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At least 469 records · Page 26Linked to original sources
PubMed1994

Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis.

Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.

Adult↗
PubMed1998

Delayed diagnosis of anomalous origin of the left coronary artery 16 years after mitral valve replacement.

Mitral insufficiency caused by ischemia is frequently found in anomalous origin of the left coronary artery from the pulmonary artery. We report a case of a 25-year-old woman who was diagnosed to have anomalous origin of the left coronary artery from the pulmonary artery and had successful left internal mammary artery bypass grafting 16 years after mitral valve replacement for mitral insufficiency of an unknown cause in her childhood.

Adult↗
PubMed2001

[The role of mitral valve balloon valvuloplasty in the treatment of rheumatic mitral valve stenosis during pregnancy].

OBJECTIVE: To analyze the immediate results and the clinical evolution of a group of fertile age women with rheumatic mitral stenosis, in whom percutaneous balloon mitral valvuloplasty was performed before or during pregnancy. PATIENTS AND METHOD: Eighty-one women with mitral stenosis, submitted to balloon mitral vavuloplasty, were studied. They were divided into three groups, according to their desire of no further pregnancies (group A; n = 19), pregnancy during the follow-up (group B; n = 23) or valvuloplasty was performed during pregnancy (group C; n = 39). Patients from group B and C were controlled during pregnancy, childbirth and puerperium, and the newborns of women in group C were followed from birth to the age of 5 years. RESULTS: Mortality in the three groups was null and the incidence of miscarriage was 2 (8.6%) in group B and 3 (9.1%) in group C. Normal delivery was predominant in group B and delivery by caesarean was predominant in group B. Success was immediate in all the cases. The procedure was repeated in 3 women due to restenosis. The media valvar area rase from 0.93 to 2.05 cm2 in group A, from 1.28 to 2.04 cm2 in group B and from 0.84 to 2.14 cm2 in group C (intergroup p = NS). The functional class improved in the three groups of patients. CONCLUSION: Percutaneous balloon mitral valvuloplasty is an effective, efficient method for the treatment of rheumatic mitral stenosis during pregnancy, after organogenesis, or at any time in a woman's life, as long as it is indicated according to clinical and echocardiographic evaluation criteria.

Adult↗
PubMed2001

[Surgical repair of myxomatous mitral valve].

Myxomatous mitral valve disease is now the most common cause of mitral regurgitation in the western world. Repair of the leaking valve has become standard surgical procedure during the past 2 decades. Between 1993-1999 we performed 113 repairs of the mitral valve. In 25 patients the etiology was myxomatous degeneration (no mortality). Long-term clinical results depend on patients' functional class at surgery. Based on this fact, and the good surgical results, it is recommended to refer such patients even with severe mitral incompetence for surgery at an early stage, even if symptoms are minimal.

Adolescent↗
PubMed2003

A coconut left atrium 23 years after mitral valve replacement for chronic mitral stenosis.

We present the case of a 65 year-old female who was admitted to the hospital because of deterioration of chronic dyspnea. Twenty-three years prior to this admission, mitral valve replacement for chronic mitral stenosis was performed using a Starr-Edwards caged-ball prosthesis. There was severe pulmonary hypertension. On transthoracic echocardiography and on cineradiography, the function of the mitral valve prosthesis was unimpaired. However, cineradiography showed extensive mural calcification of the left atrium; we report this remarkable finding.

Aged↗
PubMed1991

[Mitral valve replacement in postinfarction mitral insufficiency. Immediate and long-term results apropos of a series of 39 surgically-treated patients].

Thirty nine patients, mainly males (84.6%) with an average age of 66 years underwent mitral valve replacement for postinfarction mitral regurtation between March 1971 and December 1987. Twenty four were in Class IV of the NYHA Classification, 9 in Class III and 6 in Class II. All had a history of myocardial infarction predominantly of the inferior wall. The 33 preoperative coronary angiogrammes showed 13 patients with triple vessel disease, 15 with double vessel disease and 5 with single vessel disease. At operation, 13 patients had ruptured papillary muscles; acute dysfunction was observed in 16 and chronic in 10 patients. The hospital mortality was 36%; over three quarters of deaths were due to myocardial dysfunction. Twenty two patients had an associated myocardial revascularisation procedure with mitral valve replacement. All 25 survivors were followed up for an average of 2.3 years (94 patient-years). The 5 year actuarial survival (operative mortality included) was 55% and 77% of the 17 survivors are in Stages I or II of the NYHA Classification. The quality of these long-term results justifies surgery despite the high operative risk.

Actuarial Analysis↗
PubMed2001

The clinical and diagnostic features of mitral valve disease.

Mitral valve disease remains common, and requires regular clinical and echocardiographic review. Surgery is indicated soon after the development of symptoms or at the first sign of left ventricular decompensation in mitral regurgitation or of the right ventricle in mitral stenosis.

Echocardiography↗
PubMed1998

[Mitral valve regurgitation with anterior mitral leaflet chordal rupture or elongation--repair using the flip-over technique].

Repair of prolapsed anterior mitral leaflet has remained technically difficult. The purpose of this study was to assess the clinical results after using the flip-over technique for patients with anterior mitral leaflet prolapse due to dhordal rupture or elongation. Between January 1993 and September 1997, fifteen adult patients with pure mitral valve regurgitation (MR) due to prolapse of the anterior mitral leaflet underwent repair using the flip-over technique. The indication for this procedure were; 1) all mitral structures except the prolapsed area must appear to be intact, and 2) the corresponding chordae attached to the posterior leaflet should be sufficiently strong to be transferred to the anterior leaflet. The prognoses following this technique were retrospectively studied to assess the early and mid-term clinical outcome of this procedure. Follow up was complete in all patients and ranged from 2 to 56 months (with a mean of 25 +/- 17.9 months). There was no hospital death, None required reoperation. One patient died because of acute recurrent MR during follow-up. No other complication was experienced. Doppler echocardiographic studies at the final follow-up showed less than mild regurgitation in 11 (78.6%) of the 14 surviving patients. We believe that this procedure was effective for that the obtained repair of a prolapsed anterior mitral valve and early and mid-term clinical outcome from this procedure has been satisfactory.

Adult↗
PubMedDate not supplied

Mitral valve prolapse.

Mitral valve prolapse (MVP) is usually a primary, dominantly inherited condition. Diagnosis may be made by auscultation of a midsystolic click and late-systolic murmur that move dynamically with postural maneuvers. Echocardiography confirms the diagnosis by demonstrating M-mode late-systolic prolapse and 2-D leaflet billowing into the left atrium. More severe forms of MVP can be detected echocardiographically by documentation of significant mitral regurgitation, enlargement and thickening of the mitral leaflets and anulus, and loss of leaflet apposition. In contrast to earlier reports, the true "MVP syndrome" consists of low body weight and blood pressure, minor skeletal abnormalities, orthostatic hypotension, palpitations and mitral regurgitation of variable degree. Complications of MVP include progressive mitral regurgitation, infective endocarditis, and possible risk of neurologic ischemia, arrhythmic sudden death, and orthostatic syncope. Risk factors for complications among MVP patients include older age, male gender, the presence of a mitral regurgitant murmur, and, possibly, higher weight and blood pressure. MVP patients with neither a murmur nor Doppler evidence of mitral regurgitation may be reassured that their condition is benign. For other MVP patients, the presence and severity of mitral regurgitation govern the frequency and intensiveness of needed follow-up.

Auscultation↗
PubMed1994

Techniques and results of mitral valve repair for ischemic mitral regurgitation.

Mitral regurgitation (MR) may start during the acute phase of myocardial infarction and it may increase, decrease, or remain unchanged as the necrotic muscle is replaced by fibrous tissue and remodeling of the ventricle takes place. Acute infarction can cause MR because of rupture of papillary muscle (PM) head or dysfunction of the PM and underlying ventricular wall. When MR is due to rupture of a single PM head and the surrounding muscle is not extensively infarcted, it is possible to suture the PM head in place with pledget sutures or to use other techniques of repair of flair leaflets such as chordal transfer or chordal replacement. When MR is due to extensive necrosis of the PM and the ventricular wall, it is safer to replace the mitral valve with preservation of the chordae tendineae. Correction of MR by means of valve repair in patients with healed myocardial infarction is frequently possible when the cause of MR is determined by Doppler echocardiography. The most common cause of MR is incomplete closure of the mitral valve due to apical displacement of the PM. Prolapse of the leaflets is rare in patients with healed myocardial infarction. Mitral annuloplasty decreases or abolishes MR in most cases when lack of coaptation of the leaflets is the problem. Transient ischemia can also cause MR. Successful myocardial revascularization either by angioplasty or coronary artery bypass often cures episodic ischemic MR.

Coronary Disease↗
PubMed2006

Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis.

Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988 to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25). Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.

Echocardiography↗