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At least 703 records · Page 39Linked to original sources
PubMed1983

Effect of mitral valve replacement on left ventricular function in mitral regurgitation.

To evaluate the effect of mitral valve replacement on left ventricular function in mitral regurgitation, we measured (1) the end-systolic stress/volume ratio, which is practically independent of changes in loading conditions, and (2) the left ventricular contractile reserves upon isometric exercise, both before and one year after mitral valve replacement in 11 patients with mitral regurgitation. The end-systolic stress/volume ratio increased, though the ejection fraction decreased after mitral valve replacement. The ejection fraction decreased and the end-systolic stress/volume ratio remained unchanged during isometric exercise before operation, whereas afterwards the ejection fraction remained unchanged and the end-systolic stress/volume ratio increased during exercise. Ventricular function improves after mitral valve replacement in patients with mitral regurgitation, though the ejection fraction, which is affected by altered loading conditions, deteriorates. The left ventricular response to stress caused by isometric exercise is also improved after surgery.

Adult↗
PubMed1976

Mitral valve repair for patients with pure mitral insufficiency. 1- to 15-year follow-up.

Mitral valve repair rather than replacement was performed in 133 of 183 patients (73%) with considerable mitral valve insufficiency requiring surgery. There were seven operative deaths (50%) and 16 late deaths in the 133 patients followed up from 1 to 15 years. Only four of the late deaths were possibly related to the underlying valvular heart disease. Repair is preferable to replacement with present-day mitral valve prostheses.

Adolescent↗
PubMed1994

[Mitral valve aneurysm in a patient with mitral regurgitation: a case report].

A 66-year-old man admitted to our hospital complaining of severe dyspnea. Echocardiography demonstrated severe mitral regurgitation and an abnormal echo at the anterior leaflet of the mitral valve. It was a persistent bulge that protruded toward the left atrium throughout systole and diastole. Left ventriculography also demonstrated the same abnormal shadow of the mitral valve. At the operation, it was seen that two of the chordae tendineae of the anterior leaflet had ruptured and a small aneurysm, approximately 10 mm in length, originated from the lateral part of the leaflet. The aneurysm protruded into the left atrium and had neither rupture nor perforation. Because the aneurysm of the mitral valve was too large to resect and repair the valve, it was replaced with St. Jude Medical Valve (29 M). IABP was needed at the weaning from cardiopulmonary bypass, but he recovered gradually well afterwards. The excised anterior leaflet showed myxomatous degeneration, but had no vegetation and rheumatic change. Microscopic examination of the valve aslo revealed myxomatous degeneration and no signs of the inflammation.

Aged↗
PubMed1999

[Aortic valve papillary fibroelastoma in a patient with mitral valve regurgitation].

Papillary fibroelastoma is a rare cardiac tumour. We describe a patient with mitral valve regurgitation and aortic valve papillary fibroelastoma. The patient was 62-year-old woman. She was referred to us for surgical treatment of mitral valve. Preoperative echocardiography showed rheumatic mitral valve regurgitation (Sellers grade III) and it also demonstrated mobile masses of the aortic valve. At operation, mitral valve was repaired by a posterior annuloplasty. Through the aortotomy, small tumors were found to be attached to each cusps of the aortic valve and they were successfully removed. The histopathologic diagnosis was papillary fibroelastoma of the aortic valve. The postoperative course was uneventful.

Aortic Valve↗
PubMed1997

Values for Mitral Valve Annulus Dimensions in Normals and Patients with Mitral Regurgitation.

OBJECTIVES: The present study was designed to investigate the dimensions of mitral valve annulus in the presence of mitral regurgitation. METHOD: Fifty-four patients were examined. On transthoracic echocardiographic images, we performed linear measurements in the parasternal plane in order to define the size of the left ventricle, left atrium, and mitral valve annulus. We compared these findings with those obtained in 16 control subjects. RESULTS: Twenty-one patients with mild or moderate mitral regurgitation demonstrated no significant change of the mitral valve annulus compared with the control group (P > 0.05). Seventeen patients with severe mitral regurgitation (grade of 4) had a significant increase of the dimensions of the mitral valve annulus, left ventricle, and left atrium (P < 0.05). The etiology of mitral regurgitation was degenerative in 32 patients, rheumatic in 2 patients, and mitral valve prolapse in 4 patients. All patients had normal left ventricular systolic function. Thirty-one patients were in normal sinus rhythm, and seven were in atrial fibrillation. CONCLUSIONS: The measurement of the diameter of the mitral valve annulus is feasible with transthoracic echocardiography. In addition to the evaluation of mitral valve leaflets and subvalvular apparatus, the measurement of the mitral valve annulus is important in the evaluation of mitral regurgitation, as its enlargement is indicative for severe mitral regurgitation.

Journal Article↗
PubMed1995

Determinants of early mortality and late survival in mitral valve endocarditis.

BACKGROUND: Infective mitral valve endocarditis continues to be a significant surgical challenge. The objective of this study was to examine our experience with mitral valve endocarditis surgery and identify determinants of early mortality and late survival. METHODS AND RESULTS: Over a 24-year period, mitral valve surgery was performed in 96 patients for infective mitral valve endocarditis. Patient age ranged from 20 to 78 years (median age, 52 years). There were 44 women (46%), and 48 of the 96 patients (50%) were in New York Heart Association functional class IV before surgery. Native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) were present in 72 patients (75%) and 24 patients (25%), respectively. Surgery during the active phase of endocarditis (AE) was required in 60 patients (62%) and during the healed phase (HE) in 36 (38%). The main indications for surgery in the AE group were congestive heart failure (60%), active sepsis (67%), peripheral emboli (47%), and acute renal failure (20%), and for the HE group the main indication was progressive congestive heart failure (69%). The overall operative mortality was 5.2%. Multivariate logistic regression analysis identified PVE (odds ratio [OR] 22.5; +/- 95% confidence interval, CI, 1.9 to 268; P = .014) and an associated procedure (OR 13.3; +/- 95% CI, 1.5 to 120; P = .021) to be independent predictors for early mortality. Follow-up was 97% complete, with a median of 3.5 years. Overall 5- and 10-year survivals were 83 +/- 4% and 63 +/- 8%, respectively. Multivariate analysis for late mortality identified PVE to be a significant predictor of late mortality (hazards ratio = 3.1, +/- 95% CI, 1.4 to 6.8, P = .006). There were no significant differences in long-term morbidity results among the various subsets of mitral valve endocarditis. CONCLUSIONS: Mitral valve surgery for infective endocarditis is a significant high-risk procedure for PVE and when combined with associated procedures. The activity of endocarditis does not appear to have any influence on early mortality or long-term survival.

Adult↗
PubMed2004

Mitral valve repair with aortic valve replacement in rheumatic heart disease.

From 1992 to 2001, 609 patients with rheumatic heart disease underwent aortic valve replacement with either mitral valve repair (n = 201) or mitral valve replacement (n = 408). Follow-up extended to 10 years. Thirty-day mortality was 1.4% for mitral valve repair and 0.7% for mitral valve replacement (p = 0.4). Survival at 9 years was 96.5 +/- 1.4% after mitral valve repair and 89.7 +/- 7.8% after mitral valve replacement (p = 0.73). Freedom from major bleeding at 9 years was 94.8 +/- 2.4% after mitral valve repair and 81 +/- 7.2% after mitral valve replacement (p = 0.03). Freedom from other valve-related complications and from mitral valve re-operation was similar for the two groups. This study showed that in patients with rheumatic heart disease the results of mitral valve repair with aortic valve replacement were comparable to those of double valve replacement. Major bleeding was less frequent after mitral valve repair with aortic valve replacement. Therefore, whenever feasible, mitral valve repair should be attempted in patients with rheumatic heart disease who need concomitant aortic valve replacement.

Aortic Valve↗
PubMed1976

[Incidence and relevance of tricuspid-valve insufficiency in acquired mitral-valve defect. Analysis based on right ventricular angiograms].

To detect tricuspid incompetence (TI) right ventricular angiography was performed in 167 patients suffering from moderate to severe mitral valve disease. Holosystolic reflux of contrast medium to the right atrium through the central part of the tricuspid valve was thought to represent true TI, whereas a jet of contrast medium following the injection catheter and originating from the region of its valve passage was assumed to reflect arteficial regurgitation. True TI was found in 35% of the total group (30% mild to moderate, 5% severe TI). TI was often accompanied by atrial fibrillation (91%), pulmonary hypertension (74%) and reduced contraction of the tricuspid annulus (55%). Since tricuspid regurgitation in mitral valve disease commonly represents "functional" incompetence surgical intervention may be recommandable only in case of severe TI or concomitant valvular stenosis.

Adult↗
PubMed2003

Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation.

BACKGROUND: The most appropriate treatment for patients with ischemic mitral regurgitation (IMR) is often debated. We compared the survival rates of patients with IMR undergoing different treatment strategies, namely: medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and CABG + mitral valve (MV) surgery. METHODS AND RESULTS: Patients undergoing catheterization between 1986 and 2001 were included. IMR was defined as: >or=grade 2+ mitral regurgitation (MR) and significant coronary artery disease (CAD) without primary mitral valve disease. Patients undergoing catheterization for the evaluation of congenital or other valvular heart disease were excluded. Multivariable Cox proportional hazards modeling was utilized to assess the independent relation between treatment and survival. Propensity score methods were used to correct for the nonrandom assignment of treatment. Of the 2,757 patients who met study criteria: 1,305 were treated medically, 537 underwent PCI, 687 underwent CABG, and 228 underwent CABG + MV surgery. The median duration of follow-up was 3.2 (0.9, 7.1) years. Patients undergoing CABG + MV surgery had more severe MR and more severe heart failure than those treated by other modalities. After adjusting for differences in baseline characteristics, patients undergoing PCI, CABG, and CABG + MV surgery had a 31% (hazards ratio [HR]=0.69; P=0.0001), 42% (HR=0.58; P=0.0001), and 42% (HR=0.58; P=0.0001) reduction in the risk of death, respectively, compared with those undergoing medical therapy. The performance of mitral valve surgery with CABG was not associated with improved survival versus CABG alone (P=0.258). CONCLUSIONS: Among patients with IMR, treatment with PCI, CABG, or CABG + MV surgery is associated with improved survival compared with medical therapy.

Aged↗
PubMed1994

Carpentier "sliding leaflet" technique for repair of the mitral valve: early results.

Reconstructive mitral valve operation is now the preferred technique for the surgical treatment of prolapse of the posterior leaflet due to degenerative disease. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction has been observed after such repair, with an incidence ranging from 4.5% to 10%. In an attempt to reduce the incidence of this complication, Carpentier has devised a new technique: the sliding leaflet plasty of the posterior leaflet. We report on 48 patients who underwent this new procedure between July 1990 and July 1992. One patient died perioperatively (2.1%). All other patients were able to be discharged on the ninth postoperative day. All patients underwent M-mode, two-dimensional, and Doppler echocardiography before discharge. Forty-one patients (85%) had no evidence of postoperative regurgitation, whereas 7 patients (15%) showed mild mitral valve insufficiency. Left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve was never detected. We believe that this technique of mitral valve repair is safe and seems to be effective in achieving a decreased incidence of left ventricular outflow tract obstruction.

Adult↗
PubMed1993

Double orifice in prolapsing mitral valve.

A prolapsing mitral valve with a double orifice ('hole type') was documented by echocardiography in a 35-year-old male. His symptoms were associated to supraventricular ectopic beats and persisted unchanged during a 3-year follow-up. This malformation is usually considered benign but, as fragmentation of the atrioventricular conduction tissue was reported in some cases, a periodic observation is advisable.

Adult↗
PubMed1990

[Left ventricular performance following mitral valve replacement in patients with tight mitral stenosis combined with mild aortic regurgitation].

The severity of aortic regurgitation is difficult to estimate prior to mitral valve replacement (MVR) in cases with tight mitral stenosis (MS), because low output state due to mitral obstruction masks signs of aortic regurgitation. This study clarified left ventricular performance, possibly affected by increased diastolic loading after MVR. The study subjects consisted of 12 patients with pure mitral stenosis (MS group) and 11 with combined mitral stenosis and aortic regurgitation (MSAR group). The diagnosis was made by cardiac catheterization preoperatively. The aortographic grade of aortic regurgitation was class 1 or 2 according to the AHA classification. Both groups were matched in terms of severity in mitral obstruction evaluated by mitral valve area. On preoperative echocardiographic evaluation, there was no difference in the mean values of LVDd, LVSd, and %FS between the groups MS and MSAR. After surgery, symptoms improved in each patient. Echocardiography performed three months after MVR revealed no differences in these parameters between both the groups. We concluded that aortic regurgitation evaluated as class 1 or 2 preoperatively does not increase in respect to left ventricular diastolic overloading and echocardiographic left ventricular performance remains unchanged.

Adult↗
PubMed1990

[Effect of preserved subvalvular apparatus on regional left- ventricular function after mitral valve prosthesis in patients operated on for mitral insufficiency].

Mitral valve replacement with preservation of the chordo-papillary apparatus of the posterior mitral cusp was done in 24 patients with mitral valve incompetence. In nine patients, in addition to the conventional flow manometry, myocardiography was performed to study regional left ventricular myocardial contraction. For comparison, nine other patients were examined, who had been operated on for mitral valve incompetence by conventional mitral valve replacement with total resection of all its supravalvular structures. A significant difference in the improvement of left ventricular myocardial contraction was seen in patients with preserved chordo-papillary apparatus as compared with the other group. Improvement of the contractile function is believed to be secondary to enhanced myocardial compliance during the relaxation phase, rapid filling and pre-ejection. Enhanced compliance may be a factor governing the left ventricular myocardial performance.

Chordae Tendineae↗