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PubMed1991

Atrial fibrillation during a subarachnoid block in a patient with undiagnosed mitral valve prolapse.

Mitral valve prolapse (MVP) is a common cardiac abnormality, and there are numerous documented cases of intraoperative dysrhythmias. However, the authors describe what is believed to be the first case of atrial fibrillation in a patient with an undiagnosed MVP who was given a subarachnoid block. A possible clinical sequencing for the subarachnoid block is offered. The differential diagnosis, etiology, pathology, and pathophysiology of MVP are discussed. Also detailed are the management of intraoperative dysrhythmias. Physicians should be aware, as in the case reported, that a new-onset atrial fibrillation can occur, even without previously diagnosed MVP.

Aged↗
PubMed1983

Platelet activation and mitral valve prolapse.

Mitral valve prolapse (MVP) is a predisposing factor for cerebral ischemia, especially in young adults. Cerebral embolization of intracardiac thrombi is the probable mechanism in many cases. Platelets play a key role in the development of thrombi. We found that platelet factor 4, a marker protein of platelet activation, was elevated in 12 of 33 MVP patients (36%) without a history of stroke. This finding indicates that platelets are frequently activated in asymptomatic MVP patients and may allow identification of a subgroup of MVP patients with activated platelets who are at increased risk for emboli.

Adolescent↗
PubMedDate not supplied

[Screening for a frequent cardiac disorder: mitral valve prolapse].

Mitral valve prolapse (MVP) screening using bidimensional echocardiography was performed on 171 healthy subjects from Lorraine of both sexes, aged 20 to 60 years. Six men and seven women presented this valvular disease. In the Lorraine population, the estimated prevalence of MVP was 7.6% (95% confidence interval: 3.6-11.6%). In this study, only seven cases of MVP had a cardiac auscultation suggestive of MVP. As compared with echocardiography, clinical screening of MVP had a low validity (sensibility 54%, specificity 69%) and a poor positive predictive value (12.5%). Because MVP has severe complications, and because clinical screening has a low performance, a strategy of screening with bidimensional echocardiography could be interesting.

Adult↗
PubMed1986

Pulmonary function in dogs with mitral valve regurgitation.

Mitral valve regurgitation was created in 2 groups of dogs. Groups were selected on absence (group 1) or presence (group 2) of clinical signs of congestive left ventricular failure. Group-2 dogs, in which mean left atrial pressures were greater than 30 mm of Hg, had increases in heart rate, pulmonary arterial mean pressure, left atrial diameter, and left ventricular diastolic diameter. These changes were associated with decreased arterial O2 tension, decreased static and dynamic compliance, reduced lung volumes, and increased pulmonary resistance. Group-1 dogs, in which mean left atrial pressure was less than 30 mm of Hg, had moderate changes in hemodynamics, but no changes in pulmonary function, except during exercise when arterial O2 tension decreased.

Animals↗
PubMed1986

A method for improved exposure of the mitral valve: cannulation of innominate vein and division of superior vena cava for extended left atriotomy in mitral valve operations.

A method of improved exposure of the mitral valve and subvalvular apparatus is described. Cannulation of the left innominate vein and division of the superior vena cava allow excellent exposure of the mitral valve and subvalvular apparatus. This method is particularly useful in patients with a small left atrium or deep chest.

Brachiocephalic Veins↗
PubMed2003

[Causes and risk factors for development of mitral valve prolapse].

Mitral prolapse is a common valvular anomaly. Mechanisms of prolapse formation are studied with the use of modern investigation methods. Primary prolapse results from congenital structural defects of intracardiac formations (papillary muscles, trabecules, chordae) of the left ventricle, as well as associated microcirculatory disorders. Genetically caused rearrangement of fibrillar structures of the extracellular matrix of connective tissue (myxomatous degeneration) is observed in half of the patients with primary mitral prolapse. Concerning secondary prolapse of the leaflets, some mechanisms are singled out and a large group of diseases is described.

Heart Defects, Congenital↗
PubMed1994

[Mitral valve replacement with cryopreserved mitral homograft].

Mitral valve replacement using a cryopreserved mitral homograft was performed in a 49 year old patient with calcified mitral stenosis. The surgical technique is described. The postoperative course was uneventful. Transoesophageal echo performed 4 months later showed a normal function of the mitral homograft.

Chordae Tendineae↗
PubMed1979

Long-term changes in mitral valve area after successful mitral commissurotomy.

We examined the long-term effects of closed instrumental mitral commissurotomy on mitral valve area (MVA) in 18 patients, followed for as long as 14 years after successful operation. Each patient had preoperative and early postoperative cardiac catheterization; late postoperative determination of MVA was obtained 10-14 years (mean 12.2 years) after commissurotomy. In 17 patients, the MVA was determined by cross-sectional echocardiography and in one patient by repeat cardiac catheterization. Thirteen of 18 patients had no change in MVA between early postoperative study (mean MVA = 2.7 cm2) and late postoperative study (mean MVA = 2.9 CM2). MVA in five patients decreased 0.7-2.2 cm2 (mean 1.4 cm2) during the follow-up period. In these five patients, the mean MVA at early postoperative study was 2.7 cm2 and at late postoperative study was 1.3 cm2 (p less than 0.001). At late postoperative evaluation, cardiac symptoms were associated with severity of mitral stenosis but did not predict restenosis. A successful, closed, instrumental mitral commisurotomy can provide substantial long-term improvement in MVA.

Cardiac Catheterization↗
PubMed1995

Infective mitral valve endocarditis after percutaneous transvenous mitral commissurotomy.

Infective mitral valve endocarditis developed in a 40-year-old female patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated a vegetation in the anterior leadflet of the mitral valve and moderate aortic insufficiency. The patient underwent replacement of the infected mitral and incompetent aortic valves. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of operation are discussed.

Adult↗
PubMed1985

Long-term results of open mitral valve reconstruction for mitral stenosis.

Open mitral reconstruction for rheumatic mitral stenosis (MS) was performed in 120 patients, 101 women and 19 men, aged 22 to 75 years (mean 49). Nine patients were functional class II, 106 class III, 5 class IV; 13 only underwent noninvasive studies, including echocardiography, before surgery, while 107 had preoperative cardiac catheterization studies. The latter showed a mean valve area of 1.09 cm2 and a pulmonary artery wedge to left ventricular mean diastolic gradient of 14 mm Hg. Cardiopulmonary bypass was used in all patients for open reconstruction under direct vision. Superior commissurotomy was done in 115 patients, inferior in 114, papillary muscles were incised and chordae lengthened in 39 and calcium was excised from valve leaflets in 23. Suture or ring anuloplasty was not required in any patient. The series was begun January 1972 and terminated in January 1984. Personal follow up was conducted in July 1984. There were no operative deaths in the 120 patients. There were 5 late deaths, all from noncardiac causes. The mean follow-up time was 53 months. The actuarial probability of survival at 10 years was 95 +/- 2%. Thromboemboli occurred in 9 patients; the probability of freedom from thromboemboli at 10 years was 91 +/- 3% and the linearized rate was 1.8%/patient-year of follow-up. Reoperation was required in 9 patients, an absolute incidence of 7.5% and an annual incidence of 1.7%/patient year. At 10 years the probability of freedom from reoperation was 84 +/- 5%.

Actuarial Analysis↗
PubMedDate not supplied

Hemodynamic changes during dynamic exercise in patients after mitral valve replacement for chronic mitral regurgitation.

To evaluate hemodynamic changes during dynamic exercise, we investigated 13 patients after mitral valve replacement (MVR) for chronic mitral regurgitation (MR) and 5 control subjects by right heart catheterisation during supine bicycle exercise. According to the sizes of the St. Jude Medical (SJM) prosthesis during MVR, patients were divided into group A (n = 8) with SJM 31mm and group B (n = 5) with SJM 29mm. Significant rise in cardiac index (CI) was noted during exercise in both groups A and B (from 3.3 +/- 0.8 to 5.5 +/- 0.9 l/min/m2, p < 0.01 and from 3.0 +/- 0.6 to 5.6 +/- 0.6 l/min/m2, p < 0.01 respectively) and also in control subjects (from 3.4 +/- 0.7 to 6.2 +/- 0.6 l/min/m2, p < 0.01). Mean pulmonary artery and pulmonary capillary wedge pressure were significantly higher during exercise in patients of both groups A and B than control subjects (p < 0.05 and p < 0.01 respectively). Total pulmonary vascular resistance was significantly higher during exercise in both groups A and B than control subjects (p < 0.05 and p < 0.01 respectively). No difference in hemodynamics were noted between the patients of group A and B during exercise. It is concluded that response of CI to exercise in patients after MVR for chronic MR was adequate in comparison to control subjects irrespective of two different valve sizes.

Adult↗
PubMed1980

Patch enlargement of the aortic and the mitral valve rings with aortic-mitral double-valve replacement.

In 1 patient, patch enlargement of the aortic valve ring was accomplished by extending the aortic incision into the anterior mitral leaflet. The pericardial patch broke from the aortic leaflet of the mitral valve on the fourth postoperative day. The resultant acute mitral incompetence necessitated mitral valve replacement also. An aortic-mitral double-valve replacement with attendent enlargement of both the aortic and mitral valve rings ensued. To our knowledge, enlargement of the aortic and mitral valve rings with aortic-mitral double-valve replacement has not been described in the literature.

Aortic Valve↗
PubMed2002

Mitral valve repair for severe mitral regurgitation caused by endomyocardial biopsy.

Mitral regurgitation (MR) following endomyocardial biopsy is a rare and severe complication. A 70-year-old man with severe MR due to chordal injury caused by left ventricular endomyocardial biopsy is described. In this patient, a few chordae tendineae of the posterior-median papillary muscle were injured by the biopsy forceps. Due to the chordal rupture, both anterior and posterior leaflets were prolapsed and severe MR developed. MR was successfully treated by artificial chordal replacement using extended polytetrafluoroethylene sutures and ring annuloplasty. This mitral valve repair with artificial chordal replacement was considered suitable to treat MR resulting from iatrogenic chordal injury as the leaflets were not involved in the degenerative process and papillary muscle function was preserved. To avoid MR, the transvenous approach should be used routinely for endomyocardial biopsies; biopsy from the left ventricle is not justified.

Aged↗
PubMed1983

Isolated cleft mitral valve: a variety of congenital mitral regurgitation identified by 2-dimensional echocardiography.

Nine children with isolated cleft mitral valve, aged 1 day to 12 years, were studied. The electrocardiogram showed a normal QRS axis in 5 subjects. Cardiac catheterization was performed in 4 patients and demonstrated severe mitral insufficiency in 3 but failed to clearly demonstrate a cleft mitral valve or gooseneck deformity. The mitral cleft was confirmed at operation in 2 patients. Two-dimensional echocardiography demonstrated a cleft dividing the anterior mitral leaflet into 2 portions in each patient. The mitral anulus was normally positioned and the atrioventricular septum present. Atrial and ventricular septa were intact. Features similar to anatomic studies such as accessory chordae and thickening of the edges of the cleft with increasing age were also seen. Two-dimensional echocardiography is the only method available to reliably diagnose isolated cleft of the mitral valve.

Cardiac Catheterization↗
PubMed2000

Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.

BACKGROUND: Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been widely accepted to repair anterior mitral prolapse and other difficult situations, the long-term results of the repair and the fate of ePTFE have not been delineated. METHODS AND RESULTS: From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55. 3+/-14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11. 3 years (mean 4.6+/-3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patients, posterior in 10, and both anterior and posterior in 29. Various procedures for plasty of leaflets were necessary in 37 patients (50%). Atrial fibrillation was associated in 38 patients (51%), and the maze procedure has been performed in a selected group of 30 patients (41%) since July 1992. There was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More than moderate MR developed in 12 patients (17%) during the follow-up period. Three of these patients required early reoperation within 1 year due to hemolysis. Two patients underwent mitral valve replacement at 6 and 8 years after repair, respectively. The actuarial reoperation-free rates at 5 and 10 years were 94.3+/-2.8% and 81.7+/-9.1%, respectively. Sinus rhythm was restored in 21 patients (70%) with the maze procedure. There was only 1 thromboembolic episode (0. 3%/patient-y) in a patient with atrial fibrillation who did not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoagulation-related hemorrhage at 5 and 10 years were 91.3+/-3. 4% and 71.6+/-9.7%, respectively. There was no relationship between recurrent MR and the change of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferation was recognized at the site of fixation to the valve leaflet and the papillary muscle. The surface of the ePTFE was completely endothelialized, which may induce antithrombogenicity. CONCLUSIONS: The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for >10 years.

Adolescent↗