery. A macroscopic examination of the excised valve revealed wear of the polyethylene disc at sites where the disc abutted the cage struts, and where it impinged on the calcified mass. The long-term durability of the SE caged-disc valves has been favorable; however, when implanted for over 20 years, they should be carefully followed up.

  7. [Incidentally detected bronchial artery aneurysm with combined operation for mitral regurgitation;report of a case].

    PubMed

    Sato, Hisashi; Oteki, Hitoshi; Naito, Kozo; Yunoki, Junji

    2015-02-01

    A 77-year-old woman was admitted to the hospital for heart failure with orthopnea. Echocardiography revealed massive mitral regurgitation. During preoperative cardiac catheterization, an aneurysm was indentified incidentally just below the tracheal carina. Three dimensional computed tomography showed three bronchial artery aneurysms behind the pulmonary artery and the left atrium. The proximal aneurysm was the largest and was 22 mm in diameter. It was resected by retracting the ascending aorta to the left, the superior vana cava to the right and right pulmonary artery cranially under cardiopulmonary bypass, and mitral valve plasty was performed. We believed that resection of the proximal aneurysm would cause thrombotic occlusion of the other 2 aneurysms. Bronchial artery aneurysm is a rare entity that is observed in fewer than 1% of those who undergo selective bronchial arteriography. In addition, because bronchial artery aneurysm is a potentially life-threatening lesion, it should be treated promptly when diagnosed.

  8. [Morphogenesis of mitral valve calcification in rheumatism and the significance of the petrifications in surgical practice].

    PubMed

    Mozhina, A A; Krymskiĭ, L D; Chekareva, G A; Nestaĭko, G V

    1981-01-01

    Eighty-five calcified mitral valves were examined histologically and histochemically and 28 valves were examined in the scanning electron microscope. Different forms of calcification were discovered in rheumatic sclerosis of the mitral valve: dust-like, laminar petrifact, large-tuberous petrifact with protein apoplexy. The cardiac valve calcification in rheumatic fever is preceeded by local dystrophic changes of collagen fibers which undergo swelling, homogenization, and become picrinophilic. Qualitative changes in collagen predispose to calcium salts adsorption by collagen fibers. Scanning electron microscopy revealed the features of three-dimensional structure of petrifactions at various stages of their development. Dust-like petrifactions are microplates of lime with smooth surface, laminar petrifacts consist of accumulations of these microplates. The surface of large-tuberous petrifacts is irregular, ulcerated, covered with thrombotic masses.

  9. Fibrinolytic Treatment after Transient Ischaemic Attack Caused by Prosthetic Mitral Valve Thrombosis.

    PubMed

    Koban, Cornel; Neuß, Michael; Tambor, Grit; Hölschermann, Frank; Butter, Christian

    2016-01-01

    Prosthetic valve thrombosis is one of the most severe complications after surgical valve replacement. There are many possible presentations: from asymptomatic to life-threatening complications. We report on a 61-year-old female patient with prosthetic replacement of the aortic and mitral valve in the in-house department of cardiac surgery 3 months ago. The patient was suffering from aphasia during 5 minutes in domesticity. After her presentation in the emergency room, the echocardiographic examination revealed a thrombotic formation of the prosthetic mitral valve. At presentation, the anticoagulation was outside the effective range (INR: 1.7). A successful thrombolytic therapy with the plasminogen activator urokinase was begun with complete resolution of the thrombus. PMID:27313908

  10. Successful operation for mitral regurgitation in a patient with Gilbert's syndrome.

    PubMed

    Minami, Hiroya; Asada, Tatsuro; Gan, Kunio; Yamada, Akitoshi; Yano, Yoshihiko

    2011-05-01

    A 72-year-old woman complaining of dyspnea on effort was diagnosed as having mitral regurgitation (MR). Asymptomatic jaundice had initially been noticed during primary school, and an examination had shown hyperbilirubinemia. After the diagnosis of constitutional jaundice, she had remained well without further examination or medical treatment. Laboratory data showed a total serum bilirubin (TB) level of 12.2 mg/dl and a direct bilirubin level of 0.6 mg/dl. Transesophageal echocardiography showed severe MR, and we replaced the mitral valve. Postoperatively, genetic analyses identified constitutional jaundice as Gilbert's syndrome with Y486D mutation. The TB level gradually decreased. Four years after operation she is doing well with moderate hyperbilirubinemia and a TB level of 5 mg/dl. She is free from heart failure. PMID:21547629

  11. [Infectious mitral endocarditis after radiofrequency catheter ablation of a left lateral accessory pathway].

    PubMed

    Benito Bartolomé, F; Sánchez Fernández-Bernal, C

    2001-08-01

    A 2-years-old child with Wolff-Parkinson-White syndrome associated with life-threatening symptoms underwent radiofrequency ablation of a left lateral accessory pathway. A deflectable 5F bipolar electrode catheter positioned above the atrioventricular groove by transeptal approach was used for ablation. The catheters were repeatedly used after ethylene oxide sterilisation. Although immediate post-ablation echocardiography demonstrated no complications, the patient was readmitted two days later with fever and a new mitral murmur. Penicillin-susceptible Staphylococcus aureus was isolated and intravenous antibiotics were administered. In the following weeks, the patient developed constrictive pericarditis requiring surgical treatment and acute hemiplegia caused by brain embolism arising from valvular vegetation. At 5 years of follow-up the patient presents residual hemiparesia and grade II/IV mitral insufficiency. PMID:11481116

  12. Control of Mitral/Tufted Cell Output by Selective Inhibition among Olfactory Bulb Glomeruli.

    PubMed

    Economo, Michael N; Hansen, Kyle R; Wachowiak, Matt

    2016-07-20

    Inhibition is fundamental to information processing by neural circuits. In the olfactory bulb (OB), glomeruli are the functional units for odor information coding, but inhibition among glomeruli is poorly characterized. We used two-photon calcium imaging in anesthetized and awake mice to visualize both odorant-evoked excitation and suppression in OB output neurons (mitral and tufted, MT cells). MT cell response polarity mapped uniformly to discrete OB glomeruli, allowing us to analyze how inhibition shapes OB output relative to the glomerular map. Odorants elicited unique patterns of suppression in only a subset of glomeruli in which such suppression could be detected, and excited and suppressed glomeruli were spatially intermingled. Binary mixture experiments revealed that interglomerular inhibition could suppress excitatory mitral cell responses to odorants. These results reveal that inhibitory OB circuits nonlinearly transform odor representations and support a model of selective and nonrandom inhibition among glomerular ensembles. PMID:27346531

  13. [Clinico-morphological comparisons in thrombosis and insufficiency of mitral valve prosthesis].

    PubMed

    Tsukerman, G I; Semenovskiĭ, M L; Arutiunian, N V; Pomortseva, L V

    1977-05-01

    Clinical and morphological comparisons were conducted in 31 patients with thrombosis and insufficiency of mitral valve prostheses. The morphology of these complications was studied on the basis of autopsy data in 19 cases, and in 12 reoperations. Prosthetic thrombosis was observed in 18 patients. The leading causes of the functional disorders in the prosthesis were septic complications, persisting hypotension in the early postoperative period, errors of anticoagulation therapy. The clinical manifestations of thrombosis of a prosthesis depend on the extent and localization of the thrombus. An important role in the diagnosis of such complications belongs to a dynamic observation, especially to repeated phonocardiographic examinations. A phonocardiographic semiotics of the complications is presented. The results of reoperations for thrombosis of a mitral valve prosthesis and its insufficiency are also presented. The rationale of secondary interventions is demonstrated.

  14. An Intriguing Case Report of Functional Mitral Regurgitation Treated With MitraClip

    PubMed Central

    Duino, Vincenzo; Fiocca, Luigi; Musumeci, Giuseppe; D’Elia, Emilia; Gori, Mauro; Cerchierini, Elisa; Valsecchi, Orazio; Senni, Michele

    2015-01-01

    Abstract Functional mitral regurgitation (FMR) is frequent in patients with heart failure (HF). It develops as a consequence of left ventricle (LV) geometry alterations, causing imbalance between increased tethering forces and decreased closing forces exerted on the mitral valve apparatus during systole. FMR is known to change at rest and during effort, due to preload–afterload changes, myocardial ischemia, and/or LV dysfunction. Despite optimized medical therapy, an FMR can be responsible of shortness of breath limiting quality of life and decompensation. In this report, we present a case of dynamic FMR treated with MitraClip. MitraClip implantation is a successful and innovative opportunity for HF patients with FMR. PMID:25997036

  15. 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.

  16. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae

    PubMed Central

    Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Atsushi

    2016-01-01

    Patient: Male, 74 Final Diagnosis: Infective endocarditis Symptoms: Apetite loss • fever Medication: — Clinical Procedure: Transesophageal echocardiography Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). Case Report: A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient’s heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient’s condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. Conclusions: This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular

  17. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis

    PubMed Central

    Refatllari, Ali; Likaj, Ermal; Dumani, Selman; Hasimi, Endri; Goda, Artan

    2016-01-01

    BACKGROUND: An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. CASE PRESENTATION: A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient’s perioperative course was without complications and patient was discharged on the seventh postoperative day. CONCLUSION: Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes. PMID:27275346

  18. [Contribution of multiplane transesophageal echocardiography in the study of mitral valve prostheses].

    PubMed

    Malergue, M C; Illouz, E; Temkine, J; Dibie, A; Folliguet, T; Laborde, F

    1996-01-01

    Many reports have confirmed the value of transoesophageal echocardiography in the diagnosis of mechanical mitral valve prosthesis dysfunction: new biplane and multiplane probes seem to provide additional information in the assessment of cardiac disease. The aim of this study was to quantify the additional value of these new probes in the assessment of mitral valve prostheses. Seventy-five mitral valve prostheses were assessed with the multiplane probe, 45 normal bileaflet prostheses, 17 with regurgitant dysfunction and 12 with non obstructive thrombi and/or strands, and one with a blocked leaflet. In order to compare the respective values of monoplane, biplane and multiplane probes, the recordings were performed at 0 degrees, 90 degrees and from 0 degrees to 180 degrees in continuous sweep mode through the scanning plane. Globally, with the monoplane assessment, it was only possible to visualise both leaflets simultaneously in 13% of cases. The majority of prostheses was correctly analysed between 60 and 100 degrees. This was of paramount importance for the diagnosis of blockage of one leaflet. With respect to para-prosthetic valve regurgitation, the transverse view allowed visualisation of the lateral and paraseptal annular regions. The addition of a longitudinal view allowed visualisation of anterior and posterior regurgitant jets: the supplementary views provided by the multiplane probe allowed detection of small regurgitant jets in the diagonal planes between the longitudinal and transverse views. The multiplane probe offers the possibility of identifying the precise origin of the jet and helps quantification and peroperative localisation of its position. Small, non-obstructive thrombi and strands are better seen using a multiplane probe, especially when of small size. Therefore, multiplane transoesophageal echocardiography improves the assessment of mitral valve prostheses, the majority of diagnoses being, however, accessible with biplane probes.

  19. Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices

    PubMed Central

    El hammiri, Ayoub; Drighil, Abdenasser; Benhaourech, Sanaa

    2016-01-01

    Background Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management. Methods We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014. Results Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation. Conclusion Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions. PMID:27096525

  20. A Starr-Edwards mitral prosthesis after 44 years of good performance.

    PubMed

    De Santo, Luca Salvatore; De Feo, Marisa; Della Corte, Alessandro; Cerasuolo, Flavio; Santé, Pasquale; Torella, Michele; Nappi, Gianantonio

    2010-06-01

    The Starr-Edwards caged-ball prosthesis has been widely used to replace cardiac valves. The Model 6120 mitral prosthesis was introduced on the market in 1965 to reduce the high incidence of ball variance and thromboembolism of the previous model. We report the case of a Starr-Edwards Model 6120 which had been in place for 44 years and was still well functioning with no apparent structural damage.

  1. 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.

  2. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae.

    PubMed

    Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Astushi

    2016-01-01

    BACKGROUND Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). CASE REPORT A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient's heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient's condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. CONCLUSIONS This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular extension of the infection, which can lead to fatal heart block. PMID:27604147

  3. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation.

    PubMed

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

    2013-11-01

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

  4. Percutaneous Coronary Intervention for Coronary Thrombo-embolism during Balloon Mitral Valvuloplasty in a Pregnant Woman.

    PubMed

    Chikkabasavaiah, Nagamani; Rajendran, Ravindran; P, Beeresha; B, Ramesh

    2016-02-01

    Coronary embolism as a cause of acute myocardial infarction is considered rarer than it actually is because of the difficulties associated with its documentation. Equally rare is the event of a clot embolising to the coronary artery during balloon mitral valvuloplasty (BMV). We had a unique and a rare opportunity to encounter, recognise, document and successfully manage this rare complication during BMV in a pregnant woman. PMID:26602228

  5. Outcomes of an extended Morrow procedure without a concomitant mitral valve procedure for hypertrophic obstructive cardiomyopathy

    PubMed Central

    Liu, Yun; Song, Yunhu; Gao, Ge; Ran, Jun; Su, Wenjun; Li, Haojie; Tang, Yajie; Duan, Fujian; Sun, Hansong

    2016-01-01

    The indications for a concomitant mitral valve (MV) procedure remain controversial for patients with hypertrophic obstructive cardiomyopathy (HOCM). According to previous studies, a concomitant MV surgery was required in 11–20% of inpatient operations. Thus, we aimed to study the outcomes of an extended Morrow procedure without a concomitant MV procedure for HOCM patients who had no intrinsic abnormalities of the MV apparatus. We retrospectively reviewed 232 consecutive HOCM patients who underwent extended Morrow procedures from January 2010 to October 2014. Only 10 (4.31%) patients with intrinsic MV diseases underwent concomitant MV procedures. Of the 232 patients, 230 had no to mild mitral regurgitation (MR) postoperatively. We separated the 232 patients into two groups according to preoperative MR degree. One group is mild MR, and the other is moderate or severe MR. The three-month, one-year, and three-year composite end-point event-free survival rates had no difference between two groups (p = 0.820). When we separated the patients to postoperative no or trace MR group and mild MR group, there was also no difference on survival rates (p = 0.830). In conclusion, concomitant mitral valve procedures are not necessary for HOCM patients with MR caused by systolic anterior motion, even moderate to severe extent. PMID:27357867

  6. Echocardiographic differentiation of atrioventricular septal defects from inlet ventricular septal defects and mitral valve clefts.

    PubMed

    Sulafa, Ali K M; Tamimi, Omer; Najm, Hani K; Godman, Michael J

    2005-03-01

    Left ventricular inlet/outlet ratio and percent left atrioventricular valve (AVV) guarded by the posterior leaflet are valuable for characterizing atrioventricular septal defect (AVSD). We performed these measurements echocardiographically in normal patients (n = 101), patients who had AVSD (n = 37), those who had isolated perimembranous inlet ventricular septal defect (VSD; n = 12), and those who had "isolated" mitral valve clefts (n = 5). Surgical findings of 38 patients were reviewed. The normal inlet/outlet ratio was 1.03 +/- 0.07. For patients who had AVSD, the ratio was 0.82 +/- 0.06 (95% confidence interval [CI] 0.180 to 0.237, p = 0.001). For patients who had an isolated inlet VSD, this ratio was lower than that in normal patients (0.93 +/- 0.08, 95% CI 034 to 0.116, p = 0.001) but higher than that in patients who had AVSD (95% CI -0.175 to 0.091, p = 0.001). The percent left AVV guarded by the posterior leaflet was 56 +/- 1.4 in normal patients. For patients who had AVSD, it was significantly lower (43 +/- 1.1). For patients who had an isolated VSD and those who had an isolated mitral cleft, it was normal (57 +/- 1.9 and 55 +/- 2.2, respectively). The 2 measurements are valuable in differentiating AVSD from inlet VSD and isolated mitral cleft, but percent left AVV guarded by the posterior leaflet is more specific.

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

    NASA Astrophysics Data System (ADS)

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

    2005-11-01

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

  8. Mechanical dyssynchrony and deformation imaging in patients with functional mitral regurgitation

    PubMed Central

    Rosa, Isabella; Marini, Claudia; Stella, Stefano; Ancona, Francesco; Spartera, Marco; Margonato, Alberto; Agricola, Eustachio

    2016-01-01

    Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome. PMID:26981211

  9. 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.

  10. Mechanical dyssynchrony and deformation imaging in patients with functional mitral regurgitation.

    PubMed

    Rosa, Isabella; Marini, Claudia; Stella, Stefano; Ancona, Francesco; Spartera, Marco; Margonato, Alberto; Agricola, Eustachio

    2016-02-26

    Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.

  11. Absence of mitral cells in monolayer in monotremes. Variations in vertebrate olfactory bulbs.

    PubMed

    Switzer, R C; Johnson, J I

    1977-01-01

    An invariant feature of the olfactory bulb in placental and marsupial mammals is the arrangement of the perikarya of mitral cells in a monolayer. Contrasting with this is the arrangement found in the olfactory bulbs of the monotremes, platypus and echidna, where the large perikarya are not only absent from the position of a monolayer (usually forming the external boundary of the internal plexiform layer) but occupy a region which would characterize them as tufted cells. In other classes of amniote vertebrates, reptiles and birds, the placement of large perikarya in the olfactory bulb ranges from a compact layer to a broad band. Such an overview among several vertebrate classes suggests that a monolayer of mitral cells may be a specialized subset of the tufted-mitral cell population. The accessory olfactory formation among mammals also exhibits variation in the compactness of the large perikarya: a broadband in most but a compact layer in a few others such as the chinchilla and the capybara. Such specialized alignment of perikarya (and, consequently, of their dendritic and axonal elements) may enable more refined signal processing than does random alignment of these elements. Such speculations can be tested using appropriate phylogenetic sampling, and monotremes provide particularly advantageous test cases. PMID:899683

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

    PubMed Central

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

    1985-01-01

    The Model 6120 ball valve prosthesis introduced in 1965 is still strongly supported as a mitral valve substitute in many centers around the world. A current reassessment of the performance of this prosthesis is therefore pertinent to current medical practice. In this institution since 1974, 227 Starr-Edwards caged ball valves have been implanted in the mitral position during isolated valve replacement. Two models of caged ball valves were used concurrently: the silastic ball valve in 108 patients (48%) and the composite strut “tract” valve in 119 (52%). Hospital mortality was 7%, and 8-year survival (standard error) was 74 (6%), with 100% follow-up, documenting 752 total patient-years. No late deaths were known to be valve related, and there were no cases of prosthetic thrombosis. The actuarial estimate of patients free from thromboembolism at 8 years was 89 (4%) with a linearized rate of 1.3% per year. At the most recent follow-up, 95% of the patients were in the New York Heart Association (NYHA) Classes I or II. These good results were partly due to an awareness at operation of ventricular outflow tract size requirements and to strict control of postoperative anticoagulation. We conclude that the Starr-Edwards ball valve is the mitral valve of choice in the young patient who is able to take anticoagulation drugs and has a left ventricular outflow tract of satisfactory size. PMID:15227040

  13. 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

  14. CTS Trials Network: Surgical ablation of atrial fibrillation during mitral valve surgery - many questions unanswered.

    PubMed

    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) guidelines(2) 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).

  15. 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

  16. Absence of mitral cells in monolayer in monotremes. Variations in vertebrate olfactory bulbs.

    PubMed

    Switzer, R C; Johnson, J I

    1977-01-01

    An invariant feature of the olfactory bulb in placental and marsupial mammals is the arrangement of the perikarya of mitral cells in a monolayer. Contrasting with this is the arrangement found in the olfactory bulbs of the monotremes, platypus and echidna, where the large perikarya are not only absent from the position of a monolayer (usually forming the external boundary of the internal plexiform layer) but occupy a region which would characterize them as tufted cells. In other classes of amniote vertebrates, reptiles and birds, the placement of large perikarya in the olfactory bulb ranges from a compact layer to a broad band. Such an overview among several vertebrate classes suggests that a monolayer of mitral cells may be a specialized subset of the tufted-mitral cell population. The accessory olfactory formation among mammals also exhibits variation in the compactness of the large perikarya: a broadband in most but a compact layer in a few others such as the chinchilla and the capybara. Such specialized alignment of perikarya (and, consequently, of their dendritic and axonal elements) may enable more refined signal processing than does random alignment of these elements. Such speculations can be tested using appropriate phylogenetic sampling, and monotremes provide particularly advantageous test cases.

  17. Assessment of mitral Björk-Shiley prosthetic dysfunction using digitised M mode echocardiography.

    PubMed Central

    Dawkins, K D; Cotter, L; Gibson, D G

    1984-01-01

    Digitised M mode echocardiograms were analysed in 22 patients with possible Björk-Shiley mitral prosthetic dysfunction. Patients with paraprosthetic mitral regurgitation had a significantly greater shortening fraction, an increased peak rate of dimension change during systole, and an increased peak velocity of circumferential fibre shortening than those with poor left ventricular function. Patients with a clotted prosthesis had lower values for shortening fraction and peak rate of dimension change during systole than patients with paraprosthetic regurgitation. In this latter group, the peak rate of dimension change during diastole and peak lengthening rate were greater than in either those patients with poor left ventricular function or those with a clotted prosthesis. In addition, the peak lengthening rate was greater in those with a clotted prosthesis than in those with poor left ventricular function. Thus M mode echocardiography is a useful method of assessing mitral prosthetic dysfunction and allows patients with paraprosthetic regurgitation to be distinguished from those with either poor left ventricular function or a clotted prosthesis. PMID:6691866

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

    PubMed

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

    2013-02-01

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

  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. 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

  1. 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

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

    PubMed

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

    2013-02-01

    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. Three-dimensional echocardiography was used to obtain systolic leaflet geometry. Stereoscopic digital particle image velocimetry provided all three components of fluid velocity through the mitral valve, resolved every 25 ms in the cardiac cycle. A strong central filling jet (V ~ 0.6 m/s) was observed during peak systole with minimal out-of-plane velocities. In addition, physiologic hemodynamic boundary conditions were defined and all data were synchronously acquired through a central trigger. Finally, the simulator is a precisely controlled environment, in which flow conditions and geometry can be systematically prescribed and resultant valvular function and hemodynamics assessed. Thus, this work represents the first comprehensive database of high fidelity experimental data, critical for extensive validation of mitral valve fluid structure interaction simulations.

  3. Efficacy of Artificial Chordal Reconstruction for Idiopathic Severe Mitral Regurgitation Due To Chordal Rupture in Infancy.

    PubMed

    Sai, Sadahiro; Konishi, Akinobu; Sato, Mitsuru; Matsuo, Satoshi; Nitta, Megumi

    2015-01-01

    Early surgical intervention is required for sudden onset, severe mitral regurgitation (MR) due to chordal rupture in infants with normal development younger than 1 year. The condition has been recognized as idiopathic. However, the surgical options in children are limited because of their size and somatic growth. We sought to examine the efficacy of mitral valve plasty by artificial chordal reconstruction for these infants in mid-to-long term. From August 2005 through June 2012, 8 consecutive patients aged 1-7 months underwent mitral valve plasty by chordal reconstruction using expanded polytetrafluoroethylene sutures for MR, owing to leaflet prolapse. The geometric parameters of the diameter of the mitral annulus (D1), the long axis of the left ventricular (LV) chamber (D2), and the length of the papillary muscle including the reconstructed chordae (D3) were measured, as well as MR grade (0-4) and LV end-diastolic dimension, at each time point. The parameters were compared with those in the control group that included Kawasaki disease patients without cardiac lesions and healthy children (n = 51). Mean follow-up period was 5.8 (2.8-9.6) years. Freedom from reoperation was 100%. MR grades were 3.9 ± 0.4 preoperatively, 2.4 ± 0.9 at discharge, and 1.4 ± 0.6 at the latest. Postoperative MR was improved within 1 year in 5 of 6 patients who had grade 2 or higher regurgitation. LV end-diastolic dimensions were 109% (% of normal), 113%, and 107% at discharge, 3, and 5 years, respectively. Geometric configuration indicated by the D1/D2 ratio did not significantly change with time. The length of the papillary muscle including reconstructed chordae (D3) strongly correlated with body surface area (r(2) = 0.65), which seemed to be equivalent to that in the control group. In conclusion, postoperative mitral valve function and geometry was preserved. This procedure with a low morbidity should be an option for pediatric patients with acute severe MR. PMID:26708377

  4. Chordal geometry determines the shape and extent of systolic anterior mitral motion: in vitro studies.

    PubMed

    Cape, E G; Simons, D; Jimoh, A; Weyman, A E; Yoganathan, A P; Levine, R A

    1989-05-01

    In patients with hypertrophic cardiomyopathy, the mitral valve moves anteriorly and assumes a unique shape, with mitral-septal contact centrally and preserved valve orifice area laterally. This shape is not clearly predicted by the Venturi mechanism, which stresses flow above the valve as opposed to changes intrinsic to the valve. On the other hand, it has been suggested that displacement of the papillary muscles anteriorly and toward one another, as observed in this disease, can promote anterior mitral valve motion and produce this unusual shape. The purpose of this in vitro study was to test the hypotheses that anterior motion of a membrane in a flow field can be generated by altering the distribution or effectiveness of chordal tension tethering the membrane, and that the shape achieved by this membrane depends on the geometry of chordal tension. Accordingly, a horizontal leaflet mounted in a flow chamber was attached by chords at its distal end to a series of upstream screws. Chordal tension could be varied by turning the screws or redirected by shifting the screws anteriorly. Anterior leaflet motion having the same unusual configuration seen in patients was reproduced by decreasing central chordal restraint while tension on the leaflet edges was maintained. Directing chordal tension anteriorly caused greater degrees of anterior motion at earlier stages in the release of chordal restraint; increased flow rate had a similar but less marked effect. These studies suggest that primary geometric alterations in the papillary-mitral apparatus can play an important role in determining the presence and geometry of systolic anterior mitral motion. The nature of these alterations suggests a role for anterior and inward papillary muscle displacement in promoting such motion. The geometric factors embodied in this model can explain many observed features of this motion not adequately explained by the Venturi effect, such as early systolic onset and the importance of a

  5. 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

  6. Echocardiographic Assessment of Ischaemic Mitral Regurgitation, Mechanism, Severity, Impact on Treatment Strategy and Long Term Outcome

    PubMed Central

    Naser, Nabil; Dzubur, Alen; Kusljugic, Zumreta; Kovacevic, Katarina; Kulic, Mehmed; Sokolovic, Sekib; Terzic, Ibrahim; Haxihibeqiri-Karabdic, Ilirijana; Hondo, Zorica; Brdzanovic, Snjezana; Miseljic, Sanja

    2016-01-01

    Introduction: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Research Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE

  7. Fluid–Structure Interaction Analysis of Papillary Muscle Forces Using a Comprehensive Mitral Valve Model with 3D Chordal Structure

    SciTech Connect

    Toma, Milan; Jensen, Morten Ø.; Einstein, Daniel R.; Yoganathan, Ajit P.; Cochran, Richard P.; Kunzelman, Karyn S.

    2015-07-17

    Numerical models of native heart valves are being used to study valve biomechanics to aid design and development of repair procedures and replacement devices. These models have evolved from simple two-dimensional approximations to complex three-dimensional, fully coupled fluid-structure interaction (FSI) systems. Such simulations are useful for predicting the mechanical and hemodynamic loading on implanted valve devices. A current challenge for improving the accuracy of these predictions is choosing and implementing modeling boundary conditions. In order to address this challenge, we are utilizing an advanced in-vitro system to validate FSI conditions for the mitral valve system. Explanted ovine mitral valves were mounted in an in vitro setup, and structural data for the mitral valve was acquired with *CT. Experimental data from the in-vitro ovine mitral valve system were used to validate the computational model. As the valve closes, the hemodynamic data, high speed lea et dynamics, and force vectors from the in-vitro system were compared to the results of the FSI simulation computational model. The total force of 2.6 N per papillary muscle is matched by the computational model. In vitro and in vivo force measurements are important in validating and adjusting material parameters in computational models. The simulations can then be used to answer questions that are otherwise not possible to investigate experimentally. This work is important to maximize the validity of computational models of not just the mitral valve, but any biomechanical aspect using computational simulation in designing medical devices.

  8. Examination of mitral regurgitation with a goat heart model for the development of intelligent artificial papillary muscle.

    PubMed

    Shiraishi, Y; Yambe, T; Yoshizawa, M; Hashimoto, H; Yamada, A; Miura, H; Hashem, M; Kitano, T; Shiga, T; Homma, D

    2012-01-01

    Annuloplasty for functional mitral or tricuspid regurgitation has been made for surgical restoration of valvular diseases. However, these major techniques may sometimes be ineffective because of chamber dilation and valve tethering. We have been developing a sophisticated intelligent artificial papillary muscle (PM) by using an anisotropic shape memory alloy fiber for an alternative surgical reconstruction of the continuity of the mitral structural apparatus and the left ventricular myocardium. This study exhibited the mitral regurgitation with regard to the reduction in the PM tension quantitatively with an originally developed ventricular simulator using isolated goat hearts for the sophisticated artificial PM. Aortic and mitral valves with left ventricular free wall portions of isolated goat hearts (n=9) were secured on the elastic plastic membrane and statically pressurized, which led to valvular leaflet-papillary muscle positional change and central mitral regurgitation. PMs were connected to the load cell, and the relationship between the tension of regurgitation and PM tension were measured. Then we connected the left ventricular specimen model to our hydraulic ventricular simulator and achieved hemodynamic simulation with the controlled tension of PMs. PMID:23367454

  9. 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

  10. [A comparative assessment of immediate results of correction of mitral insufficiency from the left-auricular and transventruicular accesses in patients with postinfarction aneurysm].

    PubMed

    Osadchiĭ, A M; Paskar', N S; Sukhova, I V; Gordeev, M L

    2012-01-01

    Reconstruction of postinfarction aneurysm of the left ventricle (LV) and plasty of the mitral valve without implantation in combination with coronary shunting or without it were used in 81 patients with ischemic heart disease. Correction of mitral insufficiency was fulfilled in 40 patients by an access via the left atrium, in 41 patients--from the LV in its reconstruction. Lethality in the nearest postoperative period was 3.7%. Mitral insufficiency after operation was absent in 70% of patients with the left atrium access and in 58.5% with the transventricular access, in the rest of the patients the mitral insufficiency was not more than of the II degree. Significant differences between the immediate results depending on the access to the mitral valve were not found. PMID:22774543

  11. [Prenatal diagnosis of fetal aortic stenosis with mitral insufficiency. Review of the ultrasound diagnosis and perinatal prognosis: a case report].

    PubMed

    Iglesias-Román, Nuria; Alvarez, Teresa; Bravol, Coral; Pérez, Ricardo; Gámez, Francisco; De León Luis, Juan

    2014-09-01

    This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options. PMID:25412557

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

    PubMed

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

    2014-01-01

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

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

    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) 45 years 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.

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

    PubMed

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

    2014-01-01

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

  15. Perivalvular leakage 25 years after initial mitral valve replacement with a Björk-Shiley prosthesis.

    PubMed

    Minami, Hiroya; Asada, Tatsuro; Gan, Kunio

    2008-09-01

    An 80-year-old woman had undergone initial mitral valve replacement using a Björk-Shiley mechanical valve owing to mitral stenosis 25 years earlier. Suddenly, she had anemia and an increased lactic dehydrogenase (LDH) level. Transesophageal echography (TEE) showed perivalvular leakage. In a redo operation, two side-by-side stitches of the valve on the posterior annulus were loosened without cutting and the sewing cuff at that site was floated over the annulus, leading to the perivalvular leakage. The valve was easily removed; and round, hard, degenerative calcified tissue composed of remnant mitral valve in the suture site during the initial operation was found just under the sewing cuff. After resection of this calcified round tissue, a 25-mm bioprosthesis was put in place. Her postoperative recovery was uneventful, and 47 days after surgery she was discharged without perivalvular leakage or anemia. PMID:18791673

  16. Assessment of Mitral Valve Adaptation with Gated Cardiac Computed Tomography: Validation with Three-Dimensional Echocardiography and Mechanistic Insight to Functional Mitral Regurgitation

    PubMed Central

    Beaudoin, Jonathan; Thai, Wai-Ee; Wai, Bryan; Handschumacher, Mark D.; Levine, Robert A.; Truong, Quynh A.

    2013-01-01

    Background Mitral valve (MV) enlargement is a compensatory mechanism capable of preventing functional mitral regurgitation (FMR) in dilated ventricles. Total leaflet area and its relation with closure area measured by 3D-echocardiography have been related to FMR. Whether these parameters can be assessed with other imaging modalities is not known. Our objectives are to compare cardiac CT-based measurements of MV leaflets with 3D-echocardiography and determine the relationship of these metrics to the presence of FMR. Methods and Results We used two cohorts of patients who had cardiac CT to measure MV total leaflet, closure and annulus areas. In cohort 1 (26 patients), we validated these CT metrics to 3D-echocardiography. In cohort 2 (66 patients), we assessed the relation of MV size with the presence of FMR in three populations: heart failure with FMR, heart failure without FMR, and normal controls. Cardiac CT and 3D-echocardiography produced similar results for total leaflet (R2=0.97), closure (R2=0.89) and annulus areas (R2=0.84). MV size was largest in heart failure without FMR compared with controls and FMR patients (9.1±1.7 vs 7.5±1.0 vs 8.1±0.9 cm2/m2, p<0.01). FMR patients had reduced ratios of total leaflet:closure areas and total leaflet:annulus areas when compared to patients without FMR (p<0.01). Conclusions MV size measured by CT is comparable to 3D-echocardiography. MV enlargement in cardiomyopathy suggests leaflet adaptation. Patients with FMR have inadequate adaptation as reflected by decreased ratios of leaflet area and areas determined by ventricle size (annulus and closure areas). These measurements provide additional insight into the mechanism of FMR. PMID:23873402

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

    PubMed

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

    1995-07-01

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

  18. 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/μL. 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

  19. 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/μL. 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

  20. Factors determining early left atrial reverse remodeling after mitral valve surgery.

    PubMed

    Cho, Deok-Kyu; Ha, Jong-Won; Chang, Byung-Chul; Lee, Se-Hwa; Yoon, Se-Jung; Shim, Chi Young; Cho, Jung Rae; Kim, Jung-Sun; Choi, Eui-Young; Rim, Se-Joong; Chung, Namsik

    2008-02-01

    This study aimed to investigate the factors determining early left atrial (LA) reverse remodeling after mitral valve (MV) surgery. The left atrium is frequently dilated in patients with mitral stenosis (MS) or mitral regurgitation (MR). MV surgery usually results in LA volume reduction. However, the factors associated with LA reverse remodeling after MV surgery are not clearly defined. One hundred thirty-eight patients (51 men, 87 women; mean age, 53 years) underwent transthoracic echocardiography before and after MV surgery. Maximal LA volume was measured using the prolate ellipsoid model. The percentage of LA volume change was calculated. The patients were grouped according to age (<50 vs >or=50 years), predominant lesion (pure MR vs some degree of MS), type of surgery (MV repair vs MV replacement), and preoperative rhythm (sinus rhythm vs atrial fibrillation). LA volume decreased from 147+/-93 to 103+/-43 ml (p<0.001) after surgery. LA reverse remodeling was more prominent in patients who were <50 years old (percentage of LA volume change -31.2+/-17.4 vs -18.4+/-19.2, p<0.001), had pure MR (percentage of LA volume change -30.4+/-18.6 vs -17.3+/-18.2, p<0.001), and had a preoperative sinus rhythm (percentage of LA volume change -28.5+/-17.7 vs -20.5+/-20.0, p=0.019). In conclusion, on stepwise multiple regression analysis, preoperative LA volume, predominant lesion, age, and cardiac rhythm were significant predictors of LA reverse remodeling. A larger preoperative LA volume, MR rather than MS, younger age at the time of surgery, and sinus rhythm were important predictors of LA reverse remodeling after MV surgery. PMID:18237603

  1. Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position

    PubMed Central

    Ene, Gabriela; Garcia Raso, Aránzazu; Gonzalez-Dominguez Weber, Almudena; Hidalgo-Vega, Álvaro; Llamas, Pilar

    2016-01-01

    Background: The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding. Objectives: The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position. Methods: Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case. Results: We collected data from 151 patients receiving oral anticoagulation therapy with vitamin K antagonist who were diagnosed with mitral prosthesis (n = 90), mitro-aortic prosthesis (n = 57), and mitral and tricuspid prosthesis (n = 4). The total direct healthcare cost was €15302.59, with a mean total cost per patient per year of €1558.15 (±2774.58) consisting of 44.38 (±42.30) for drug cost, €71.41 (±21.43) for international normalized ratio monitoring, €429.52 (±126.87) for medical visits, €26.31 (±28.38) for rescue medication and €986.53 (±2735.68) for related complications. Conclusion: Most direct healthcare costs associated with the sampled patients arose from the specialist-care monitoring required for treatment. Good monitoring is inversely related to direct healthcare costs. PMID:27579168

  2. Defining the clinical need and indications: who are the right patients for transcatheter mitral valve replacement.

    PubMed

    Baumgarten, Heike; Squiers, John J; Arsalan, Mani; John, M; Dimaio, Michael J

    2016-06-01

    Mitral regurgitation (MR) can be divided into two major etiologies, primary and secondary MR. Primary MR, also termed degenerative or organic MR, is a disease of the valve itself and is treated routinely by surgical repair in all but prohibitive risk patients. In these patients, transcatheter repair techniques, including edge to edge repair with the MitraClip device have been largely successful and widely adopted. Transcatheter placement of artificial chords has also been performed. The potential role for transcatheter mitral valve replacement (TMVR) in primary MR will likely be quite limited. Secondary or functional MR is due to a disease of the left ventricle and not the valve itself. The MR is a result of dilation of the left ventricle causing distraction of the papillary muscles with tethering of the mitral leaflets and lack of leaflet coaptation. Medical therapy is the mainstay treatment, with resynchronization used in appropriate patients. Surgical repair, usually with an undersized annuloplasty, is used in a limited number of patients. Transcatheter edge to edge repair is used extensively outside the US in secondary MR and is the subject of a pivotal trial in the US. However, it is in this group of patients with secondary MR that there is the largest clinical unmet need and, hence, the greatest potential opportunity for TMVR. At least ten TMVR platforms are in early feasibility, first in human, or preclinical trial stages. Four devices have cumulative early human experience in <100 patients. In this article, we discuss those patients most likely to benefit from TMVR and detail lessons learned from the first human studies regarding patient selection. PMID:27028332

  3. 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

  4. Afterload mismatch after MitraClip insertion for functional mitral regurgitation.

    PubMed

    Melisurgo, Giulio; Ajello, Silvia; Pappalardo, Federico; Guidotti, Andrea; Agricola, Eustachio; Kawaguchi, Masanori; Latib, Azeem; Covello, Remo Daniel; Denti, Paolo; Zangrillo, Alberto; Alfieri, Ottavio; Maisano, Francesco

    2014-06-01

    Afterload mismatch, defined as acute impairment of left ventricular function after mitral surgery, is a major issue in patients with low ejection fraction and functional mitral regurgitation (FMR). Safety and efficacy of MitraClip therapy have been assessed in randomized trials, but limited data on its acute hemodynamic effects are available. This study aimed to investigate the incidence and prognostic role of afterload mismatch in patients affected by FMR treated with MitraClip therapy. We retrospectively analyzed patients affected by FMR and submitted to MitraClip therapy from October 2008 to December 2012. Patients were assigned to 2 groups according to the occurrence of the afterload mismatch: patients with afterload mismatch (AM+) and without afterload mismatch (AM-). Of 73 patients, 19 (26%) experienced afterload mismatch in the early postoperative period. Among preoperative variables, end-diastolic diameter (71 ± 8 vs 67 ± 7 mm, p = 0.02) and end-systolic diameter (57 ± 9 vs 53 ± 7 mm, p = 0.04) were both significantly larger in AM+ group. An increased incidence of right ventricular dysfunction (68% vs 31%, p = 0.049) and pulmonary hypertension (49 ± 10 vs 40 ± 10 mm Hg, p = 0.0009) was found in AM+ group. Before hospital discharge, left ventricular ejection fraction (LVEF) became similar in both groups (31 ± 9% vs 33 ± 11%, p = 0.65). Long-term survival was comparable between the 2 groups (p = 0.44). A low LVEF in the early postoperative period (LVEF <17%) was significantly associated with higher mortality rate in long-term follow-up (p = 0.048). In conclusion, reduction of mitral regurgitation with MitraClip can cause afterload mismatch; however, this phenomenon is transient, without long-term prognostic implications.

  5. New mitral annular force transducer optimized to distinguish annular segments and multi-plane forces.

    PubMed

    Skov, Søren Nielsen; Røpcke, Diana Mathilde; Ilkjær, Christine; Rasmussen, Jonas; Tjørnild, Marcell Juan; Jimenez, Jorge H; Yoganathan, Ajit P; Nygaard, Hans; Nielsen, Sten Lyager; Jensen, Morten Olgaard

    2016-03-21

    Limited knowledge exists about the forces acting on mitral valve annuloplasty repair devices. The aim of this study was to develop a new mitral annular force transducer to measure the forces acting on clinically used mitral valve annuloplasty devices. The design of an X-shaped transducer in the present study was optimized for simultaneous in- and out-of-plane force measurements. Each arm was mounted with strain gauges on four circumferential elements to measure out-of-plane forces, and the central parts of the X-arms were mounted with two strain gauges to measure in-plane forces. A dedicated calibration setup was developed to calibrate isolated forces with tension and compression for in- and out-of-plane measurements. With this setup, it was possible with linear equations to isolate and distinguish measured forces between the two planes and minimize transducer arm crosstalk. An in-vitro test was performed to verify the crosstalk elimination method and the assumptions behind it. The force transducer was implanted and evaluated in an 80kg porcine in-vivo model. Following crosstalk elimination, in-plane systolic force accumulation was found to be in average 4.0±0.1N and the out-of-plane annular segments experienced an average force of 1.4±0.4N. Directions of the systolic out-of-plane forces indicated movements towards a saddle shaped annulus, and the transducer was able to measure independent directional forces in individual annular segments. Further measurements with the new transducer coupled with clinical annuloplasty rings will provide a detailed insight into the biomechanical dynamics of these devices.

  6. The use of a high-power laser on swine mitral valve chordae tendineae.

    PubMed

    Pinto, Nathali Cordeiro; Chavantes, M Cristina; Zezell, Denise; Deana, Alessandro; Benetti, Carolina; Marcos, Rodrigo Labat; Lopes, Luciana Almeida; Martins, Rodrigo A B Lopes; Aiello, Vera Demarchi; Jatene, Fabio Biscegli; Pomerantzeff, Pablo M A

    2016-08-01

    Worldwide, rheumatic fever remains a significant cause of mitral valve insufficiency. It is responsible for approximately 90 % of early childhood valvular surgeries in Brazil. Elongated or flail chordae are frequently responsible and require surgical correction. The purpose of this study was to analyze and compare the histological tissues of the mitral valve chordae and the mechanical resistance generated by the chordae, both with and without the application of a high-power laser. Twenty normal porcine mitral valve chordae were measured and divided randomly into the following two groups: control group (not subjected to a high-power laser) and laser group (subjected to photonic irradiation). Laser surgery was performed under controlled conditions, using following parameters: λ = 980-nm wavelength, power = 3 W, and energy = 60 J. A mechanical test machine was used in combination with a subsequent histological study to measure chordae tensile properties. A histological analysis demonstrated a typical collagen bundle arrangement in the control group; however, under a particular reached temperature range (48), the collagen bundles assumed different arrangements in the laser group. Significant reductions in the chordae tendineae lengths and changes in their resistance in the laser group were observed, as these chordae exhibited less rigid fibers. The chordae tendineae of normal porcine valves subjected to a high-power laser exhibited its length reduction and less stiffness compared to the control group. A histological analysis of the laser treatment specimens demonstrated differences in collagen bundle spatial organization, following slight changes into tissue temperature.

  7. Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era

    PubMed Central

    Rafique, Asim M; Zarrini, Parham; Singh, Nirmal; Beigel, Roy; Tadwalkar, Rigved; Chonde, Meshe; Slipczuk, Leandro; Cercek, Bojan; Kar, Saibal; Siegel, Robert J

    2016-01-01

    Objective One-half of patients with severe symptomatic mitral regurgitation (MR) do not undergo surgery due to comorbidities. We evaluated prognosticators of outcomes in patients with unoperated significant MR. Methods In this observational study, we retrospectively evaluated medical records of 75 consecutive patients with unoperated significant MR. Results All-cause mortality was 39% at 5 years. Non-survivors (n=29) versus survivors (n=46) were: older (77±9.8 vs 68±14, p=0.006), had higher New York Heart Association (NYHA) class (2.7±0.8 vs 2.3±0.8, p=0.037), higher brain natriuretic peptide (1157±717 vs 427±502 pg/mL, p=0.024, n=18), more coronary artery disease (61% vs 35%, p=0.031), more frequent left ventricular ejection fraction <50% (20.7% vs 4.3%, p=0.026), more functional MR (41% vs 22%, p=0.069), higher mitral E/E′ (12.7±4.6 vs 9.8±4, p=0.008), higher pulmonary artery systolic pressure (PASP; 52.6±18.7 vs 36.7±14, p <0.001), more ≥3+ tricuspid regurgitation (28% vs 4%, p=0.005) and more right ventricular dysfunction (26% vs 6%, p=0.035). Significant predictors of 5-year mortality were PASP (p=0.001) and E/E′ (p=0.011) using multivariate regression analysis. Conclusions Patients with unoperated significant MR have high mortality. Elevated PASP and mitral E/E′ were the most significant predictors of 5-year survival in patients with unoperated significant MR. Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines provide a limited incorporation of echo-Doppler parameters in the preoperative risk stratification of patients with severe MR. PMID:27547425

  8. 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.

  9. 3D printed cardiac phantom for procedural planning of a transcatheter native mitral valve replacement

    NASA Astrophysics Data System (ADS)

    Izzo, Richard L.; O'Hara, Ryan P.; Iyer, Vijay; Hansen, Rose; Meess, Karen M.; Nagesh, S. V. Setlur; Rudin, Stephen; Siddiqui, Adnan H.; Springer, Michael; Ionita, Ciprian N.

    2016-03-01

    3D printing an anatomically accurate, functional flow loop phantom of a patient's cardiac vasculature was used to assist in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D geometry of the patient's cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic (STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis Carm bi-Plane angiography system. Results: After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the sizing of the valve to be implanted. Conclusion: With advances in image processing and 3D printing technology, it is possible to create realistic patientspecific phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing method shows potential as a more informative technique than typical CTA reconstruction alone.

  10. The role of age and comorbidities in postoperative outcome of mitral valve repair

    PubMed Central

    Bonnet, Vincent; Boisselier, Clément; Saplacan, Vladimir; Belin, Annette; Gérard, Jean-Louis; Fellahi, Jean-Luc; Hanouz, Jean-Luc; Fischer, Marc-Olivier

    2016-01-01

    Abstract The average age of patients undergoing mitral valve repair is increasing each year. This retrospective study aimed to compare postoperative complications of mitral valve repair (known to be especially high-risk) between 2 age groups: under and over the age of 80. Patients who underwent mitral valve repair were divided into 2 groups: group 1 (<80 years old) and group 2 (≥80 years old). Baseline characteristics, pre- and postoperative hemodynamic data, surgical characteristics, and postoperative follow-up data until hospital discharge were collected. A total of 308 patients were included: 264 in group 1 (age 63 ± 13 years) and 44 in group 2 (age 83 ± 2 years). Older patients had more comorbidities (atrial fibrillation, history of cardiac decompensation, systemic hypertension, pulmonary hypertension, and chronic kidney disease) and they presented more postoperative complications (50.0% vs 33.7%; P = 0.043), with a longer hospital stay (8.9 ± 6.9 vs 6.6 ± 4.6 days; P = 0.005). To assess the burden of age, a propensity score was awarded to postoperative complications. Active smoking, chronic pulmonary disease, chronic kidney disease, associated ischemic heart disease, obesity, and cardio pulmonary by-pass duration were described as independent risk factors. When matched on this propensity score, there was no difference in morbidity or mortality between group 1 and group 2. Older patients suffered more postoperative complications, which were related to their comorbidities and not only to their age. PMID:27336886

  11. The use of a high-power laser on swine mitral valve chordae tendineae.

    PubMed

    Pinto, Nathali Cordeiro; Chavantes, M Cristina; Zezell, Denise; Deana, Alessandro; Benetti, Carolina; Marcos, Rodrigo Labat; Lopes, Luciana Almeida; Martins, Rodrigo A B Lopes; Aiello, Vera Demarchi; Jatene, Fabio Biscegli; Pomerantzeff, Pablo M A

    2016-08-01

    Worldwide, rheumatic fever remains a significant cause of mitral valve insufficiency. It is responsible for approximately 90 % of early childhood valvular surgeries in Brazil. Elongated or flail chordae are frequently responsible and require surgical correction. The purpose of this study was to analyze and compare the histological tissues of the mitral valve chordae and the mechanical resistance generated by the chordae, both with and without the application of a high-power laser. Twenty normal porcine mitral valve chordae were measured and divided randomly into the following two groups: control group (not subjected to a high-power laser) and laser group (subjected to photonic irradiation). Laser surgery was performed under controlled conditions, using following parameters: λ = 980-nm wavelength, power = 3 W, and energy = 60 J. A mechanical test machine was used in combination with a subsequent histological study to measure chordae tensile properties. A histological analysis demonstrated a typical collagen bundle arrangement in the control group; however, under a particular reached temperature range (48), the collagen bundles assumed different arrangements in the laser group. Significant reductions in the chordae tendineae lengths and changes in their resistance in the laser group were observed, as these chordae exhibited less rigid fibers. The chordae tendineae of normal porcine valves subjected to a high-power laser exhibited its length reduction and less stiffness compared to the control group. A histological analysis of the laser treatment specimens demonstrated differences in collagen bundle spatial organization, following slight changes into tissue temperature. PMID:27184152

  12. Transapical closure of paraprosthetic mitral leak in a patient with inferior vena cava interruption and azygos continuation.

    PubMed

    Mega, Simona; Patti, Giuseppe; Carminati, Mario; Sedati, Pietro; D'Ambrosio, Andrea; Di Sciascio, Germano

    2015-01-01

    Para-valvular leaks represent a relevant post-operative complication of cardiac valve replacement, often causing heart failure or severe hemolysis. We report a case of a 72 year-old woman with aortic and mitral mechanical prostheses who developed hemolytic anemia because of a para-prosthetic mitral leak. Chest tomography in such patient unexpectedly documented inferior vena cava interruption with azygos continuation into superior vena cava. Given the high surgical risk, the venous anomaly and the presence of the aortic valve prosthesis, transcatheter leak closure via antero-lateral mini-thoracotomy and transapical approach was performed.

  13. Mitral valve replacement with preservation of subvalvular apparatus in a patient with familial dextrocardia and situs solitus.

    PubMed

    Khan, Junaid Fayyaz; Khan, Imran; Khan, Kamran

    2014-11-01

    Familial dextrocardia with situs solitus is extremely rare entity. Dextrocardia offers a difficult situation to surgeon. A different strategy for cannulation and approach to the left atrium has to be followed. Surgery in such settings has rarely been reported. We present the case of a patient with dextrocardia and situs solitus wherein a left sided approach was adopted for a better exposure of the valve. The patient had a rheumatic regurgitant mitral valve with ruptured chordae to anterior mitral leaflet. Since the valve was severely thickened, it was replaced rather than repaired. The left sided approach provided good exposure of the valve.

  14. Two rings too tight: sequential emergency PCI for hemodynamic and arrhythmic complications of mitral and tricuspid valve repair.

    PubMed

    Patel, Niket; Cuculi, Florim; Banning, Adrian P

    2014-01-01

    New intra-operative mitral regurgitation is an unusual complication of tricuspid annuloplasty and maybe ischemic in etiology as a consequence of right coronary artery distortion. We report the case of a woman in whom this was treated by mitral valve annuloplasty with ensuing hemodynamic instability and ventricular arrhythmia secondary to a new left circumflex occlusion. Injury/distortion to either of the coronary arteries running in the atrio-ventricular groove is rare, and described only several times. To our knowledge, concurrent right coronary artery and circumflex artery injury/distortion has not been reported previously.

  15. Severe Acute Traumatic Mitral Regurgitation, Cardiogenic Shock Secondary to Embolized Polymethylmethracrylate Cement Foreign Body After a Percutaneous Vertebroplasty.

    PubMed

    Elapavaluru, Subbarao; Alhassan, Sulaiman; Khan, Fawad; Khalil, Ramzi; Schuett, Amy; Bailey, Stephen

    2016-03-01

    We report the case of a 61-year-old woman with acute decompensated heart failure secondary to acute traumatic mitral regurgitation, resulting from polymethylmethacrylate cement found in the left ventricle less than 24 hours after fluoroscopic percutaneous vertebroplasty. The patient had a history of ovarian cancer and had undergone treatment for symptomatic osteoporotic compression fractures of the vertebrae (T11, L1, and L3). The patient underwent a successful emergency open-heart operation, mitral valve replacement, closure of an atrial septal defect, and video-assisted removal of the cement foreign body from the left ventricle. The patient was later discharged with a good outcome.

  16. Heme oxygenase derived carbon monoxide and iron mediated plasmatic hypercoagulability in a patient with calcific mitral valve disease.

    PubMed

    Thompson, Jess L; Nielsen, Vance G; Castro, Allison R; Chen, Andrew

    2015-05-01

    We present a case of a patient with calcific mitral valve stenosis and plasmatic hypercoagulability. Using thrombelastography, the patient was determined to have an abnormally large velocity of plasma thrombus growth and strength with reduced vulnerability to lysis. Critically, increased carboxyhemoglobin concentration (2.4 %) was present, likely secondary to hemolysis from mitral stenosis and engagement of systemic heme oxygenase. It was determined that the patient's plasmatic hypercoagulability was in part due to carboxyhemefibrinogen formation and iron-enhancement of coagulation via two thrombelastographic methods. In conclusion, future investigation of the involvement of both carbon monoxide and iron mediated hypercoagulability in the setting of stenotic valve disease is warranted.

  17. Myocardial infarct associated with a partial thickness left atrial tear in a dog with mitral insufficiency.

    PubMed

    Sleeper, Meg M; Maczuzak, Meredith E; Bender, Susan J

    2015-09-01

    A 10-year-old male neutered cavalier King Charles Spaniel with a 1-year history of degenerative mitral valve disease presented for dyspnea and severe weakness. He was diagnosed with congestive heart failure, systolic dysfunction, presumptive myocardial infarction and a left atrial thrombus based on thoracic radiographs, electrocardiogram and echocardiographic findings. Clinical signs also suggested right foreleg embolism. The dog was euthanized due to the grave prognosis and a postmortem evaluation was performed. The postmortem examination confirmed myocardial infarction and was thought to be due to embolic showering from the thrombus attached to a partial thickness left atrial endocardial tear. PMID:26263842

  18. A case of ventricular septal defect and mitral insufficiency after blunt trauma.

    PubMed

    Masuoka, Ayumu; Kimura, Naritaka; Katogi, Toshiyuki; Suzuki, Takaaki

    2014-09-01

    Few reports have described traumatic heart injury in children. We describe a case of acute mitral regurgitation associated with papillary muscle rupture, traumatic ventricular septal defect, and impending left ventricular free wall rupture due to blunt trauma in a 2-year-old girl. The papillary muscle was sutured to the left ventricular free wall. The septal defect and surrounding ruptured muscle were covered with a pericardial patch, and a Hemashield patch was used to close the ventriculotomy. A residual defect caused by dehiscence of the pericardial patch necessitated reoperation 10 months later. The patient is currently being observed on an outpatient basis. PMID:24887820

  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. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial

    PubMed Central

    Siminiak, Tomasz; Wu, Justina C.; Haude, Michael; Hoppe, Uta C.; Sadowski, Jerzy; Lipiecki, Janusz; Fajadet, Jean; Shah, Amil M.; Feldman, Ted; Kaye, David M.; Goldberg, Steven L.; Levy, Wayne C.; Solomon, Scott D.; Reuter, David G.

    2012-01-01

    Aims Functional mitral regurgitation (FMR) contributes to morbidity and mortality in heart failure (HF) patients. The aim of this study was to determine whether percutaneous mitral annuloplasty could safely and effectively reduce FMR and yield durable long-term clinical benefit. Methods and results The impact of mitral annuloplasty (Carillon Mitral Contour System) was evaluated in HF patients with at least moderate FMR. Patients in whom the device was placed then acutely recaptured for clinical reasons served as a comparator group. Quantitative measures of FMR, left ventricular (LV) dimensions, New York Heart Association (NYHA) class, 6 min walk distance (6MWD), and quality of life were assessed in both groups up to 12 months. Safety and key functional data were assessed in the implanted cohort up to 24 months. Thirty-six patients received a permanent implant; 17 had the device recaptured. The 30-day major adverse event rate was 1.9%. In contrast to the comparison group, the implanted cohort demonstrated significant reductions in FMR as represented by regurgitant volume [baseline 34.5 ±11.5 mL to 17.4 ±12.4 mL at 12 months (P < 0.001)]. There was a corresponding reduction in LV diastolic volume [baseline 208.5 ±62.0 mL to 178.9 ±48.0 mL at 12 months (P =0.015)] and systolic volume [baseline 151.8 ±57.1 mL to 120.7 ±43.2 mL at 12 months (P =0.015)], compared with progressive LV dilation in the comparator. The 6MWD markedly improved for the implanted patients by 102.5 ±164 m at 12 months (P =0.014) and 131.9 ±80 m at 24 months (P < 0.001). Conclusion Percutaneous reduction of FMR using a coronary sinus approach is associated with reverse LV remodelling. Significant clinical improvements persisted up to 24 months. PMID:22613584

  1. QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

    PubMed Central

    İmamoğlu, Ebru Yalın; Eroğlu, Ayşe Güler

    2016-01-01

    Aim: To investigate ventricular arrhythmias in children with primary mitral valve prolapse and to evaluate its relation with QT length, QT dispersion, autonomic function tests and heart rate variability measurements. Material and Methods: Fourty two children with mitral valve prolapse and 32 healthy children were enrolled into the study. Twelve-lead electrocardiograms, autonomic function tests, echocardiography and 24-hour rhythm Holter tests were performed. Electrocardiograms were magnified digitally. The QT length was corrected according to heart rate. The patients were grouped according to the number of premature ventricular contractions and presence of complex ventricular arhythmia in the 24-hour rhythm Holter monitor test. Heart rate variability measurements were calculated automatically from the 24-hour rhythm Holter monitor test. Orthostatic hypotension and resting heart rate were used as autonomic function tests. Results: The mean age was 13.9±3.3 years in the patient group and 14.6±3.1 years in the control group (p>0.05). Thirty four of the patients (81%) were female and eight (19%) were male. Twenty five of the control subjects (78%) were female and seven (22%) were male. The QT dispersion and heart rate corrected QT interval were found to be significantly increased in the children with primary mitral valve prolapse when compared with the control group (56±16 ms vs. 43±11 ms, p=0.001; 426±25 ms vs. 407±26 ms, p=0.002, respectively). In 24-hour rhythm Holter monitor tests, ventricular arrhythmias were found in 21 out of 42 patients (50%) and 6 out of 32 control subjects (18.8%) (p=0.006). QT dispersion was found to be significantly increased in patients with premature ventricular contractions ≥ 10/day and/or complex ventricular arrhythmias compared to the control group without ventricular premature beats (p=0.002). There was no significant difference in autonomic function tests and heart rate variability measurements between the patient and control

  2. Which patient undergoing mitral valve surgery should also have the tricuspid repair?

    PubMed

    Bianchi, Giacomo; Solinas, Marco; Bevilacqua, Stefano; Glauber, Mattia

    2009-12-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which patient undergoing mitral valve surgery should also have the tricuspid repair?' Altogether 390 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. While a general agreement exists for tricuspid valve (TV) repair in cases of severe regurgitation and concomitant multivalvular disease requiring surgical intervention, current guidelines provide more vague indications for patients with less severe tricuspid regurgitation (TR). Since this condition has a lower event-free survival rate and the prognosis after symptoms development is dismal, a lower threshold and a more aggressive strategy for intervention is needed. In rheumatic valve disease, mitral valve involvement and disease spreading to TV may be responsible for further regurgitation. Although patients with pulmonary hypertension (PH) may benefit from mitral valve replacement (MVR) or balloon valvotomy, many studies found that preoperative PH does not predict late TR. However, patients with high pulmonary pressure have a lower occurrence of late TR. Tricuspid annular dilation is probably the most important factor for late TR. Once established, it might be irreversible even after resolution of PH as well as absence of 'reverse remodelling'. It has been proposed to treat TR independently from the grade of regurgitation when the annular dimension is over 21 mm/m(2) or > or =3.5 cm at echo measurement or when the intra-operative tricuspid annulus (TA) diameter is >70 mm. TV repair should be accomplished in patients with preoperative atrial fibrillation (AF), since it may cause late significant TR development and affect the patient's long-term survival. The presence of a trans

  3. 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. PMID:26904241

  4. Utilization of artificial neural networks and autoregressive modeling in diagnosing mitral valve stenosis.

    PubMed

    Kara, Sadik; Güven, Ayşegül; Okandan, Mustafa; Dirgenali, Fatma

    2006-05-01

    This research is concentrated on the diagnosis of mitral heart valve stenosis through the analysis of Doppler Signals' AR power spectral density graphic with the help of ANN. Multilayer feedforward ANN trained with a Levenberg Marquart backpropagation algorithm was implemented in the MATLAB environment. Correct classification of 94% was achieved, whereas 4 false classifications have been observed for the test group of 68 subjects in total. The designed classification structure has about 97.3% sensitivity, 90.3% specifity and positive prediction is calculated to be 92.3%. The stated results show that the proposed method can make an effective interpretation. PMID:15890326

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

    PubMed

    Reif, T H; Huffstutler, M C

    1985-01-01

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

  6. Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta.

    PubMed

    Botta, Luca; Fratto, Pasquale; Cannata, Aldo; Bruschi, Giuseppe; Merlanti, Bruno; Brignani, Christian; Bosi, Mauro; Martinelli, Luigi

    2014-01-01

    Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.

  7. Prolonged Intracellular Na+ Dynamics Govern Electrical Activity in Accessory Olfactory Bulb Mitral Cells.

    PubMed

    Zylbertal, Asaph; Kahan, Anat; Ben-Shaul, Yoram; Yarom, Yosef; Wagner, Shlomo

    2015-12-01

    Persistent activity has been reported in many brain areas and is hypothesized to mediate working memory and emotional brain states and to rely upon network or biophysical feedback. Here, we demonstrate a novel mechanism by which persistent neuronal activity can be generated without feedback, relying instead on the slow removal of Na+ from neurons following bursts of activity. We show that mitral cells in the accessory olfactory bulb (AOB), which plays a major role in mammalian social behavior, may respond to a brief sensory stimulation with persistent firing. By combining electrical recordings, Ca2+ and Na+ imaging, and realistic computational modeling, we explored the mechanisms underlying the persistent activity in AOB mitral cells. We found that the exceptionally slow inward current that underlies this activity is governed by prolonged dynamics of intracellular Na+ ([Na+]i), which affects neuronal electrical activity via several pathways. Specifically, elevated dendritic [Na+]i reverses the Na+-Ca2+ exchanger activity, thus modifying the [Ca2+]i set-point. This process, which relies on ubiquitous membrane mechanisms, is likely to play a role in other neuronal types in various brain regions. PMID:26674618

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

    PubMed

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

    2012-07-01

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

  9. A biomimetic bi-leaflet mitral prosthesis with enhanced physiological left ventricular swirl restorative capability

    NASA Astrophysics Data System (ADS)

    Tan, Sean Guo-Dong; Kim, Sangho; Leo, Hwa Liang

    2016-06-01

    Mechanical heart valve prostheses are often implanted in young patients due to their durability and long-term reliability. However, existing designs are known to induce elevated levels of blood damage and blood platelet activation. As a result, there is a need for patients to undergo chronic anti-coagulation treatment to prevent thrombosis, often resulting in bleeding complications. Furthermore, recent studies have suggested that the implantation of a mechanical prosthetic valve at the mitral position results in a significant alteration of the left ventricular flow field which may contribute to flow turbulence. This study proposes a bi-leaflet mechanical heart valve design (Bio-MHV) that mimics the geometry of a human mitral valve, with the aim of reducing turbulence levels in the left ventricle by replicating physiological flow patterns. An in vitro three-dimensional particle velocimetry imaging experiment was carried out to compare the hemodynamic performance of the Bio-MHV with that of the clinically established ATS valve. The Bio-MHV was found to replicate physiological left ventricular flow patterns and produced lower turbulence levels.

  10. Endoscopic feature tracking for augmented-reality assisted prosthesis selection in mitral valve repair

    NASA Astrophysics Data System (ADS)

    Engelhardt, Sandy; Kolb, Silvio; De Simone, Raffaele; Karck, Matthias; Meinzer, Hans-Peter; Wolf, Ivo

    2016-03-01

    Mitral valve annuloplasty describes a surgical procedure where an artificial prosthesis is sutured onto the anatomical structure of the mitral annulus to re-establish the valve's functionality. Choosing an appropriate commercially available ring size and shape is a difficult decision the surgeon has to make intraoperatively according to his experience. In our augmented-reality framework, digitalized ring models are superimposed onto endoscopic image streams without using any additional hardware. To place the ring model on the proper position within the endoscopic image plane, a pose estimation is performed that depends on the localization of sutures placed by the surgeon around the leaflet origins and punctured through the stiffer structure of the annulus. In this work, the tissue penetration points are tracked by the real-time capable Lucas Kanade optical flow algorithm. The accuracy and robustness of this tracking algorithm is investigated with respect to the question whether outliers influence the subsequent pose estimation. Our results suggest that optical flow is very stable for a variety of different endoscopic scenes and tracking errors do not affect the position of the superimposed virtual objects in the scene, making this approach a viable candidate for annuloplasty augmented reality-enhanced decision support.

  11. Effect of mitral orifice shape on intra-ventricular filling fluid dynamics

    NASA Astrophysics Data System (ADS)

    Okafor, Ikechukwu; Angirish, Yagna; Yoganathan, Ajit; Santhanakrishnan, Arvind

    2013-11-01

    The natural geometry of the mitral orifice is D-shaped. However, most current designs of prosthetic valves employ O-shaped orifice geometry. The goal of this study was to compare the effect of geometrical modification between the D and O orifice on the intra-ventricular fluid dynamics during diastolic filling. The different mitral orifice geometries were incorporated into an in vitro left heart simulator consisting of a flexible-walled anatomical left ventricle (LV) physical model enclosed in an acrylic housing. Physiological flow rates and pressures were obtained via tuning systemic resistance and compliance elements in the flow loop. A programmable piston pump was used to generate the LV model wall motion. 2D Particle image velocimetry measurements were conducted along multiple longitudinal planes perpendicular to the annulus plane. During peak diastole, the incoming jet width at the LV central plane was smaller for the D-orifice than that of the O-orifice. Further, the core of the vortex ring in the D-orifice was reduced in size compared to that of the O-orifice. The spatiotemporal spreading of the inflow jet as well as the propagation of the vortex ring will be discussed. This study was funded by a grant from the National Heart, Lung and Blood Institute (RO1HL70262).

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

    PubMed

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

    2014-12-01

    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. PMID:25319496

  13. Baseline and post-atrial pacing release of atrial natriuretic factor in mitral stenosis.

    PubMed

    Malatino, L S; Stancanelli, B; Greco, G; Polizzi, G; Leonardi, C; Russo, G; Tamburino, C; Greco, G; Giuffrida, G; Tamburino, G

    1990-01-01

    To investigate the release of atrial natriuretic factor (ANF) in mitral stenosis and the influence of the increase on the frequency of atrial contraction or atrial distention on ANF secretion, we studied 10 patients with symptoms of congestive heart failure (New York Heart Association classes II and III) in sinus rhythm, who were undergoing cardiac catheterization as part of an evaluation workup for mitral stenosis. Echocardiographic tracings, repeat determinations of mean pulmonary artery wedge pressure (MPAWP) and mean right atrial pressure, and blood sampling from the pulmonary artery for measurements of ANF were performed at baseline, during atrial pacing (pacing rate of 125 beats/min for 5 minutes), and 5 minutes after the pacing protocol was completed. Baseline ANF levels were closely related to right atrial pressure (r = 0.89; p less than 0.001) and increased markedly after atrial pacing from 205.6 +/- 39.8 (SEM) to 343.9 +/- 57.9 (SEM) pg/ml. A similar pacing-induced increase was shown for MPAWP and left atrial size. Our data indicate that pacing-induced increases in atrial distention and intracavitary pressure further stimulate release of ANF. However, an independent effect of frequency of atrial pacing on plasma ANF in humans could not be identified. PMID:2136967

  14. Prolonged Intracellular Na+ Dynamics Govern Electrical Activity in Accessory Olfactory Bulb Mitral Cells.

    PubMed

    Zylbertal, Asaph; Kahan, Anat; Ben-Shaul, Yoram; Yarom, Yosef; Wagner, Shlomo

    2015-12-01

    Persistent activity has been reported in many brain areas and is hypothesized to mediate working memory and emotional brain states and to rely upon network or biophysical feedback. Here, we demonstrate a novel mechanism by which persistent neuronal activity can be generated without feedback, relying instead on the slow removal of Na+ from neurons following bursts of activity. We show that mitral cells in the accessory olfactory bulb (AOB), which plays a major role in mammalian social behavior, may respond to a brief sensory stimulation with persistent firing. By combining electrical recordings, Ca2+ and Na+ imaging, and realistic computational modeling, we explored the mechanisms underlying the persistent activity in AOB mitral cells. We found that the exceptionally slow inward current that underlies this activity is governed by prolonged dynamics of intracellular Na+ ([Na+]i), which affects neuronal electrical activity via several pathways. Specifically, elevated dendritic [Na+]i reverses the Na+-Ca2+ exchanger activity, thus modifying the [Ca2+]i set-point. This process, which relies on ubiquitous membrane mechanisms, is likely to play a role in other neuronal types in various brain regions.

  15. Robust physically-constrained modeling of the mitral valve and subvalvular apparatus.

    PubMed

    Voigt, Ingmar; Mansi, Tommaso; Ionasec, Razvan Ioan; Mengue, Etienne Assoumou; Houle, Helene; Georgescu, Bogdan; Hornegger, Joachim; Comaniciu, Dorin

    2011-01-01

    Mitral valve (MV) is often involved in cardiac diseases, with various pathological patterns that require a systemic view of the entire MV apparatus. Due to its complex shape and dynamics, patient-specific modeling of the MV constitutes a particular challenge. We propose a novel approach for personalized modeling of the dynamic MV and its subvalvular apparatus that ensures temporal consistency over the cardiac sequence and provides realistic deformations. The idea is to detect the anatomical MV components under constraints derived from the biomechanical properties of the leaflets. This is achieved by a robust two-step alternate algorithm that combines discriminative learning and leaflet biomechanics. Extensive evaluation on 200 transesophageal echochardiographic sequences showed an average Hausdorff error of 5.1 mm at a speed of 9 sec, which constitutes an improvement of up to 11.5% compared to purely data driven approaches. Clinical evaluation on 42 subjects showed, that the proposed fully-automatic approach could provide discriminant biomarkers to detect and quantify remodeling of annulus and leaflets in functional mitral regurgitation.

  16. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial

    PubMed Central

    Lipiecki, Janusz; Siminiak, Tomasz; Sievert, Horst; Müller-Ehmsen, Jochen; Degen, Hubertus; Wu, Justina C; Schandrin, Christian; Kalmucki, Piotr; Hofmann, Ilona; Reuter, David; Goldberg, Steven L; Haude, Michael

    2016-01-01

    Objective Functional (or secondary) mitral regurgitation (FMR) is associated with greater morbidity and worse outcomes in patients with congestive heart failure (CHF) and cardiomyopathy. The Carillon® Mitral Contour System® is a coronary sinus-based percutaneous therapy to reduce FMR. We evaluated the safety and efficacy of a modified version of the Carillon device in the treatment of patients with cardiomyopathy and FMR. Methods 36 patients with CHF, depressed left ventricular function (ejection fraction <40%) and at least moderate FMR underwent the Carillon device implant. Results There was 1 major adverse event within 30 days—a death (not device related)—occurring 17 days after the implant. Reductions in FMR and improvements in functional class and 6 min walk tests were seen, similar to prior studies. Device fractures in the high strain region of the proximal anchor (seen in prior studies) were not seen in this study. Conclusions The modified Carillon device was associated with improvements in clinical and echocardiographic parameters in treating patients with FMR, while successfully addressing the issue of anchor fracture. This version of the Carillon device will be used in a blinded randomised trial of symptomatic patients with FMR. PMID:27493761

  17. 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

  18. Prolonged Intracellular Na+ Dynamics Govern Electrical Activity in Accessory Olfactory Bulb Mitral Cells

    PubMed Central

    Zylbertal, Asaph; Kahan, Anat; Ben-Shaul, Yoram; Yarom, Yosef; Wagner, Shlomo

    2015-01-01

    Persistent activity has been reported in many brain areas and is hypothesized to mediate working memory and emotional brain states and to rely upon network or biophysical feedback. Here, we demonstrate a novel mechanism by which persistent neuronal activity can be generated without feedback, relying instead on the slow removal of Na+ from neurons following bursts of activity. We show that mitral cells in the accessory olfactory bulb (AOB), which plays a major role in mammalian social behavior, may respond to a brief sensory stimulation with persistent firing. By combining electrical recordings, Ca2+ and Na+ imaging, and realistic computational modeling, we explored the mechanisms underlying the persistent activity in AOB mitral cells. We found that the exceptionally slow inward current that underlies this activity is governed by prolonged dynamics of intracellular Na+ ([Na+]i), which affects neuronal electrical activity via several pathways. Specifically, elevated dendritic [Na+]i reverses the Na+-Ca2+ exchanger activity, thus modifying the [Ca2+]i set-point. This process, which relies on ubiquitous membrane mechanisms, is likely to play a role in other neuronal types in various brain regions. PMID:26674618

  19. 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

  20. A rare case of enterobacter endocarditis superimposed on a mitral valve rheumatoid nodule.

    PubMed

    Giladi, Hili; Sukenik, Shaul; Flusser, Daniel; Liel-Cohen, Noah; Applebaum, Azai; Sion-Vardy, Netta

    2008-04-01

    We present the case of a 56-year-old man with longstanding seropositive active erosive and deforming rheumatoid arthritis with no peripheral rheumatoid nodules; he immigrated from the former Soviet Union (where he did not receive any disease-modifying antirheumatic drugs) to Israel in 1995. In February 2005, he had a buccogingival mucosal abscess on his lower lip, which was treated by surgical drainage, followed by prolonged antibiotic therapy. One and a half years later, he had 2 episodes of transient ischemic attacks characterized by speech difficulties and moderate weakness on his right side. Transesophageal echocardiogram revealed a mass on the anterior mitral valve leaflet. Repeated blood cultures were negative, and the patient was afebrile all the time. The patient underwent mitral valve replacement and the histologic findings of the mass were typical of both a rheumatoid nodule and bacterial endocarditis. The patient recovered fully after 6 weeks of antibiotic therapy. Emboli from a rheumatoid nodule should always be considered in patients with rheumatoid arthritis who present with transient ischemic attacks. PMID:18391680

  1. 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

  2. Unusual findings in secondary hypertension: double orifice mitral associated to aortic coarctation, bicuspid aortic valve, and ventricular septal defect.

    PubMed

    Mouine, Najat; Amri, Rachida; Cherti, Mohamed

    2014-01-01

    Double orifice mitral valve is a rare congenital anomaly presenting as the division of the mitral orifice into two anatomically distinct orifices, it is most often associated with other congenital heart defects such as left-sided obstructive lesions, ventricular septal defects or aortic coarctation. We report the case of a 15 year's old boy, admitted for arterial hypertension, auscultation revealed a rude aortic systolic murmur. Femoral pulses were weak. Owing to the suspicion of aortic coarctation, transthoracic echocardiography was performed, the aortic coarctation with dilation of the aorta proximal to the stenosis was confirmed and bicuspid aortic valve was found with good function. The mitral valve was dysmorphic, having two orifices; it was divided into 2 separate valve orifices by a fibrous bridge. No mitral or aortic regurgitation was documented by color Doppler flow imaging. The left ventricular ejection fraction was normal. There was a small peri membranous ventricular septal defect with left to right shunt. Owing to the severity of the aortic coarctation and taking into account the anatomy and characteristics of the patient, he was made a surgical correction of aortic coarctation with good outcome. PMID:24693935

  3. Cleft posterior mitral valve leaflet in an adult with Turner syndrome diagnosed with the use of 3-dimensional transesophageal echocardiography.

    PubMed

    Negrea, Stefania Luminita; Alexandrescu, Clara; Sabatier, Michel; Dreyfus, Gilles D

    2012-01-01

    Turner syndrome is a monosomy (45,X karyotype) in which the prevalence of cardiovascular anomalies is high. However, this aspect of Turner syndrome has received little attention outside of the pediatric medical literature, and the entire spectrum of cardiovascular conditions in adults remains unknown. We present the case of a 34-year-old woman who had Turner syndrome. When she was a teenager, her native bicuspid aortic valve was replaced with a mechanical prosthesis. Fifteen years later, during preoperative examination for prosthesis-patient mismatch, severe mitral regurgitation was detected, and a congenital cleft in the posterior leaflet of the mitral valve was diagnosed with use of 3-dimensional transesophageal echocardiography. The patient underwent concurrent mitral valve repair and aortic valve replacement. To our knowledge, this is the first report of a cleft in the posterior mitral valve leaflet as a cardiovascular defect observed in Turner syndrome, and the first such instance to have been diagnosed with the use of 3-dimensional echocardiography.

  4. 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

  5. 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

  6. 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.

  7. Fluid-Structure Interaction Analysis of Papillary Muscle Forces Using a Comprehensive Mitral Valve Model with 3D Chordal Structure.

    PubMed

    Toma, Milan; Jensen, Morten Ø; Einstein, Daniel R; Yoganathan, Ajit P; Cochran, Richard P; Kunzelman, Karyn S

    2016-04-01

    Numerical models of native heart valves are being used to study valve biomechanics to aid design and development of repair procedures and replacement devices. These models have evolved from simple two-dimensional approximations to complex three-dimensional, fully coupled fluid-structure interaction (FSI) systems. Such simulations are useful for predicting the mechanical and hemodynamic loading on implanted valve devices. A current challenge for improving the accuracy of these predictions is choosing and implementing modeling boundary conditions. In order to address this challenge, we are utilizing an advanced in vitro system to validate FSI conditions for the mitral valve system. Explanted ovine mitral valves were mounted in an in vitro setup, and structural data for the mitral valve was acquired with [Formula: see text]CT. Experimental data from the in vitro ovine mitral valve system were used to validate the computational model. As the valve closes, the hemodynamic data, high speed leaflet dynamics, and force vectors from the in vitro system were compared to the results of the FSI simulation computational model. The total force of 2.6 N per papillary muscle is matched by the computational model. In vitro and in vivo force measurements enable validating and adjusting material parameters to improve the accuracy of computational models. The simulations can then be used to answer questions that are otherwise not possible to investigate experimentally. This work is important to maximize the validity of computational models of not just the mitral valve, but any biomechanical aspect using computational simulation in designing medical devices.

  8. Fluid-Structure Interaction Analysis of Papillary Muscle Forces Using a Comprehensive Mitral Valve Model with 3D Chordal Structure.

    PubMed

    Toma, Milan; Jensen, Morten Ø; Einstein, Daniel R; Yoganathan, Ajit P; Cochran, Richard P; Kunzelman, Karyn S

    2016-04-01

    Numerical models of native heart valves are being used to study valve biomechanics to aid design and development of repair procedures and replacement devices. These models have evolved from simple two-dimensional approximations to complex three-dimensional, fully coupled fluid-structure interaction (FSI) systems. Such simulations are useful for predicting the mechanical and hemodynamic loading on implanted valve devices. A current challenge for improving the accuracy of these predictions is choosing and implementing modeling boundary conditions. In order to address this challenge, we are utilizing an advanced in vitro system to validate FSI conditions for the mitral valve system. Explanted ovine mitral valves were mounted in an in vitro setup, and structural data for the mitral valve was acquired with [Formula: see text]CT. Experimental data from the in vitro ovine mitral valve system were used to validate the computational model. As the valve closes, the hemodynamic data, high speed leaflet dynamics, and force vectors from the in vitro system were compared to the results of the FSI simulation computational model. The total force of 2.6 N per papillary muscle is matched by the computational model. In vitro and in vivo force measurements enable validating and adjusting material parameters to improve the accuracy of computational models. The simulations can then be used to answer questions that are otherwise not possible to investigate experimentally. This work is important to maximize the validity of computational models of not just the mitral valve, but any biomechanical aspect using computational simulation in designing medical devices. PMID:26183963

  9. [Mitral Valve Replacement with a Low-Profile Bioprosthesis in Combination with Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy;Report of a Case].

    PubMed

    Furukawa, Koji; Sakaguchi, Shuhei; Nakamura, Eisaku; Yano, Mitsuhiro

    2015-06-01

    An 83-year-old woman diagnosed with hypertrophic obstructive cardiomyopathy was referred to our hospital. Her echocardiogram revealed diffuse left ventricular hypertrophy, severe mitral valve regurgitation with systolic anterior motion of the mitral valve, and left ventricular obstruction with a peak outflow gradient of 142 mmHg. Cardiac catheterization revealed a peak pressure gradient of 60 mmHg across the left ventricular outflow tract. Because of the patient's advanced age, as well as uncertainty regarding our ability to resolve her mitral regurgitation, we performed mitral valve replacement with a St. Jude Medical Epic porcine low-profile bioprosthesis in combination with septal myectomy. The patient's postoperative course was uneventful. At 1 year after the operation, her functional status was New York Heart Association class I. The echocardiogram showed the peak outflow gradient markedly decreased to 9 mmHg. PMID:26066877

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

    PubMed Central

    2013-01-01

    Background The prevalence of mitral regurgitation in cardiac diseases requires annuloplasty systems that can be implanted without excessive patient burden. This study was designed to examine the morphological and functional outcome of a new double helix mitral annuloplasty ring in an ovine model in comparison to the classical Carpentier-Edwards (CE) annuloplasty ring as measured by reduction of mitral regurgitation and tissue integration. The Medtentia annuloplasty ring (MAR) is a helical device that is rotated into the annulus self-restoring the valve geometry, enabling a faster fixation without the need of elaborate repair of the valve geometry. The ventricular part of the helical ring encircles the valve chords. Methods Twenty adult sheep were overpaced until 2+ level mitral valve regurgitation was achieved. Seven animals per group received either the MAR or the CE ring. Implantation was performed on-pump in a beating heart through the left atrial appendix. The animals were sacrificed 3.6 ± 0.3 months after surgery following an echocardiography for assessing mitral regurgitation as primary endpoint. The annuloplasty rings with surrounding tissue were harvested for histological analyses as secondary endpoints. The remaining six sheep received the MAR system and were sampled seven, nine or 12 months after surgery. Results Implantation time (p < 0.01) and perfusion time (p < 0.001) as clinical secondary endpoints were significantly shorter in the MAR group. Echocardiography follow-ups showed sufficient valve function repair in nearly all animals with a normalization of the ventricle diameters in both groups (group difference: p = 0.147). The weights of the hearts did not differ significantly. Histology revealed adequately covered atrial annuloplasty rings with functional endothelium and lack of excessive granulation tissue or fibrosis in all specimens. The ventricular projections of the MAR systems encircling the chordae tendineae were not

  11. Mitral Valve Replacement in a Patient with Sickle Cell Disease Using Perioperative Exchange Transfusion

    PubMed Central

    Chabot, David; Sutton, Robin

    2008-01-01

    Abstract: Sickle cell disease is a genetic hemoglobinopathy in which a significant number of red blood cells carry hemoglobin-S as opposed to normal red blood cells that contain hemoglobin-A. Under certain conditions such as hypoxia, acidosis, and hypothermia, the red blood cells containing hemoglobin-S will sickle, leading to occlusion of the microvasculature. As such, patients with sickle cell disease present unique challenges during heart surgery using cardiopulmonary bypass (CPB). After conducting a literature review, we discovered that the exact hemoglobin-S level for conducting cardiac surgery with CPB is not known. However, a hemoglobin-S level <30% is considered safe for conducting CPB. The following case report will discuss these challenges and present a patient with sickle cell disease undergoing a mitral valve repair. Management of this patient involved exchange transfusions both preoperatively and intraoperatively. PMID:19192758

  12. Mitral Valve Perforation in Libman-Sacks Endocarditis: A Heart-Wrenching Case of Lupus.

    PubMed

    Aby, Elizabeth S; Rosol, Zachary; Simegn, Mengistu A

    2016-08-01

    Libman-Sacks (LS) endocarditis is one of the most common cardiac manifestations of systemic lupus erythematosus. Rarely, however, it can lead to serious complications, including severe valvular regurgitation or superimposed bacterial endocarditis. We describe the initial diagnostic challenges, clinical course, imaging studies and histopathological findings of a patient who presented with life-threatening lupus complicated by hemoptysis and respiratory failure secondary to a rare complication of LS endocarditis, acute mitral valve perforation. We review the current literature on valve perforation in the setting of LS endocarditis. In conclusion, although the disease is often asymptomatic and hemodynamically insignificant, it can result in serious and potentially fatal complications secondary to valve perforation, which may demand emergency surgical management.

  13. Evaluation of growth differentiation factor 11 (GDF11) levels in dogs with chronic mitral valve insufficiency

    PubMed Central

    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

  14. [PECULIARITIES OF ROTATIONAL MOTION OF LEFT VENTRICULAR WALLS IN PATIENTS ON MITRAL VALVE INSUFFICIENCY].

    PubMed

    Trembovetskaya, E M; Knyshov, G V; Rudenko, S A; Babochkina, A R; Luchynets, A F

    2015-07-01

    The peculiarities of rotational motion of left ventricular (LV) walls in patients on mitral valve insufficiency (MVI) were studied. In normal heart and MVI the rotation of basal and apical portions of the LV occurs in inter-reverse directions: the basal portion rotates clockwise and apical portion rotates counterclockwise. In patients with MVI the increase of the LV volumes is accompanied by compensatory rise of LV myocardium torsion up to (23.7 ± 5.0)degrees. The increase of indices of LV myocardium torsion in MVI occurs due to basal portions of the heart only. This is a compensatory factor in preserving of normal cardiac output for a long period of time in such disease. PMID:26591217

  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. 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.

  17. Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

    PubMed Central

    Russo, Antonio; Pasquale, Ferdinando; Biagini, Elena; Barberini, Francesco; Ferlito, Marinella; Leone, Ornella; Rapezzi, Claudio

    2015-01-01

    Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR. PMID:26448820

  18. [PECULIARITIES OF ROTATIONAL MOTION OF LEFT VENTRICULAR WALLS IN PATIENTS ON MITRAL VALVE INSUFFICIENCY].

    PubMed

    Trembovetskaya, E M; Knyshov, G V; Rudenko, S A; Babochkina, A R; Luchynets, A F

    2015-07-01

    The peculiarities of rotational motion of left ventricular (LV) walls in patients on mitral valve insufficiency (MVI) were studied. In normal heart and MVI the rotation of basal and apical portions of the LV occurs in inter-reverse directions: the basal portion rotates clockwise and apical portion rotates counterclockwise. In patients with MVI the increase of the LV volumes is accompanied by compensatory rise of LV myocardium torsion up to (23.7 ± 5.0)degrees. The increase of indices of LV myocardium torsion in MVI occurs due to basal portions of the heart only. This is a compensatory factor in preserving of normal cardiac output for a long period of time in such disease.

  19. Role of cardiac dyssynchrony and resynchronization therapy in functional mitral regurgitation.

    PubMed

    Spartera, Marco; Galderisi, Maurizio; Mele, Donato; Cameli, Matteo; D'Andrea, Antonello; Rossi, Andrea; Mondillo, Sergio; Novo, Giuseppina; Esposito, Roberta; D'Ascenzi, Flavio; Montisci, Roberta; Gallina, Sabina; Margonato, Alberto; Agricola, Eustachio

    2016-05-01

    Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction. Finally, we propose a practical diagnostic and therapeutic strategy for the management of symptomatic patients with severe LV dysfunction and concomitant 'prognostic' FMR.

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

    PubMed Central

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

    2013-01-01

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

  1. Port Access (Thru-Port System) video-assisted mitral valve surgery

    PubMed Central

    Chirichilli, Ilaria; D’Ascoli, Riccardo; Rose, David; Frati, Giacomo

    2013-01-01

    The aim of this review is to focus the attention on the “state of the art” of port-access and video-assisted mitral valve surgery appraising the results compared to the traditional approach, describing different technical strategies and analyzing how to avoid and manage its related complications concomitantly elucidating which procedure is associated with the most favorable risk-benefit and cost-benefit profile. Our default strategy is to use the minimally invasive approach combining video-assisted right mini-thoracotomy with endo-cardiopulmonary bypass and endo-aortic balloon occlusion (EBO) whenever possible. This choice is supported by the evidence that, after an initial learning curve, it is a safe and effective approach in terms of short- and long-term results, mainly for redo operations and even for elderly patients with moderately elevated peri-operative risk. PMID:24251028

  2. Nectin-1 spots as a novel adhesion apparatus that tethers mitral cell lateral dendrites in a dendritic meshwork structure of the developing mouse olfactory bulb.

    PubMed

    Inoue, Takahito; Fujiwara, Takeshi; Rikitake, Yoshiyuki; Maruo, Tomohiko; Mandai, Kenji; Kimura, Kazushi; Kayahara, Tetsuro; Wang, Shujie; Itoh, Yu; Sai, Kousyoku; Mori, Masahiro; Mori, Kensaku; Mizoguchi, Akira; Takai, Yoshimi

    2015-08-15

    Mitral cells project lateral dendrites that contact the lateral and primary dendrites of other mitral cells and granule cell dendrites in the external plexiform layer (EPL) of the olfactory bulb. These dendritic structures are critical for odor information processing, but it remains unknown how they are formed. In immunofluorescence microscopy, the immunofluorescence signal for the cell adhesion molecule nectin-1 was concentrated on mitral cell lateral dendrites in the EPL of the developing mouse olfactory bulb. In electron microscopy, the immunogold particles for nectin-1 were symmetrically localized on the plasma membranes at the contacts between mitral cell lateral dendrites, which showed bilateral darkening without dense cytoskeletal undercoats characteristic of puncta adherentia junctions. We named the contacts where the immunogold particles for nectin-1 were symmetrically accumulated "nectin-1 spots." The nectin-1 spots were 0.21 μm in length on average and the distance between the plasma membranes was 20.8 nm on average. In 3D reconstruction of serial sections, clusters of the nectin-1 spots formed a disc-like structure. In the mitral cell lateral dendrites of nectin-1-knockout mice, the immunogold particles for nectin-1 were undetectable and the plasma membrane darkening was electron-microscopically normalized, but the plasma membranes were partly separated from each other. The nectin-1 spots were further identified between mitral cell lateral and primary dendrites and between mitral cell lateral dendrites and granule cell dendritic spine necks. These results indicate that the nectin-1 spots constitute a novel adhesion apparatus that tethers mitral cell dendrites in a dendritic meshwork structure of the developing mouse olfactory bulb.

  3. A new cardiac manifestation associated with woolly hair: report of two cases of woolly hair, palmoplantar keratoderma, and mitral valve regurgitation.

    PubMed

    Zandi, Soodabeh; Farajzadeh, Saeedeh

    2007-09-01

    Two siblings (a 24-year-old woman and a 14-year-old girl) with congenital woolly hair, epidermolytic palmoplantar keratoderma, and mitral valve regurgitation are described. An interesting additional feature in one of the patients (the 14-year-old girl) was posterior subcapsular cataract. The association of woolly hair and mitral valve regurgitation has not been reported previously. The occurrence of cataract in one of our patients is also a new ophthalmologic finding in this hair shaft anomaly.

  4. 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.

  5. Real Time 3D Echocardiographic Evaluation of Iatrogenic Atrial Septal Defects After Percutaneous Transvenous Mitral Commissurotomy

    PubMed Central

    Devarakonda, Sarath Babu; Mannuva, Boochi Babu; Durgaprasad, Rajasekhar; Velam, Vanajakshamma; Akula, Vidya Sagar; Kasala, Latheef

    2015-01-01

    Introduction: Percutaneous transvenous mitral commissurotomy (PTMC) is a safe and effective procedure for relief of severe mitral stenosis. PTMC is being done widely and many transseptal procedures requiring large diameter catheters, sheaths are becoming popular. The knowledge of iatrogenic atrial septal defect (iASD) is vital. This study assessed the use of real-time 3D echocardiography (RT3DE) and incidence of iASD in a cohort of patients undergoing transseptal catheterization during PTMC. Methods: One hundred ten patients underwent PTMC. The reliability and accuracy of RT3DE for iASD detection was determined, RT3DE was compared with 2D echocardiography (2DE) for iASD occurrence, influencing variables analyzed and followed up for 1 year. Results: RT3DE is more reliable and accurate for the study of iASD than 2DE. Color RT3DE detected iASD in 94 (85.5%), with 2DE iASD was detected in 74 (67.3%) (P < .0001).On follow up 85% had iASD post procedure, 56% at 6 months, 19% at 1 year follow up. The mean iASD diameter was 5.41 ± 3.12 mm and area 6.57 ± 3.81 mm2. iASD correlated with patient height, Wilkins score, pre-PTMC LA ‘v’, and post-PTMC LVEDP. Conclusion: RT3DE imaging is superior in accuracy to traditional 2DE techniques. All the modes of RT3DE are useful in the assessment of iASD. iASD measured by RT3DE correlates with several patient, procedural and echocardiographic variables. PMID:26430495

  6. Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction.

    PubMed

    Fernández-Golfín, Covadonga; De Agustin, Alberto; Manzano, M Carmen; Bustos, Ana; Sánchez, Tibisay; Pérez de Isla, Leopoldo; Fuentes, Manuel; Macaya, Carlos; Zamorano, José

    2011-04-01

    Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.

  7. Brain 'Embolism' Detected by Magnetic Resonance Imaging During Percutaneous Mitral Balloon Commissurotomy

    SciTech Connect

    Rocha, Paulo; Qanadli, Salah D.; Strumza, Pierre; Kacher, Safia; Aberkane, Linda; Aubry, Pierre; Rigaud, Michel; Lacombe, Pascal; Raffestin, Bernadette

    1999-05-15

    Purpose: The common finding of thrombi between the bifoil balloons when they were extracted after mitral dilation prompted us to look for evidence of minor brain embolisms using the sensitive technique of BMRI (brain magnetic resonance T2-weighted imaging). Methods: BMRI was performed within 48 hr before and after a percutaneous mitral balloon commissurotomy (PMBC) in each of the 63 patients in this study. Results: There was evidence (hyperintensity foci: HI) of a previous asymptomatic brain embolism in 38 of 63 patients before PMBC and a new HI appeared in 18 of 63 patients after the procedure. New HI signals were found exclusively in the white matter in 8 of 18 patients and in only 3 of 18 were HI signs larger than 1 cm. One patient, with an HI signal >1 cm in the thalamus and another <1 cm in the brain stem, presented diplopia accompanied by other minor clinical signs. The differences in HI rate among four subgroups (1, older vs younger than 43 years; 2, sinus rhythm vs atrial fibrillation; 3, echo score <8 vs >8; 4, patients from western countries vs the others) were not statistically significant, probably because the number of patients in each subgroup was low. Patients in atrial fibrillation had slightly more (not significant) HI before PMBC (15/20, 75%) than patients in sinus rhythm (23/43, 53%), but after PMBC their HI frequencies were similar (atrial fibrillation: 5/20, 25%; sinus rhythm: 13/43, 30%). Conclusion: Brain microembolism is frequent during PMBC, but is often anatomically limited and free from clinical signs in most cases. Brain embolism seems to be related mainly to the procedure itself and not the features of the patient.

  8. Barlow’s 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

    Barlow’s 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 Barlow’s 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 Barlow’s MV repair is more complex than that for most degenerative pathologies, several centers have published relatively large series of MIS MV repair for Barlow’s disease. In this review article, we highlight and compare the early and long-term results of conventional and minimally invasive approaches to Barlow’s 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 Barlow’s 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

  9. Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness

    PubMed Central

    Sgorbini, Luca; Scuteri, Angelo; Leggio, Massimo; Leggio, Francesco

    2004-01-01

    Background Mitral annular calcification (MAC) and aortic annular calcification (AVC) may represent a manifestation of generalized atherosclerosis in the elederly. Alterations in vascular structure, as indexed by the intima media thickness (IMT), are also recognized as independent predictors of adverse cardiovascular outcomes. Aim To examine the relationship between the degree of calcification at mitral and/or aortic valve annulus and large artery structure (thickness). Methods We evaluated 102 consecutive patients who underwent transthoracic echocardiography and carotid artery echoDoppler for various indications; variables measured were: systemic blood pressure (BP), pulse pressure (PP=SBP-DBP), body mass index (BMI), fasting glucose, total, HDL, LDL chlolesterol, triglycerides, cIMT. The patients were divided according to a grading of valvular/annular lesions independent scores based on acoustic densitometry: 1 = annular/valvular sclerosis/calcification absence; 2 = annular/valvular sclerosis; 3 = annular calcification; 4 = annular-valvular calcification; 5 = valvular calcification with no recognition of the leaflets. Results Patient score was the highest observed for either valvular/annulus. Mean cIMT increased linearly with increasing valvular calcification score, ranging from 3.9 ± 0.48 mm in controls to 12.9 ± 1.8 mm in those subjects scored 5 (p < 0.0001). In the first to fourth quartile of cIMT values the respective maximal percentual of score were: score 1: 76.1%, score 2: 70.1%, score 4: 54.3% and score 5: 69.5% (p > 0.0001). Conclusion MAC and AVC score can identify subgroups of patients with different cIMT values which indicate different incidence and prevalence of systemic artery diseases. This data may confirm MAC-AVC as a useful important diagnostic parameter of systemic atherosclerotic disease. PMID:15471552

  10. Surgical Strategy for Ischemic Mitral Regurgitation Adopting Subvalvular and Ventricular Procedures

    PubMed Central

    Wakasa, Satoru; Shingu, Yasushige; Ooka, Tomonori; Katoh, Hiroki; Tachibana, Tsuyoshi

    2015-01-01

    Purpose: The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). Methods: We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). Results: The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). Conclusion: Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering. PMID:25740449

  11. Surgical Strategies for Management of Mitral Regurgitation: Recent Evidence from Randomized Controlled Trials.

    PubMed

    Tolis, George; Sundt, Thoralf M

    2015-12-01

    In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.

  12. Mitral stenosis

    MedlinePlus

    ... KA, Gerwitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease ...

  13. Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling

    PubMed Central

    Szymanski, Catherine; Bel, Alain; Cohen, Iris; Touchot, Bernard; Handschumacher, Mark D.; Desnos, Michel; Carpentier, Alain; Menasché, Philippe; Hagège, Albert A.; Levine, Robert A.; Messas, Emmanuel

    2012-01-01

    Background Undersized ring annuloplasty for ischemic mitral regurgitation (MR) is associated with variable results and >30% MR recurrence. We tested whether subvalvular repair by severing second-order mitral chordae can improve annuloplasty by reducing papillary muscle tethering. Methods and Results Posterolateral myocardial infarction known to produce chronic remodeling and MR was created in 28 sheep. At 3 months, sheep were randomized to sham surgery versus isolated undersized annuloplasty versus isolated bileaflet chordal cutting versus the combined therapy (n=7 each). At baseline, chronic myocardial infarction (3 months), and euthanasia (6.6 months), we measured left ventricular (LV) volumes and ejection fraction, wall motion score index, MR regurgitation fraction and vena contracta, mitral annulus area, and posterior leaflet restriction angle (posterior leaflet to mitral annulus area) by 2-dimensional and 3-dimensional echocardiography. All groups were comparable at baseline and chronic myocardial infarction, with mild to moderate MR (MR vena contracta, 4.6±0.1 mm; MR regurgitation fraction, 24.2±2.9%) and mitral annulus dilatation (P<0.01). At euthanasia, MR progressed to moderate to severe in controls but decreased to trace with ring plus chordal cutting versus trace to mild with chordal cutting alone versus mild to moderate with ring alone (MR vena contracta, 5.9±1.1 mm in controls, 0.5±0.08 with both, 1.0±0.9 with chordal cutting alone, 2.0±0.7 with ring alone; P<0.01). In addition, LV end-systolic volume increased by 108% in controls versus 28% with ring plus chordal cutting, less than with each intervention alone (P<0.01). In multivariate analysis, LV end-systolic volume and mitral annulus area most strongly predicted MR (r2=0.82, P<0.01). Conclusions Comprehensive annular and subvalvular repair improves long-term reduction of both chronic ischemic MR and LV remodeling without decreasing global or segmental LV function at follow-up. PMID:23139296

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

    PubMed

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

    2014-08-01

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

  15. Evaluation of mitral valve prolapse using newly developed real-time three-dimensional echocardiographic system with real-time volume rendering.

    PubMed

    Goktekin, Omer; Matsumura, Makoto; Omoto, Ryozo; Kyo, Shunei; Mochizuki, Tsuyoshi

    2003-02-01

    The development of a real-time three-dimensional (RT3D) image acquisition system and direct digital links between ultrasound equipment and the data processing computer facilitate improved 3D image reconstruction. However, at present time, it is hard to promptly display 3D images and is also ineffective for a practical use. The objective of this study was to assess the feasibility of a new transthoracic RT3D echocardiographic system for evaluation of mitral valve prolapse. Eighteen patients with mitral valve prolapse diagnosed by transthoracic two-dimensional (2D) echocardiography and M-mode were examined through this technique (11 male, mean age 42 +/- 17 years). Since visualization of mitral valve from apical four-chamber view was better than that of the parasternal approach, only apical approach was used for mitral valve evaluation. This system is capable of acquiring volumetric data from mechanical scanning of the phased-array transducer (3.5 MHz) as well as displaying the volume rendered images of the structure without storing the image data and reconstruction of the object. The prolapse of leaflet could be seen in 14/ 18 (77%) of patients with mitral valve prolapse based on conventional echocardiography. The newly developed transthoracic RT 3D ultrasound system without a reconstruction process seemed to be a useful noninvasive tool for diagnosis of mitral valve prolapse and detection of prolapsed leaflet or scallop, which is very important for deciding on a reliable surgical technique.

  16. Multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography in patients with mitral valve prolapse, flail, and endocarditis: diagnostic accuracy in the identification of mitral regurgitant defects by correlation with surgical findings.

    PubMed

    Agricola, Eustachio; Oppizzi, Michele; De Bonis, Michele; Maisano, Francesco; Toracca, Lucia; Bove, Tiziana; Alfieri, Ottavio

    2003-01-01

    Multiplane transesophageal echocardiography is a useful tool to study mitral regurgitation. We evaluated the diagnostic accuracy of multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography. We used 4 midesophageal and 2 transgastric views in 313 patients with degenerative lesions, endocarditic lesions, or both to identify regurgitant defects, comparing transesophageal echocardiography results with surgical findings. The overall diagnostic accuracy using individual scallops was 97.2% (P <.00001) with a sensitivity of 96.6% and a specificity of 97.6%. Considering the single sections of the mitral valve, an accuracy of 98%, 97.1%, and 98%, was found, respectively, for the lateral, middle, and medial third of the anterior leaflet. For the posterior leaflet, the accuracy was 98% for the lateral scallop, 98.4% for the middle, and 96.1% for the medial. This strategy provides good accuracy in diagnosing both simple and challenging mitral-valve lesions and its widespread use should be recommended.

  17. Implantation of mitral, aortic, and tricuspid bioprostheses due to infective endocarditis with necessary reimplantation of the bioprosthetic aortic valve

    PubMed Central

    Bugajski, Paweł; Olszewski, Roman; Greberski, Krzysztof; Kalawski, Ryszard

    2016-01-01

    The patient was admitted to the Department of Cardiac Surgery of the J. Struś City Hospital in Poznan due to infective endocarditis involving the aortic, mitral, and tricuspid valves. Implantation of three biological valve prostheses proceeded without complications. Starting on day 23, the patient's general condition deteriorated, with high fever. Despite postoperative antibiotic therapy, transesophageal echocardiography revealed the presence of vegetation on the bioprosthetic aortic valve. On the 46th day after the initial surgery, the patient required replacement of the aortic bioprosthesis, which exhibited the presence of numerous vegetations. The bioprosthetic mitral and tricuspid valves were not affected by the degenerative process. On the 12th day after the reimplantation of the bioprosthetic aortic valve, the patient was discharged from the hospital in good general condition. PMID:27785140

  18. Evidence for a further stimulation of atrial natriuretic factor release by atrial pacing in patients with mitral stenosis.

    PubMed

    Malatino, L S; Stancanelli, B; Greco, G; Polizzi, G; Leonardi, C; Russo, G; Tamburino, C; Greco, G; Giuffrida, G; Tamburino, G

    1989-12-01

    To investigate the release of atrial natriuretic factor (ANF) in mitral stenosis and the effect of an increased atrial contraction frequency on atrial distension and ANF secretion, we studied 14 patients [New York Heart Association (NYHA) grades II-III] in sinus rhythm, undergoing cardiac catheterization for mitral stenosis. Echocardiographic tracings, repeat determinations of mean pulmonary artery wedge pressure and blood samples from the pulmonary artery for ANF measurements were taken at baseline, during atrial pacing (125 beats/min for 5 min) and 5 min after pacing. After pacing, ANF levels rose markedly with a parallel increase in mean pulmonary artery wedge pressure and left atrial size. These data indicate that atrial pacing is capable of further stimulating ANF release, even in patients with elevated baseline ANF and left atrial pressure and an increased left atrial dimension. PMID:2534411

  19. Results after mitral valve replacement with cloth-covered Starr-Edwards prostheses (models 6300, 6310/6320, and 6400).

    PubMed Central

    Forman, R; Beck, W; Barnard, C N

    1978-01-01

    The actuarial survival and thromboembolic rates for the three types of cloth-covered Starr-Edwards mitral prostheses, models 6300, 6310/6320, and 6400 followed 6, 5, and 2 years, respectively, were not significantly different throughout the years they were followed. The combined cumulative survival and thromboembolic proportion at 5 years for these prostheses were 71 and 66 per cent, respectively. The thromboembolic rates were not different in the following two groups: (a) 238 patients receiving anticoagulants, and (b) 52 patients who had discontinued or who were not receiving anticoagulants. Four patients thrombosed their mitral prostheses. Another 8 per cent had class 3 symptoms after operation, which were attributed to myopathic or restrictive left ventricular dysfunction or other valvular disease. PMID:656234

  20. Uncontrolled daily pulmonary oedema due to severe mitral regurgitation emergently and effectively corrected by Mitraclip® implantation.

    PubMed

    Leurent, Guillaume; Corbineau, Hervé; Donal, Erwan

    2016-04-01

    MitraClip® is usually implanted in stable patients. We report the case of a patient having a severe, refractory and daily pulmonary oedema, related to a severe restrictive mitral regurgitation secondary to a primitive dilated cardiomyopathy. A Mitraclip® was emergently implanted, with a dramatic long-term clinical success. The critical unstable status of a patient should not prevent any Mitraclip® implantation. PMID:25838439