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At least 73 records · Page 4Linked to original sources
PubMed2004

[Severe, non-infectious mitral valve endocarditis after mitral valve reconstruction in a 32-year old female with primary antiphospholipid syndrome].

BACKGROUND: A 32-year old female with primary antiphospholipid syndrome presented 8 months after mitral valve reconstruction with progressive exertional dyspnea and echocardiographically demonstrable critical mitral stenosis and regurgitation. Tachycardia, weight loss, sleep disturbances and increasing nervosity led to the diagnosis of concomitant hyperthyroidism. After the patient stopped the oral anticoagulation by herself, a 'catastrophic antiphospholipid syndrome' with multiple microthromboembolic events in several organs developed rapidly within a few weeks. Severe respiratory failure was observed 14 days after admission at our hospital because of a pulmonary edema. TREATMENT: Removal of the annuloplasty ring and alloplastic mitral valve replacement with a 25 mm bilifleat valve. Postoperatively, the patient was placed on oral anticoagulation. Several pre- and postoperative plasmaphereses lowered the level of antiphospholipid antibodies. The patient additionally underwent radioiodtherapy 5 months postoperatively. RESULTS: While hemodynamics and diuresis remained sufficient, ventilatory support with tracheostomy was necessary for 16 postoperative days to achieve stable respiration. Thirty months later, the patient is well and without further cardiac and neurological dysfunction. CONCLUSION: Secondary cardiac valve operations on patients with primary antiphospholipid syndrome may be successfully performed within a multidisciplinary approach. Oral anticoagulation remains the treatment of choice to prevent further thromboembolic events.

Adult↗
PubMed1990

[Selection of a prosthetic valve for mitral valve replacement].

The early and the late results of mitral valve replacement were retrospectively evaluated to delineate the concept of selection of the prosthetic valve for the mitral position. The mitral valve was replaced with porcine bioprosthesis (P-B) in 102 patients and with St. Jude Medical prosthesis (SJM) in 341 patients between 1975 and 1987. Operative mortality was 5.3% for the SJM and 8.8% for the P-B group (N.S.). Cumulative duration of follow up was 1479.8 patient-years for the SJM and 888.9 patient-years for the P-B group. Actuarial survival rate was 90% for the SJM at 9 years and 81%, 76% for the P-B group at 10 and 13 years (N.S.). Freedom from valve-related death was 94% for the SJM at 9 years and 94% for the P-B at 13 years (N.S.). Thrombo-embolic complications occurred at an incidence of 0.47%/patient-years (p-y) for the SJM and 0.67%/p-y for the P-B group (N.S.). Freedom from prosthetic valve dysfunction due to primary tissue failure (PTE) lowered rapidly after the seventh postoperative year from 88% to 35% in the P-B group. Prosthetic valve dysfunction free rate was significantly lower in the P-B group compared with the SJM between the seventh post operative year and ninth postoperative year (p less than 0.01). From this analysis, we believe that the SJM prosthesis is suitable cardiac valve prosthesis to the mitral position.

Adolescent↗
PubMed1994

Mitral valve replacement versus mitral valve repair. A Doppler and quantitative stress echocardiographic study.

BACKGROUND: Standard mitral valve replacement (MVR) in patients with chronic mitral regurgitation results in consistent reductions in resting postoperative ejection fraction. This has been attributed to removal of the low-impedance ejection pathway into the left atrium or to disruption of the chordal apparatus. Mitral valve repair (MVP) does not reduce ejection fraction at rest. However, whether MVP confers any advantages with regard to dynamic left ventricular performance has not been investigated. The aim of this study was to directly compare standard MVR with MVP and to determine their respective influences on ventricular ejection performance during bicycle exercise. METHODS AND RESULTS: Ten consecutive patients with pure chronic mitral regurgitation who underwent MVP and 10 patients matched for age, sex, and preoperative ejection fraction who underwent standard MVR for pure chronic mitral regurgitation performed symptom-limited, graded upright bicycle exercise with simultaneous Doppler and quantitative two-dimensional echocardiography. Patients with MVP had significantly greater rest (55 +/- 12%) and exercise (63 +/- 11%) ejection fractions than matched patients with MVR (40 +/- 13% [P < .0001] and 42 +/- 17% [P < .005], respectively). End-systolic circumferential wall stress was significantly lower at rest (190 +/- 36 versus 244 +/- 46; P < .03) and at peak exercise (231 +/- 46 versus 300 +/- 52; P < .02) in patients with MVP. At peak exercise, left ventricular shape was significantly more spherical in patients with MVR than those with MVP (1.84 +/- 0.31 versus 2.45 +/- 0.59; P < .02). CONCLUSIONS: MVR with chordal transection resulted in significant reductions in rest and exercise ejection fraction. This was caused in part by a significant increase in end-systolic circumferential wall stress. MVP resulted in improved rest and exercise ejection indexes, primarily due to a marked reduction in end-systolic stress and maintenance of a more ellipsoidal chamber geometry.

Echocardiography, Doppler↗
PubMed1992

[Long-term clinical results after aortic valve replacement with mechanical heart valves and mitral valve replacement with porcine valves].

Long-term clinical results of aortic valve replacement (AVR) with mechanical heart valves and mitral valve replacement (MVR) with porcine valves were analysed. Sixty-three patients received isolated AVR and 48 received isolated MVR. Sixty-eight patients with MVR including double or triple valve replacement were also added in order to evaluate the primary tissue failure (PTF). The patients with operative deaths were excluded. Survival rate at 11 years in AVR was 68 +/- 10% and 67 +/- 15% in MVR without statistical difference. At 11 years, 76 +/- 8% of the patients in AVR were free from valve-related complications in contrast with the poor result of 34 +/- 31% in MVR (p less than 0.01). Main cause of this poor result in MVR was PTF as indicated in following event free rates; 83 +/- 9% at 7 years, 61 +/- 25% at 10 years and 49 +/- 31% at 13 years. There was no statistical difference between patients of above 50 years and below 49 years in PTF. Valve-related death event free was 93 +/- 5% in AVR and 86 +/- 11% in MVR at 11 years (not significant), however, there was statistical difference in re-operation event free rate as 94 +/- 5% in AVR and 76 +/- 11% in MVR at 11 years (p less than 0.001). These results suggest that the use of porcine valves in mitral position is confined to the selected patients.

Adult↗
PubMed1994

Results of mitral valve reconstruction in mitral valve insufficiency.

In the last three years forty mitral valve reconstruction (MR) procedures were performed in case of mitral insufficiency (MI). In three cases, anatomical changes made reconstruction impossible for us. One patient had to be re-operated because of unsatisfactory valve function. There was no operative mortality. In twelve of the patients, mitral insufficiency was the only problem, while in twenty eight others additional cardiac procedures (CABG, AVR) were performed. The patients' age ranged from 17 to 77 years. The aortic cross-clamping time for mitral reconstruction without additional cardiac procedures ranged from 35 to 134 minutes. With one exception, the post-operative TEE indicated no, or very little, insufficiency. We concluded that the mitral valve insufficiency can be corrected with very good results and with a very low rate of complications. Such corrections ought therefore be taken into consideration before valve replacement.

Adolescent↗
PubMed1999

[Double oriface mitral valve: severe mitral regurgitation secondary to chord rupture].

Double orifice mitral valve is a rare congenital malformation. Most commonly it is associated with other cardiac diseases, usually in children. The echocardiographic technique has allowed a noninvasive and more frequent detection of this entity. The isolated occurrence of this anomaly is exceptional. We present the case of a 68-year-old male with double orifice mitral valve presented with severe mitral regurgitation secondary to chords rupture, without any other congenital malformations.

Aged↗
PubMed2005

Differentiating clinical and echocardiographic characteristics of chordal rupture detected in patients with rheumatic mitral valve disease and floppy mitral valve: impact of the infective endocarditis on chordal rupture.

AIMS: We aimed to compare the clinical and echocardiographic correlates of chordal rupture in patients with rheumatic mitral valve disease and floppy mitral valve. METHODS AND RESULTS: The study group comprised of 224 patients who underwent transthoracic and transesophageal echocardiography because of the severe mitral regurgitation. Chordal rupture was detected in 58 (25.9%) out of the 224 patients, in 33 out of the 83 (39.7%) patients with floppy mitral valve, and in 25 out of the 141 (17.7%) patients with rheumatic mitral valve disease. Chordal rupture was more frequently associated with anterior leaflet (80%) in patients with rheumatic mitral valve disease, and posterior leaflet (72.7%) in patients with floppy mitral valve (p<0.05). Univariate correlates of chordal rupture were age, male sex, posterior mitral leaflet thickening and chordal elongation in patients with floppy mitral valve (p<0.05), and chordal shortening (p<0.0001) and infective endocarditis involving mitral anterior leaflet (p<0.05) in rheumatic group. Independent predictors of chordal rupture were age (>50 years), posterior mitral leaflet thickness (> or =0.45cm), and male sex (p<0.05) in patients with floppy mitral valve while infective endocarditis involving mitral anterior leaflet (p<0.05) in patients with rheumatic mitral valve disease. Patients with chordal rupture due to floppy mitral valve had an older age (p<0.0001), a male dominance, longer mitral leaflets and chordae, and a larger mitral annulus circumference (p<0.05) as compared to those with rheumatic chordal rupture. Despite the comparable severity of mitral regurgitation and left atrial diameters between the two groups of chordal rupture (p>0.05), functional class and pulmonary artery systolic pressure were higher, and atrial fibrillation, acute deterioration, infective endocarditis, mitral leaflet rupture and need for mitral valve surgery in the 3 months were more frequent in rheumatic chordal rupture subgroup (p<0.05). CONCLUSION: Chordal rupture seems to be more frequently associated with anterior mitral leaflet in rheumatic mitral valve disease, whereas it was the posterior leaflet in floppy mitral valve. Chordal rupture was related to male sex, older age, posterior leaflet thickening, and chordal elongation in patients with floppy mitral valve. However, infective endocarditis, acute deterioration, and need for early mitral surgery were more frequent in patients with rheumatic chordal rupture.

Adult↗
PubMed1985

Risks of mitral valve replacement and mitral valve replacement with coronary artery bypass.

One hundred thirty consecutive patients who underwent mitral valve replacement (MVR) or MVR with coronary artery bypass grafting (CABG) using cold crystalloid cardioplegic solution were analyzed to determine operative mortality and risk factors. Twenty-eight patients had mitral stenosis (MS), 37 had mitral regurgitation (MR), 37 had mixed MS and MR, 23 had MR with coronary artery disease (CAD), and 5 had MS with CAD. Preoperative pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac index were not different among groups, but patients with MR and CAD had a significantly higher left ventricular end-diastolic pressure (LVEDP) and a significantly lower ejection fraction than other groups. Mortality was 7.1% for patients with MS, 5.4% for MR, 8.1% for mixed MS and MR, 0 for MS with CAD, and 21.7% for MR and CAD. Overall mortality was 9.2%. Eleven patients had emergency operations for cardiogenic shock with a mortality of 45%. Nineteen additional patients in New York Heart Association (NYHA) Functional Class IV had MVR or MVR plus CABG with a mortality of 26%. Sixteen patients required intraaortic balloon pump assistance, and 9 survived. Four patients with MR and CAD required the left ventricular assist device, and 3 survived. Excluding patients who had emergency operations, overall mortality was 5.8%. Excluding patients who had emergency operations and patients in NYHA Functional Class IV, overall mortality was 2%. Factors associated with death were cardiogenic shock, NYHA Class IV, LVEDP greater than 15 mm Hg (16% mortality), and age greater than 60 years (15% mortality).

Adult↗
PubMed1976

Acute aortic dissection and medial degeneration in patients with 'floppy' mitral valves.

Mitral regurgitation due to 'floppy' valves is frequently associated with areas of medical necrosis in the ascending aorta. Application of the aortic clamp to such an area during valve replacement may produce an intimal tear followed by acute dissection. This complication occurred in three patients and was treated successfully by repair of the tear in the two cases where the dissection was observed at the time of operation. Is is suggested that infrequent clamping of the aorta and careful control of the pefusion pressure may decrease the risk of intimal trauma and acute dissection.

Aged↗
PubMedDate not supplied

[Mitral valve and mitral ring movement in mitral stenosis. An ultrasonic study with different valve models (author's transl)].

We constructed three different mitral valve models in order to investigate the different mechanisms which account for the concordant opening and closing movement of the posterior compared to the anterior mitral valve in mitral stenosis. Three different types of movements are possible: a dorso-anterior movement of the mitral ring, opening and closure of the valve itself and a rotation of the entire valve apparatus. Our in-vitro studies showed that the best explanation for the concordant diastolic movement of the posterior valve is given by the assumption that during the early diastolic opening phase of the valves the whole stenotic valve apparatus is rotated upward, i.e. towards the transducer. This rotation, has a higher amplitude compared to the residual downward-oriented opening movement of the posterior valve.

Mitral Valve↗
PubMed1995

[Mitral valve replacement with homemade heterologous pericardial roll valve for mitral regurgitation after repair of complete atrioventricular septal defect].

Repair of using the double patch method was performed on a 6-month old child with Down's syndrome. However, at 1 year and 4 months (BW: 3.6 kg), the patient's resulting mitral regurgitation became severe and clinically unmanageable, necessitating further operation. At operation the anterior leaflet of the mitral valve was lifted up at the anterolateral side due to the patch attached to the interventricular septum, which restricted the valve from closing completely. Moreover, secondary severe hardening of the valve tissue made it difficult to reconstruct the valve. Since the diameter of the valve was only 13 mm after resection, making the impossible use of a standard prosthetic valve, we constructed a new roll valve out of a heterologous pericardium. Almost no regurgitation was observed and prognosis was favorable although a pattern of mitral stenosis was observed. The patient died 6 months later due to the worsening of respiratory infection before a reoperation could be performed. Post mortem examination revealed comparatively good valve function except mitral stenosis due to inadequate valve size. This technique has practical application for mitral valve replacement of small valve annuli of infants when other methods are not feasible.

Bioprosthesis↗
PubMed2003

Reoperation in mitral valve repair for regurgitant mitral valve disease.

OBJECTIVES: Reviewing reoperative mitral valve repair, we evaluated a predictor for future reoperation by comparing degenerative and rheumatic mitral regurgitation. METHODS: From June 1988 to September 2002, 159 patients with mitral valve regurgitation underwent a variety of surgical reconstruction. Our 9 subjects--2 men and 7 women with a mean age of 55.3 years--including 1 undergoing initial repair at an other hospital, underwent reoperation for mitral valve lesions. Four patients had rheumatic (Group R) and 5 degenerative (Group D) mitral valve disease. We studied reoperative outcomes and initial procedures were retrospectively. RESULTS: The mean interval from initial repair was 111 months. Mitral valve lesions at reoperation in Group D were annular dilation in 3, leaflet prolapse in 1, and suture disruption in 1, while that in Group R involved severe thickening of both leafle. Rerepair was possible in 3 patients of Group D, but all others, (including Group R patients) required valve replacement. All survived reoperation. CONCLUSIONS: Rerepair in rheumatic mitral regurgitation, rerepair was difficult. In degenerative mitral valve regurgitation, however, rerepair was possible because procedure-related origin was a major cause of reoperation. Reoperation can be prevented by proper technical improvement at initial repair.

Adult↗
PubMedDate not supplied

Evaluation of the mitral valve leaflet morphology after mitral valve reconstruction with a concept "coaptation length index".

BACKGROUND: In clinical settings, information on morphology of mitral valve leaflet after mitral valve reconstruction is limited. METHODS: Between January 1996 and June 2000, 36 patients underwent mitral valve repair for mitral regurgitation (MR). The etiology of mitral insufficiency was prolapse, dilated annulus, and ischemia. Ring annuloplasty was performed in all cases. Mitral valve short-axis dimension (MVd), vertical distance between annular line and closing point (Vd), coaptation length (CL), and coaptation length index (CLI) were measured by two-dimensional transesophageal echocardiography for the present 11 cases. RESULTS: In 11 cases, residual MR, using a scale from 0 to 4, was 0 in 5 patients, 1 in 4 patients, 2 in 2 patients whose etiology of regurgitation was cardiomyopathy. MVd and Vd decreased significantly (38.7+/- 6.2 to 27.0 +/- 5.6 mm, 10.1 +/- 7.7 to 6.5 +/- 4.6 mm, respectively). CL and CLI increased significantly (6.4 +/- 2.4 to 11.6 +/- 4.6 mm, 0.16 +/- 0.06 to 0.44 +/- 0.21, respectively). Among those indices, only CLI has a statistically significant negative correlation with the degree of residual MR. CONCLUSION: Mitral valve ring annuloplasty produces the morphologic change of the mitral apparatus, especially increase of CLI, which may be one of the main factors in regulation of regurgitation.

Adult↗