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PubMed2005

Cleft mitral valve in association with anomalous left coronary artery arising from pulmonary artery.

An anomalous origin of the left coronary artery from the pulmonary artery is commonly associated with mitral valve insufficiency. Usually this is secondary to left ventricular dysfunction or papillary muscle ischemia. We describe the association of an anomalous left coronary artery from the pulmonary artery with structural abnormalities of the mitral valve (cleft mitral leaflet) in 2 children, both of whom were being investigated for primary mitral valve disease. Both underwent successful operations for coronary transfer and mitral valve repair.

Cardiac Surgical Procedures↗
PubMed1997

Mitral valve strands and the risk of ischemic stroke in elderly patients. The French Study of Aortic Plaques in Stroke (FAPS) Investigators.

BACKGROUND AND PURPOSE: Strands are thin and filamentous attachments on the cardiac valves shown by transesophageal echocardiography. Their nature and their potential for embolization are largely unknown. The objective was to estimate the risk of brain infarction in patients with mitral valve strands. METHODS: Using transesophageal echocardiography, we compared the frequency of strands on native mitral valves in 284 consecutive patients admitted with brain infarction and 276 control patients, all older than 60 years. In a second part, case subjects were followed up over a 2- to 4-year period, and the risk of recurrence of brain infarction was estimated in patients with and without strands. RESULTS: In the case-control study, mitral valve strands were found in 22.5% of the case patients and in 12.1% of the control subjects. In case subjects, mitral valve strands were more frequent in those with mitral valve dystrophy (52.4% versus 37.4%; P = .03). Strands were not associated with mitral valve prolapse, annular calcifications, or left atrial spontaneous echocardiographic contrast. After adjustment for age, sex, and mitral valve dystrophy, the odds ratio for ischemic stroke among patients with mitral strands was 2.2 (95% confidence interval, 1.4 to 3.6; P = .005). The frequency of strands was not different in patients with a known cause of brain infarction (24.4%) from that in patients with no other apparent cause (20.9%). During 646 per 100 person-years of follow-up, the incidence of recurrent brain infarction was 6.0 person-years in patients with strands and 4.2 in those without. In the Cox analysis, including potential confounders and poststroke treatment, mitral valve strands did not appear as independent predictors of recurrent brain infarction (relative risk, 1.3; 95% confidence interval, 0.5 to 3.0; P = .54). CONCLUSIONS: The present study shows an independent association between mitral valve strands and the risk of brain infarction. However, the lack of an increased relative risk of recurrence raises doubts about the potential causal relation with brain infarction in patients aged 60 years or older.

Aged↗
PubMed2002

Evaluation of clinical treatment of atrial fibrillation associated with rheumatic mitral valve disease by radiofrequency ablation.

OBJECTIVES: The aim of this clinical study was to evaluate the effectiveness and advantages of the radiofrequency ablation maze procedure in the treatment of atrial fibrillation associated with rheumatic mitral valve disease. METHODS: We developed one kind of modified Cox III maze procedure with the use of radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic mitral valve disease and compared the outcome of 96 patients of atrial fibrillation associated rheumatic mitral valve disease who underwent radiofrequency ablation maze procedure plus mitral valve replacement with that of 87 patients with atrial fibrillation associated rheumatic mitral valve disease who had mitral valve replacement during the same interval by the same surgeon. The patients in the two groups were similar in age, gender, preoperative New York Heart Association class and duration of preoperative atrial fibrillation. RESULTS: No operative deaths occurred in the study group and the control group. Duration of cardiopulmonary bypass (137.63 +/- 10.82 vs. 90.95 +/- 7.65 min, P<0.01) and duration of aortic crossclamping (56.96 +/- 6.19 vs. 32.66 +/- 3.55 min, P<0.01) were prolonged in the study group. Blood loss from chest tubes was similar in the two groups (494.06 +/- 100.44 vs. 476.09 +/- 115.84 ml, P=0.263). Freedom from atrial fibrillation in the study group was 77% 3 years after the operation compared with 25% in the control group (P<0.01). CONCLUSIONS: The addition of the radiofrequency ablation maze procedure to mitral valve replacement is safe and effective in the treatment of atrial fibrillation associated with rheumatic mitral valve disease.

Adolescent↗
PubMed2006

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

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

Aged↗
PubMed1991

[Development of severe mitral regurgitation following percutaneous transvenous mitral valve commissurotomy].

The purpose of this study was to analyze the risk factors of unexpected occurrence of mitral regurgitation (MR) following percutaneous transvenous mitral valve commissurotomy (PTMC) in patients with mitral stenosis. The analyzed factors were clinical pictures, hemodynamic findings, echocardiographic findings and balloon inflation techniques during PTMC. Among 24 patients undergoing successful PTMC using an Inoue's balloon, severe MR developed in five patients (21%). No significant correlation in the occurrence of MR was observed in clinical findings, hemodynamic data and balloon inflation techniques including the times and size of ballooning. Echocardiographic findings of the mitral valve including the pliability of the mitral leaflet and localized calcification of the mitral orifice were the most contributory factors to the occurrence of severe MR. The localized alternation of valve stiffness produced localized tear or excessive dilatation of the mitral leaflet during PTMC, resulting in severe MR. Hemodynamic results and calculated mitral valve areas after PTMC showed significant improvement in both groups with and without MR. However, symptomatic improvement in patients with severe MR was less prominent when compared to the patients without MR. Thus, the complete echocardiographic evaluation of the mitral valve apparatus before PTMC is important to prevent severe MR.

Aged↗
PubMed1995

Morphometry of the fibrous ring of the mitral valve.

In standard textbooks of anatomy it is generally accepted that the fibrous ring of the mitral valve lies in a single plane throughout its entire circumference. Some authors have stated otherwise, but there are no morphometric studies. 30 formalin-fixed hearts were sectioned to reveal the shape of the fibrous ring of the mitral valve and studied by morphometric, radiographic and histological methods. It was noted that the fibrous ring adopted a horizontal "S" shape around the two commissures and the average distance between the highest and lowest parts of the fibrous ring was found to be 7.1 mm (range 6.2-12.5 mm). Radiographic evaluation revealed that the fibrous ring lies approximately in two planes rather than in one. Histological study showed that the fibrous tissue of the mitral valve is continuous with the aortic fibrous ring, and that a slight but significant thickening marks the insertion of the mitral valve. The mitral valve thus lies in two planes, and it is hoped that this information will contribute to cardiac and valvuloplastic surgery.

Aorta, Thoracic↗
PubMed2001

Artificial mitral valve chordae replacement made simple.

Mitral valve repair techniques are now widely applied in patients with myxomatous valve disease. The use of artificial chords to achieve correct height adjustment of the prolapsing anterior leaflet segment can often be challenging. We describe a simple method of artificial chord reconstruction performed after annuloplasty, which allows for easy identification of functional prolapse and accurate chordal height adjustment.

Bioprosthesis↗
PubMed1983

Myxoid degeneration with prolapse and dystrophic calcification of the annulus fibrosus of the mitral valve. Pathological and clinical survey.

Two degenerations of the mitral valve apparatus, namely myxoid degeneration of the mitral cusps and necrosis with subsequent calcification of the annulus fibrosus, are extensively reviewed and discussed. Both lesions are mainly noticed in elderly patients, with the possible exception of systemic dystrophies of the connective tissue associated with metabolic disorders. The clinicopathological correlations of several cases are reported, with special emphasis on modern diagnostic procedures and their wide anatomic spectrum.

Adult↗
PubMed1998

Mitral valve replacement with homograft.

The technique for replacement of the mitral valve with a mitral valve homograft is described. Principles include side-by-side approximation of the papillary muscles using multiple stitches of fine monofilament suture, direct attachment of the annulus of the mitral homograft to the annulus of the patient, and support of the repair by remodeling annuloplasty ring.

Cardiac Surgical Procedures↗
PubMed1995

Valve replacement for regurgitant lesions of the aortic or mitral valve in advanced left ventricular dysfunction.

Patients with aortic regurgitation and severe left ventricular dysfunction remain candidates for aortic valve replacement, as long as the risks of late left ventricular dysfunction and congestive heart failure have been fully discussed with the patient, the patient's family, and the referring physician. In contrast, patients with mitral regurgitation and severe systolic dysfunction are at considerable risk of more severe left ventricular dysfunction after operation, especially if mitral valve repair or chordal-sparing procedure cannot be performed. In patients who are candidates for such procedures that preserve the integrity of the subvalvular mitral apparatus, operation may be successful in selected patients despite moderate-to-severe depression of systolic function. Prognosis is guarded to poor in patients with regurgitant valvular lesions and advanced left ventricular dysfunction, and the emerging alternative treatments discussed in other articles in this Cardiology Clinics deserve consideration in these patients.

Aortic Valve↗
PubMed1997

Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations.

BACKGROUND: We have devised a simple surgical procedure to be performed on the posterior wall of the left atrium for the treatment of chronic atrial fibrillation (AF) associated with mitral valve disease. The effectiveness of this procedure for serial mitral valve operations was then evaluated. We postulated that chronic AF associated with mitral valve disease could be attributable to a distended left atrium. The refractory period of the distended left atrium was significantly shorter in the left posterior atrial wall, especially at the base of the left atrial appendage and at the orifice of the left posterior pulmonary vein. We hypothesized that the left posterior atrial wall with its shorter fibrillatory cycle length would act as a driver for maintaining the AF, and therefore, surgical ablation of this critical area in the left atrium could terminate the chronic AF. METHODS: The surgical patients were divided into two groups. In group 1 (control group), 15 patients with chronic AF were operated on by the mitral valve procedure only. In group 2, 36 patients underwent this procedure in combination with a concomitant mitral valve operation. The disappearance rate of the AF was estimated by electrocardiography, and atrial function was estimated by transthoracic and transesophageal echocardiography. RESULTS: The chronic AF had been reduced significantly or eliminated at discharge in 4 of 15 patients (26.7%) in the group 1, versus 31 of 36 patients (86%) in group 2 (p < 0.05). In group 2, 29 of the 31 patients (94%) whose AF had disappeared recovered the atrial kick of their right atrium, and 21 patients (22/31; 71%) recovered the atrial kick of their left atrium. CONCLUSIONS: Surgical ablation of the posterior wall of the left atrium was effective in the treatment of chronic AF associated with mitral valve disease. This simple procedure could restore a sinus rhythm and also recovered atrial systolic function. We conclude that the left atrium may act as a driver for sustaining AF in mitral valve disease.

Aged↗
PubMed2002

Combined atrial fibrillation and mitral valve surgery using microwave technology.

Atrial fibrillation is associated with a significant morbidity and mortality and is typically related to patients with mitral valve disease. Microwave ablation is a new option for surgical treatment of chronic atrial fibrillation. We present our experience with surgical treatment of mitral valve disease and microwave ablation in patients with chronic atrial fibrillation. In 105 patients (73 women, 32 men, 68.6 +/- 8 years of age from 45 to 83 years, ejection fraction 28% to 80%, left atrial diameter 56 +/- 9.1 mm from 35 to 97 mm) with mitral valve disease, chronic atrial fibrillation was documented for 8.6 +/- 6.8 years. Microwave ablation was performed using a continuous ablation line starting at the posterior mitral valve annulus and incorporating the interior of all pulmonary veins. In 33 patients, mitral valve reconstruction was performed. Ten patients received biologic valve replacement; 3 of them got a stentless quattro mitral valve prosthesis. Survival rate was 99.1% (n = 104). In the 6-month follow-up, 42 of 69 patients were in sinus rhythm (61%); in the 1-year follow-up, 37 of 64 patients were in sinus rhythm (57.8%). Microwave ablation is a safe and efficient method for surgical treatment of chronic atrial fibrillation in patients with mitral valve disease.

Aged↗
PubMed1988

Long-term results of mitral valve surgery in patients with severe pulmonary hypertension.

Mitral valve surgery was performed in 88 patients with severe pulmonary hypertension (average systolic pulmonary artery pressure, 94.7 +/- 22 mm Hg; range, 70-180 mm Hg) over a 10-year period. Sixty-four patients (73%) were in New York Heart Association Functional Class III or IV. There were 64 valve replacements and 24 open mitral commissurotomies. Operative mortality was 5.6% (5 patients) and was not related to the degree of pulmonary hypertension, surgical procedure performed, or type of valve lesion. A 100% follow-up was obtained, ranging from nine months to 10 years, with a mean of 44 months. Six late cardiac deaths (7.2%) occurred, 5 in patients with valve replacement and 1 in a patient who underwent a commissurotomy. Actuarial survival was 86 +/- 3% at five years and 83 +/- 4% at 10 years. Fourteen patients underwent right ventricular catheterization a mean of 24 months following operation. Systolic pulmonary artery pressure had decreased from a mean preoperative value of 101 +/- 22 to 40.5 +/- 7 mm Hg (p less than 0.001). Cardiac index increased by 55% of the preoperative values. Functional status improved markedly; 71 survivors (93%) were in New York Heart Association Class I or II. These results indicate that, in patients with mitral valve lesions and severe pulmonary hypertension, (1) surgical procedures can be performed with an acceptable operative mortality; (2) excellent long-term survival and functional results can be obtained; and (3) pulmonary hypertension decreases significantly after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Conservative surgery of congenital isolated mitral valve anomalies in children. Early and late results].

Conservative surgery for non-av-canal mitral valve anomalies was performed in 30 children under 15 years of age between 1965 and 1986 at our institution. In 14/30 (47%) children these anomalies were isolated (without other intra- or extracardiac defects). Mean age of the 14 children was 6.7 years (range 9 months to 15 years). Preoperatively mitral insufficiency was found in 12 cases, stenosis in one and combined insufficiency and stenosis in one case. The following morphological substrates of mitral valve were found: annular dilation 3, leaflet anomalies 20, chordal anomalies 4, papillary muscle anomaly 1. Surgical technique was as follows: annuloplasty 9, plication of leaflet 4, closure of cleft 10, commissurotomy 2, displacement of papillary muscle 1. Early mortality was 1/14 (7%) patients. There was no death during a mean follow-up interval of 14.8 years (range 30 days to 25 years). Actuarial survival was 93% after 10 and 15 years (95% confidence limits 78-100%). A total of 2 reoperations was necessary (delay 16 day and 46 months). In both cases valve replacement was performed (valve size 27 and 29 mm). Actuarial reoperation-free interval was 77% after 10 and 15 years (95% confidence limits 53-100%). In conclusion conservative surgery for isolated mitral valve disease gives good long-term results. When reoperation is necessary, adult-sized prosthesis can be implanted. Conservative surgery is the procedure of choice for congenital mitral valve disease.

Actuarial Analysis↗
PubMedDate not supplied

[Echocardiography and Doppler echocardiography in mitral valve stenosis. A review].

One- and two-dimensional echocardiography are the most reliable methods of detecting mitral stenosis. Planimetry of the mitral valve area allows a reliable assessment of the degree of stenosis in 75% of all patients. Doppler echocardiography offers the possibility of measuring the transmitral pressure gradient and to determine pressure half-time, from which the mitral valve area can be calculated. The transmitral pressure gradient, however, undergoes considerable day-to-day variations and therefore its value for quantification is limited. The pressure half-time and planimetry of the mitral valve area are supplementary methods, for they allow the determination of the functional and the anatomic mitral valve area. These combined techniques allow a reliable quantification of the degree of mitral stenosis in about 90% of all patients. Doppler and color-coded Doppler echocardiography are sensitive tools in detecting accompanying disorders as mitral and aortic regurgitation or aortic stenosis. Subsequent disorders of mitral stenosis such as pulmonary hypertension or relative tricuspid incompetence can be assessed. In selected cases mitral valve surgery may be performed without prior catheterization.

Blood Flow Velocity↗
PubMed1988

Rupture of the posterior wall of the left ventricle after mitral valve replacement: etiological and technical considerations.

Rupture of the posterior wall of the left ventricle after mitral valve replacement, although infrequent, may be a highly lethal complication. Controversy exists regarding the etiology of this complication. Suggested causative factors include the type and extent of the valvular disease, type and size of the prosthesis, and the surgical techniques used. Our experience over a 20-year period includes 10 patients with rupture of the left ventricle following mitral valve replacement. In all patients, both mitral leaflets were excised together with the attached chordae. Three patients survived after repair of the rupture. Repair consisted of compressing the area between the left atrium and the base of the papillary muscle using two strips of Teflon and deep mattress sutures passed beneath the coronary vessels in the atrioventricular groove. Since 1983 we have routinely preserved the posterior leaflet of the mitral valve with its attached chordae to maintain a "tethered loop" between the mitral valve and ventricle. No further ruptures have occurred. The technique used for repair represents reconstitution of the divided loop between the ventricle and the mitral valve.

Aged↗
PubMed1975

Mitral valve replacement with the Hancock stabilized glutaraldehyde valve. Clinical and laboratory evaluation.

From March 1971 through April 1975, one hundred twenty patients underwent mitral valve replacement with a Hancock "stabilized glutaraldehyde process" porcine aortic xenograft. A simultaneous canine experimental series was also carried out. In the clinical series, the early mortality was 8.3%. Actuarial analyses of all patients predicts survival at two years of 81.0% and at four years of 70.0%. The predicted survival for patients without coronary disease or prior prosthetic valve replacement is 87.5% at two years and 77.5% at four years. There were four thromboembolic episodes, a rate of 2.4% per patient-year. None were fatal. No valve failure were noted. Histologic examination and shrink temperature analysis of recovered valves show excellent tissue preservation at 40 months. The data indicate that the Hancock valve is durable, enjoys a low incidence of thromboembolism, and may be the valve of choice for mitral valve replacement.

Adult↗
PubMed2004

Joint hypermobility syndrome and mitral valve prolapse in panic disorder.

OBJECTIVE: The purpose of this study is to test the association between joint hypermobility syndrome (JHS) and panic disorder (PD) and to determine whether mitral valve prolapse (MVP) modifies or accounts in part for the association. METHOD: A total of 115 subjects are included in this study in three groups. Group I (n = 42): panic disorder patients with MVP. Group II (n = 35): panic disorder patients without mitral valve prolapse. Group III (n = 38): control subjects who had mitral valve prolapse without any psychiatric illness. Beighton criteria were used to assess joint hypermobility syndrome. Two-dimensional and M-mode echocardiography was performed on each subject to detect mitral valve prolapse. RESULTS: Joint hypermobility syndrome was found in 59.5% of panic disorder patients with mitral valve prolapse, in 42.9% of patients without mitral valve prolapse and in 52.6% of control subjects. Beighton scores was 4.93 +/- 2.97 in group I, 4.09 +/- 2.33 in group II, and 4.08 +/- 2.34 in group III. There was no significant difference between groups according to Beighton scores. CONCLUSION: We did not detect a statistically significant relationship between panic disorder and joint hypermobility syndrome. Mitral valve prolapse and joint hypermobility syndrome are known to be etiologically related and we suggest that mitral valve prolapse affects the prevalence of joint hypermobility syndrome in the panic disorder patients.

Adult↗

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