[Experimental replacement of the mitral valve by mitral homograft].
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Animals↗
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Mitral valve repair vs replacement for mitral valve prolapse with severe mitral regurgitation.
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Chordae Tendineae↗
[A case of mitral valve prolapse simulating mitral tumor or vegetation].
We observed a case of mitral valve prolapse (MVP) mimicking mitral tumor or vegetation. The patient was a 34-year-old man. He complained of palpitation and precordial oppression. Shaggy and mass echoes of the anterior mitral valve were recorded by M-mode and two-dimensional echocardiograms. The "mass" echo was confirmed to by originated in a markedly myxomatous change of the spongiosa layer of the mitral valve at operation. These problems on echocardiographic diagnosis of MVP and mitral "mass", such as mitral tumor or vegetation, were discussed in detail.
Adult↗
Mitral valve hemorrhage and mitral annulus shrinkage in rabbits with transient ventricular bigeminies induced by vagal stimulation.
BACKGROUND AND AIM OF THE STUDY: Cervical vagal stimulation in rabbits frequently induces transient ventricular bigeminies, followed by mitral regurgitation lasting a few days, and development of peculiar lesions of the mitral complex. The present study investigated early lesions of the mitral valve and subsequent deformation of the mitral annulus associated with ventricular bigeminies in this animal model METHODS: A 1-min period of right cervical vagal electrical stimulation was repeated in anesthetized rabbits under ECG monitoring. Animals were sacrificed at 1 h after stimulation to investigate early mitral valve lesions (n = 71; group A), or after one week for measurement of mitral annulus area, using photographic planimetry (n = 56; group B). RESULTS: Ventricular bigeminies were recorded during vagal stimulation in 72% of group A (n = 51), and 73% of group B (n = 41). The most prominent early mitral valve lesion comprised widespread punctate hemorrhages over the chordae and leaflets, which developed in most animals with ventricular bigeminies (88%), but rarely in those without ventricular bigeminies (5%). This inter-group difference was highly significant (p <0.001). Gross examinations performed at one week after vagal stimulation revealed a deformed mitral annulus resulting from stiff, edematous periannular myocardial tissues. Animals with ventricular bigeminies displayed a significantly smaller mitral annulus area than those without ventricular bigeminies (26.8 +/- 1.0 versus 31.7 +/- 1.2 mm2; p <0.01). CONCLUSION: Early mitral valve hemorrhage and later mitral annulus shrinkage occur following vagus-induced transient ventricular bigeminies. This may result from unusual mechanical stress on the mitral complex secondary to distorted ventricular contraction in the context of ventricular bigeminies.
Animals↗
Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve.
The myxomatous, degenerated, prolapsed or "floppy" mitral valve is the most common cause of mitral regurgitation in North America. Mitral valve reconstruction for mitral regurgitation was carried out in 219 consecutive patients with a myxomatous mitral valve from 1984 to 1993. Of the 139 men and 80 women, 23 to 84 years of age (mean 63 years), 36% of patients were 70 years of age or older, 77% were in New York Heart Association functional class III or IV, and 29% had coronary artery disease necessitating coronary bypass. The most common operation was posterior leaflet resection (161 patients [73%]). The anterior leaflet was resected in 14 patients, and both the anterior and posterior leaflets were resected in 15 patients. A variety of other techniques were used, including commissuroplasty and use of annuloplasty rings. A flexible Duran ring was used in 111 patients (51%), a Carpentier-Edwards ring in 44 patients (20%), and no ring was used in 64 patients (29%). Five operative deaths occurred (2.3%); four of the five deaths occurred in patients 70 years of age or older (5.1%); and one in 141 patients (0.7%) was younger than 70 years of age. In the late postoperative period (mean follow-up 2 years), 90% of patients had no symptoms, two had endocarditis, and seven patients had thromboemboli (transient in four, permanent in three). Structural valve degeneration requiring reoperation occurred late in 12 patients; eight were in posterior leaflet resection and two in anterior or anterior and posterior; six of 12 had no annuloplasty ring. The incidence of structural valve degeneration was less than 5% from 1990 to 1993. No systolic anterior motion of the mitral valve was seen with postoperative echocardiography before discharge. Actuarial analysis at 5 years for overall survival was 86% +/- 5%, freedom from infectious valve degeneration 97% +/- 2%, and freedom from thromboembolism 94% +/- 3%. Freedom from structural valve degeneration overall was 83% +/- 4%, with a flexible ring it was 89% +/- 6%, with a rigid ring it was 88% +/- 6%, and with no ring it was 67% +/- 12% (p = 0.03). Mitral valve reconstruction for complicated myxomatous disease of the mitral valve, regardless of leaflet involvement, is feasible and offers excellent early and late results.
Actuarial Analysis↗
Stentless mitral valve implantation in comparison to conventional mitral valve repair or replacement at five years.
OBJECTIVE: A chordally supported stentless mitral valve (SMV) may be a suitable prosthesis for patients with severe degenerative mitral valve disease. We analyzed the five-year results and compared them with results after conventional mitral valve repair or replacement. METHODS: 155 patients, operated on since August 1997, were evaluated. 53 patients (ages, 68 +/- 8 years, 37 female, valve repair not feasible) received a SMV (Quattro), 51 patients (69 +/- 9 years, 32 female) had mitral valve repair (MVR) and 51 patients (66 +/- 9 years, 32 female) had a conventional mitral valve replacement (MVP). There were no significant differences with respect to preoperative NYHA functional class, left ventricular ejection fraction, cardiac index and surgical risk, according to the EuroSCORE. Mean follow-up is 64 +/- 18 (21-89) months. RESULTS: Surgery was performed using a median sternotomy (32 [SMV]/20 [MVR]/34 [MVP]) or a lateral mini-thoracotomy 21/31/17 approach. The SMV was safely attached to the papillary muscles. In-hospital mortality was 1, 2 and 4 respectively; re-operation was required in 6, 2 and 3 patients. Five-year survival rate was 80.6 +/- 4.4 % (SMV), 80.2 +/- 5.6 % (CMV) and 82.6 +/- 5.6 % (MVP), p = n.s. After hospital discharge, there was no significant difference in mortality in comparison to an age-matched control population. Echocardiography revealed acceptable SMV hemodynamics with preservation of left ventricular function. CONCLUSION: Midterm results after SMV implantation are comparable to conventional approaches. Complete preservation of the annulo-ventricular continuity is advantageous and close to physiologic hemodynamics can be achieved. Long term follow-up is required.
Aged↗
Mitral valve replacement for mitral stenosis secondary to Hunter's syndrome.
Hunter's syndrome is a rare, X-linked recessive, mucopolysaccharidosis. Survival into adulthood is uncommon. Mitral valve disease, predominantly regurgitation, has been reported in these patients. We have found no reports of mitral valve replacement for mitral stenosis secondary to Hunter's syndrome in the English literature. We report that mitral valve replacement for this pathology is a viable treatment option in an adult patient; however, specific precautions must be considered.
Adult↗
Aortic valve replacement and mitral valve repair with allograft.
Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.
Adult↗
Survival following mitral valve replacement for mitral regurgitation due to coronary artery disease.
Forty-six patients who underwent mitral valve replacement for mitral regurgitation due to coronary artery disease during 1970-1975 were identified. Forty patients underwent aortocoronary bypass procedures at the same operation. The survival rate at the fourth postoperative year was 73% in the 22 patients in whom the preoperative left ventricular ejection fraction exceeded 0.35, 38% in the 16 patients in whom the preoperative left ventricular ejection fraction was 35% or less, and 25% in the eight patients in whom aneurysmectomy was performed at the time of mitral valve replacement (p less than 0.05 for the former group compared to the latter two groups). Heart failure, present preoperatively in 41 patients, was improved in most of the long-term survivors. Neither the angiographic extent of coronary artery disease nor whether mitral valve replacement was performed in the acute (within 2 months in 13 patients) or chronic phase of myocardial infarction were distinctly correlated with survival.
Aged↗
Effect of atrial fibrillation and mitral regurgitation on calculated mitral valve area in mitral stenosis.
Forty-nine patients with mitral stenosis (MS) were studied by Doppler echocardiography and 2-dimensional (2-D) echocardiography to assess the ability of Doppler ultrasound to accurately measure mitral valve orifice area and to assess whether atrial fibrillation (AF) or mitral regurgitation (MR) affected the calculation. Twenty-four patients underwent cardiac catheterization. Mitral valve area by Doppler was determined by the pressure half-time method. Mean mitral valve area of all 49 patients by Doppler and 2-D echocardiography correlated well (r = 0.90). There was good correlation between Doppler and 2-D echocardiography in patients with pure MS in sinus rhythm (r = 0.88), in patients with MR (r = 0.93) and in patients with AF (r = 0.96). In the 7 patients with pure MS in sinus rhythm, there was good correlation between Doppler, 2-D echocardiography and cardiac catheterization (r = 0.95). In patients with either MR or AF, cardiac catheterization appeared to underestimate mitral valve orifice compared with both Doppler and 2-D echocardiography (p less than 0.05). Doppler echocardiography can estimate valve area in patients with MS regardless of the presence of MR or AF.
Adult↗
Excessive papillary muscle traction and dilated mitral annulus in mitral valve prolapse without mitral regurgitation.
This study demonstrated excessive papillary muscle displacement during peak systole but normal mitral annulus function during the cardiac cycle in patients with mitral valve prolapse and no mitral regurgitation. The excessive papillary muscle displacement may play an important role in the pathogenesis of the superior displacement of mitral leaflets in patients with mitral valve prolapse.
Adolescent↗
Refractory ventricular arrhythmias in a patient with mitral valve prolapse. Successful control with mitral valve replacement.
A 35-year-old woman with proven mitral valve prolapse developed life threatening ventricular arrhythmias which were refractory to medical therapy. She had one episode of "cardiac arrest" presumably due to ventricular tachycardia or possibly ventricular fibrillation, and was successfully resuscitated with closed chest compression. Mitral valve replacement resulted in dramatic control of the ventricular arrhythmias. Over a period of three years following the operation, she has been able to resume an active life with occasional ventricular premature beats and no further episodes of ventricular tachyarrhythmias.
Adult↗
Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement.
BACKGROUND: The purpose of this study was to evaluate morbidity and mortality after double valve replacement (DVR) and aortic valve replacement with mitral valve repair (AVR + MVP). METHODS: From 1977 to 2000, 379 patients underwent DVR (n = 299) or AVR + MVP (n = 80). Actuarial survival and freedom from reoperation were determined by the Kaplan-Meier method. Potential predictors of mortality and reoperation were entered into a Cox multiple regression model. Propensity score was introduced for the multivariable regression modeling for adjustment of a selection bias. RESULTS: Survival 15 years after surgery was similar between the groups (DVR, 81% +/- 3%; AVR + MVP, 79% +/- 7%; p = 0.44). Freedom from thromboembolic event at 15 years was similar between the groups (p = 0.25). Freedom from mitral valve reoperation at 15 years was significantly better for the DVR group (54% +/- 5%) as compared with the AVR + MVP group (15% +/- 6%; p = 0.0006), primarily due to progression of mitral valve pathology and early structural deterioration of bioprosthetic aortic valve used for patients with AVR + MVP. After AVR + MVP, freedom from mitral reoperation at 15 years was 63% +/- 16% for nonrheumatic heart diseases, and 5% +/- 5% for rheumatic disease (p = 0.04). CONCLUSIONS: Although both DVR and AVR + MVP provided excellent survival, DVR with mechanical valves should be the procedure of choice for the majority of patients because of lower incidence of valve failure and similar rate of thromboembolic complications compared with AVR + MVP. MVP should not be performed in patients with rheumatic disease because of higher incidence of late failure.
Actuarial Analysis↗
[A case of scheduled mitral valve replacement for mitral regurgitation caused by papillary muscle rupture after acute myocardial infarction].
Mitral regurgitation caused by papillary muscle rupture after acute myocardial infarction has poor prognosis, and it is the usual course for such cases in cardiogenic shock to be performed early mitral valve replacement. However, we recently experienced a case of successful scheduled mitral valve replacement for mitral regurgitation caused by rupture of the posterior papillary muscle after acute inferior myocardial infarction. The patient was a 63-year-old woman who admitted to a hospital with back pain and dyspnea and was diagnosed as pulmonary edema due to mitral regurgitation after acute myocardial infarction. She was treated with dopamine and diuretic agents effectively, but not weaned from these drugs. Then, she was transferred to our hospital. At the admission, she was in the NYHA class II due to mitral regurgitation and inferior myocardial infarction with papillary muscle rupture revealed by transesophageal echocardiography. Cardiac catheterization demonstrated total occlusion of the proximal right coronary artery (segment #2) and mitral regurgitation in Sellers III. The patient underwent a successful scheduled mitral valve replacement with SJM 27M concomitant with coronary artery bypass grafting 47 days after the onset of acute mitral regurgitation. There are few reports that successful surgical treatment for papillary muscle rupture was done more than 4 weeks after the onset of mitral regurgitation in Japan.
Female↗
Systolic anterior motion of the mitral valve. An unusual echocardiographic feature of mitral valve endocarditis.
An unusual M-mode echocardiographic feature of mitral valve endocarditis is described: systolic anterior motion of the mitral valve, likely due to mitral valve vegetations, protruding during systole into the left ventricular outflow tract. The presence of mitral valve vegetation was confirmed at operation.
Echocardiography↗
[Mitral valve repair for mitral regurgitation].
UNLABELLED: In these 14 years, 54 adult patients, 28 males and 26 females, mean age 49.6 years old, underwent mitral valve repair for mitral regurgitation. Valve lesion consisted of 28 valve prolapse, 23 torn chordae, 4 ischemic lesion, 3 rheumatic changes, and 3 clefts. Valve prolapse near the commissure was repaired by Kay-Reed's annuloplasty in 31 patients. Torn chordae of the posterior leaflet was repaired by quadrangular resection of the leaflet in 21 cases. Commissural valve prolapse by torn chordae was treated by commissural resection and sliding repair of the leaflet in 5 patients. Torn chordae of the anterior leaflet was repaired by small triangular resection of the leaflet with artificial chordae using ePTFE suture or transfer of posterior chordae to the anterior leaflet in 6 cases. Ring annuloplasty was performed in 21 cases. Postoperative echocardiographic examination revealed no regurgitation in 41 patients, mild MR in 10, and moderate MR in 3. One patient died of arrhythmia early postoperatively. Another patient had cerebral infarction 10 months after the operation. No other complication or no late death was experienced. CONCLUSIONS: Early and late results of mitral valve repair for mitral regurgitation was satisfactory. Better long-term results will be expected by the improvement of surgical technique.
Adult↗
Current status of mitral valve repair.
Mitral valve repair is the procedure of choice to treat mitral valve dysfunction. Advantages of mitral valve repair over mitral valve replacement include improved long-term survival, better preservation of left ventricular function, and greater freedom from endocarditis, thromboembolism, and anticoagulant-related hemorrhage. The feasibility and durability of mitral valve repair depend upon the etiology of mitral valve dysfunction. In degenerative and ischemic mitral valve diseases, valve repair is possible in 90% of cases and freedom from reoperation is high. In contrast, rheumatic valves are less amenable to repair and durability is limited. Most isolated valve operations can be performed in a minimally invasive fashion using a partial upper sternotomy. In patients with atrial fibrillation and mitral valve disease, the Maze procedure or pulmonary vein isolation is performed, eliminating atrial fibrillation and the need for long-term anticoagulation.
Adult↗
Current management of mitral valve prolapse.
Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.
Diagnosis, Differential↗