[Degree of mitral valve stenosis and mitral commissurotomy performed during pregnancy. Its results and the course of pregnancy and labor].
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Adolescent↗
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[Echocardiographic evaluation of the size of the left atrium in patients with mitral valve stenosis after mitral commissurotomy].
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Adult↗
Comparative morbidity of mitral valve repair versus replacement for mitral regurgitation with and without coronary artery disease.
Mitral valve repair has been increasingly used at our hospital for mitral regurgitation with and without coronary disease. From January, 1984, to June, 1987, of 338 patients undergoing all forms of mitral valve surgery, 140 had first-time surgery for pure mitral regurgitation: 75 had valve repair, and 65 had valve replacement. Thirty-three of 75 (44%) had concomitant coronary bypass in the repair group, while 21 of 65 (32%) had coronary bypass in the replacement group. The mean functional class (3.4 versus 3.5), age (60 versus 61 years), and preoperative hemodynamics were similar in both groups. The cause of mitral regurgitation in the repair group was myxomatous change in 32 patients, ischemia in 27, rheumatic valve disease in 12, and endocarditis in 4. A Carpentier ring was used in 46, a Duran ring was used in 11, and none was used in 18. The operative mortality was 3 of 75 patients (4%) in the repair group, all with coronary artery bypass grafting, versus 2 of 65 patients (3%) in the replacement group, 1 of whom had undergone coronary artery bypass grafting. The mean postoperative functional class 15 months postoperatively was 1.12 in the repair group versus 1.15 in the replacement group. There were 7 late deaths in the replacement group and only 3 late deaths in the repair group. Actuarial survival at 30 months was 85 +/- 6% for the replacement group and 94 +/- 4% for the repair group. There were 5 late emboli (1 fatal, 4 nonfatal) after valve replacement and none after valve repair (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
"Bow-tie" mitral valve repair: an adjuvant technique for ischemic mitral regurgitation.
BACKGROUND: Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation. METHODS: We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths. RESULTS: Mitral regurgitation decreased from 3.6+/-0.5 to 0.8+/-0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33%+/-13% to 45%+/-11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5+/-0.3 to 2.1+/-0.3 cm2, with a mean transvalvular gradient of 4.5+/-2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function. CONCLUSIONS: These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
Adult↗
[Supra-annular mitral valve replacement for a patient with prosthetic valve endocarditis].
Supraanular mitral valve replacement with a 29 mm CarboMedics prosthetic valve was performed for a 58-year-old patient of prosthetic valve endocarditis. He has received mitral valve replacement 2 years ago, and was admitted because of high fever and severe heart failure diagnosed mitral regurgitation due to valve dehiscence. An annular abscess was observed and the new 29 mm CarboMedics prosthetic valve was sutured to the left atrial wall approximately 10 mm above the original annulus in order to secure the firm suturings for valve implantation and to left the infected annulus intact. The patient, however, underwent reoperation because of valve dehiscence from atrial wall 6 months after surgery. Infectious abscess at the native mitral annulau was observed to be completely cured, and a mitral prosthesis was implanted at the annulus. The patient is discharged under satisfactory condition.
Endocarditis↗
Value of a modified continuity equation method to quantify mitral valve area in patients with mitral stenosis and sinus rhythm.
To quantify valve area in mitral stenosis, a modified continuity equation method using continuous wave Doppler and thermodilution measurements was applied. In 14 patients with mitral stenosis and sinus rhythm (age: 49 +/- 11 years), transmitral flow velocity was recorded by continuous wave Doppler during right and left heart catheterization. Mitral valve area was calculated by three different methods: 1. According to the continuity equation, stroke volume (thermodilution technique) was divided by the registered time velocity integral of the mitral stenotic jet (continuous wave Doppler). 2. Mitral valve area was calculated by the pressure half-time method. 3. Simultaneous pulmonary capillary wedge and left ventricular pressure measurements were used for determination of mitral valve area according to the Gorlin formula. The mitral valve area determined by application of the continuity equation (y) showed a close correlation to the valve area calculated by the Gorlin equation (x): y = 0.73x + 0.12, SEE = 0.11 cm2, r = 0.88, P less than 0.001. In contrast, the correlation between mitral valve area determined by pressure half-time (y) and the Gorlin formula (x) was not as good: y = 0.77x + 0.11, SEE = 0.26 cm2, r = 0.65, P less than 0.05. Thus, the continuity equation method using combined continuous wave Doppler and thermodilution technique allows a valid determination of mitral valve area. In patients with mitral stenosis and sinus rhythm, this technique is superior to the noninvasive determination of mitral valve area by the conventional pressure half-time method.
Adult↗
Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis (with or without associated mitral regurgitation).
Among 104 patients with mitral stenosis (MS) severe enough or symptomatic enough to warrant mitral valve replacement (MVR), 47 (45%) had atrial fibrillation (AF) and 57 (55%) had sinus rhythm just before the MVR. Of the latter 57 patients, 21 (37%) had had previous episodes compatible with AF. If these 21 patients were included with the 47 patients with electrocardiographic documentation of AF just before MVR, a total of 68 (65%) would have had > or =1 presumed episodes of AF before MVR. The 13 patients with previous mitral commissurotomy had a frequency of AF similar to that of the 91 whose first operation was MVR. Compared with the patients with sinus rhythm just before MVR, those with AF had more heart failure (functional class III or IV preoperatively, 79% vs 62%), larger left atria (6.0 vs 5.2 cm), larger left ventricles in peak systole (4.0 vs 2.6 cm), and more had 2 or 3 coronary arteries narrowed >50% in diameter (23% vs 10%).
Adult↗
Cost implications of mitral valve replacement versus repair in mitral regurgitation.
BACKGROUND: Mitral valve repair and replacement (MVR) with preservation of the tendinous chordae [MVR(p)], may have better results than MVR with valve excision [MVR(e)]. It is not known whether the type of surgery affects in-hospital stay and cost. METHODS AND RESULTS: We reviewed all patients who had mitral valve surgery for regurgitation over 5 years from January 1991. Patients were considered in three groups; MVR(e), MVR(p), and Repair. Cost was calculated using operating room, intensive care unit, and ward expenses, not hospital charges. There were a total of 253 patients; 84 MVR(e), 42 MVR(p), and 127 Repair. Mean ages and preoperative New York Heart Association (NYHA) classes were similar in the three groups. There were more male patients in the Repair (62%) and MVR(p) (67%) groups than in the MVR(e) (44%) group (P<.05), and more patients with degenerative etiology in the Repair group (P<.01). A majority of MVR(e) were in atrial fibrillation (63%), while 59% of Repair were in sinus rhythm (P<.01). Of 9 patients who died in the hospital; four had MVR(e), 3 had MVR(p), and 2 had Repair. In univariate analyses, in-hospital stay increased with patient age >70 years (P<.01), preoperative atrial fibrillation (P<.05), and NYHA class III or IV (P<.01). The median and interquartile ranges for postoperative stay was 10 (8 to 13) days for MVR(e), 8 (7 to 11) days for MVR(p), and 8 (7 to 10) days for Repair (P<.01 versus MVR(e); multivariate analysis adjusting for age, rhythm, and NYHA class). Cost per patient was US $14469 for MVR(e), $13151 for MVR(p), and $11606 for Repair. CONCLUSIONS: Repair and MVR(p) may predict shorter in-hospital stay and reduced cost, although there are important differences in the group of patients who have MVR(e).
Aged↗
Resynchronization of mitral valve annular segments reduces functional mitral regurgitation in cardiac resynchronization therapy.
AIM: Cardiac resynchronization therapy (CRT) reduces the severity of functional mitral regurgitation (FMR) in patients with heart failure and left bundle branch block. Our hypothesis was that the induction of a more synchronous mitral valve anulus contraction can be a mechanism of FMR reduction in CRT patients. METHODS: An echo tissue Doppler imaging (TDI) examination was performed at baseline and 6 months after biventricular pacing system implant in 30 patients (4 females and 26 males, 74.1+/-6.1 years) with dilatative or ischemic chronic heart failure, NYHA class = or >III, ejection fraction (EF) = or <35% and QRS = or >140 ms. EF, Myocardial Performance Index (MPI), left end-diastolic and systolic volumes (LVEDV, LVESV), mitral regurgitation jet area/left atrial area (JA/LAA), effective regurgitant orifice area (EROA), mitral anulus contraction (MAC) were evaluated. Using TDI, at the 6 left ventricle (LV) basal segments the time to the peak myocardial sustained systolic velocity (Ts) and the standard deviation (SD) of TS were evaluated. RESULTS: At 6 months follow-up NYHA class, EF, MPI were significantly improved, LV volumes were reduced. FMR degree, evaluated both as JA/LAA and EROA, was significantly reduced. This effect was associated with the 6 basal segments resynchronization and with a more effective annular contraction. CONCLUSIONS: Our data show that CRT by resynchronizing left ventricular basal segments produces a more effective mitral valve annulus contraction and contributes to FMR improvement. Further studies need to evaluate if this could be taken into account as new therapeutic perspective of functional mitral valve regurgitation.
Aged↗
[Mitral valve replacement after closed mitral commissurotomy].
From June 1978 to Dec. 1987, 35 cases of MVR were performed. All of these patients had closed mitral valvocommissurotomy before. Our experiences show: 1. The main causes of high mortality and morbidity are pericardial adhesion and blood oozing, poor exposure of mitral valve, and prolonged operative time. Therefore, it is wise not to do too much dissection, and to use biatrial incision. With these techniques, good results were obtained. The mortality decreased from 41.2% to 6.25%, the morbidity of postoperative complications decreased from 23.5% to 12.5%. 2. The important factors influencing late results were poor cardiac function and chronic atrial fibrillation. In this series, surgical mortalities of patients with CF of degree 4(NYHA) and degree 3 were 30% and 13.1%. So the main point is to discover the patients as early as possible and to advise them surgery whenever needed.
Adult↗
Mitral valve reconstruction: intermediate term results in rheumatic mitral regurgitation.
From January 1988 through December 1992, 281 patients underwent reconstruction of the mitral valve for mitral regurgitation (MR) with or without mitral stenosis (MS). Two hundred and fifteen patients (76.2%) were between 11 and 30 years of age. The cause of mitral regurgitation was rheumatic in 248 patients (88.3%). Combined lesion (MR + MS) was present in 204 (72.6%). The technique included a modification of the posterior collar annuloplasty described by Cooley et al. Operative mortality was 3.9% (11 patients). There were four late deaths. The 270 operative survivors were followed up by physical examination, echocardiography or by a questionnaire mailed to them after March 1993. Follow up data was available in all but 14 patients (95%). The actuarial survival at 66 months was 95.2% and event free survival was 80%. We conclude that mitral valve repair in a mainly rheumatic patient population is feasible, the probability of reoperation is low and the symptomatic relief is gratifying.
Adolescent↗
Systolic closure of aortic valve in patients with prosthetic mitral valves.
Systolic closure of the aortic valve was found in 10 of 36 patients who underwent mitral valve replacement. Eight patients had early systolic closure, and two had mid-systolic closure. The left ventricular outflow tract dimension on M-mode and two dimensional echocardiograms, left ventricular posterior wall and septal thickness, left ventricular dimensions in systole and diastole, aortic valve opening, and mitral to aortic valve distance were not significantly different between patients with and without systolic closure of the aortic valve. Two of the 10 patients with systolic aortic valve closure were catheterised and in neither was there a gradient between the left ventricle and the aorta. The two patients with mid-systolic closure, however, were the patients who had the narrowest left ventricular outflow tract which could cause significant distortion of blood flow. Systolic closure of the aortic valve in patients with mitral valve replacement is probably not caused by left ventricular outflow tract obstruction, though abnormalities in laminar flow from the left ventricular outflow tract may be involved.
Adolescent↗
Mitral valve replacement in patients after aortic valve replacement.
BACKGROUND: Mitral valve replacement in patients who previously had undergone aortic valve replacement is a technical challenge. The rigid aortic prosthesis limits visualization of the anterior mitral annulus and placement of sutures. METHODS: Reoperative mitral valve replacement was performed in five patients after aortic valve replacement. Two patients underwent resternotomy to allow verification of normal aortic prosthetic valve function. Anterolateral right thoracotomy was used for reentry in the remaining three patients. Exposure of the anterior mitral annulus was accomplished by initial traction on the intact anterior leaflet, with resection of this leaflet only after placement of sutures. RESULTS: All patients survived the surgical procedure and are well 2 to 30 months after operation. In one patient it was impossible to open one cusp of the mitral prosthesis, nor was it possible to rotate the valve. The valve was reimplanted, but sutures were tied only after testing for full free cusp motion. CONCLUSIONS: When appropriate, right thoracotomy incision offers excellent exposure of the mitral valve with minimal dissection. Placement of sutures along the anterior portion of the annulus is facilitated by traction downwards on the anterior leaflet. Full range of motion of the prosthetic cusps should be verified before tying the sutures.
Aged↗
Outcome after mitral valve repair for functional ischemic mitral regurgitation.
BACKGROUND AND AIM OF THE STUDY: Functional ischemic mitral regurgitation (MR) can occur secondary to coronary artery disease. Controversy exists regarding management of these patients. Mitral valve annuloplasty in conjunction with coronary artery bypass grafting (CABG), accepted as the best treatment for severe MR, has been disputed for lesser degrees of regurgitation due to higher mortality. The results of a combined procedure approach were reviewed. METHODS: Between February 1992 and June 1999, 100 consecutive patients (mean age 67+/-11 years) with functional ischemic MR underwent mitral valve repair + CABG. The repair was limited to a Duran flexible annuloplasty ring. Among patients, 72% had a preoperative myocardial infarction and 51% required perioperative intra-aortic balloon pump. NYHA functional class was III-IV in 72%; preoperative MR by transesophageal echocardiography (TEE) was grade 3-4+ in 80% and grade 2+ in 20%. RESULTS: Intraoperative completion TEE indicated 0-1+ MR in 98%. Early mortality was 12% and late mortality 14%, for an overall survival of 74%. The mean follow up was 35.8 months. Follow up TEE on 82% of patients showed zero to trivial MR in 42% of patients, grade 1+ MR in 29%, 2+ MR in 24%, and 3-4+ MR in 5%. Follow up NYHA class was I-II in 81% of patients and III-IV in 19%. A significant correlation was found between recurrent MR and declining left ventricular function on follow up only, as well as the occurrence of preoperative myocardial infarction. CONCLUSION: Functional ischemic MR remains a difficult problem to treat, and has a poor long-term outcome. Ring annuloplasty for functional ischemic MR with coronary artery disease achieves immediate valve competence. However, a significant number of patients develop recurrent MR at intermediate follow up.
Aged↗
[Preservation of the posterior mitral valve leaflet and effect on follow-up results after additional mitral valve implantation].
As early as 1964, Lillehei et al. published the technique of preservation of the posterior mitral leaflet (PML) and chordae tendineae in combination with mitral prosthesis implantation (MPI). In a limited randomized number of 95 patients with MPI the influence of preservation of PML on hemodynamics and physical capacity at least 46 months after surgery without (group A) and with preservation of PML (group B) was investigated. Statistically significant differences in favor of group B were found for cardiac index, pulmonary artery pressure after stress, end-diastolic volume index (EDVI), physical capacity and survival rate after a complication-free course. Basing on these results at rest and after exertion (30 W), patients with preservation of PML and MPI are long-term in a better clinical condition.
Adult↗
[A case of mitral valve replacement and left atrial plication for infantile Marfan syndrome with giant left atrium due to mitral valve regurgitation].
In Marfan syndrome, there is a subset, called infantile Marfan syndrome, in which the disease is diagnosed during infancy and cardiac lesions including mitral regurgitation and aortic root dilatation tend to be deteriorated rapidly. In infantile Marfan syndrome, respiratory function is sometimes impaired when skeletal abnormalities such as scoliosis and pectus excavatum are severe. In this report, we describe a 2-year and 4-months old boy with infantile Marfan syndrome who presented with severe mitral regurgitation and the collapsed left lung. In addition to the impairment of respiratory function due to severe scoliosis, the left lung was collapsed because of the compression of the left bronchus by the enlarged left atrium. The patient required mitral valve replacement concomitantly with left atrial plication, resulting in the decompression of the left bronchus and the re-expansion of the left lung. Characteristics and surgical management of infantile Marfan syndrome are discussed in this report.
Child, Preschool↗
Robotic mitral valve surgery.
Traditionally mitral valve surgery has been performed via median sternotomy. However, a renaissance in cardiac surgery is occurring. Cardiac operations are being performed through smaller and alternative incisions with enhanced technological assistance. Specifically, minimally invasive mitral valve surgery has become standard for many surgeons. At our institution, we have developed a robotic mitral surgery program with the da Vinci(TM) telemanipulation system. This system allows the surgeon to perform complex mitral valve operations through small port sites rather than a traditional median sternotomy. Our techniques and initial results are reported as is a brief overview of the evolution of robotic cardiac surgery.
Cardiac Surgical Procedures↗
Mitral valve replacement using a cryopreserved mitral homograft.
Mitral valve replacement, using a cryopreserved mitral homograft, was performed in a 49-year-old patient with calcified mitral stenosis. Postoperative course was uneventful. Transesophageal echocardiography performed 6 months later showed normal function of the mitral homograft.
Cryopreservation↗