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At least 217 records · Page 12Linked to original sources
PubMed1993

[A successful mitral valve replacement for infective endocarditis with mitral valve aneurysm].

We reported a rare case of mitral valve aneurysm. The patient was a 67-year-old woman with regurgitation of mitral and aortic valve due to infective endocarditis. Preoperative two-dimensional echocardiogram revealed a aneurysmal change and prolapsing on anterior mitral leaflet. Left ventriculogram showed mitral regurgitation of Sellers IV. She underwent mitral valve replacement with 27 mm Carbo Medicus prosthesis successfully. There was a perforated valvular aneurysm (21 x 15 x 11 mm) and inflammatory cleft on anterior mitral leaflet at histopathological findings. The pathogenesis of mitral valve aneurysm was generally infective endocarditis and rarely congenital anomaly, syphylis, Aortitis syndrome, or Marfan syndrome. Mitral valve replacement was a procedure of choice for mitral valve aneurysm, which is especially large, perforated and severely inflammatory one.

Aged↗
PubMed1996

Thirty years experience with heart valve surgery: isolated mitral valve replacement.

BACKGROUND: Thirty years have elapsed since the commencement of open-heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic mitral valve replacement during this period. METHODS: Questionnaires and personal contact have been used to generate a combined database of pre-operative and post-operative information and long-term follow-up on 938 patients who underwent isolated prosthetic mitral valve replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1993. RESULTS: Complete survival follow-up data were obtained for 92% (865) of the patients. The Starr-Edwards valve was used in 95% (891) of the patients, a Bjork-Shiley prosthesis in 2.5% (23) of the patients, and only 24 (2.5%) other valves were inserted. The hospital mortality rate for the 30-year period was 4.7%. The mean age of the patients who underwent surgery was greater in each of the three successive decades. A long-term survival advantage was observed for patients with mitral stenosis, however, survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications and for patients in pre-operative atrial fibrillation. Pre-operative dyspnoea was significantly improved following mitral valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series. CONCLUSION: Mitral valve recipients do not regain a normalized life expectancy, but risk factors that determine long-term survival can be identified pre-operatively to aid appropriate patient selection.

Adolescent↗
PubMed2003

Late results of mitral valve repair for mitral regurgitation.

OBJECTIVE: This study was undertaken to evaluate the long-term results of mitral valve repair for mitral regurgitation. METHODS: Between 1991 and 2000, 301 patients with mitral regurgitation underwent mitral valve repair. There were 167 men and 134 women whose mean age was 56 +/- 14 years. The patients were comprised of 7 patients in Carpentier's type I, 277 patients in type II, and 17 patients in type III. Chordal replacement with expanded polytetrafluoroethylene sutures had been prospectively applied to repair the anterior mitral leaflet prolapse. Ring annuloplasty was performed in 230 patients (76%). The follow-up was complete and mean follow-up was 67 +/- 33 months, for a cumulative follow-up of 1,624 patient-years. RESULTS: There were 5 hospital deaths and 11 late deaths (2 cardiac and 9 noncardiac). All survivors except those with stroke were in the New York Heart Association (NYHA) functional class I or II. At 10 years, the actuarial survival was 90 +/- 3%, the freedom from embolism was 86 +/- 4%, the freedom from reoperation was 96 +/- 2%, and the freedom from valve-related events was 77 +/- 4%. At 10 years, the freedom from reoperation in the patients with anterior leaflet prolapse was 90 +/- 5%. CONCLUSIONS: Mitral valve repair is feasible in most patients with mitral regurgitation and is associated with low mortality and low rates of valve related events. Chordal replacement with expanded polytetrafluoroethylene sutures is effective, safe, and durable at long-term follow-up for patients with anterior leaflet prolapse.

Adolescent↗
PubMed2005

Comparison of accuracy of mitral valve area in mitral stenosis by real-time, three-dimensional echocardiography versus two-dimensional echocardiography versus Doppler pressure half-time.

Mitral valve area (MVA) in 30 patients with mitral stenosis (MS) and 34 normal controls was calculated by real-time, 3-dimensional echocardiography (RT3DE); MVA in patients with MS correlated well with the mitral area determined by 2-dimensional echocardiography (r = 0.98) and by pressure half-time (r = 0.90). MVA in normal controls on RT3DE correlated well with MVA on 2-dimensional echocardiography (r = 0.94) and pressure half-time (r = 0.91). There were significant differences between the orifice areas in patients with MS and normal controls. RT3DE can provide not only the anatomic structure of mitral valve apparatus, but also the optimal plane of the smallest mitral valve orifice, and can thus accurately measure the MVA.

Adult↗
PubMed1994

[Obstruction of the left ventricular outflow tract due to an anomalous muscle bundle and an accessory tissue on the mitral valve associated with mitral stenosis].

This paper details a rare cause of subaortic obstruction, a discrete membrane combined with an anomalous muscle bundle and an accessory tissue on the mitral valve. A 13-year-old boy was referred to our hospital for surgical relief of subaortic obstruction and mitral stenosis. He had received two additional operations, the first was for coarctation of aorta when 5 years old and the second was for discrete subaortic stenosis when 6 years old. Recatheterization at this time revealed an peak systolic gradient of 44 mmHg across the left ventricular outflow tract, and an peak diastolic gradient of 7 mmHg across the mitral valve. An echocardiogram revealed two longitudinally anomalous tissues in the left ventricular outflow tract. Excision of both anomalous tissue and mitral valve replacement were performed. The macroscopic findings and histological reports of the excised specimens showed that one was the accessory mitral valve tissue and another was the anomalous muscle bundle. Intraoperative epicardial echocardiography is beneficial for evaluating the obstructive status of the LV outflow tract before and after excision of the anomalous tissues in this case.

Adolescent↗
PubMed1980

A new valve retractor for mitral valve procedures.

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.

Cardiac Surgical Procedures↗
PubMed1997

Calculation of mitral valve area in mitral stenosis using the proximal isovelocity surface area method. Comparison with two-dimensional planimetry and Doppler pressure half time method.

Two-dimensional echocardiographic (2-D) planimetry and the Doppler pressure half-time (PHT) method have been used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS). Recently, the proximal isovelocity surface area (PISA) method has been shown to be accurate for calculating MVA. The purpose of this study was to compare the PISA method with previous methods. Thirty patients with MS were studied; 17 had pure MS, 4 combined mild MR, 6 combined mild AR, and 3 combined MR and AR. Color Doppler flow mapping was performed at an aliasing (blue-red interface) velocity of 14 cm/sec using the zero-baseline shift. MVA was calculated as 2 x 3.14 x R2 x 14 x (theta/180) / PFV, where R is the distance from aliasing to orifice, 14 is the aliasing velocity, theta is the internal angle of the mitral valve, and PFV is the peak flow velocity at the mitral orifice. MVA was also calculated using the 2-D and PHT methods, and compared with the PISA method. MVA calculated using the PISA method correlated well with the 2-D (r=0.90, p < 0.01, SEE = 0.18 cm2) and PHT methods (r=0.82, p < 0.01, SEE = 0.24 cm2). Compared with the 2-D method, the standard error of the estimate of the PISA method was - 0.14+/-0.18 cm2 and the percent error was -10.4+/-18.9%. Compared with the PHT method, the standard error of the estimate of the PISA method was + 0.01+/-0.24 cm2 and the percent error was +3.4+/-34.6%. MVA calculated using the PISA method correlated well with the 2-D and PHT methods in patients with pure MS or with MS combined mild regurgitation. The PISA method may be useful for calculating MVA as an alternative method.

Adult↗
PubMedDate not supplied

Mitral valve reconstruction for mitral insufficiency.

Mitral valve reconstruction is now the procedure of choice for many mitral regurgitant lesions. Early enthusiasm and technical advances in plastic reconstruction of the mitral valve were overshadowed by the development of prosthetic and bioprosthetic valves. With long-term follow-up studies came the realization that the complication rates of prosthetic mitral valves and the durability of bioprostheses were less than ideal. The use of annuloplasty rings and standardization of mitral repair techniques have made these procedures more universally reliable and the excellent results reproducible. Due to the pathological diversity of mitral regurgitation, many different techniques are used to correct the various lesions. Many centers are reporting hospital mortality, survival, freedom from thromboembolism, freedom from reoperation, freedom from infective endocarditis, and freedom from valve-related complications results that compare favorably with those following mitral valve replacement. The preservation of the papillary muscles and chordae tendinea during mitral reconstruction, as well as a lack of foreign materials, contribute to the enhanced systolic function with improved survival and lower complication rates following mitral repair compared with replacement. With improved results and technical advances, the indications for mitral repair have expanded to encompass a broader diversity of lesions and earlier operative intervention.

Heart Valve Prosthesis↗
PubMed1977

[Heart valve prosthesis in mitral valve defects of patients with chronic circulatory insufficiency].

The data of long-term follow-up of 67 patients subjected to mitral valve replacement for severe heart diseases support the rationale of surgical management of chronic circulatory insufficiency in mitral disease. A prosthetic replacement of the mitral valve helps to return the majority of operated on patients to active live patterns. Improvements of the patients' state within 5 years after surgery was recorded in 58 cases, 9 patients died within 2 to 34 months. Actuarial statistics showed that the 5-year survival rate comprised 75.9% following prosthetic mitral valve replacement.

Adolescent↗
PubMed1975

Aortic valve allografts for mitral valve replacement.

Between May, 1967, and April, 1971, 122 patients underwent mitral valve replacement with fresh aortic valve allografts mounted on rigid support rings. The operative mortality rate was 6.6 percent. Current evaluation was obtained on all patients; the average postoperative follow-up interval for surviving patients is 4.8 years (range, 3.3 to 7.1). Survival rates 1, 2, and 5 years after mitral valve replacement are 89, 86, and 71 percent, respectively. The average functional class of 90 current survivors is 1.6, as compared to 2.9 preoperatively. Thirty-six thromboembolic episodes have occurred in 28 patients, generating a thromboembolism rate of 7 percent per patient year of analysis. Allograft valve dysfunction has occurred in 64 patients, requiring reoperation in 16 and causing death in two. The linearized valve dysfunction rate is 13 percent per patient year. Pathological examination of recovered allograft valves revealed predominantly leaflet fibrosis and calcification, acellular collagenous valve matrix, and infiltration with chronic inflammatory cells. The results of this long-term analysis indicate that mitral valve replacement with fresh aortic allografts provides significant functional improvement and an acceptably low rate of thromboembolism. However, the time-related rate of allograft valve dysfunction is unacceptably high and does not justify further clinical use of this type of bioprosthesis.

Adolescent↗
PubMed1991

[Contribution of the continuity equation for the assessment of mitral valve area in mitral stenosis].

The aim of this study was to evaluate the continuity equation in the quantification of mitral valve area in mitral stenosis, the area being considered as the product of the area of the left ventricular outflow tract multiplied by the ratio of the velocity time integrals of the aortic or pulmonary flow to that mitral flow. The continuity equation was compared to two other echocardiographic methods, planimetry and Hatle's method, and to the results obtained at catheterization using the Gorlin formula in a population of 44 patients with mitral stenosis. All were in sinus rhythm; twelve had Grade I mitral regurgitation and 9 patients had Grade I aortic regurgitation. Excellent correlation were observed between the values obtained by the continuity equation and planimetry (r = 0.91; SEE = 0.19 cm2; p less than 0.001) and Hatle's method (r = 0.87; SEE = 0.20 cm2, p less than 0.001). The correlation with the catheter values were also excellent (r = 0.83; SD = 0.22 cm2, p less than 0.001), better than those observed with Hatle's method (r = 0.73; SEE = 0.27 cm2, p less than 0.001) and very similar to those obtained with planimetry (r = 0.87; SEE = 0.23 cm2, p less than 0.001). The sensibility and specificity of the continuity equation for the diagnosis of severe mitral stenosis (surface less than 1.5 cm2) were 90% and 100% respectively, when those of Hatle's method were 88% and 91% respectively. The continuity equation in the evaluation of mitral valve area in mitral stenosis seems to be reliable and accurate compared with catheter data, and superior to Hatle's method.

Echocardiography, Doppler↗
PubMed1988

Current concepts of mitral valve reconstruction for mitral insufficiency.

In recent years, there has been a renewed interest in surgical reconstruction of the insufficient mitral valve because of reconfirmation of the limitations of existing prosthetic and bioprosthetic valves. A follow-up study, including late functional data, of 148 patients who underwent mitral valve reconstruction at our institution was combined with a review of the literature to assess the current status of mitral reconstruction. The results indicate that mitral reconstruction by Carpentier techniques is widely applicable, durable, and relatively free of complication. Freedom from late thromboembolic and anticoagulant complications is particularly notable. These factors could prove to justify earlier operative intervention in patients with mitral insufficiency before permanent myocardial damage evolves. As mitral valve reconstruction techniques become more familiar and widely used, mitral reconstruction may become the operative procedure of choice for mitral insufficiency, especially insufficiency due to degenerative disease.

Actuarial Analysis↗
PubMed1995

Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis.

Mitral valve replacement with preserving all chordae tendineae in patients with mitral regurgitation has been proved to be beneficial for left ventricular performance in the postoperative period. To evaluate the effectiveness of this technique in patients with mitral stenosis a comparison of the hemodynamic and echocardiographic data between patients having operation with this technique (Group P, n = 15, mean age = 37.5 +/- 12 years), and those having operation with the conventional method of mitral valve replacement (Group C, n = 15, mean age = 39 +/- 10.4 years) was made. The study population was limited to patients who had no clinical evidence of coronary artery disease and if over 40 years of age had normal coronary artery anatomy on coronary arteriography; patients with no evidence of aortic stenosis and/or regurgitation; and patients who had pure mitral stenosis or mitral stenosis with slight regurgitation (Grade 2 or less) with a mean gradient across the mitral valve greater than 10 mmHg. Hemodynamic parameters improved in both groups after the operation. However, echocardiographic measurements obtained six months postoperatively revealed a significant decrease in left ventricular ejection fraction in Group C (61.33 +/- 9.29% preoperatively versus 53.2 +/- 10.3% postoperatively; p < 0.05). The difference between left ventricular ejection fraction diminution of the two groups was statistically significant (-0.71 +/- 6.28% in Group P versus -8.07 +/- 13.35% in Group C; p < 0.01). Left ventricular end systolic and end diastolic dimensions decreased in patients with preserved valves and increased in patients operated on with conventional method without reaching a statistical significance. Sizes of prosthetic valves inserted were in the same range and no significant differences were found in preoperative and postoperative comparison of the two groups in respect to effective mitral orifice area and transvalvular gradient. There were no evidence of prosthetic valve dysfunction and paravalvular leakage and no operative or late deaths. It is concluded that if it is suitable, mitral valve replacement with preservation of chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.

Adult↗
PubMed2001

Fate of mild aortic valve disease after mitral valve intervention.

OBJECTIVE: This study was performed to assess the long-term outcome of untreated mild aortic valve disease present at the time of initial mitral valve intervention. METHODS: A total of 284 patients with rheumatic heart disease aged 7 to 62 years (mean, 23.5 +/- 12.2 years) who underwent mitral valve intervention and had mild aortic valve disease initially were followed up for 2 to 18 years (mean, 10.8 +/- 3.7 years). At initial intervention, 232 patients had pure mild aortic regurgitation, and 52 patients had mild aortic stenosis with or without aortic regurgitation. RESULTS: Among patients with mild aortic regurgitation initially, 11 (5%) patients progressed to moderate (n = 6) or severe (n = 5) regurgitation over an interval of 9 to 17 years (mean, 12.1 +/- 2.8 years), and 1 patient had moderate aortic stenosis and severe aortic regurgitation after 10 years. Freedom from development of moderate-severe aortic valve disease in patients who initially had mild aortic regurgitation was 100%, 97.0% +/- 1.7%, and 87.4% +/- 4.6% at 5, 10, and 15 years, respectively. Seventeen (35%) patients with initial mild aortic stenosis (with or without regurgitation) had moderate or severe stenosis (with or without moderate-severe regurgitation) after an interval of 4.9 +/- 3.8 years. Freedom from development of moderate-severe aortic valve disease in patients who initially had mild aortic stenosis was 75.6% +/- 6.2%, 61.5% +/- 8.5%, and 46.1% +/- 11.2% at 5, 10, and 15 years, respectively. Ten patients required aortic valve replacement for aortic valve dysfunction. CONCLUSIONS: Mild aortic regurgitation present at the time of mitral valve intervention progresses very slowly and less frequently requires reintervention. However, mild aortic stenosis diagnosed initially progresses more often and more rapidly and thus needs closer follow-up.

Adolescent↗
PubMed1997

Rupture of mitral valve annulus after mitral balloon valvotomy: a case report.

We report the case of a 51-year-old woman who underwent percutaneous mitral valvotomy using single balloon technique for restenosis after a previous surgical closed commissurotomy. After the procedure, she presented with severe mitral regurgitation and was referred to our center for mitral valve replacement. At surgery, the underlying cause of the mitral regurgitation was shown to be a tear at the commissural site which extended into the annulus. The mitral valve was successfully replaced and the post-operative course was uneventful. One year later the patient is in good clinical condition.

Catheterization↗
PubMed1989

[A case of mitral valve replacement with autologous pulmonic valve in congenital mitral stenosis].

A one-year-old infant with congenital mitral stenosis and pulmonary hypertension underwent by mitral valve replacement with his pulmonic valve autograft and pulmonary tract reconstruction with heterogeneous pericardial conduit. His postoperative hemodynamics data showed that left atrial pressure decreased and pulmonary hypertension continued. Echocardiography showed that the implanted autograft functioned properly. On the seventh postoperative day, he died of pulmonary hypertension. In case with congenital mitral stenosis with the small mitral annulus and the small left ventricular cavity, it is difficult to perform mitral valve replacement by commercially available mechanical or tissue valves. Because these valves are not suitable for the small mitral annulus. The mitral valve replacement with pulmonic valve autograft is recommended in such a case with the congenital mitral stenosis.

Female↗
PubMedDate not supplied

[Vegetations of the mitral valve and the mitral prosthesis in patients with subacute bacterial endocarditis. Echocardiographic diagnosis].

In a patient with SBE in three differents ocassions in a period approximately of 9 months, the mitral valve was replaced on two occasions. The echocardiogram detected vegetations on two ocassions. The diagnosis of vegetation at the level of the mitral valve, was done for the first time in our hospital by this method. During the last admission, the echocardiogram suggested a vegetation at the level of the artificial mitral valve, projecting into the left atrium with the systole. This was confirmed by surgery.

Adult↗